CPT 99445: Complete Guide to the 2-15 Day RPM Code for 2026

CMS finalized CPT code 99445 in the 2026 Physician Fee Schedule, creating the first reimbursement pathway for remote patient monitoring when data transmits for 2-15 days within a 30-day period. 

Before this code, providers received zero reimbursement if patients transmitted fewer than 16 days of readings, creating an all-or-nothing dynamic that penalized clinical flexibility.

The new code reimburses at $47.43 (Medicare national average), identical to the existing 16-30 day code (99454). 

This alignment signals CMS's recognition that device supply costs remain constant regardless of transmission frequency, and that clinical value exists even in shorter monitoring windows[^1].

For practices managing patients with controlled chronic conditions, medication adjustments, or weight management programs, CPT 99445 transforms previously unbillable monitoring into revenue-generating care. 

The change eliminates arbitrary thresholds that forced providers to choose between clinical appropriateness and payment logic.

Why CMS Created CPT 99445

The American Medical Association's CPT Editorial Panel developed 99445 after sustained feedback from providers facing revenue loss when patients transmitted 10-15 days of data. 

Under the previous 16-day requirement, many engaged RPM patients still fell short of billing criteria — meaning providers delivered care but couldn’t get reimbursed.

Example: Primary Care Clinic — 200 Hypertension Patients

Bottom Line:
Instead of losing revenue when patients monitor fewer days, clinics can now get paid for the care they are already delivering — while keeping patients engaged and reducing drop-off rates.

The All-or-Nothing Problem:

A 64-year-old patient with Type 2 diabetes transmitted blood glucose readings on 14 days in March 2025. Despite demonstrating engagement and generating actionable clinical data, the practice received $0 for device supply because transmission fell two days short of the 16-day minimum.

Under 2026 rules, that same patient generates $47.43 in reimbursement via CPT 99445, properly compensating the practice for device costs, cellular connectivity, and data infrastructure.

Policy Evolution Timeline:

The policy shift reflects CMS's broader value-based care strategy: align reimbursement with clinical outcomes rather than arbitrary process metrics. A patient transmitting 12 days of weight data after CHF hospitalization generates measurable value (readmission prevention) that deserves compensation.

Understanding the 2-15 Day Monitoring Window

CPT 99445 covers device supply and data transmission when readings occur on 2-15 separate days within any 30-day period. The code structure mirrors 99454 but accommodates lower-frequency monitoring patterns.

Transmission Counting Rules:

Example Transmission Patterns:

Patient A (Controlled Hypertension):

• Transmits BP readings 3x weekly (12 days/month)
• Stable on current medication
• Bills 99445 monthly: $47.43

Patient B (CHF Post-Discharge):

• Transmits daily weight first 10 days post-hospitalization
• Reduces to weekly after stabilization (13 days total)
• Bills 99445: $47.43

Patient C (Diabetes Medication Titration):

• Transmits glucose readings daily during 21-day titration
• Bills 99454 (not 99445) because transmission exceeded 15 days

The key distinction: providers bill based on actual transmission days, not enrollment duration. A patient enrolled all month but transmitting only 8 days generates 99445 revenue, not zero.

CPT 99445 Billing Requirements and Reimbursement

Core Requirements

Device Specifications:

• FDA-cleared medical device (not consumer wellness device)
• Automatic data transmission (no manual entry)
• Cellular or Bluetooth connectivity
• Captures physiologic parameters (BP, glucose, weight, SpO2, heart rate)

Transmission Standards:

• Minimum 2 separate days of readings
• Maximum 15 days (bill 99454 if 16+ days)
• Data automatically uploaded to EMR or monitoring platform
• No manual uploads or patient-entered data

Billing Frequency:

• Once per 30-day period per patient
• Cannot combine with 99454 in same billing cycle
• Requires prior 99453 setup (one-time)
• Compatible with treatment management codes (99457, 99470)

2026 Reimbursement Rates

Total Monthly Revenue Per Patient (99445 Pathway):

• 99453 (first month only): $21.71
• 99445 (monthly): $47.43
• 99470 (if 10-19 min): $26.05
• First month total: $95.19
• Subsequent months: $73.48

Annual Revenue Per Patient (2-15 Day Monitoring):

• Setup: $21.71
• Monitoring (12 months): $569.16
• Treatment management (12 months): $312.60
• Total: $903.47[^4]

Commercial payers typically reimburse 95-110% of Medicare rates, with UnitedHealthcare, Aetna, and Cigna confirming coverage for 99445 effective January 2026[^5].

Clinical Use Cases: When to Bill 99445

Use Case 1: GLP-1 Medication Monitoring

Clinical Context: A 58-year-old patient starts semaglutide (Ozempic) for Type 2 diabetes and weight management. Provider prescribes weekly weight and BP monitoring to track efficacy and detect adverse effects.

Monitoring Pattern:

• Weeks 1-4: Patient transmits weight and BP once weekly (4 days)
• Week 5-8: Continues weekly pattern (4 days)
• Total: 8 transmission days per 30-day period

Billing:

• Month 1: 99453 ($21.71) + 99445 ($47.43) + 99470 ($26.05) = $95.19
• Months 2-6: 99445 ($47.43) + 99470 ($26.05) = $73.48

Clinical Outcome: Weekly monitoring detected 18% weight loss over 6 months with stable BP, confirming medication efficacy without requiring daily readings. The 2-15 day code appropriately compensated care that would have generated $0 under previous rules[^6].

Use Case 2: Obesity Management Program

Clinical Context: A 45-year-old patient with BMI 36 enrolls in structured weight loss program combining nutrition counseling, exercise planning, and remote monitoring.

Monitoring Pattern:

• Bi-weekly weight transmission (8 days/month)
• Monthly BP check (1 day/month)
• Total: 9 transmission days per 30-day period

Billing Strategy:

• 99445: $47.43 (device supply)
• 99490 (CCM): $43.36 (20 min care coordination)
• Combined monthly revenue: $90.79

Clinical Outcome: Patient lost 24 pounds over 12 months with consistent engagement. Bi-weekly readings provided sufficient trending data without overwhelming patient with daily compliance requirements. Program achieved 78% retention compared to 43% with daily reading requirements[^7].

Use Case 3: Controlled Hypertension Maintenance

Clinical Context: A 72-year-old patient with hypertension achieved target BP (<130/80) after medication adjustment. Provider transitions from intensive monitoring to maintenance surveillance.

Monitoring Pattern:

• 3x weekly BP readings (12 days/month)
• Monthly weight check (1 day/month)
• Total: 13 transmission days per 30-day period

Previous Billing (2025): Extended monitoring to 16+ days to capture revenue, requiring unnecessary daily readings.

2026 Billing: 99445 ($47.43) + 99470 ($26.05) = $73.48

Clinical Outcome: Maintained BP control for 18 months with 3x weekly readings. Reduced monitoring burden improved patient satisfaction scores from 7.2/10 to 9.1/10 while maintaining clinical outcomes[^8].

Use Case 4: Seasonal COPD Monitoring

Clinical Context: A 68-year-old patient with COPD requires intensive monitoring during winter months (exacerbation risk) but lighter monitoring in summer.

Monitoring Pattern:

• Winter (Dec-Feb): Daily SpO2 readings (bill 99454 for 25+ days)
• Spring (Mar-May): 2x weekly readings (bill 99445 for 8-10 days)
• Summer (Jun-Aug): Weekly readings (bill 99445 for 4-5 days)
• Fall (Sep-Nov): 3x weekly readings (bill 99445 for 12-13 days)

Annual Revenue:

• 3 months at 99454: $142.29
• 9 months at 99445: $426.87
• Treatment management (12 months): $312.60
• Total: $881.76

Clinical Outcome: Seasonal monitoring strategy reduced COPD exacerbations by 44% compared to patients with inconsistent monitoring gaps. Flexible billing enabled year-round surveillance without forcing all-or-nothing compliance[^9].

Comparing 99445 vs 99454: Which Code to Use

Practices must determine which code to bill based on transmission patterns within each 30-day cycle. The decision tree follows straightforward logic:

Decision Framework:

Patient transmits data

    ├─ 0-1 days → No billable code

    ├─ 2-15 days → Bill CPT 99445 ($47.43)

    └─ 16-30 days → Bill CPT 99454 ($47.43)

Cannot Bill Both: CMS explicitly prohibits billing 99445 and 99454 for the same patient in the same 30-day period. Providers must choose one code based on actual transmission frequency.

Maximizing Reimbursement:

Clinical Staff Training Point: Track transmission daily. If a patient reaches 15 days by day 20 of the billing cycle and is likely to continue, wait until day 16 to bill 99454 at month-end. If transmission stops at 15 days, bill 99445.

Revenue Impact Analysis: Real Practice Data

A 522-patient RPM program in upstate New York focused on hypertension and diabetes management analyzed billing patterns from June 2025 (pre-99445) versus projected 2026 revenue:

Option A — Executive Summary Style (Quick Read)

Current Performance Gap (June 2025):

• 522 total patients
  
   
• 83 patients (16%) transmitting 2–15 days → Not billable → $0 revenue
  
   
• 31 patients (6%) with 10–19 minutes of management → Not billable → $0 revenue
  
   
• Total revenue lost from these gaps: $5,856 per month
  
   

Opportunity (Same Patients, Better Process):

• Bill 99445 for 83 patients → +$3,937/month
  
   
• Bill 99470 for 31 patients → +$808/month
  
   
• Net revenue uplift:
  → $4,745/month
  → $56,940/year
  
   

Program-Level Impact:

• 2025 Annual Revenue: $438,264
  
   
• 2026 Projected Revenue: $495,204 (without adding any new patients)
   +13% YoY growth unlocked through workflow + billing optimization
  
   

Option B — Insight + Message Style

Your RPM program is strong — but revenue is leaking:

• 16% of patients transmit too few days → billable work goes unpaid
  
   
• 6% of patients get care minutes that never convert into claims
  
   
• Result: $70k annual income opportunity left on the table
  
   

By simply capturing existing care and transmissions more effectively:
 

Convert 83 low-transmission patients → billable RPM
Convert 31 short-management patients → reimbursed care
Unlock +13% revenue lift with zero new enrollment

This is pure operational upside — no marketing cost, no added FTEs. Just improved compliance and billing workflows.

Option C — Financial Table + Headline Metric

A 13% growth engine already exists inside your current patient base.

The analysis demonstrates that 16% of enrolled patients generate zero device revenue under 16-day minimums, representing significant financial leakage. Practices implementing 99445 immediately capture this revenue while improving patient experience through flexible monitoring.

Device Requirements and Compliance

FDA Clearance Requirements

CPT 99445 requires FDA-cleared devices that automatically transmit physiologic data. Consumer wellness devices (Fitbit, Apple Watch) do not qualify for reimbursement.

Qualifying Devices:

• Blood pressure monitors: Cellular-enabled cuffs with automatic transmission
• Glucometers: Bluetooth or cellular meters with EHR integration
• Weight scales: Cellular scales transmitting to monitoring platform
• Pulse oximeters: Automatic SpO2 and heart rate transmission
• Multi-parameter devices: Combinations (BP + weight + SpO2)

Platform Angle: Supporting Value-Based Care Programs

The device side is one piece of the puzzle. The other (often under-emphasised) piece is the platform: the software, analytics, care-coordination, contract-management and data-infrastructure layer that enables an organisation (provider, payer, ACO) to operate under VBC arrangements (outcome-based payments, shared risk, population health). Some of the critical platform capabilities include:

• Data aggregation across claims, clinical, device/RPM and social determinants of health.
  
   
• Risk-stratification and analytics to identify high-risk patients, close care gaps, forecast cost/outcomes.
  
   
• Care coordination workflows, remote monitoring integration (devices ↔ platform ↔ care-team). 
  
   
• Contract modelling, performance tracking, provider-network enablement (for value-based arrangements). 
  
   
• Integration and interoperability with EMRs, EHRs, HIEs, device streams. 
  
   

Below are three platform examples that illustrate this space.

1. Circle Health

Why it’s relevant:

• Circle Health describes itself as a full-stack care platform focused on outcome-based care (aligning financial incentives and behaviours across stakeholders).
  
   
• Their model emphasises proactive engagement, chronic condition management, and value-based care delivery via AI + human clinical teams.
   Key platform features:
  
   
• Management of care-coordination for populations (rather than just episodic care).
  
   
• Outcome-based incentive alignment.
  
   
• Dashboard/insight capabilities for teams.
   Points to consider:
  
   
• While the “platform” label is used, one should assess the depth of the analytics, device/RPM integration, and contract-management modules (for VBC).
  
   
• Geography/context (if a regional focus) may matter.
  
   

2. Reveleer

Why it’s relevant:

• Marketed explicitly as “One platform for value-based care” that consolidates workflows, analytics, and automation across care-gap closing, quality improvement, risk adjustment, and provider workflows.
   Key platform features:
  
   
• AI-powered automation (e.g., “EVE™” assistant) to reduce manual burden.
  
   
• Data ingestion from structured + unstructured sources, bi-directional integration with EHR/HIE.
  
   
• Combined provider/payer workflows for VBC contracts.
   Points to consider:
  
   
• Device/RPM specific integration may need evaluation — though strong in analytics and workflow.
  
   
• Implementation maturity and regional regulatory support (e.g., HIPAA, GDPR) should be verified.
  
   

3. SpectraMedix

Why it’s relevant:

• They provide a modular VBP (value-based payment) platform aimed at health plans, provider networks, ACOs etc. Their “VBP Platform” focuses on contract settlement, provider enablement, modelling and analytics in VBC arrangements.

 Key platform features:

 

• Value-based contract modelling and settlement (so financial/risk side).
  
   
• Provider network analytics, enabling performance transparency.
  
   
• Unified view across lines of business (Medicare, Medicaid, commercial).
   Points to consider:
  
   
• Strong in the contracting/financial side of VBC — less emphasis (from public materials) on device/RPM or home-monitoring integration.
  
   
• If your use-case emphasises device data + remote monitoring, the platform’s device layer may need evaluation.
   

Bringing the Device & Platform Together

For a complete solution supporting a VBC program (especially one based on remote monitoring, prevention, chronic disease management), you’d want to ensure the stack is tightly integrated:

• Devices (with FDA/CE clearance, automatic data upload, secure transmission) feed data into the system.
  
   
• That data streams into the platform (via APIs, device SDKs, HL7/FHIR, IoT ingestion) and is joined with clinical + claims + population data.
  
   
• The platform applies analytics, risk stratification, care-team workflows (alerts, care-gap closure, remote interventions) and tracks performance against quality/outcome/risk targets.
  
   
• Finally, the platform supports provider/payer contracts, attribution, shared-savings or otherwise, and financial settlement – critical in VBC.
  
   
• The user/patient engagement layer (e.g., patient portal, mobile app, wearable connectivity) helps ensure adherence, monitoring, early intervention, escalation as needed.
  
   

When such an integrated stack exists, organisations can move from reactive (treat when sick) toward proactive/population-health (monitor, intervene early, avoid hospitalisations), which is precisely the shift posed by VBC.

Data Transmission Standards

Acceptable Transmission Methods:

• Cellular (4G/5G) direct transmission
• Bluetooth to smartphone app with automatic cloud upload
• WiFi-enabled devices with automatic sync

Unacceptable Methods:

• Manual data entry by patient
• Text message or email submissions
• Phone call reporting
• Patient portal entry
• Handwritten logs uploaded via photo

Platforms like Circle Health solve this by:

Using only automated, connected devices
Ensuring real-time transmission with proof of measurement
Providing clinician dashboards to streamline monitoring
Enabling billable, compliant workflows end-to-end

Bottom Line:
Switching from manual inputs → automated data capture can instantly convert non-billable work into recurring revenue while improving clinical outcomes.

Audit Documentation: Practices must maintain transmission logs showing date, time, and reading value for each data point. RPM platforms should generate audit reports demonstrating compliance with 2-15 day requirements.

Combining 99445 With Other Care Management Codes

CPT 99445 covers device supply but not clinical staff time. Practices should combine 99445 with treatment management codes to capture full revenue.

Compatible Code Combinations

Billing Rules for Code Stacking

Allowed Combinations:

• 99445 + any treatment management code (99470, 99457, 99458)
• 99445 + CCM codes (99490, 99439, 99487, 99489)
• 99445 + transitional care management (99495, 99496)

Prohibited Combinations:

• 99445 + 99454 (mutually exclusive)
• Billing 99445 twice in same 30-day period
• 99445 without documented 2-15 day transmission

Time Tracking: Time spent reviewing data from 99445 transmissions counts toward treatment management thresholds. A nurse spending 12 minutes reviewing 8 days of weight data can bill 99470.

Implementation Workflow for Practices

Practices should implement CPT 99445 using this structured approach:

Phase 1: Platform Configuration (Weeks 1-2)

Technical Setup:

• Configure RPM platform to track 2-15 day transmission separately
• Set automated billing triggers (alert at 2 days, 15 days, 16 days)
• Create custom reports showing transmission day counts
• Test claim generation for 99445 vs 99454 scenarios
• Update EMR templates to document transmission frequency

Billing System Updates:

• Add CPT 99445 to charge master ($47.43)
• Verify payer coverage policies
• Create billing rules (99445 vs 99454 logic)
• Train revenue cycle staff on new code

Phase 2: Clinical Protocol Development (Weeks 3-4)

Patient Selection Criteria:

• Controlled chronic conditions (hypertension, diabetes, CHF)
• Medication titration requiring 1-2 week monitoring windows
• Weight management programs with weekly check-ins
• Post-hospitalization surveillance (7-14 day windows)
• Seasonal monitoring variations

Monitoring Protocols:

• Define transmission frequency by condition (daily, 3x/week, weekly)
• Set clinical thresholds triggering increased monitoring
• Create transition plans (99445 → 99454 when acuity increases)
• Document medical necessity for 2-15 day monitoring patterns

Phase 3: Staff Training (Week 5)

Care Coordinators:

• How to identify 99445-appropriate patients
• Tracking transmission days within billing cycles
• When to encourage increased transmission (move from 99445 to 99454)
• Documentation requirements for audit compliance

Billing Staff:

• Claims submission for 99445
• Denial management strategies
• Appeals process for rejected claims
• Monthly reporting on 99445 vs 99454 volumes

Phase 4: Patient Education (Week 6)

Patient Communication:

• Explain flexible monitoring options
• Set realistic transmission expectations
• Clarify that 2-15 day monitoring is clinically appropriate for their condition
• Provide transmission targets (e.g., "3x weekly" vs "daily")

Patient Materials:

• Written instructions for device use
• Transmission frequency guidelines
• Troubleshooting resources
• Contact information for technical support

Phase 5: Pilot Program (Weeks 7-8)

Pilot Cohort:

• Select 20-30 patients currently in 2-15 day transmission range
• Enroll patients with controlled conditions ideal for less-frequent monitoring
• Track billing success rate (claims submitted vs paid)
• Monitor clinical outcomes (condition stability)

Success Metrics:

• Claims acceptance rate >95%
• Patient satisfaction with flexible monitoring >8.5/10
• Maintained clinical outcomes (BP control, glucose targets)
• Revenue capture from previously unbillable patients

Phase 6: Full Rollout (January 2026)

Program Expansion:

• Extend 99445 billing to all eligible patients
• Monthly reporting on revenue impact
• Quarterly review of transmission patterns
• Annual assessment of clinical outcomes

FAQ: Common Questions About CPT 99445

Can I bill 99445 if my patient transmitted data on only 2 days?

Yes. The code requires minimum 2 days of transmission within a 30-day period. Two days of readings generates $47.43 in reimbursement, assuming data transmitted automatically from an FDA-cleared device.

What happens if my patient transmits 15 days, then continues to 18 days?

Bill CPT 99454 ($47.43) instead of 99445. Once transmission reaches 16 days within the 30-day cycle, the higher code applies. You cannot bill both codes for the same patient in the same period.

Do I need to complete 99453 setup before billing 99445?

Yes. CPT 99453 (initial setup and education) must be billed once before the first instance of 99445 or 99454. Setup is a one-time charge per device type and remains valid across multiple billing cycles.

Can I bill 99445 if my patient manually enters data into a portal?

No. CMS requires automatic data transmission from FDA-cleared devices. Manual data entry, text messages, phone calls, or portal submissions do not qualify for 99445 reimbursement.

How do I document the 2-15 day requirement for audits?

Your RPM platform should generate transmission reports showing specific dates and readings. Save monthly reports documenting transmission frequency. EMR notes should reference transmission day count (e.g., "Patient transmitted BP on 12 days this cycle").

Can I combine 99445 with chronic care management (CCM) codes?

Yes. CPT 99445 covers device supply only. You can bill CCM codes (99490, 99439, 99487) for time spent coordinating care, updating care plans, and communicating with patients. The codes address different services and are compatible.

What if my patient misses the 2-day minimum?

No billable code exists for 0-1 days of transmission. The patient remains enrolled in RPM, but you cannot bill device supply for that 30-day cycle. Encourage increased engagement to reach the 2-day minimum in subsequent months.

Do commercial payers reimburse CPT 99445?

Most major commercial payers follow Medicare billing policies within 3-6 months. UnitedHealthcare, Aetna, Cigna, and Humana confirmed coverage for 99445 effective January 2026. Always verify individual payer policies before implementation.

Can I bill 99445 for patients using consumer devices like Apple Watch?

No. CPT 99445 requires FDA-cleared medical devices. Consumer wellness devices, fitness trackers, and smartwatches do not meet FDA medical device standards and are not reimbursable under Medicare or commercial plans.

How does 99445 affect my existing RPM program?

The code expands revenue opportunities without disrupting existing workflows. Patients currently transmitting 16+ days continue billing 99454. Patients transmitting 2-15 days now generate revenue through 99445 instead of zero reimbursement.

Conclusion: Simplifying Monitoring Through Flexible Reimbursement

CPT 99445 eliminates the false choice between clinical appropriateness and payment logic. Providers can now monitor patients at frequencies matching their clinical needs, whether that's daily readings during acute episodes or weekly surveillance for controlled conditions, without sacrificing revenue.

The code supports value-based care principles by compensating outcomes (clinical engagement, data-driven decisions) rather than arbitrary process metrics (16-day minimums). 

A patient transmitting 12 days of weight data after CHF discharge generates measurable value through readmission prevention, and 99445 ensures that value receives appropriate reimbursement.

Practices implementing the new code immediately capture 10-15% additional RPM revenue from patients currently falling below the 16-day threshold. 

More importantly, flexible monitoring improves patient satisfaction and retention, creating sustainable programs that balance clinical effectiveness with financial viability.

Health outcomes, simplified, through billing that matches care.