Big Changes Outlined for Remote Patient Monitoring in the Proposed 2026 Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) has released its proposed 2026 Physician Fee Schedule (PFS), which includes several key changes to Remote Patient Monitoring (RPM) reimbursement. These updates—largely driven by recent actions from the American Medical Association’s CPT Editorial Panel—are designed to make RPM services more flexible and accessible, but they also introduce new considerations for coding, billing, and reimbursement.

No More 16 Day and 20 Minute RPM Requirements

One of the most significant proposed changes is the introduction of a new code to reimburse for 2-15 days of data transmission. Currently, CPT 99454—which covers the supply of RPM devices and the collection of daily data for each 30-day period— requires at least 16 days of transmitted data in order to be billed. This threshold has been a barrier to reimbursement for providers managing patients requiring less frequent device use or those facing compliance challenges.

What’s Proposed for 99454?

Effective January 2026:

• 99454 will be revised to cover initial device supply with 16-30 days of data collection and alert transmission per 30-day period.
  
• A new CPT code, 99XX4 will be introduced for initial device supply with 2-15 days of data collection and alert transmission in a 30-day period allowing providers to bill for monitoring a broader population of patients.
  

This change represents a long-awaited shift that aligns better with real-world RPM usage and addresses one of the most frequently cited operational challenges in RPM programs.Importantly, both codes are meant to cover devices and alert transmission systems that were initially supplied by the billing provider; providers using a “bring your own device” model still can not bill for 99XX4 or 99454. 

What’s Proposed for 99457/8? 

In addition to changes in device monitoring codes, the CPT Editorial Panel has also proposed a new treatment management service code in addition to the existing 99457 and 99458 codes, which cover clinical staff time reviewing data and providing care management, with at least one interactive communication per time increment. 

• A new CPT code, 99XX5, will be introduced to cover 10 minutes of clinical staff time  with at least 1 interactive communication. 
• CPT 99457 will still cover the first 20 minutes of monitoring and treatment management services with interactive communication.
• CPT 99458 will still cover each additional 20 minutes of communication beyond the initial 20 minutes.
  

These revisions reflect an effort to recognize the value of shorter—but still meaningful—interactions between providers and patients that can drive better engagement and outcomes and the individual needs of diverse patients.

Key Takeaways for RPM in 2026 Proposed PFS

Here’s what providers need to know about these proposed RPM changes:

1. Increased Flexibility for RPM Programs

With the introduction of a new code for 2-15 days of data collection, RPM becomes more accessible for a broader range of patients and conditions. Providers will have new opportunities to bill for meaningful—but shorter—engagements.

2. Shorter Time Thresholds for RPM Management Codes

By introducing an option for 10 minutes of treatment management services, CMS and the AMA are acknowledging the reality of modern care delivery, where frequent, shorter check-ins may be just as impactful as longer consultations for some patients.

3. Reimbursement Rates Still to Be Determined

While these coding changes are designed to enhance flexibility, it’s important to note that the AMA’s Relative Value Scale Update Committee (RUC) will reevaluate pricing for these codes in January 2025. Reimbursement for services involving fewer days of data transmission and less time spent on data review and patient communication is likely to be lower than current rates, but the exact amounts won’t be known until CMS finalizes the 2026 PFS later this year.

4. Documentation Remains Critical

Despite the changes, one constant remains: thorough documentation. Providers must continue to document:

• The number of days of data transmission
• The specifics of patient communication and care management
• Device supply and patient usage

Rimidi’s platform ensures proper documentation, which is key for both RPM compliance and reimbursement.

What’s Next? 

While the AMA sets CPT codes, CMS determines reimbursement and policy details through the Physician Fee Schedule. The 2026 proposed rule is now open for public comment, and the final rule will be released later this year, providing definitive guidance for RPM services in the year ahead.

As RPM continues to evolve, these proposed changes represent a further step toward making remote monitoring a core component of chronic care management and patient engagement.