2026 RPM Code Changes: Financial Upside Meets Clinical Flexibility

If you’ve been following remote patient monitoring (RPM) for a while, you know it’s been a journey of starts and stops. Since 2019, RPM has evolved remarkably fast for healthcare, but that progress has been uneven, especially when it comes to how the work is reimbursed.

The 2026 Proposed Physician Fee Schedule (PFS) marks the biggest step forward since the Centers for Medicare & Medicaid Services (CMS) started covering RPM. The American Medical Association (AMA) and Medicare have proposed coverage for new CPT codes that would make RPM more flexible, more clinically aligned, more accessible, and more financially viable for programs that have been squeezed by arbitrary thresholds.

The Road to Change

When RPM debuted in 2019, it came with a blunt billing requirement: To submit for the device supply code, CPT 99454, you needed at least 16 separate days of transmitted data within a 30-day period. 

The goal of the AMA and CMS with the 16-day requirement was to create a single standard that allows RPM to be reimbursable with any connected medical device. But such universality created an “all-or-nothing” barrier. Even if a patient transmitted 15 days of data instead of 16, the provider couldn’t bill at all. In other words, reach 16 days, get paid. Fail to reach 16 days, don’t get paid.

Advocates started pushing for a more flexible approach almost immediately after the initial rules were finalized. Three times the AMA’s CPT Editorial Panel considered the matter and three times it said “no.” Finally, in September 2024, the panel approved a proposal that added more nuanced codes, and CMS has now proposed adopting them in 2026.

The New Codes for 2026

The 2026 PFS proposed rule keeps the original RPM codes but adds two key new ones, each designed to capture patients who are engaged but don’t meet the higher thresholds.

CPT 99XX4 – Device Supply, 2–15 Days in 30 Days

• Covers remote monitoring of physiologic parameter(s) with device supply, daily recordings, or programmed alert transmissions for 2–15 days in a 30-day period.
• Can be billed once per month, and you can choose either 99XX4 or 99454 (16-plus days), not both.
• Reimburses at the same national average rate as 99454, which would be about $44.45 for 2026.
• Designed for patients who do not need daily readings but still benefit from consistent tracking.

CPT 99XX5 – Care Management, 10–20 Minutes in a Month

• Covers remote physiologic monitoring treatment management services with at least one interactive communication in the month, for 10–20 minutes of clinical staff or provider time.
• Can be billed once per month, and you can choose either 99XX5 or 99457 (20-plus minutes).
• Reimburses at roughly $25.73, which is about half the 99457 rate (~$49.46).
• Time beyond 20 minutes still follows the existing structure: 99457 for the first 20-plus, then 99458 for each additional 20 minutes (up to 60).

These proposed additions are also mirrored for remote therapeutic monitoring (RTM), broadening their potential impact beyond traditional physiologic data.

Why This Matters Clinically

If approved, this RPM code expansion would free clinicians from the “meet-16-days-or-get-paid-nothing” scheme. Now, providers could set monitoring schedules based on clinical judgment and patient need, rather than an inflexible billing rule.

Think about:

• Blood pressure patients: Daily measurements during medication titration, then twice weekly once stable.
• GLP-1 weight loss monitoring: Weekly weigh-ins to track efficacy and side effects without the burnout of daily tracking.
• Pulmonary conditions: Less frequent but high-quality spirometry sessions.

On the care management side, the new 10–20 minute code allows for briefer, but still valuable, monthly touchpoints without encouraging providers to extend conversations to meet thresholds.

The Financial Impact: A Straightforward Scenario

Let’s look at a simplified case study of a 500-patient RPM program to see how these new codes, if approved as proposed, would financially benefit providers in 2026. 

• Current rules: 400 patients meet the 16-day device threshold and are billable at ~$44/month. The remaining 100 patients have at least two readings but fall short of the 16-day threshold, so they generate no device supply revenue. On the care management side, 475 patients meet the 20-minute threshold at ~$49/month, while 25 patients receive at least 10 minutes of services but fail to reach the minimum required 20 minutes, so they aren’t billable.
• New rules: Those 100 patients who had at least two readings but failed to meet the 16-day threshold can now be billed under 99XX4 at ~$44 each, adding about $4,400 per month. The 25 “shorter interaction” care management patients can now be billed under 99XX5 at ~$26 each, adding about $650/month.

That’s roughly an extra $5,000/month, amounting to a 12–13% annual revenue increase, with zero change in patient volume or program scope. And that’s before accounting for new patients who might now be eligible for RPM because the 16-day rule no longer knocks them out.

Responsibility Still Rests With Providers

CMS isn’t considering making these changes without caution. In the PFS proposed rule, the agency stressed that while it is removing arbitrary barriers, it expects documentation to support the medical necessity of the monitoring schedule.

Instructing your patients to only take two readings per month without a solid clinical rationale may not pass the smell test. And while shorter-duration codes allow for “RPM light,” the expectation is that these programs sstill provide meaningful engagement and measurable outcomes.

Bottom Line on the Proposed 2026 RPM Code Expansion

For years, RPM has been constrained by rules that didn’t match the realities of patient care and clinical needs. The 2026 proposed changes keep the original RPM CPT codes in place but add options that reflect the spectrum of monitoring needs and value.

If finalized, the new CPT codes could improve patient adherence, broaden RPM’s clinical applications and patient access, and give RPM programs a healthy revenue bump without requiring growth in patient numbers.

In a healthcare landscape where reimbursement often tightens, this proposal feels refreshingly aligned with both patient needs, provider realities, and the continued movement toward value-based care. For RPM, 2026 could be the year it starts working exactly the way it was intended: flexible, clinically driven, scalable, and sustainable.