Medicare has released its proposed Physician Fee Schedule (PFS) for 2026, and it includes some of the most meaningful updates we’ve seen for Remote Patient Monitoring (RPM) since the program began. If finalized, these changes could significantly expand your clinic’s ability to reach more patients, simplify care workflows, and enhance reimbursement opportunities — all while staying compliant.
At Telecare-USA, we’ve reviewed the highlights and are breaking down what matters most for your practice. These proposals reflect a clear push from CMS to modernize and streamline remote care — and we believe they’re a major step in the right direction.
To understand what’s changing, let’s recap the current CPT codes that define RPM billing today:
While effective, this structure comes with strict thresholds — including the often-challenging 16-day rule for device billing and a 20-minute minimum for billable clinical engagement. These requirements limit reimbursement options for patients who need short-term or lower-frequency monitoring.
CMS is proposing two significant adjustments that would improve flexibility and access to RPM.
What’s New:
CMS proposes a new code for supplying RPM devices even if a patient records just 2–15 days of readings within the month — a sharp contrast from the current 16-day requirement.
Proposed Codes:
Big Win: Both codes are expected to be reimbursed at the same rate, acknowledging that access to monitoring tools — not just data volume — holds clinical value.
What’s New:
CMS is also introducing a new CPT code that would allow practices to bill for 10–20 minutes of RPM clinical time per month.
Proposed Code:
Why It Matters:
Your staff’s time has value — even if a patient doesn’t need a full 20-minute interaction. This change would finally let providers bill for those meaningful but previously unbillable 10- to 15-minute check-ins.
|
Attribute |
Current Rule |
2026 Proposal |
Reimbursement Impact |
|---|---|---|---|
|
Device Supply |
99454 (16+ days) |
99XX4 (2–15 days), 99454 (16+ days) |
Same rate for both codes |
|
Management Time |
99457 (20+ min),99458 (add’l 20 min) |
99XX5 (10–20 min),99457, 99458 |
New flexibility, existing rates preserved |
These aren’t just coding updates — they’re operational game-changers. Here's how your practice could benefit:
Patients who were previously ineligible due to short-term needs — like post-op monitoring or weekly GLP-1 weight management check-ins — would now qualify for reimbursable RPM.
Short interactions (10–19 minutes) that previously went unbilled can now be captured, improving efficiency and ensuring your team is compensated for the care they deliver.
The combination of broader eligibility and time-based flexibility allows your clinic to serve more patients, capture more revenue, and better align care plans with individual needs — all without taking on additional administrative burden.
When monitoring and check-ins are tailored to the patient — not billing thresholds — you create a more engaging, personalized experience that drives adherence and long-term success.
CMS is making it clear: remote care is here to stay. These proposed changes signal a move toward smarter, more responsive care delivery — and they provide new opportunities for practices to grow their RPM programs sustainably.
At Telecare-USA, we’re ready to help you take advantage of these updates. Whether you’re launching RPM for the first time or scaling an existing program, our team is here to guide you through billing, compliance, and growth strategy.
Want to learn more about these changes?
Download our updated RPM Guide or book a consultation with our team.
Just click the link below to talk to a member of our sales team or to learn more about our Remote Patient Monitoring solution and get your clinic started in no time.