Discover the latest 2026 RPM CPT codes and new billing updates that simplify Remote Patient Monitoring reimbursement. Learn key changes, requirements, and how providers can maximize RPM revenue.
CMS finalized two new remote patient monitoring codes in the 2026 Physician Fee Schedule, expanding billing flexibility for providers who monitor patients between 2-15 days or deliver treatment management in 10-minute increments.
These codes address a critical gap: providers can now bill for shorter monitoring cycles without waiting for the 16-day threshold, directly improving outcomes for patients in care transitions or medication titrations.
The change reflects CMS's commitment to value-based care models. According to the 2026 PFS final rule, Medicare now reimburses six distinct RPM codes, allowing practices to match billing patterns to clinical needs rather than forcing artificial 16-day minimums[^1].
What Changed in the 2026 Physician Fee Schedule
CMS introduced CPT 99445 and CPT 99470 after recommendations from the AMA CPT Editorial Panel. The addition targets two persistent challenges in RPM programs:
- Challenge 1: Providers monitored patients for 10-15 days during hospital-to-home transitions but couldn't bill because 99454 requires 16 days minimum.
- Challenge 2: Clinical staff spent 12-18 minutes on treatment management but couldn't bill 99457, which requires 20 minutes.
The 2026 codes eliminate these billing gaps. A practice monitoring 100 CHF patients for 12 days post-discharge can now generate $4,700 in monthly revenue using 99445, compared to $0 under previous rules[^2].
The Two New RPM CPT Codes Explained
CPT 99445: Short-Term Monitoring (2-15 Days)
Description: Remote monitoring of physiologic parameters with daily recordings or programmed alerts, 2-15 days in a 30-day period.
2026 Reimbursement: $46.85 (Medicare national average)
Clinical Use Cases:
- Post-hospitalization monitoring (7-10 days)
- Medication adjustment periods (5-8 days)
- Pre-operative optimization (10-14 days)
- Seasonal exacerbation management (3-12 days)
Billing Requirements:
- Minimum 2 days of data transmission
- Daily readings or programmed alerts
- Cannot be billed with 99454 in same 30-day period
- Requires initial setup (99453) before first use
CPT 99470: Brief Treatment Management (10 Minutes)
Description: Treatment management services requiring one real-time interactive communication, first 10 minutes.
2026 Reimbursement: $25.74 (Medicare national average)
Time Documentation:
- 10-19 minutes total = 99470 ($25.74)
- 20-39 minutes total = 99457 ($51.48)
- 30-39 minutes total = 99457 + 99470 ($77.22)
- 40+ minutes total = 99457 + 99458 ($92.37)
Interactive Communication Requirements:
- Synchronous phone or video encounter
- Documented in patient record
- Must occur within same calendar month as time counted
- One interactive session minimum per billing period
Complete 2026 RPM Code Portfolio
Billing Logic for Maximum Reimbursement:
A patient enrolled in RPM for CHF management generates this revenue profile:
Month 1 (Setup + Standard Cycle):
- 99453: $21.93 (setup)
- 99454: $70.34 (monitoring)
- 99457: $51.48 (20 min management)
- Total: $143.75
Month 2 (Post-Discharge Monitoring):
- 99445: $46.85 (12-day intensive monitoring)
- 99470: $25.74 (12 min follow-up)
- Total: $72.59
Annual Revenue Per Patient: $1,450-$1,650 depending on monitoring frequency and time invested[^3].
Reimbursement Impact: Revenue Per Patient
Practices using the full RPM code portfolio see measurable financial outcomes:
Scenario 1: Primary Care Practice (200 Patients)
- Average monitoring: 22 days/month
- Average management time: 18 minutes
- Monthly revenue using old codes: $24,364
- Monthly revenue with 99470: $25,512
- Annual increase: $13,776
Scenario 2: Cardiology Group (500 CHF Patients)
- 30% require short-term monitoring (150 patients)
- 12 days average during titration periods
- Additional monthly revenue: $7,027
- Annual increase: $84,324[^4]
The new codes particularly benefit specialists managing chronic conditions with variable monitoring needs. A nephrologist adjusting BP medications can bill 99445 during the 8-10 day titration window, then resume standard 99454 monitoring once stable.
Clinical Scenarios Where New Codes Drive Outcomes
Scenario 1: CHF Hospital Discharge
Clinical Context: A 68-year-old patient discharged after CHF exacerbation requires daily weight and BP monitoring for 10 days.
Previous Billing: No RPM revenue (couldn't reach 16 days)
2026 Billing:
- 99453: $21.93 (if new to RPM)
- 99445: $46.85 (10 days monitoring)
- 99470: $25.74 (15 min phone review)
- Total: $94.52
Outcome: Patient readmission risk drops 76% with daily monitoring during first 10 days post-discharge[^5].
Scenario 2: Hypertension Medication Adjustment
Clinical Context: Provider changes antihypertensive medication, requires 12 days of close BP monitoring.
Previous Billing: Waited 16 days to start billing, delaying intervention feedback.
2026 Billing:
- 99445: $46.85 (12 days)
- 99470: $25.74 (11 min check-in)
- Total: $72.59
Outcome: Medication effectiveness confirmed within 12 days instead of 16+, reducing titration period by 25%[^6].
Scenario 3: COPD Seasonal Monitoring
Clinical Context: Patient with COPD needs intensive monitoring during winter months (January-March) but lighter monitoring in summer.
Previous Billing: All-or-nothing approach (16+ days or nothing).
2026 Billing Strategy:
- Winter months: 99454 ($70.34) + 99457 ($51.48)
- Summer months: 99445 ($46.85) + 99470 ($25.74)
- Flexible monitoring matches clinical acuity
Outcome: Maintains continuous monitoring year-round, reducing exacerbations by 44% compared to seasonal gaps[^7].
Implementation Checklist for the New Codes
Practices implementing 99445 and 99470 should complete these steps before January 1, 2026:
Technical Setup (Week 1-2):
- Verify RPM platform tracks monitoring days separately (2-15 vs 16-30)
- Configure automatic billing triggers at 10, 20, 40 minute thresholds
- Test data transmission frequency (daily alerts required for 99445)
- Update EHR templates to document interactive communication timing
Staff Training (Week 3-4):
- Train clinical staff on 10-minute documentation requirements
- Create workflows for short-term monitoring enrollment
- Review billing logic with revenue cycle team
- Establish protocols for choosing 99445 vs 99454
Clinical Protocols (Week 5-6):
- Identify patient populations needing short-term monitoring
- Define clinical criteria for 2-15 day monitoring periods
- Create transition workflows (hospital discharge, medication changes)
- Document medical necessity for shortened monitoring cycles
Billing Integration (Week 7-8):
- Update charge master with new codes
- Verify payer policies (most follow Medicare)
- Test claims submission for 99445 and 99470
- Monitor denial rates and appeal if necessary
Practices should pilot the new codes with 10-15 patients in December 2025 before full implementation[^8].
FAQ: 2026 RPM Billing Questions
Can I bill both 99445 and 99454 in the same month?
No. CMS guidelines state these codes are mutually exclusive within the same 30-day period. If a patient needs monitoring beyond 15 days, wait until day 16 and bill 99454 instead.
What counts toward the 10 minutes for CPT 99470?
Time includes data review, care plan updates, and interactive communication. The interactive session (phone/video) must occur within the calendar month, but preparatory time from previous days can count toward the 10-minute threshold.
Do commercial payers reimburse the new codes?
Most major payers follow Medicare's RPM policies within 3-6 months. UnitedHealthcare, Aetna, and Cigna confirmed 2026 coverage for both codes. Verify individual payer policies before implementation.
Can I bill 99470 multiple times per month?
No. Bill 99470 once for the first 10-19 minutes. At 20 minutes, bill 99457 instead. At 30-39 minutes, bill 99457 plus 99470. At 40+ minutes, bill 99457 plus 99458.
What documentation proves "daily recordings" for 99445?
Your RPM platform should generate reports showing transmission dates. CMS requires readings or alerts on at least 2 separate days within the 2-15 day window. Save these reports for audit purposes.
Does 99453 need to be rebilled with 99445?
No. Bill 99453 only once per device type. If a patient previously completed a setup for standard monitoring (99454), that same setup covers short-term monitoring (99445).
How do the new codes affect value-based contracts?
The codes support value-based care by enabling monitoring during high-risk periods (transitions, titrations). Practices in MSSP or ACO REACH programs can reduce readmissions without sacrificing revenue.
Simplifying RPM Billing While Improving Outcomes
The 2026 CPT code expansion removes artificial barriers between clinical needs and reimbursement logic. Providers can now monitor patients for 8 days post-discharge and bill appropriately, rather than stretching monitoring to 16 days to meet billing thresholds.
This alignment between patient care and payment models demonstrates CMS's commitment to outcome-focused reimbursement.
Practices that implement the new codes effectively will see both improved clinical metrics (fewer readmissions, faster medication optimization) and enhanced revenue capture (fewer unbilled monitoring days).
The opportunity is clear: match monitoring intensity to patient acuity, document time accurately, and bill accordingly. Health outcomes, simplified.