The CY 2026 Medicare Physician Fee Schedule final rule took effect on January 1, 2026, and it restructured remote monitoring billing more than any rule since remote patient monitoring entered the fee schedule. Six new CPT codes are now live across remote patient monitoring (RPM) and remote therapeutic monitoring (RTM). Months with as few as two days of device data are billable. Months with as little as ten minutes of treatment management time are billable. The all-or-nothing version of the 16-day rule — where a patient who transmitted readings on 15 of 30 days earned the practice nothing — is over.
This guide covers what changed, what the new codes pay, how the pairing rules work, and what practices should be doing differently this year.
Update: On July 14, 2026, CMS proposed further changes for 2027 — including a practice-employment requirement for monitoring staff and a new initiating-visit rule. Everything below remains in effect through December 31, 2026; see our analysis of the CY 2027 proposed rule for what may come next.
What changed on January 1, 2026
CMS released the CY 2026 Physician Fee Schedule final rule (CMS-1832-F) on October 31, 2025. It was published in the Federal Register on November 5, 2025, and its provisions took effect January 1, 2026. For remote monitoring, the rule finalized the CPT Editorial Panel's restructuring of both code families:
- Two new RPM codes. CPT 99445 covers device supply with 2–15 days of data in a 30-day period, and CPT 99470 covers the first 10 minutes of treatment management in a calendar month.
- A revised 99454. The core device-supply code now explicitly covers 16–30 days of data within 30 days.
- Four new RTM codes. 98984, 98985, and 98986 bring the same short-duration device-supply concept to respiratory, musculoskeletal, and cognitive behavioral therapy monitoring, and 98979 mirrors the new 10-minute management code.
- Revised setup codes. RTM's 98975 setup code now requires two or more days of data in the episode, and reporting on the final rule indicates RPM's 99453 is now aligned with a two-day minimum as well.
The structural idea behind all of it is the same: Medicare now pays along a spectrum of monitoring intensity instead of a single cliff at 16 days and 20 minutes.
The new RPM codes: 99445 and 99470
CPT 99445 — device supply, 2 to 15 days
99445 is the code practices have been asking for since RPM billing began. It covers supplying the monitoring device and collecting between 2 and 15 days of physiologic data within a 30-day period. CMS priced it at parity with 99454 — roughly $47 national average non-facility; verify against the CMS Physician Fee Schedule lookup, since geographic adjustment and payer policy vary.
The pricing decision matters as much as the code itself. A short monitoring episode is not paid at a discount. A ten-day post-discharge blood pressure protocol and a full month of monitoring carry roughly the same device-supply payment.
The one hard restriction: 99445 and 99454 can never both be billed for the same 30-day period. Each period gets exactly one device-supply code — 2–15 days of data maps to 99445, and 16–30 days maps to 99454.
CPT 99470 — the first 10 minutes of management
99470 covers the first 10 minutes of remote physiologic monitoring treatment management in a calendar month. It exists for months where total management time lands between 10 and 19 minutes — months that were previously unbillable because 99457 requires 20. CMS valued it at 0.31 work RVUs, roughly $26 national average; again, verify the figure against the CMS fee schedule lookup before building financial projections on it.
99470 is not billable in the same month as 99457. Once management time reaches 20 minutes, the month belongs to 99457, with 99458 available for each additional 20 minutes. And 99458 remains an add-on to 99457 only — it never attaches to 99470.
Is the 16-day requirement actually gone?
No — and this is where much of the commentary on the 2026 rule overstates the change. The 16-day threshold still exists. What ended is the all-or-nothing structure around it.
CPT 99454 was revised, not retired. Its descriptor now reads 16–30 days of data in a 30-day period, at roughly the same ~$47 national average as before. Practices with strong patient engagement and consistent transmission should keep billing 99454 exactly as they always have.
What changed is the consequence of falling short. Before 2026, a month with 15 days of readings produced zero device-supply revenue. Now it produces a 99445 claim at parity. The 16-day rule stopped being a cliff and became a boundary between two codes.
The setup code moved in the same direction. RTM's 98975 was formally revised to require two or more days of data in the episode, and legal analyses of the final rule report that RPM's 99453 is now aligned with the same two-day minimum — a point worth confirming in the final rule text or with your Medicare Administrative Contractor before relying on it for short-episode setup billing.
How do the pairing rules work?
Think of RPM billing in 2026 as two independent axes.
The device-supply axis — one code per 30-day period, based on days of data:
| Days of data in 30 days | Code |
|---|---|
| 0–1 days | Nothing billable |
| 2–15 days | 99445 |
| 16–30 days | 99454 |
The management axis — one code path per calendar month, based on minutes:
| Management time in the month | Codes |
|---|---|
| 0–9 minutes | Nothing billable |
| 10–19 minutes | 99470 |
| 20+ minutes | 99457, plus 99458 per additional 20 minutes |
Mixing across the axes is explicitly allowed. A month with 20 days of data and 12 minutes of management is 99454 + 99470. A month with 9 days of data and 35 minutes of management is 99445 + 99457. What is never allowed is billing both codes of the same pair — 99445 with 99454, or 99470 with 99457 — for the same period.
One further clarification from the final rule, reported in legal analyses: CMS indicated that discussing RPM data with the patient during an in-person clinic visit may count toward the interactive-communication requirement of the management codes. Practices should confirm the details before changing workflows, but it suggests a more practical reading of the requirement than many compliance teams have assumed.
For a code-by-code walkthrough with worked monthly examples, see our 2026 RPM CPT code billing reference.
What changed for RTM in 2026?
Remote therapeutic monitoring received the same structural overhaul. Four new codes took effect January 1, 2026:
- 98984 — respiratory monitoring device supply, 2–15 days (roughly $52 national average)
- 98985 — musculoskeletal monitoring device supply, 2–15 days (roughly $51 national average)
- 98986 — cognitive behavioral therapy monitoring device supply, 2–15 days (contractor-priced)
- 98979 — first 10 minutes of RTM treatment management (roughly $26 national average)
A caution on the first two: several vendor blogs have the respiratory and musculoskeletal mappings swapped. Per APTA's practice advisory on the 2026 codes, 98984 is respiratory and 98985 is musculoskeletal. Verify the descriptors in your billing system rather than trusting a secondary summary — including this one.
The existing RTM family continues alongside the new codes: 98975 (setup, now requiring 2+ days of data in the episode, roughly $22), 98976 (respiratory device supply, 16–30 days, roughly $52), 98977 (musculoskeletal device supply, 16–30 days, roughly $40), 98978 (CBT device supply, contractor-priced), and the management pair 98980 (first 20 minutes, roughly $54) and 98981 (each additional 20 minutes, roughly $41). All figures are national averages from secondary tables — verify against the CMS Physician Fee Schedule lookup.
The same-pair prohibitions mirror RPM: one device-supply code per 30-day period within each modality, and 98979 is not billable in the same month as 98980. All RTM codes retain their "sometimes therapy" designation.
For therapy practices and specialty groups building programs around these codes, our RTM service overview covers how Neuvora operationalizes them.
Can you bill RPM and CCM in the same month?
Yes. RPM and chronic care management (CCM) have been billable for the same patient in the same month since CY 2021, provided no minute of clinical time is counted toward both services. Nothing in the 2026 rule changed that — but the new 10-minute RPM code makes concurrent programs more attainable, because a light-touch RPM month no longer has to reach 20 minutes to produce a claim alongside CCM.
The operational requirement is disciplined time tracking: separate logs for RPM management time and CCM care-coordination time, with no overlap. We compare the two programs — and when the newer APCM codes change the equation — in CCM vs RPM in 2026.
Can you bill RPM and RTM in the same month?
No. This restriction survived the 2026 restructuring unchanged: RPM and RTM remain mutually exclusive for the same patient in the same month. Practices choose the program that fits the clinical picture — physiologic data such as blood pressure, glucose, weight, or pulse oximetry points to RPM; therapeutic response and adherence data points to RTM.
Did the telehealth cliff ever threaten RPM?
No — and this point deserves to be stated plainly, because the late-2025 telehealth turbulence generated real confusion. RPM and RTM are care-management services under the Physician Fee Schedule. They are not statutory "telehealth" services, so the expiration dates attached to the pandemic-era telehealth flexibilities never applied to them. CMS reiterated that position in the 2026 rule.
The turbulence was real for telehealth itself: the flexibilities lapsed on October 1, 2025 during the government shutdown, were restored retroactively by the November 2025 continuing resolution, and were then extended through December 31, 2027 by the Consolidated Appropriations Act of 2026. Remote monitoring billing continued uninterrupted through all of it. A practice's RPM revenue was never exposed to that cliff, and it is not exposed to the 2027 one either.
What is the payment environment behind the new codes?
Two features of the 2026 fee schedule matter for remote monitoring economics.
First, the conversion factor split. For the first time, CMS finalized two conversion factors: $33.5675 for qualifying APM participants (a 3.77% increase) and $33.4009 for everyone else (a 3.26% increase), both incorporating the 2.5% statutory update enacted in 2025. Either way, the dollar multiplier behind every RPM and RTM code went up.
Second, the widely discussed −2.5% "efficiency adjustment" does not touch these services. CMS exempted evaluation and management, care management, telehealth, time-based, and new-for-2026 codes from the adjustment — which covers the entire RPM, RTM, CCM, and APCM families. The practice-expense redistribution in the rule also favors non-facility (office) rates, the setting where remote monitoring is billed. CMS additionally moved code valuation toward a method based on hospital outpatient cost data (the OPPS geometric mean cost approach), which is how the new codes were priced.
What does this mean for your practice?
The practical consequences are larger than the code list suggests.
Short-episode monitoring is now a program, not a write-off. Post-discharge blood pressure checks, post-operative recovery monitoring, and medication titration windows of one to two weeks were clinically useful but financially invisible before 2026. With 99445 priced at parity with 99454, a deliberate 10-day protocol is a billable service.
Previously lost months are recoverable. Every practice running RPM has patients who transmit 12 or 14 days in a month. Those months now generate a 99445 claim instead of nothing. The same logic applies on the time axis: months with 10–19 minutes of management now produce 99470.
The compliance surface changed. Billing teams need the pairing rules encoded in their workflows — one device-supply code per 30 days, one management path per month, never both of a pair. Claim-scrubbing logic, EHR templates, and vendor platform reporting all need to reflect the 2026 structure.
Documentation discipline pays. The new codes reward practices that can show exactly how many days a device transmitted and exactly how many minutes staff spent, with dates and activities. That was always good practice; it now determines which of two codes applies in a given month.
A reasonable adaptation sequence: confirm your monitoring platform reports transmission days per 30-day period accurately, update billing rules for the four new RPM/RTM pairings, retrain staff on the 10-minute threshold, and re-run your program economics. Our reimbursement calculator models monthly revenue under the 2026 code structure, and our RPM overview covers how a physician-led program handles the operational side.
The bottom line
The 2026 rule did not lower the bar for remote monitoring — it removed the cliff. Full months of monitoring bill the way they always have, at slightly improved rates. Partial months, short episodes, and light-touch management now bill too, under new codes with clear boundaries. Practices that encode the pairing rules correctly and document days and minutes precisely will find that the program they already run captures meaningfully more of the work they already do.
This article is general billing information, not billing, legal, or medical advice. Verify current rates and payer policies against the CMS Physician Fee Schedule and your MAC before billing.
