The American Medical Association (AMA) has announced a significant and welcome expansion of remote patient monitoring (RPM).
These changes, which were made by AMA’s CPT Editorial Panel and published on October 18th, are effective January 2026. They are as follows:
- Add a remote patient monitoring device supply CPT code that covers 2-15 calendar days of collected and transmitted data. AMA is revising existing CPT 99454 to cover 16-30 days.
- Revise CPT 99457 to include 11-20 minutes. This reduces the amount of time clinical staff must engage in interactive communication with a patient/caregiver during the month for 99457 to be reportable. CPT 99457 currently requires at least 20 minutes.
- Revise CPT 99458 to cover each additional 10 minutes of interactive communication. This reduces the amount of additional time clinical staff must engage in interactive communication for 99458 to be reportable. CPT 99458 currently requires at least an additional 20 minutes.
AMA also announced changes to remote therapeutic monitoring (RTM) CPT codes. It is adding three RTM codes to cover the reporting of respiratory, musculoskeletal, and cognitive behavioral therapy for 2-15 calendar days. AMA is revising CPT 98980 to include 11-20 minutes of service. As with the revision to the existing 99457 RPM time code, this change reduces the amount of time clinical staff must engage in interactive communication with a patient/caregiver during the month for 98980 to be reportable. AMA will revise the 20-minute time component for CPT 98981.
What This Means to Remote Care Management Programs
With AMA implementing these changes, now we wait to see if Medicare follows suit. If it does, providers of remote patient monitoring (i.e., remote physiologic monitoring) and remote therapeutic monitoring will need to revise how they are coding and billing for RPM and RTM to comply with the new codesets and rules. The same is true for private payers and health plans that modify their coding rules to align with AMA's changes. Providers that use remote care management technology to support coding and billing will want to ensure the software's vendor keeps current with the evolving rules and makes any necessary changes to the software to maintain compliant coding and billing.
In addition, beginning in 2026, RPM and RTM providers will want to begin coding and billing for patients who report RPM or RTM services for periods of 2-15 days and for interactive communication that initially lasts at least 11 minutes and then for 10-minute additional blocks of time beyond 20 minutes of communication. These new coding and billing opportunities may further enhance the financial value and performance of a remote care management program.
How We Got Here
The CPT Editorial Panel has long-deliberated revisions to the RPM codeset. A discussion on potential changes was scheduled for the February 2024 CPT Editorial Panel meeting, but the agenda topic was pulled at the last minute. During the May 2024 meeting, the panel appeared close to agreeing on updating the codeset. However, as the discussion progressed, the panel failed to reach the consensus needed to approve any changes and members agreed to postpone a vote. Revisions to the RPM codes were on the September’s meeting agenda, and the panel finally agreed to proceed with the changes outlined above, publicizing the revisions in late October.
Learn More About These Changes In Our On-Demand Webinar
Prevounce goes further in depth about these changes and more in our on-demand webinar "Understanding Medicare's 2025 Changes to Remote Care Management." Watch the on-demand webinar here.
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Health economic and reimbursement information provided by Prevounce is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.