Medicare RPM Billing Guide 2026: CPT Codes, Rules

Medicare coding for remote physiologic monitoring (RPM) changed on January 1, 2026. The CY2026 Physician Fee Schedule final rule adopted two new CPT codes: 99445, for 2 to 15 days of device data in a 30-day period, and 99470, for the first 10 minutes of treatment management in a calendar month. The 16-day requirement did not go away. Among the RPM codes it now applies only to 99454, and 99453 setup can be reported once monitoring reaches 2 days.

This guide covers the rules in force for calendar year 2026: which code fits which month, the conditions every claim must meet, how FQHCs and RHCs bill, and what CMS has proposed for 2027.

What changed for 2026

In September 2024 the CPT Editorial Panel created the two new RPM codes and revised the descriptor of 99454 to state its minimum number of data days. CMS adopted the new codes, and in the final rule it said it is adopting all descriptors, guidelines, prefatory language, and parenthetical changes in the Remote Monitoring section of the 2026 CPT codebook. That includes the change to 99453, which now requires 2 days of monitoring in a 30-day period instead of 16.

Two clarifications matter most for coding:

• The 2 to 15 day code (99445) and the 16 to 30 day code (99454) are not additive. You bill one of them for a given 30-day period, based on the number of days of data transmitted.
• The 10-minute code (99470) and the 20-minute code (99457) are not additive either. You choose the one that fits the time spent that calendar month. 99458 is added only after 99457 has been billed and more than 20 minutes of treatment management was needed.

CMS also gave 99445 and 99454 the same valuation, because the device is supplied for the full 30-day period whatever the number of days it transmits. Those practice expense values were then updated in a March 2026 correction notice, so payment figures published in late 2025 may be out of date. Use the CMS Physician Fee Schedule look-up tool on cms.gov for your locality's current rates.

The 2026 RPM codes at a glance

• 99453: initial setup and patient education on use of the equipment. Reportable once monitoring reaches 2 days in a 30-day period.
• 99445: device supply with daily recordings or programmed alert transmission, 2 to 15 days in a 30-day period.
• 99454: device supply with daily recordings or programmed alert transmission, 16 to 30 days in a 30-day period.
• 99470: treatment management, first 10 minutes in a calendar month, with at least one interactive communication with the patient or caregiver.
• 99457: treatment management, first 20 minutes in a calendar month, with at least one interactive communication.
• 99458: each additional 20 minutes of treatment management after 99457.
• 99091: collection and interpretation of physiologic data by the physician or other qualified health care professional, 30 minutes each 30 days. This is practitioner work, not clinical staff time.

Note the two different clocks. The device codes run on a 30-day period; the treatment management codes run on a calendar month. Commenters asked CMS to align them, and the final rule deferred that to future rulemaking, so your tracking has to handle both.

On interactive communication, CMS adopted the CPT wording: 99470, 99457, and 99458 require a live, interactive communication with the patient or caregiver, which contributes to the total time but does not need to make up all of it. CMS did not add further exclusions on the type of communication as long as it meets the CPT specification, and it noted that no time or effort should be counted twice, including time spent in an in-clinic discussion.

Conditions every RPM claim has to meet

These come from the CMS Telehealth and Remote Monitoring booklet (MLN901705), which summarizes policy from the CY2021, CY2022, CY2024, and CY2026 final rules:

• The patient is an established patient of the billing practice. This applies to RPM, not RTM.
• Only physicians and non-physician practitioners eligible to bill evaluation and management services can bill remote monitoring.
• You are monitoring an acute or chronic condition, and the monitoring is reasonable and necessary.
• Patient consent is obtained at the time RPM services are provided, and documented.
• Data are collected electronically and uploaded automatically to a secure location where the billing practitioner can review them. Patient-typed or self-reported readings do not count for RPM.
• The device meets the FDA definition of a medical device.
• Only one practitioner can bill remote monitoring for a patient in a 30-day period.
• RPM and remote therapeutic monitoring (RTM) cannot be billed together for the same patient.
• Auxiliary personnel can furnish the services under the general supervision of the billing practitioner.

RPM can be billed in the same period as chronic care management, transitional care management, behavioral health integration, principal care management, or chronic pain management, as long as time and effort are not counted twice. The booklet also allows RPM during a surgical global period when it addresses an underlying condition not linked to the procedure. If you run RPM alongside chronic care management, keep the two time logs separate so a minute of work appears in only one of them.

Worked example: coding one month for four patients

Assume each patient is established, consented, and using a qualifying device.

• Patient A transmitted readings on 22 days. Clinical staff logged 27 minutes, including a phone call to review a rising blood pressure trend. Bill 99454 and 99457. The 27 minutes have not reached a second 20-minute increment, so 99458 does not apply.
• Patient B transmitted on 9 days after a hospital discharge. Staff logged 12 minutes, including a live video check-in. Bill 99445 and 99470. In 2025 neither service was billable for this month.
• Patient C transmitted on 18 days. Staff spent 15 minutes reviewing readings and messaging the prescriber, but never reached the patient or caregiver for a live, interactive communication. Bill 99454 only. No treatment management code applies without the interactive communication.
• Patient D is new to monitoring. Staff completed setup and education, and the device transmitted on 4 days in its first 30-day period. 99453 is reportable because monitoring reached 2 days, and the 4 days of data support 99445.

Denials tend to come from the same places: device codes without a day count in the record, treatment management without a dated interactive communication, and time logs that mix RPM with other care management time.

FQHCs and rural health clinics

FQHCs and RHCs no longer bill the bundled care management code G0511. The CY2026 final rule restates that they must bill the individual codes that made up G0511, and that payment for these care coordination services is made in addition to the otherwise billable visit, outside the RHC all-inclusive rate and the FQHC prospective payment system.

Check which codes your MAC will pay. The March 2026 FQHC booklet (MLN006397) lists 99091, 99453, 99454, 99457, and 99474 for remote physiological monitoring, with 99458 as the add-on. The new 99445 and 99470 do not appear in that table, so confirm their status with your Medicare Administrative Contractor before billing them from a health center. The same booklet states that FQHC care coordination coinsurance is 20 percent, based on the lesser of the submitted charges or the code's national non-facility rate, which is worth explaining to patients during consent.

Documentation checklist

Each item maps to a requirement above. If an auditor cannot find it in the record, assume it will be treated as not done.

• Established-patient status and the date of the last visit with the billing practitioner
• The condition being monitored and why monitoring is reasonable and necessary
• Consent, with the date, who obtained it, and that cost sharing was explained
• Device type, that it meets the FDA medical device definition, and that it uploads automatically
• Setup and education date for 99453
• Days of data transmitted in each 30-day period, which decides 99445 versus 99454
• Dated treatment management activities with minutes, staff name, and credentials, totaled by calendar month
• The date, mode, and participant of each live interactive communication
• What changed because of the readings: a medication adjustment, an order, an escalation, or a documented decision to continue the current plan
• Confirmation that no other practitioner billed remote monitoring for the same 30-day period

Entries like "reviewed RPM data" do not show the work. Our post on whether the record can show care happened walks through what a defensible monthly note looks like.

What CMS has proposed for 2027 (not in effect)

In July 2026, CMS published the CY2027 Physician Fee Schedule proposed rule, with comments due September 14, 2026. Nothing in it applies to 2026 claims, but several proposals would change how programs run if they are finalized for January 1, 2027:

• A separately reportable, face-to-face initiating visit (in person or telehealth) by the billing practitioner at the start of RPM or RTM, at which monitoring is discussed with the patient
• Payment only when the clinical staff time comes from direct employees of the practitioner or practice, not third-party contractors
• RTM limited to established patients, matching the RPM rule
• Revaluation of the device codes, and a request for comment on replacing the RPM and RTM CPT codes with four new HCPCS G-codes

CMS tied these proposals to two HHS Office of Inspector General reports on remote patient monitoring. We cover the staffing proposal and its effect on care teams in our analysis of the proposed rule, and the wider 2026 schedule in our Medicare care management 2026 review. Wait for the CY2027 final rule before changing contracts or staffing.

Putting it into practice

Most 2026 RPM billing errors come from two counts: data days per 30-day period and minutes per calendar month. Track both automatically and record every interactive communication as a dated event, and most of the compliance work is done before the claim is built. If you are still deciding whether to start a program, read our guide to evaluating an RPM investment.

Hoss Care's remote monitoring program keeps device days, staff time, and patient contacts in one record next to the patient's other care, so the billing team works from the same documentation the clinicians signed.