Remote Monitoring in the 2026 MPFS: New Codes, Old Concerns, and a Call to Action for Stakeholders

Nixon Law Group has been at the forefront of remote monitoring policy since CMS first established reimbursement for Remote Physiologic Monitoring (RPM) in 2019. Since then, we’ve seen comments by our clients lead to codes for Remote Therapeutic Monitoring (RTM), guided digital health companies and providers through regulatory changes, and advocated for fair, innovation-friendly reimbursement. We’ve also helped dozens of digital health companies launch and scale compliant RPM and Remote Therapeutic Monitoring (RTM) programs.

Now, the 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule marks another important evolution in this space—most notably with new codes allowing reimbursement for fewer than 16 days of data transmission per month and fewer than 20 minutes of monthly treatment management services. These long-awaited changes bring opportunity, but they may also raise compliance risks in today’s heightened enforcement climate.

The Long and Winding Road to Change

CMS has long required 16 days of data transmission in a 30-day period to bill the RPM and RTM device supply codes (99454 and 98976–98978). This threshold, which many physicians viewed as arbitrary, created challenges for use cases like post-discharge monitoring, obesity treatment, and short-term interventions—scenarios where 16 days of data is often unnecessary or clinically inappropriate.

Stakeholders have spent years pushing for a more flexible option for the supply of device codes. In fact, the American Medical Association’s CPT Committee rejected such proposals three times.  Interestingly, most stakeholders were not actively advocating for codes reimbursing for shorter durations of treatment management services.  However, in September 2024, the CPT Editorial Panel finally approved a proposal for new supply of device codes for <16-day use AND new codes for fewer than 20 minutes of monthly treatment management services. CMS has now proposed to adopt these codes in the 2026 MPFS.

New RPM and RTM Codes in the 2026 Proposed Rule

Remote Physiologic Monitoring (RPM)

Device Supply Code for <16 Days of Monitoring

  • CPT 99XX4Remote physiologic monitoring treatment management services, device(s) supply with daily recording(s) and/or programmed alert(s) transmission to monitor one or more physiologic parameters (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), for fewer than 16 days (minimum of 2 days) in a 30-day period; each 30-day period

Treatment Management Code

  • CPT 99XX5Remote physiologic monitoring treatment management services, 2–19 minutes of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month

Remote Therapeutic Monitoring (RTM)

Device Supply Codes for <16 Days of Monitoring

  • CPT 98XX4Remote therapeutic monitoring treatment management services, device(s) supply with daily recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system status, for fewer than 16 days (minimum of 2 days) in a 30-day period; each 30-day period

  • CPT 98XX5Remote therapeutic monitoring treatment management services, device(s) supply with daily recording(s) and/or programmed alert(s) transmission to monitor respiratory system status, for fewer than 16 days (minimum of 2 days) in a 30-day period; each 30-day period

  • Notably, CMS did not establish a new device supply code for Cognitive Behavioral Therapy, maintaining its prior position that such devices should be priced by the local Medicare Administrative Contractors (MACs)

Treatment Management Code

  • CPT 98XX7Remote therapeutic monitoring treatment management services, 2–19 minutes of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month

But…Proceed with Caution: Fraud Risks Remain

While the proposed changes are a win for care flexibility, they may introduce new opportunities for abuse by bad actors—particularly because billing could be allowed with as few as two data points per month.

In 2024, the HHS OIG issued a report critical of Remote Monitoring, highlighting concerns with RPM utilization and suggesting increased enforcement activity. Stakeholders should expect more scrutiny—not less—in this space.

To prepare, digital health providers and vendors should:

  • Establish clear protocols for when <16-day monitoring is appropriate

  • Maintain robust documentation and medical necessity justifications

  • Train teams on correct code selection and compliance practices

 

Solicitation for Public Comment

CMS invites input on a number of key policy decisions, including but not limited to:

  • Whether RPM and RTM codes should be valued similarly given their comparable clinical workflows

  • What real-world data exists to support valuation of physician work, clinical staff time, and direct practice expenses?

  • Should CMS use Hospital Outpatient Prospective Payment System (OPPS) cost data to establish the PE RVUs for certain PE-only RPM and RTM codes (e.g., CPT codes 99454, 99XX4, 98XX5, 98977)? Would this better reflect the actual cost of devices?

Now Is the Time to Engage

The 2026 MPFS Proposed Rule reflects years of advocacy—but CMS is still seeking stakeholder input. This is your opportunity to shape final policy by submitting comments.

If your company uses RPM or RTM—or plans to—this is the moment to ensure your voice is heard. Comments that include clinical rationales, cost data, or real-world use cases are especially impactful.

CMS is required to read every comment, and we’ve seen client-submitted comments cited in past Final Rules. Make yours count.

Need help preparing and submitting your comments? Or reviewing your RPM/RTM program for compliance? We can help. Contact us to schedule a consultation.