2026 Remote Patient Monitoring CPT Codes: 99470, 99457, 99453 and more

What is Remote Patient Monitoring?

Remote Patient Monitoring (RPM) is a healthcare delivery method that uses FDA-cleared digital devices to collect and transmit physiological data from patients to their providers. Reimbursed by Medicare Part B, RPM enables continuous chronic disease management outside of traditional clinical settings.

RPM is covered for patients with a small co-pay. This monthly program offers patients personalized care plans, continuous care team engagement, and informed condition management.

Remote Patient Monitoring CPT codes:
99470, 99457, 99445, 99453, 99454 and more

Remote monitoring CPT codes correspond to an exact activity, whether that be device setup or providing care services. The codes reflect different rates, each with its own restrictions.

Effective January 1, 2026, Medicare updated the Physician Fee Schedule (PFS) to include new codes for shorter monitoring durations.

To optimize care delivery and avoid denied claims, providers should utilize the following code set:

2026 Medicare National Average Reimbursement Rates for Remote Patient Monitoring (RPM) services.

How to Bill for Remote Patient Monitoring in 2026

Navigating different codes is critical for compliance. Providers must select the single most appropriate code based on the data transmitted and time spent each month.

1. Billing for Device Data (99453, 99445 and 99454)

• Device set-up: CPT code 99453 ($21.71 on avg.) can be claimed only once per device, and it cannot be billed more than once per month per patient. For example, if a patient receives two devices within the same calendar month, only one device can be billed for in that timeframe. The second device would be billable in the subsequent month.
  
• The 2-Day Rule: You may now bill for device supply code 99445 ($52.11 on avg.) if the patient transmits data for at least 2 days in a 30-day period.
• The 16-Day Rule: If the patient transmits data for 16 or more days, you must bill 99454 ($52.11 on avg.).
• Note: These codes are mutually exclusive; you cannot bill both in the same 30-day window.

2. Billing for Care Management in RPM (99470 vs. 99457)

• The 10-Minute Threshold: For patients requiring "light-touch" care, use 99470 ($26.05 on avg.) once 10 minutes of clinical time is reached.
• The 20-Minute Threshold: Once clinical time reaches 20 minutes, bill 99457 ($51.77 on avg.) instead of 99470.
• Add-on Time: CPT code 99458 ($41.42 on avg.) can be billed in unlimited 20-minute increments only after the initial 20-minute (99457) threshold is met.

It is important to note: CPT code 99454 (device use) can be billed every 30 days while codes 99457 and 99458 (program time) are calendar month codes. Aligning claims submissions for these codes is recommended. 

We would suggest submitting all RPM-related claims together by calendar month.

Which Patients Are Eligible for Medicare RPM?

Any patient covered by Medicare Part B with an acute or chronic condition is eligible.

• Coverage: Medicare overs 80% of the cost, with secondary insurances often covering the remaining 20%.
• Devices: Must be FDA-cleared medical devices (e.g., blood pressure monitors, glucometers, weight scales) that transmit data digitally.
• Supervision: While a provider with an NPI must direct the program, clinical staff can perform the majority of the monitoring under general supervision.

How Does CMS Determine RPM Rates Each Year?

CMS calculates reimbursement rates for RPM services using a variety of factors, including: 

• CPT billing codes – specific codes that reflect the complexity of patient needs and time spent
• Relative value unit (RVU) –reflects the relative time and intensity of each CPT code
• Annual conversion factor (CF) – used to calculate a national average fee
• Geographic practice cost index (GPCI) – adjusts the national average fee to reflect variation in practice costs across the US

The following graphic illustrates the Medicare PFS payment rates formula that is used to establish what physicians and other providers are paid. 

What are the Requirements for Medicare RPM?

To qualify for reimbursement under Medicare Part B, Remote Patient Monitoring (RPM) must follow specific clinical and regulatory guidelines. The program is designed for beneficiaries with acute or chronic conditions who use digital devices to transmit physiological data.

• Clinical Goal: Providers must use the collected data to monitor a patient’s status and make necessary treatment adjustments to improve condition management.

What Devices and Data are Eligible for RPM?

Under 2026 guidelines, RPM devices must meet the Food and Drug Administration’s (FDA) criteria for a designated medical device. These devices must automatically and digitally transmit data. Manual entry by the patient is generally not permitted for billing.

Commonly Used RPM Devices

• Blood Pressure Monitors: For hypertension management.
• Glucometers: For diabetes and blood sugar tracking.
• Pulse Oximeters: For monitoring oxygen saturation in COPD or heart failure.
• Weight Scales: For monitoring fluid retention in congestive heart failure.
• Spirometers & Thermometers: For respiratory and infection monitoring.

Data Compliance

All transmitted data (weight, blood glucose, heart rate, etc.) must be stored in a HIPAA-compliant platform, such as care coordination software, to ensure patient privacy and audit-readiness.

Which Healthcare Providers Are Eligible to Offer and Bill for RPM?

RPM billing must be directed by a provider with a valid National Provider Identifier (NPI). While clinical staff can administer the daily operations of the program under "general supervision," the following providers are eligible to bill Medicare:

• Physicians (MD/DO)
• Nurse Practitioners (NP) and Physician Assistants (PA)
• Certified Nurse Midwives and Clinical Nurse Specialists
• Pharmacists: Pharmacists are increasingly utilized to manage RPM programs, typically billing under the direct or general supervision of a physician to capture 100% of the Medicare PFS rate

How to Submit a Medicare Claim for RPM

To ensure claim approval and minimize denials, five data points are required for every submission:

1. CPT Codes: The specific codes for setup (99453), data (99445/99454), and time (99470/99457).
2. ICD-10 Codes: The diagnosis codes for the conditions being managed (e.g., I10 for Hypertension).
3. Date of Service: The date the threshold (days or minutes) was met.
4. Place of Service: Typically indicated as "Office" (11) or "Telehealth" (02/10).
5. Provider NPI: The ID of the billing practitioner.

4 Steps to Successful RPM Billing

1. Verify Thresholds: Confirm if the patient met the 2-day (99445) or 16-day (99454) data requirement, and whether clinical time reached 10 (99470) or 20 (99457) minutes.
2. Audit Logs: Ensure the care coordination software has captured an "audit trail" of all automated data transmissions and clinical interactions.
3. Submit Monthly: File claims according to the calendar month to align with Medicare's 2026 reporting preferences.
4. Cross-Check Codes: Confirm that no conflicting codes (like overlapping Remote Therapeutic Monitoring or Home Health codes) have been billed for the same period.

Rural Health Clinics and Federally Qualified Health Centers can deliver Remote Patient Monitoring

CMS allows use of individual care management codes

Established in 2025, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) may use individual program codes to bill for specific services. 

This move to give RHCs/FQHCs access to individual billing codes aims to improve payment accuracy and provide clarity about which services beneficiaries receive. 

Can RPM Be Billed with Chronic Care Management?

Providers can offer RPM alongside Chronic Care Management (CCM). 

Providers can use CCM to engage patients on a monthly basis between regular appointments. Delivered through remote interactions, either by phone or a telehealth platform, CCM is billable when at least 20 minutes are spent with the patient performing appropriate tasks. 

CCM supports its own CPT billing codes, and these can be billed concurrently with RPM, supporting dual reimbursements. However, all CCM service and time requirements must be met separately from RPM. 

Learn more about CCM billing codes here.

Revenue potential of Remote Patient Monitoring 

For healthcare organizations, care management programs can drive revenue and support cost savings. Below is a general example of how reimbursement for a RPM program could add up.

The final figure does not include billable time beyond the 20-minute minimum, but additional time would increase revenue for your practice. 

For example, CPT code 99458 is utilized for additional increments of 20 minutes after the initial 20-minute minimum has been met. It is an add-on code to 99457 and can be billed in unlimited 20-minute increments each month with reimbursement averaging $51.77 each time billed.

As long as the patient is provided with an RPM device, CPT code 99453 can be utilized once per device per patient to help offset device reimbursement.

In addition to creating practice revenue, RPM programs broaden patient care access and can prevent emergency situations through daily monitoring.

RPM promotes value-based care

RPM programs offer additional provider benefits, beyond direct reimbursement. They can be optimized to report data, engage and motivate patients, and meet specific quality metrics key to value-based care. 

RPM enhances patient engagement and improves care coordination. Personalized care planning can be used to establish and track SMART goals, or identify social determinants of health. 

Patients benefit from enhanced engagement, as well as access to a care manager. They have a monthly check-in to ask questions, discuss conditions, and access resources. 

A RPM program can generate significant revenue just by billing certain CPT codes. However, elements of the program, especially within a larger healthcare system, can also promote a value-based care model.

ThoroughCare simplifies Remote Patient Monitoring

ThoroughCare gives providers the tools and support to make Remote Patient Monitoring effective.

We help providers, based on their specific needs, build Remote Patient Monitoring programs or scale existing services. ThoroughCare supports a comprehensive software platform, clinical expertise to optimize workflows and assistance with data and reporting for quality improvement. 

We simplify the process, so providers can focus on engaging patients. ThoroughCare offers: 

• Use of more than 400 RPM devices for seamless data collection
• Analytics to report on care performance and operations
• Comprehensive care planning tools
• Evidence-based assessments (lifestyle, health risks, behavioral conditions, SDOH) 
• Automated billing code assignment with audit trail
• Data integration across EHRs, HIEs, and advance care plans

*Reimbursement rates are based on a national average and may vary depending on your location.

Check the Physician Fee Schedule for the latest information.