How the 2026 CPT Updates Unlock Flexible Remote Patient Monitoring (RPM) Programs

Introduction

What if you could bill for Remote Patient Monitoring(RPM) services after just two days of data transmission, without risking claim denials or violating CMS thresholds?

Starting January 1, 2026, that becomes a reality.

The Centers for Medicare & Medicaid Services (CMS) has released significant updates to the CPT codes governing RPM. These changes are designed to simplify reimbursement, expand access, and reflect the realities of how patients engage with monitoring technology.

For practice administrators, physicians, and billing companies, this represents a major opportunity to scale RPM programs with more flexibility and less friction.

This guide breaks down the key changes, compares old and new codes, and shows how to make the most of the 2026 updates.

The Current RPM Landscape

Under current guidelines, RPM reimbursement is only available if:

• A patient transmits data for 16 or more days in a 30-day period

• A provider or clinical staff spends 20+ minutes reviewing data and communicating with the patient

This rigid structure often disqualifies patients who are intermittent users or whose clinical status doesn't require constant tracking. Many practices have also struggled with denials for falling even slightly short of the thresholds.

While RPM has proven to improve outcomes and reduce unnecessary visits, these rules have limited participation, especially among smaller practices and patients with fluctuating conditions.

What's Changing in 2026

CMS is introducing two major enhancements to RPM coding:

1. New Device Supply Code: 99XX4

   • Covers patients who transmit data for just 2–15 days in a 30-day period

   • Reimbursed at the same rate as the existing 99454 code

   • Designed to capture patients with intermittent needs, such as post-op monitoring or temporary medication changes

2. New Time Management Code: 99XX5

   • Bills for 10–20 minutes of RPM-related work

   • Roughly half the work RVU of 99457

   • Allows billing for shorter clinical reviews or brief check-ins that still provide value

Meanwhile, 99454 has been revised to explicitly cover 16–30 days, which brings clarity to the reimbursement rules. The existing 99457/99458 codes (20+ minute thresholds) remain unchanged.

Side-by-Side Code Comparison

Implications for Billing and Documentation

These new codes are not "easier" in the sense that they lower documentation standards. However, they provide much-needed flexibility by allowing:

• Reimbursement for brief interventions that previously went unpaid

• Use of RPM for patients with less intensive needs

• More predictable revenue models even when patient adherence fluctuates

Documentation must still include:

• Patient consent

• Number of days data was collected and transmitted

• Duration of time spent by clinical staff

• Summarized notes of patient communication or data review

How This Impacts Your Practice

For practice administrators:

• You can now enroll a wider range of patients in RPM programs

• Patient drop-off no longer means a total loss of reimbursement

• Easier to scale programs with fewer staffing or device hurdles

For providers:

• More patient touchpoints are reimbursable

• Incentive aligns with proactive, data-driven care

• Reduces the pressure to "hit 20 minutes" every month

For billing and RCM teams:

• Fewer claim denials due to non-compliance with rigid thresholds

• Simplified eligibility criteria means better claim acceptance

• Easier to train staff on documentation requirements

Patient Access and Experience

From a patient perspective, the changes make RPM more approachable:

• They don’t need to remember to transmit daily for 16 days

• Even brief use during acute recovery periods can qualify

• Easier onboarding for elderly or tech-challenged patients

Your Roadmap for 2026 RPM Success

1. Update internal RPM protocols to include patients who transmit less frequently

2. Train care coordinators and billing staff on 99XX4 and 99XX5 documentation

3. Revise consent forms to reflect the expanded eligibility

4. Track RPM revenue by code type to optimize performance

5. Partner with a vendor like OnCare360 to streamline tech, staffing, and compliance

Conclusion

The 2026 RPM CPT updates mark a pivotal shift in how remote care is delivered and reimbursed. With the ability to bill for shorter time spans and less data, practices can now serve a wider group of patients without adding administrative complexity.

At OnCare360, we help healthcare providers stay ahead of policy and billing changes, while delivering real outcomes.

Ready to expand your RPM program under the new codes?

Contact us today for a tailored strategy session.