What Is Remote Patient Monitoring: Why Do Clinics Need It?

PT, OT, and SLP clinics treat patients for an hour, then send them home till the next appointment. What happens during that period, whether a patient is moving, recovering, sleeping, or quietly declining, becomes invisible. Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) change that. They give clinicians a continuous data feed between visits, turning subjective check-ins into actionable insight.

Centers for Medicare & Medicaid Services (CMS) began reimbursing clinics for RPM in 2019 and extended it to RTM in 2022, creating a clear billing pathway for PT, OT, and SLP clinics. To further promote this shift, in the 2026 Physician Fee Schedule final rule, CMS added two new lower-tier RTM codes (98984 and 98985) that require fewer than 16 days of data per month, effectively lowering the bar for clinics earlier in their RTM programs. 

Yet a national analysis of Medicare data found that remote monitoring remains concentrated among a narrow group of clinicians. The barrier is usually infrastructure: the data is too fragmented to build on.

What does remote patient monitoring actually track?

RPM and RTM cover two distinct but complementary data layers.

RTM: therapeutic response via consumer wearables

RTM tracks how a patient's body is responding to therapy between visits, using devices patients already own. For PT, OT, and SLP clinics, RTM is specifically scoped to therapeutic outcomes: pain levels, range of motion, exercise adherence, and functional reporting, not general physiological measurements.

The data points include:

• Mobility & activity data (steps, walking distance, cycling distance) can be used as exercise adherence proxies and indicators of gait recovery and functional mobility progress.
• Workout data (count, duration, intensity) can be used to verify home exercise program (HEP) completion and flag non-adherence within days of a missed protocol.

Beyond what's directly billable under RTM, the broader wearable dataset provides clinically meaningful signals. For example, if a patient's sleep deteriorates, the clinician can intervene early and adjust the plan of care before the next visit. These check-ins and program modifications can translate into additional RTM/RPM treatment-management minutes that support reimbursement.

How RTM billing actually works

The billing mechanism is based on two things: the number of days data was collected in 30 days, and the amount of time the clinician spent engaging with the patient on the results. 

RPM: clinical-grade vitals via FDA-cleared devices

RPM captures physiologic data that patients collect using connected medical devices, which automatically transmit readings to their provider to be used in ongoing care. CMS requires these devices to meet FDA standards and transmit at least 16 readings per 30-day period. Relevant data points include:

• Blood pressure (systolic/diastolic + min/max range) can be used for hypertension monitoring and cardiovascular variability assessment.
• Glucose (including continuous CGM readings) can be used to flag diabetic complications in patients managing comorbidities alongside active rehab.
• Oxygenation (SpO₂ avg/min/max) can be used for pulmonary monitoring and post-operative care oversight.
• Cardiac data (ECG voltage, R-R interval, HRV) can be used for arrhythmia detection and autonomic nervous system assessment.
• Temperature and weight can be used to flag infection, post-surgical wound status, fluid retention, and pregnancy monitoring.

What does continuous monitoring enable

RTM opens five specific capabilities for PT, OT, and SLP clinics, with RPM available where a supervising physician is involved.

1. Early intervention

Continuous remote monitoring enables flagging patients whose recovery metrics deviate from the expected trajectory before the next scheduled visit. For example, a post-surgical knee patient whose step count plateaus in the first 48–72 hours and is experiencing poor sleep due to pain is a different clinical situation than one who's progressing on schedule.

2. Objective outcome documentation

Replacing subjective patient recall, like "I've been doing my exercises" and “I am sleeping enough,” with timestamped device data supports clinical decision-making and documentation, making it more accurate and impactful.

3. Reduced no-show impact

Continuous data means clinicians can monitor adherence to treatment protocols and recovery metrics remotely, prompting the patient for an earlier visit or reevaluation if things are not going according to the initial plan. 

4. Extended care reach

Remote monitoring enables supporting patients who can't attend frequent in-person sessions due to geography, mobility limitations, or schedule constraints.

5. Reimbursement

RTM codes allow PT, OT, and SLP providers to bill for monitoring services. A mid-size PT clinic with 3,000 active patients can generate over $150k in annual RTM revenue.

RTM improves patient experience and directly increases revenue.

The data problem with RTM and RPM

Each wearable ecosystem has its own API, authentication flow, data schema, and rate limits. A heart_rate value from Apple HealthKit arrives in a different format than the same value from a Garmin device. Neither is in the structure that an EMR/EHR expects to receive.

RTM and RPM data need to land in the patient's clinical record to be audit-ready and support claim submission. The more structured and complete the data in the record, the stronger the documentation behind each claim, reducing the risk of claim denial. Connecting an EMR like Raintree to a growing list of wearable and IoT device sources requires ongoing infrastructure maintenance. 

When put together, introducing an in-house solution means building and maintaining hundreds of wearables integrations, connecting them to EMRs, and building interfaces both for patients and clinicians. 

Where Spike comes in

Spike sits between the device and the application layers. Clinics integrate once to get normalized, encrypted, standardized data from wearables and FDA-cleared devices, supporting both RTM and RPM. It is also possible to add Lab Reports to enable standardized mapping regardless of which clinic the tests were done in, thanks to LOINC codes. 

For the RTM wearable layer, Spike handles OAuth flows, data normalization, and schema standardization across 500+ devices. A steps field from a Garmin and a steps field from Apple HealthKit come back in the same format, with the same units, ready for CMS documentation.

For the RPM device layer, Spike connects to Dexcom and Freestyle Libre CGM clouds and Omron blood pressure APIs, normalizing clinical vitals for FHIR/HL7 ingestion. The data flows through Spike's unified platform to the patient's record. 

That data lands directly in the EMR. Health Ops by Spike is built to write wearable and device data into the patient record automatically. It also handles insurance verification, prior authorizations, and claim submission and denial rework. Spike is built to blend into your existing workflows, reducing admin work and claim denials. 

Book a demo to see how Spike handles the device layer to enable  RTM or RPM programs.