Every year, the release of the CMS Medicare Physician Fee Schedule (PFS) proposed rule brings important insights—and the 2026 draft is no exception. This year’s 1,800+ page document signals a strong continued investment from the Centers for Medicare & Medicaid Services (CMS) in expanding support for remote patient monitoring (RPM).
With substantial updates that extend beyond routine fine-tuning, CMS is proposing what could be the most impactful evolution of RPM policy since the program first launched. The proposed changes aim to offer healthcare providers greater flexibility, streamline reimbursement, and make remote care more accessible to a broader group of patients—all while maintaining the financial viability of existing services.
If you provide or bill for RPM or RTM services, now is the time to prepare and consider submitting comments. These changes signal a significant step toward making remote care a sustainable and scalable part of the healthcare system.
Looking Back: The Current RPM Billing Structure
Since its start in 2019, CMS has supported RPM through four key CPT codes:
- 99453 – Used for onboarding and educating patients on RPM devices; requires 16 days of tracked data to bill.
- 99454 – Monthly device supply fee; currently limited to patients who transmit data for at least 16 out of 30 days.
- 99457 – Covers the first 20 minutes per calendar month of interactive care management.
- 99458 – Used for each additional 20-minute block of time.
These codes laid the groundwork for home-based care and monitoring, but two main challenges persisted:
- A 16-day minimum device usage rule limited eligibility.
- A 20-minute threshold made short, meaningful clinical engagements non-billable.
What’s Changing: Highlights from the 2026 Proposed Rule
1. More Flexibility in Device Usage: The New 2-Day Rule
Currently, reimbursement hinges on patients recording and transmitting data on 16 or more days in a month. The new rule proposes a two-tier system:
- New Code (99XX4): Would allow billing if patients are monitored for just 2 to 15 days in a monthly period.
- Revised 99454: Would remain, but now officially covers the 16-to-30-day range.
Strikingly, CMS proposes the same reimbursement rate for both the 2–15-day and 16–30-day codes. This marks a significant shift—recognizing that clinical value isn’t only measured in frequency of readings but in the availability of monitoring capability overall.
2. Billing for Shorter Clinical Time: New 10-Minute Code
In another leap toward realism in remote care, CMS introduced a new way to bill for briefer clinical engagement:
- New Code (99XX5): Would allow practices to bill for 10 to 20 minutes of RPM treatment management per month—at about half the rate of the current 20-minute code (99457).
- Existing Codes (99457 & 99458): CMS has rejected proposals to reduce reimbursement for these codes, ensuring continued payment stability.
With this change, brief but valuable touchpoints—such as a 15-minute follow-up call—can now be reimbursed when they previously weren’t.
Quick Comparison: Current vs. Proposed RPM Codes
| Category | Current | Proposed (2026) | Reimbursement Impact |
| Device Monitoring | 99454: 16+ days in 30 days | 99XX4: 2–15 days 99454: 16–30 days | Same payment regardless of day range above 2 |
| Care Management | 99457: first 20 min 99458: add’l 20 min | 99XX5: 10–20 min 99457/99458 remain | Shorter sessions now billable at 50% of 99457 |
Why This Matters for Your Practice
These updates go far beyond new codes—they open the door to smarter, more personalized patient monitoring programs that are easier to run and scale. Here’s how:
✅ More Patients Eligible:
Patients who previously didn’t qualify for RPM—such as those needing only weekly weight checks (e.g., GLP-1 patients) or temporary post-op care—can now be enrolled and reimbursed.
✅ No More Lost Time:
Short interactions that fall under 20 minutes in a month, like a 12-minute phone review, can now produce revenue.
✅ Grow the Program with Confidence:
These enhancements help ensure that RPM remains a sustainable service, improving cash flow and justifying staff resources.
✅ Better Outcomes Through Customization:
By removing arbitrary constraints, care teams can tailor monitoring frequency and engagement based on clinical need—not billing requirements.
Final Thoughts
If finalized, the 2026 Medicare PFS updates will empower healthcare organizations to run more effective, inclusive, and flexible RPM programs. They simplify how providers manage care and ensure that critical, often-overlooked patient interactions aren’t left uncompensated.
These proposed changes represent a major step in the ongoing evolution of remote monitoring. What was once considered an innovative or experimental model of care is now being embedded into mainstream reimbursement policy. The introduction of more granular codes for shorter-duration monitoring is a direct result of the sustained advocacy by digital health providers, vendors, and stakeholders urging CMS and the AMA to recognize how RPM and RTM are implemented in everyday clinical practice.
However, this growing legitimacy also comes with increased oversight. CMS’s careful approach to valuing new and existing remote monitoring codes suggests that scrutiny around billing accuracy and documentation will only intensify. Stakeholders aiming to influence final valuations should prepare to submit robust, data-backed comments. CMS has noted that isolated invoice submissions may not adequately represent typical resource usage—and could distort cost estimates if not substantiated by broader, credible third-party data.
In short: remote monitoring is being scaled, standardized, and scrutinized—all at the same time.
📌 For the full proposed rule, visit: CMS Proposed 2026 Medicare PFS Rule (Download & Info)
CONTACT US to learn more about how AIE Medical Management can support your RPM billing needs.
