2026 CMS Proposed Fee Service Schedule Change (RPM/RTM)
Impact on RPM/RTM and Patient Care Opportunities
It's that time again! The Centers for Medicare and Medicaid are planning to introduce some key fee schedule changes for 2026.
The 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule introduces major changes for both Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM), designed to widen access, modernize billing, and create more revenue opportunities for providers.
We’ve provided a high-level summary below of the proposed changes, what they mean and why they're important.
What’s Changing for RPM and RTM in 2026?
Shorter, Flexible Device Data Periods
CMS now allows billing for only 2–15 days of device transmission in a 30-day period (codes: 99XX4 for RPM, 98XX4/98XX5/98XX6 for RTM), in addition to maintaining the classic 16–30 day billing under existing codes. This permanently ends the “all-or-nothing” 16-day minimum that previously excluded many patients.
Shorter Billable Clinical/Management Contact
Previously, providers needed to spend at least 20 minutes on care management (CPT 99457 for RPM, 98980 for RTM). In 2026, new codes (99XX5 for RPM, 98XX7 for RTM) allow billing for 10–19 minutes of management—at about half the typical rate.
RTM Gains Parity with RPM
RTM device codes get the same 2–15 days/16–30 days structure for respiratory, musculoskeletal, and cognitive behavioral monitoring. Some RTM codes may be priced locally by Medicare contractors.
2025 vs. 2026 RPM & RTM Billing Codes Comparison
Code | Service | 2025 | 2026 Proposed | Provider Effect |
99453 | RPM/RTM Setup/Education | ≥16 days, $19.73 | No change | Stable, one-time/episode |
99454 | RPM Device Supply | ≥16 days, $48.79 | 16–30 days, $48.79 | Only 16+ days; stricter, but unchanged |
99XX4 | NEW RPM Device Supply | Not billable | 2–15 days, $48.79 | Bill for low-use patients |
98976/77/78 | RTM Device Supply | ≥16 days, ~$48.79 | 16–30 days, ~$48.79 | Only 16+ days; stricter, but unchanged |
98XX4/5/6 | NEW RTM Device Supply | Not billable | 2–15 days, ~$48.79/contractor | Bill for low-use and short-term RTM |
99457 | RPM Management | ≥20 min, $47.87 | No change | Stable for standard management |
99XX5 | NEW RPM Mgmt. (short) | Not billable | 10–19 mins, ~$29 | Bill for briefer clinical engagement |
98980 | RTM Management | ≥20 min, $47.87 | No change | Stable for standard management |
98XX7 | NEW RTM Mgmt. (short) | Not billable | 10–19 mins, ~$29 | Bill for brief management in RTM |
99458/98981 | Add’l RPM/RTM Management | +20 min, $43.02 | No change | Extended care continues to be covered |
Rates and codes are subject to CMS finalization; see the CMS Fact Sheet, NatLawReview summary, ChartSpan analysis, Prevounce blog, CareSimple executive summary
How Will the 2026 Proposed Medicare PFS Affect RPM/RTM?
The Centers for Medicare & Medicaid Services (CMS) has introduced proposals for the 2026 Physician Fee Schedule that suggest a shift in remote care, reimbursement, and compliance processes. While it's early to assess the full effects, the details signal several important directions for healthcare organizations preparing for the future
1. Expanding Access Through Adaptive Monitoring Periods
CMS is considering shortening the required remote monitoring period from 16 days to a flexible 2-15 day window. This change may help providers reach patient groups that previously faced barriers—such as those needing short-term care after surgeries or those in rural communities where connectivity isn't consistent. This adjustment could support more equitable care pathways and offer new opportunities to engage with diverse populations, encouraging programs that fit individual care needs rather than rigid criteria.
2. Adapting Financial Models to Real Clinical Workflows
The proposal includes potential billing for shorter, 10-minute remote interactions, moving reimbursement closer to the realities of day-to-day clinical care. These incremental engagements could offer organizations the flexibility to design financial models that not only address fee-for-service needs but also support value-based strategies that aim to keep patients healthier and out of the hospital. This approach may incentivize more proactive outreach and help demonstrate the broader impact of remote care.
3. Supporting Long-Term Investments in Remote Care Solutions
CMS’s focus on solidifying frameworks for Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) may encourage organizations to evaluate their technology and infrastructure choices through a future-ready lens. The proposed rules highlight remote care as a foundational element of contemporary healthcare delivery, prompting leaders to consider how their investments align with long-term digital strategies such as Hospital-at-Home and scalable, integrated care models.
4. Navigating Compliance in an Evolving Landscape
With expanded billing flexibility comes the need for increased attention to compliance and audit readiness. The proposals introduce new operational and documentation requirements that could make thorough, automated tracking a strategic priority. Investing in platforms capable of robust data capture and audit trails may help minimize regulatory risk while preserving staff time for direct patient care, fostering an environment where compliance supports rather than hinders clinical goals.
Summary of 2026 Proposed Fee Schedule
The CMS 2026 proposals present organizations with opportunities to reassess care delivery, financial sustainability, and compliance practices within a rapidly evolving healthcare landscape. Preparing thoughtfully for these changes may position providers to serve patients more effectively and maintain operational resilience.
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*This content is intended for general informational purposes only and should not be construed as legal advice. For guidance on your specific situation, please consult a licensed attorney.