CMS Proposes Major Updates to Remote Monitoring Reimbursement in CY 2026 PFS Rule
Centers for Medicare & Medicaid Services (CMS) has suggested some major changes in remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) reimbursement in its CY 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule, published July 16, 2025, in the Federal Register.
The proposal encourages new billing codes, reduces existing thresholds, and increases reimbursement pathways to be more consistent with clinical practice in the field.
Key Proposed Changes:
Device Supply and Data Transmission: A new code (99XX4) would be used to bill 2-15 days of data transmission that would be reimbursed at the same rate as the existing 16-day code (99454).
Treatment Management Services: A new code (99XX5) would replace 10-20 minutes of clinical interaction each month at approximately half the current rate (99457).
RTM Updates: 2-15 days of data and 11- to 20-minute interactions would be codeable and would incur proportionally less work relative value units (wRVUs).
Summary Table
| Area | Current Requirement | Proposed CY 2026 Update |
| RPM Data Transmission | ≥ 16 days/month (CPT 99454) | New code 99XX4 for 2–15 days, reimbursed at the same rate as 99454 |
| RPM Treatment Mgmt. | ≥ 20 min/month (CPT 99457) | New code 99XX5 for 10–20 minutes (≈ half reimbursement) |
| RTM Data Transmission | ≥ 16 days/month | New device codes for 2–15 days of data collection |
| RTM Treatment Mgmt. | ≥ 20 min (98980/98981) | Revised codes for 11–20 minutes with reduced wRVUs |
CMS said the reforms would modernize utilization and eliminate operational barriers, as well as promote preventive and value-based care models. Reduction of thresholds would increase beneficiary access, aid in care transition after discharge, and improve population health management within plans such as the Medicare Shared Savings Program (MSSP).
Nevertheless, CMS focused on compliance and referred to a recent DOJ False Claims Act settlement of 1.29 million, in connection with non-compliant RPM practices. The agency cautioned that fraud and abuse enforcement could be initiated by improper billing.
The comment window on the proposed rule is open till September 12, 2025, and a final rule is likely to follow later this year. Provided that it is adopted, changes would become effective January 1, 2026.
