RPM Code for 2–15 Days of Data Transmission: Guide to CPT 99XX4

Stay current with Medicare's most recent changes and register for our webinar "Understanding Medicare's 2026 Changes to Remote Care Management," on November 20, 2025, at 2:00 PM ET / 11:00 AM PT. Medicare expert, Daniel Tashnek, J.D., will discuss the new RPM CPT codes and other impactful updates in the PFS final rule.

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Remote patient monitoring (RPM) continues to evolve as the Centers for Medicare & Medicaid Services (CMS) seeks to make care management programs more flexible and accessible. One of the most notable proposals in the Medicare’s 2026 Physician Fee Schedule Proposed Rule is the introduction of CPT code 99XX4, a new RPM device supply code designed specifically for patients who transmit data for 2–15 days in a 30-day period.

If approved, this new code would address a longstanding gap in RPM reimbursement. Under current rules, providers can only bill CPT 99454 if a patient transmits at least 16 days of data in a 30-day period. The addition of 99XX4 would allow providers to receive reimbursement when patients fall short of that threshold or do not benefit from more than 16 days of device transmission.

In this post, we break down everything you need to know about the proposed CPT 99XX4, including valuation details, billing requirements, how it fits with other RPM codes, and best practices for implementation.

The History Behind RPM CPT 99XX4

Providers and industry stakeholders have long expressed concerns over the all-or-nothing reimbursement tied to the 16-day data transmission threshold for CPT 99454. If a patient transmits data in fewer than 16 days in a 30-day period, the provider receives no reimbursement under current rules.

The American Medical Association’s CPT Editorial Panel developed CPT 99XX4 in response to this concern. CMS’s proposal to accept and value the code — at the same rate as 99454 — is a significant step forward for remote patient monitoring policy as it would reduce revenue volatility and improve clinical flexibility.

Improving Clinical Flexibility With the 2-15 Day RPM CPT Code

One of the most exciting aspects of CPT 99XX4 is its potential to expand the types of patients eligible for RPM services. Under the current 16-day minimum requirement for CPT 99454, many clinically appropriate candidates are excluded simply because they don't require — or cannot realistically achieve — daily data transmission.

CPT 99XX4 will allow providers to enroll and monitor patients who may benefit from less frequent, but still meaningful, remote monitoring.

Some common use cases include:

• Patients using GLP-1 medications: Individuals prescribed GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) may benefit from periodic weight and blood pressure monitoring but may not need daily readings.
• Obesity management: Patients with obesity often experience slow physiological changes that don’t require daily tracking. Weekly or biweekly weight monitoring may be more appropriate and more likely to secure patient buy-in.
• Controlled hypertension: Patients with hypertension who have stabilized after medication titration may benefit from less frequent, ongoing monitoring to ensure their blood pressure remains within a healthy range. 

By enabling reimbursement for these lower-frequency scenarios, CPT 99XX4 promotes clinical judgment and flexibility, allowing RPM to be tailored to the patient, not the current arbitrary billing threshold.

Key Details About CPT 99XX4

To better understand how CPT 99XX4 would function in practice, it's helpful to look at the core components of the code as outlined in the 2026 Physician Fee Schedule Proposed Rule. From billing frequency to transmission requirements, the following details clarify when and how this new RPM code could be used:

• Code (proposed): CPT 99XX4
• Status: Included in CMS's 2026 Physician Fee Schedule Proposed Rule
• Description: Covers the supply of an FDA-cleared device and the collection/transmission of physiological data on 2–15 days within a 30-day period
• Billing frequency: Once every 30 days per patient
• Data transmission requirement: Must receive at least 2 but fewer than 16 days of data

Who Can Bill for CPT 99XX4?

Similar to other RPM codes, CPT 99XX4 must be billed by a provider with a national provider identifier (NPI) number. However, internal clinical staff or external clinical staff can administer most of the program under general supervision, saving physician time and involvement. Eligible providers include: 

• Physicians
• Advanced practice registered nurses (APRNs)
• Physician assistants (PAs)
• Clinical staff operating under general supervision

Only one provider may bill 99XX4 per patient per 30-day period.

Billing Requirements for CPT 99XX4

To receive reimbursement under CPT 99XX4, providers must meet the following conditions:

• The RPM device must meet the FDA’s definition of a medical device
• Device data must be automatically collected and transmitted
• At least 2 but fewer than 16 days of physiological data must be transmitted during the 30-day billing period
• Manual uploads do not qualify
• Only one claim may be submitted per patient per 30-day cycle

What Devices Qualify for CPT 99XX4?

Like CPT code 99454, to qualify for reimbursement, the device must be:

• FDA-cleared
• Capable of automatic data transmission
• Used to collect physiologic data, such as:
  • Blood pressure
  • Blood glucose
  • Weight
  • Oxygen saturation
  • Heart rate

Examples of qualifying devices include:

• Blood pressure monitors
• Glucometers
• Weight scales
• Pulse oximeters

Do Not Bill CPT 99XX4 With CPT 99454

As proposed, CPT 99XX4 and CPT 99454 cannot be billed for the same patient during the same 30-day period. If a patient meets the 16-day threshold, providers should continue to bill CPT 99454. If the patient transmits data on 2-15 days, CPT 99XX4 should be billed instead.

How CPT 99XX4 Fits in With Other RPM Codes

Here’s how CPT 99XX4 fits into the broader RPM billing structure:

*Estimated reimbursement values as of August 2025

Compared to 2025, this additional code — along with the proposed 99XX5 covering 10-20 minutes of care management time — will significantly expand revenue opportunities for providers. Take one of Prevounce’s clients for example. A 522-patient RPM program out of upstate New York is focused on longitudinal hypertension and diabetes monitoring. In June 2025, 16% of patients (83 total) had between 2 and 16 measurements and 6% of patients (31 total) received between 10 and 20 minutes of care management time. Here’s a side by side comparison of 2025 revenue compared to 2026 forecasted revenue (assuming no new patients are added):

This program would see a 13% increase in revenue — nearly $65,000 — thanks to the new reimbursement opportunities.

Combining 99XX4 With Chronic Care Management (CCM)

Just like CPT 99454, providers could pair the new RPM CPT code 99XX4 with CCM codes such as CPT 99490 or 99491. For patients who transmit at least 2 days of data but fewer than 16 days of data, 99XX4 covers device supply while CCM codes reimburse for time spent reviewing data, updating care plans, and communicating with the patient. This combination helps practices maintain revenue while ensuring high-touch care.

Best Practices for Billing the 2-15 Day RPM CPT Code

To maximize the value of CPT 99XX4 while maintaining compliance, follow these best practices:

• Monitor device connectivity daily to ensure data is transmitting properly.
• Track patient adherence so you can determine whether to bill CPT 99454 or CPT 99XX4 at the end of each 30-day period.
• Document all transmissions and interactions to support audit readiness.
• Educate patients upfront about the importance of daily readings and how data transmission affects their care.
• Use RPM platforms that automatically calculate eligibility and generate the correct claims based on real-time patient data.

Final Thoughts on CPT 99XX4

Approval of CPT 99XX4 would represent a welcome policy shift that better aligns RPM reimbursement with clinical requirements and real-world patient behavior. By allowing billing for 2–15 days of device data transmission, CMS would be enabling providers to expand the clinical application of RPM and ensure that providers aren’t penalized for minor gaps in adherence.

With the right workflows and billing tools in place, providers would be able to integrate CPT 99XX4 into their RPM programs and enhance both patient care and financial sustainability.

Get More Out of RPM With Prevounce

Whether you are preparing to bill this new code in 2026 or are considering implementing an RPM program now that clinical and financial opportunities are expected to increase, Prevounce is here to help. Schedule a demo with our care management experts to learn how we can help you.

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Disclaimer

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.

Prevounce encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently.

Prevounce recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.