Heads up: this issue is from July 2, 2025. Because it covers time-sensitive coding and regulatory topics, some details may have changed since. See the latest issues for current guidance.
Have you been wanting to do Remote Patient monitoring but the 16-day rule is way too much?? Take heart, here come some changes you just might love. On October 18, 2024, the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Editorial Panel released a Summary of Panel Actions from its September 2024 Panel Meeting, which includes six new remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) codes in addition to revisions to the existing codes. Effective January 2026, these changes include removing the current requirement for healthcare providers to receive 16 days’ worth of data to bill RPM codes. The AMA CPT Editorial Panel likely made these updates in response to stakeholder feedback that the 16-day billing threshold was not necessary in certain clinical use cases. Additionally, two new codes will reimburse providers for 10-19 minutes of managing RPM or RTM data in a month. Over the past few years, there is data indicating that reimbursement for RPM has been decreasing
Background
Remote patient monitoring, including RPM and RTM, is a form of Medicare reimbursed virtual care that allows providers to remotely monitor and manage their patients’ acute and chronic conditions. RPM involves the use of technology to remotely monitor and analyze patients’ physiological metrics (e.g. oxygen saturation, blood pressure, blood sugar) while RTM involves the use of technology to remotely capture patients’ non-physiologic data related to patients’ musculoskeletal or respiratory system, including treatment adherence. RTM data, unlike RPM, can be self-reported by a patient. Currently, both RPM and RTM reimbursement codes require that data is collected for at least 16 days in a 30-day period.
Along with telehealth, there has been a recent scrutiny on fraud and abuse issues related to Medicare reimbursement of RPM/RTM services. A report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) found potential fraud in RPM/RTM billings and urged additional oversight. OIG found that 28 percent of enrollees in RPM programs never had a claim or encounter record for the education or set up of RPM devices; 23 percent never had a claim or encounter record for the supply of an RPM device; and 12 percent did not receive treatment management services. According to the OIG report, CMS concurs with OIG’s recommendations to set additional safeguards, educate providers on RPM billing, and monitor companies specializing in RPM.
Updates to CPT and RPM Codes
These are the new codes that have been proposed so far. Remember the codes with XX's are placeholders. Once the Proposed Rule is released, we will see how these will be paid.
99XX5 – remote physiologic monitoring treatment management services code
98XX4 – respiratory remote patient monitoring code
98XX5 – musculoskeletal remote patient monitoring code
98XX6 – cognitive behavioral therapy remote patient monitoring code
98XX7 – remote therapeutic monitoring treatment management services
The following codes will be revised for 2026:
99454 – Will cover 16 – 30 days of remote monitoring.
99457 – Will include only 11-20 minutes. Previously you had to interact with a patient for 20 minutes or more to bill this code, now when you hit the 11-minute threshold the code is billable.
99458 – (an add on code) Will cover each additional 10 minutes of interactive communication. The code is currently for each additional 20 minutes, the time is more granular enabling you to capture more of your billable time and be reimbursed for that time.
98975 – Will be updated to include digital therapeutic intervention.
98976 – Will be revised to include device supply for data access or data transmissions to support respiratory remote therapeutic monitoring of patients.
98977 – Will be revised to include device supply for data access or data transmissions to support musculoskeletal remote therapeutic monitoring of patients.
98978 – Will be revised to include device supply for data access or data transmissions to support cognitive behavior remote therapeutic monitoring of patients.
98980 – Will be revised to include only 11-20 minutes. Currently you must interact with a patient for 20 minutes or more to bill this code. In 2026, when you hit the 11-minute threshold, the code is billable.
98981 (an add on code) will cover each additional 10 minutes of interactive communication. This change makes time more granular, enabling you to capture more of your billable time and be reimbursed. The code is currently used for each additional 20 minutes.
The changes will be effective in January of 2026 so don’t use these as described now! As more details and guidelines for these remote monitoring codes come out, we will inform you.
Bottom Line
Again, more about pricing will be in our next newsletter covering the Medicare Proposed Rule for Physicians. Stakeholders should continue to monitor additional developments from the AMA and CMS related to RPM/RTM CPT codes.
With the development of digital health tools, many patients and providers have chosen to use this path to support clinical care and save travel time. Federal reimbursement policies have posited financial obstacles for some folks. These recent coding changes may make RPM services more accessible and financially viable for providers, potentially leading to increased adoption of these tools across the country. But, let's see what Medicare will pay for these in the coming weeks.
For additional information, see this article.
