Remote Patient Monitoring has always made clinical sense, but the reimbursement structure has been onerous. Especially when real patients behave like real people.
CMS took a meaningful step in the 2026 Physician Fee Schedule (PFS) final rule by adding flexibility where programs have historically broken down: months where patients transmitted fewer than 16 days of data, and months where care teams did valuable work but did not quite reach 20 minutes of documented treatment management time.
This guide walks through what changed, what stayed the same, and what practices should do now so billing, operations, and clinical workflows can adjust to the new rules.
CMS finalized two new CPT codes that create a tiered structure for RPM. One fills the “2 to 15 days of data” gap, and one fills the “10 to 19 minutes of time” gap.
CPT 99445 covers the RPM device supply and the collection, transmission, and monitoring of physiologic data when the patient transmits readings for 2 to 15 days during a 30-day period.
This is the big shift for programs that previously saw “partial month” engagement turn into “non-billable month,” even when monitoring was clinically appropriate and useful.
CPT 99470 covers RPM treatment management when the care team documents 10 to 19 minutes of time in a calendar month, and there is at least one interactive communication with the patient or caregiver during that month.
The practical implication is simple: brief, high-value touchpoints that used to fall short of the 20-minute threshold can now be reimbursed when documented correctly.
The core RPM code set remains intact. Practices that already have RPM running do not need to rebuild their programs from scratch, but they do need to understand how the new options layer in.
99453 remains the code for initial device setup and patient education.
99454 still applies when the patient transmits readings on 16 or more days in a 30-day period.
99457 remains the first 20 minutes of RPM treatment management in a calendar month, and 99458 remains the add-on code for additional 20-minute increments. Previously, clinics could bill up to three 99458 codes per month. The new rule does not have a limit on the number of 99458 codes that can be billed.
These time-based codes continue to require interactive communication with the patient or caregiver during the month, so teams should continue treating that as a core compliance and documentation requirement.
The most important operational concept for billing teams is that the “device supply” codes and “treatment management time” codes are mutually exclusive within their categories. In plain language, you pick the correct code based on what actually happened that month.
Here is a practical quick reference:
|
Category |
Lower tier (new) |
Higher tier (existing) |
How to choose |
|
Device supply + data transmission |
99445 (2–15 days) |
99454 (16–30 days) |
Choose based on number of days with transmitted data in the 30-day period |
|
Treatment management time |
99470 (10–19 minutes + interactive communication) |
99457 (20+ minutes + interactive communication) and 99458 (each additional 20 minutes) |
Choose based on total documented time in the calendar month |
The 2026 changes create opportunity, but they also expose weak spots that many RPM programs have lived with quietly. The goal now is to make sure your systems, workflows, and documentation can support the tiering cleanly, month after month.
Start by validating how your RPM platform determines “days of data transmission.” Billing accuracy depends on this number, and it now determines which device supply code applies in a given month.
If you have had recurring questions like “does this count as a day,” or “what about multiple readings in one day,” this is the moment to get those answers documented internally.
For time-based RPM treatment management, interactive communication is not an afterthought. It is a requirement that should be operationalized.
This does not mean every patient needs long calls. It means your team needs a reliable workflow for capturing at least one compliant interaction in the month when billing the time-based codes. In practice, this is often where teams get tripped up because the clinical work happens, but the documentation does not tell the story clearly.
The fastest way to lose the upside of 2026 is to deliver appropriate care but document it inconsistently. Time-based codes live and die on documentation discipline.
Two practical moves help immediately:
The new structure is straightforward, but only if everyone is using the same mental model. Your billing team should be able to answer, without hesitation:
CMS policy sets the direction, but payer policies can vary in how they interpret and implement reimbursement details.
Also, there may be differences in some commercial plans as to how RPM is reimbursed; a short payer review now can prevent avoidable denials later.
The point of these changes is not just improved reimbursement. It is improved alignment.
The 2026 updates acknowledge something care teams have known for years: RPM often delivers its value in bursts. It is episodic for some patients, variable for many, and clinically meaningful even when it does not neatly hit the same monthly benchmark every time.
The practices that benefit most from 2026 will be the ones that treat RPM as a care model first and a billing model second. When workflows, patient engagement, and documentation are built around real-world behavior, the reimbursement finally has a better chance of matching the work.
Disclaimer: This article is for informational purposes only and does not constitute legal, coding, or reimbursement advice. Practices should consult their billing specialists, legal counsel, and payer guidance for final coding and compliance decisions.