Medicare’s 2026 PFS Proposed Rule Supercharges RPM: What It Means for Your Practice

The annual release of the Medicare Physician Fee Schedule (PFS) proposed rule is always a major event for healthcare providers, and the newly released 1,800-plus-page draft for 2026 is no exception. While we at Prevounce are still analyzing the full document, one thing is already clear: The Centers for Medicare & Medicaid Services (CMS) is doubling down on its commitment to remote care.

The proposed changes for remote patient monitoring (RPM) are not just minor tweaks. They represent what is arguably the most significant and positive expansion of the RPM program since its inception. For practices currently offering RPM and those considering launching a program, these updates introduce game-changing flexibility designed to improve patient care, expand eligibility, and streamline operations and do so in ways that can improve the financial value of the service.

This column will break down the history of RPM CPT codes, detail the exciting new proposed device and time codes for 2026, and explain what these changes mean for remote patient monitoring programs.

A Quick Look Back: The Foundation of RPM Billing

To understand why the 2026 proposals are so significant, it helps to remember how the current RPM program is structured. Introduced around 2019, the core RPM CPT codes created a framework for reimbursement that, while revolutionary for the time, had some built-in limitations.

To date, the key RPM codes have been:

• CPT 99453: Initial patient setup and education on using the RPM device(s), billable after 16 measurement-days in a 30-day period.

• CPT 99454: Supplying the device for a 30-day period. Crucially, this code required the device to record and transmit data on at least 16 days out of the 30 to be billable.

• CPT 99457: The first 20 minutes of clinical staff time spent on interactive communication and care management with the patient per calendar month.

• CPT 99458: Each additional 20 minutes of time.

While this structure has enabled hundreds of thousands of patients to receive proactive care at home, the "16-day rule" for device billing and the "20-minute threshold" for time have been operational hurdles. Not every clinical condition requires 16 days of monitoring, and valuable clinical interactions lasting 10 or 15 minutes couldn't be billed.

The Game Changer: What’s New for RPM in the 2026 Proposed Rule?

The 2026 proposed changes would directly address these limitations, creating a more flexible and clinically relevant RPM program.

1. More flexibility in device supply: New "2-day" rule

CMS is proposing to make the rigid 16-day requirement for CPT 99454 a thing of the past. The proposed new structure is as follows:

• New code (99XX4): A new device supply code would cover remote monitoring for 2 to 15 days in a 30-day period.
• Revised code (99454): The existing code would officially cover 16 to 30 days in a 30-day period.

Here’s the most exciting part: CMS is proposing that the new 2-15 day code be reimbursed at the exact same rate as the 16-30 day code. If this change is finalized, it would be a massive win. It acknowledges that the clinical value is in having the monitoring capability available to the patient for the month, not just in the number of transmissions.

2. More efficiency in time management: New "10-Minute" CPT Code

The all-or-nothing 20-minute threshold for care management is also being addressed as follows:

• New code (99XX5): A new time code would cover 10 to 20 minutes of RPM treatment management services. It is proposed to have a work RVU of 0.31, paying approximately half of the 20-minute code.
• Reimbursement stability: In another significant victory for remote care providers, CMS rejected a recommendation from the American Medical Association to cut the reimbursement value for the existing 20-minute codes (99457 and 99458), maintaining their current valuation.

If finalized, this would provide stability for existing programs and introduce new efficiency for capturing reimbursement for shorter, yet still vital, patient interactions.

Side-By-Side: Current vs. Proposed RPM CPT Codes

Key takeaway: For patients who record fewer than 16 reading days or need brief clinician engagement, 2026 finally offers billable options.

What This RPM Expansion Means for Your Practice

These proposed changes aren't just about billing codes. They are about empowering providers to build better, more efficient, and more inclusive RPM programs. Consider the following:

• Expanded patient access to RPM: The new 2-day threshold for device billing would open the door to numerous patients who were previously excluded. Think of patients on GLP-1s for weight loss who may only need weekly weigh-ins, or postoperative patients who only require a short period of monitoring. You could now enroll these patients and get reimbursed for providing valuable oversight.
• Increased operational efficiency: The new 10+ minute time code would ensure your clinical staff is compensated for their work, even for brief check-ins. This would eliminate the "wasted" time of a 15-minute call that previously went unbilled and allow you to right-size the care plan to the patient's specific needs.
• Drive revenue and scale your program: With the ability to enroll more patients and bill more efficiently for your staff's time, your practice would be able to more easily adopt and scale a financially sustainable RPM program. The stable reimbursement for existing codes provides the confidence to invest in and grow your remote care initiatives.
• Improve patient outcomes: Ultimately, a more flexible RPM program is a more effective one. By tailoring monitoring frequency and clinical check-ins to the patient’s actual needs rather than rigid billing rules, you would be able to drive better patient engagement, adherence, and long-term positive health outcomes.

The Future of Remote Patient Monitoring is More Flexible and More Accessible

The 2026 PFS proposed rule sends a powerful message: CMS clearly sees remote patient monitoring as a cornerstone of modern healthcare. These changes, if finalized, would unlock the full potential of RPM, making it a more powerful tool than ever for managing chronic conditions, improving outcomes, and building a more efficient practice.

Note: I will be discussing these and other key remote care management changes included in the PFS proposed rule, along with broader developments shaping care management in 2026 and beyond, during the upcoming webinar, "Understanding Medicare's 2026 Proposed Changes to Remote Care Management," on July 31, 2025, at 2:00 PM EDT / 11:00 AM PDT. I encourage you to register for the program here.

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