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 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.
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.
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.
Any patient covered by Medicare Part B with an acute or chronic condition is eligible.
CMS calculates reimbursement rates for RPM services using a variety of factors, including:
The following graphic illustrates the Medicare PFS payment rates formula that is used to establish what physicians and other providers are paid.
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.
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.
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.
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:
To ensure claim approval and minimize denials, five data points are required for every submission:
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.
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.
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 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 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:
*Reimbursement rates are based on a national average and may vary depending on your location.
Check the Physician Fee Schedule for the latest information.