Medicare Unveils New RPM CPT Codes for 2026
Major updates have been announced regarding the reimbursement codes for Remote Physiologic Monitoring. Medicare has introduced two new CPT codes effective from January 1, 2026. The updates will mark a significant change in how healthcare providers bill for RPM services, offering greater flexibility for shorter monitoring periods and reduced management time.
Understanding the New RPM Codes
Over the years, CMS has introduced new CPT codes, 99445 and 99470, to help fix long-standing limitations in the RPM billing structure. Previously, providers were hampered by rigid requirements that required at least 16 days of data transmission and a minimum of 20 minutes of clinical management time before reimbursement could be claimed. These thresholds often excluded patients with acute conditions or stable chronic conditions requiring less intensive monitoring.
Feature
New 2026 Code
Description (Effective Jan 1, 2026)
Device Supply
99445
Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure), initial device supply for 2-15 days of data transmission in 30 days.
Management Time
99470
RPM treatment management services, clinical staff/physician/other qualified healthcare professional time; first 10 minutes in a calendar month requiring at least one real-time interactive communication.
The first of the new codes, CPT 99445, encompasses initial supply and setup for patients who are transmitting data between 2 to 15 days within a 30-day period. This code monitors physiologic parameters such as weight, blood pressure, blood glucose, or oxygen saturation.
The second new code, CPT 99470, provides for billing for clinical staff, physician or other qualified healthcare professional time spent on RPM treatment management services for at least 10 minutes in a calendar month. This code requires at least one real-time interactive communication with the patient during that period.
Changes to Existing RPM Codes
While new codes expand options for billing, Medicare has also provided clarification on existing RPM codes in an effort to eliminate confusion and support proper billing practices.
CPT 99454 applies specifically to device supply for 16 to 30 days of data transmission in a 30-day period. The previous language simply required “16 or more days,” but the new specification creates a clear distinction between the two device supply codes.
CPT 99457 still describes the first 20 minutes or more of interactive communication for treatment management services in a calendar month and remains the standard for more intensive patient management. CPT 99458 remains available for each additional 20 minutes of management time beyond the initial period covered by either 99470 or 99457.
Critical Billing Guidelines
Along with these new codes come several key restrictions that healthcare providers must understand in order to ensure compliant billing.
Mutual Exclusivity Rules: Codes 99445 and 99454 are mutually exclusive, meaning only one is to be billed per 30-day period. The choice between them is entirely based on how many days the patient transmits data within a calendar month. For a patient transmitting data 2 to 15 days, use code 99445. Use code 99454 for 16 to 30 days of transmission.
Similarly, codes 99470 and 99457 are mutually exclusive within a calendar month. Providers must choose the single most appropriate code based on the total time of treatment management services spent. If you spend 10 to 19 minutes, bill 99470. If you spend 10 to 19 minutes, bill 99470. If you spend 20 minutes or more, bill 99457. For time over the initial 20 minutes represented by 99457, providers may bill additional units of 99458 for each additional 20-minute increment.
Expected Reimbursement Rates
Reimbursement rates for CPT 99445 are $47.
Reimbursement rates for CPT 99470 are $26.
Current 2025 Medicare national average reimbursement rates for the current RPM codes are approximately $64 for CPT 99454, $51 for CPT 99457, and $41 for CPT 99458. Providers can expect the new codes to fall within a similar range, adjusted for the reduced requirements.
Implementation Considerations
Health care organizations should begin the necessary work now to facilitate seamless implementation on January 1, 2026. Specifically, work will include updating billing systems and electronic health records with the new codes; training clinical and billing staff on proper code selection and related documentation requirements; and re-evaluation of current RPM protocols to identify patients who would best benefit from the shorter options of monitoring.
Supportive documentation of these codes will be paramount. The practitioner must clearly document the number of days patients are transmitting data in every 30 days, while precisely tracking time spent providing treatment management services including date and length of time of interactive communications.
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Growing Primary Care Practice — Case Study
Primary Care 04
Growing primary care practice clears a 40% provider enrollment backlog
Provider enrollment and billing support needed to keep pace with new hires and payer participation — new providers were seeing patients months before they could bill for them.
- Practice type
- Primary care, two locations
- Location
- Southwest US
- Provider count
- 9 providers, 5 onboarded during engagement
- Engagement length
- Ongoing, quarterly reporting
| Period | Value | Phase |
|---|---|---|
| Month 1 | 45 | Before engagement |
| Month 2 | 43 | Before engagement |
| Month 3 | 34 | After engagement |
| Month 4 | 30 | After engagement |
| Month 5 | 27 | After engagement |
The challenge
The practice was hiring faster than it could credential. Enrollment applications were filed reactively after a provider started, revalidation dates were tracked by memory, and claims for newly hired providers were held for months before anyone could bill them.
Our approach
Credentialing was coordinated around the onboarding calendar rather than the start date, so applications were filed before a provider arrived. Revalidation moved onto a maintained schedule, and billing workflows were connected to enrollment status so held claims were released the day participation was confirmed.
How the engagement unfolded
- Month 1 Backlog triage Listed every open provider–payer combination and sequenced it by revenue impact rather than by submission date.
- Month 2 Ahead of the start date Moved enrollment filing to the offer-acceptance point, so paperwork runs while a provider is still working out their notice.
- Month 3 Revalidation calendar Put every existing provider on a maintained revalidation schedule instead of tracking renewals informally.
- Ongoing Quarterly review Enrollment status and clean-claim performance reported together each quarter as the practice keeps hiring.
New providers used to sit idle on the billing side for months. Now their enrollment is done before their first clinic day.
Figures on this page are an illustrative example of a typical engagement, not measured results from a named client. Your own outcome depends on your payer mix, specialty and current workflow.
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