Remote patient monitoring billing changed in 2026, when Medicare started paying for months with as few as two days of device readings instead of holding every claim to a 16-day minimum. That fixed one of the most common reasons RPM months went unbilled, and it added two new codes that have to be matched to the right month and the right patient. Remote patient monitoring credentialing carries equal weight, since every RPM claim goes out under a treating practitioner who has to be enrolled with the patient’s plan.
Key Takeaways
- Device supply bills as 99454 for 16 to 30 days of readings or 99445 for 2 to 15 days, once per patient per 30-day period.
- Treatment management bills as 99470 for 10 to 19 minutes, 99457 for the first 20 minutes, and 99458 for each additional 20, with at least one real-time interaction with the patient.
- Medicare requires an established patient relationship, documented consent, and an FDA-defined medical device that transmits data automatically.
- Only one practitioner can bill RPM for a patient in a 30-day period, and RPM and RTM can’t be billed together.
- Each RPM claim goes out under an enrolled practitioner’s NPI, so NPs and PAs who manage RPM patients need their own payer enrollment.
How RPM Billing Works
RPM bills in three parts. Setup and patient education happen once at the start. Device supply bills for each 30-day period the patient transmits readings. Treatment management bills each calendar month for the time the care team spends reviewing data and talking with the patient about it.
All three parts have to happen for an RPM program to work the way Medicare intends. In a 2024 report, the HHS Office of Inspector General found that 43 percent of Medicare enrollees who received RPM didn’t receive all three components. Programs billing device supply month after month with no management time are the pattern auditors look for first.
These are the codes RPM programs bill, and our guide to which CPT codes are used in remote patient monitoring billing covers each one in more detail.
| Code | What it covers | How often |
|---|---|---|
| 99453 | Initial device setup and patient education | Once per episode of care |
| 99454 | Device supply with daily recordings or alerts, 16 to 30 days | Once per 30 days |
| 99445 | Device supply, 2 to 15 days (new in 2026) | Once per 30 days |
| 99470 | Treatment management, 10 to 19 minutes (new in 2026) | Once per calendar month |
| 99457 | Treatment management, first 20 minutes | Once per calendar month |
| 99458 | Treatment management, each additional 20 minutes | Add-on to 99457 |
This table lists the CPT codes used in remote patient monitoring billing and how often each one can be billed. Device supply codes count days of readings in a 30-day period, while treatment management codes count staff time in a calendar month. The 2026 codes 99445 and 99470 cover months with fewer readings or less management time than 99454 and 99457 require.
Device supply codes
99454 and 99445 measure days of readings within a 30-day period, not a calendar month. A patient with 16 or more days of transmitted data bills 99454, a patient with 2 to 15 days bills 99445, and a patient with fewer than 2 days doesn’t support a device code that period. The two codes can’t be billed for the same patient in the same period, so the billing team needs the device platform’s day count before the claim goes out.
Treatment management codes
Management time counts per calendar month and includes time spent by the physician, NP, PA, or clinical staff working under general supervision. Each month needs at least one real-time interaction with the patient or caregiver. A portal message or an automated alert doesn’t count. 99470 covers months with 10 to 19 minutes, and 99457 covers the first 20 minutes when the month reaches it. The two aren’t billed together, and 99458 adds each additional 20 minutes on top of 99457.
Medicare Rules for RPM
Medicare covers RPM for both acute and chronic conditions. The patient has to have an established relationship with the billing practitioner, which for a new patient means an initial visit before monitoring starts. Consent has to be obtained and documented at the time RPM begins.
The device has to meet the FDA’s definition of a medical device and transmit readings automatically. Values a patient types into an app or reads off over the phone don’t count toward the day totals. The CMS Telehealth and Remote Monitoring booklet lists the full set of requirements.
Only one practitioner can bill remote monitoring for a patient in a 30-day period, even when the patient has more than one condition being monitored. RPM can be billed in the same month as chronic care management, principal care management, or transitional care management, as long as the same minutes aren’t counted twice. RPM and remote therapeutic monitoring can’t be billed for the same patient in the same period, so practices running both programs need to assign each patient to one.
Federally qualified health centers and rural health clinics have billed RPM under the individual CPT codes since 2024, rather than through a single general care management code.
Medicare Advantage, Commercial, and Medicaid Coverage
Medicare Advantage plans generally recognize the RPM codes, but some require prior authorization, limit which device vendors they’ll pay for, or apply their own day and time rules. Commercial plans vary more. Some cover RPM only for specific diagnoses like hypertension or heart failure, and some may not have loaded 99445 and 99470 onto their fee schedules yet, so the 2026 codes need checking payer by payer.
Most state Medicaid programs now cover some form of RPM, though eligible conditions, codes, and payment amounts differ widely from state to state. Where RPM makes up a meaningful share of a practice’s volume, the rates belong in payer contracting discussions, since many plans pay well below Medicare for the same codes.
Where RPM Claims Go Wrong
The most common RPM denials come from billing a device code without enough days of readings, billing management time with no documented real-time interaction, and billing RPM for a patient another practice or an RTM program already billed that period. Missing consent and patient-entered readings show up on audit more often than on the initial claim, which means the money gets paid and then taken back.
Time logs cause their own problems. When the same nurse handles a patient’s RPM and chronic care management, each minute has to be assigned to one service, and the note needs to show which.
Vendor arrangements need a compliance review too. Free devices given to patients, or vendor contracts that pay a per-patient fee tied to enrollment, can raise Anti-Kickback Statute concerns. The safest programs keep the practice in charge of patient selection and document why each patient was enrolled and when monitoring stopped being needed.
RPM Credentialing
Enrolling the billing practitioners
RPM claims bill under the NPI of the physician, NP, or PA managing the patient. NPs and PAs who run RPM panels need their own enrollment with Medicare and each commercial and Medicaid plan, and a practitioner who isn’t enrolled with a patient’s plan can’t be paid for that patient’s monitoring. That’s why you can’t bill what you can’t credential, and why enrollment should be finished before a new practitioner takes on an RPM panel.
Multi-state programs
The practitioner managing a patient’s care generally needs a license in the state where the patient is located. RPM programs that monitor patients across state lines need licensure and payer enrollment in each of those states, tracked by practitioner.
Clinical staff and vendor teams
Nurses and medical assistants who perform management time don’t enroll with payers on their own. Their work bills under the supervising practitioner, who is responsible for the documentation. When a vendor supplies the clinical staff, the contract should spell out supervision, documentation access, and who keeps the records if the arrangement ends.
Remote Patient Monitoring Billing FAQs
What changed for RPM billing in 2026?
Two codes were added. 99445 covers device supply for 2 to 15 days of readings in a 30-day period, and 99470 covers 10 to 19 minutes of treatment management in a calendar month. Before 2026, months below 16 days or 20 minutes couldn’t be billed.
Can RPM be billed when a patient transmits fewer than 16 days of readings?
Yes, starting in 2026. Months with 2 to 15 days of readings bill under 99445 instead of 99454. Fewer than 2 days doesn’t support a device code.
Does a patient portal message count as interactive communication for 99457?
No. The month needs at least one real-time interaction with the patient or caregiver, such as a phone or video call. Portal messages and automated alerts don’t meet that requirement.
Can RPM and chronic care management be billed in the same month?
Yes. RPM can be billed alongside CCM, PCM, or TCM for the same patient, as long as each minute of staff time is counted toward only one service.
Can RPM and RTM be billed for the same patient?
No. Medicare doesn’t allow remote physiologic monitoring and remote therapeutic monitoring for the same patient in the same period, so each patient has to be assigned to one program.
Do nurses who provide RPM time need payer credentialing?
No. Clinical staff time bills under the supervising physician, NP, or PA, who does need to be enrolled with the patient’s plan. General supervision is enough for RPM management services.
Medwave’s Role in Your RPM Program
RPM claims get built at month end, and that’s where most programs lose money. Medwave reconciles device days and management minutes before billing, then chooses between 99454 and 99445 or 99457 and 99470 based on what the month’s data supports. That reconciliation is the reason our RPM billing holds a 98% clean claim rate.
Most monitoring runs inside primary care and cardiology practices, so we bill the office visits right alongside it. For programs with patients in several states, our credentialing team enrolls clinicians wherever those patients live, at roughly 85 days per enrollment.
Programs that span several states can reach our RPM team through the form below.