A Turning Point for Remote Patient Monitoring
Two new Remote Patient Monitoring (RPM) codes took effect January 1, 2026. CPT 99445 pays for device supply over a 2 to 15 day window, and CPT 99470 pays for 10 to 19 minutes of treatment management. Both close gaps that left real clinical work unbillable under the old code set.
CMS finalized them in the 2026 Physician Fee Schedule (PFS). This guide covers what each code pays, when to bill it instead of its longer-duration counterpart, and where the documentation exposure sits.
What Changed in the 2026 Physician Fee Schedule
Before 2026, the RPM code set had two hard floors. Device supply required 16 days of readings in a 30-day period to bill 99454. Treatment management required a full 20 minutes to bill 99457. Fall short of either threshold and the month produced no billable service, regardless of how much clinical work the care navigators and provider actually performed.
That structure penalized three common situations. Patients enrolled mid-month. Patients on short-term monitoring after a medication change or a discharge. Patients whose condition was stable enough that a 12-minute check-in was clinically sufficient.
99445 and 99470 give those months a billable path. The clinical work has not changed. The reimbursement structure has.
The Complete 2026 RPM Code Set and Reimbursement
National non-facility rates under the 2026 Medicare Physician Fee Schedule. Rates are national averages and adjust by geographic locality.
| Code | Description | Threshold | 2026 Non-Facility | vs 2025 |
|---|---|---|---|---|
| 99453 | Initial device setup and patient education | One-time per episode | $21.71 | +10.1% |
| 99454 | Device supply and data transmission | 16 to 30 days in a 30-day period | $52.10 | +21.1% |
| 99445 | Device supply and data transmission | 2 to 15 days in a 30-day period | $52.10 | New for 2026 |
| 99470 | Treatment and management time, first increment | 10 to 19 minutes per calendar month | $26.05 | New for 2026 |
| 99457 | Treatment and management time, first 20 minutes | 20 minutes, with interactive communication | $51.77 | +8.2% |
| 99458 | Each additional 20 minutes of treatment management | Per additional 20-minute increment | $41.41 | +7.7% |
Two things stand out. Device supply rose 21.1 percent year over year, the largest increase in the set. And 99445 pays the same as 99454, meaning a 2-day monitoring period and a 30-day monitoring period carry identical device-supply reimbursement.
CPT 99445: Device Supply, 2 to 15 Days
99445 reimburses device supply and data transmission when the patient records between 2 and 15 days of readings in a 30-day period. It is the short-duration counterpart to 99454, which covers 16 to 30 days.
When to bill 99445 instead of 99454
The two codes are mutually exclusive per patient per month. Count the days of transmitted readings in the 30-day period, then bill one code or the other. Never both.
- 2 to 15 days of readings: bill 99445
- 16 or more days of readings: bill 99454
- 0 or 1 day: neither code is billable. The 2026 two-day floor is the minimum.
99445 in practice
A patient enrolls on the 20th of the month following a hypertension medication adjustment. The provider orders daily blood pressure readings. By the close of the 30-day period the patient has transmitted 11 days of data.
Under the pre-2026 code set that month billed nothing for device supply. Under the 2026 set it bills 99445 at $52.10. The device was supplied, the data moved, and the code now exists to reflect it.
CPT 99470: Treatment and Management, 10 to 19 Minutes
99470 reimburses 10 to 19 minutes of RPM treatment and management time in a calendar month. It sits below 99457, which requires a full 20 minutes.
How 99470, 99457, and 99458 stack
Total the qualifying treatment management minutes for the calendar month, then apply the tier. 99470 and 99457 are alternatives, not additions.
- Under 10 minutes: no treatment management code is billable
- 10 to 19 minutes: 99470, $26.05
- 20 to 39 minutes: 99457, $51.77
- 40 to 59 minutes: 99457 plus one unit of 99458, $93.18
- 60 to 79 minutes: 99457 plus two units of 99458, $134.59
99470 does not stack with 99458. If the month reaches 20 minutes, the correct code is 99457, not 99470 plus an add-on.
99470 in practice
A stable heart failure patient transmits weight readings daily. In a given month the care navigator reviews trends, places one interactive call to confirm the patient is holding to fluid restriction, and documents 14 minutes of qualifying time. No escalation is needed.
Fourteen minutes previously produced no billable treatment management service. It now bills 99470 at $26.05. Combined with 99454 for device supply, the month reimburses $78.15 for care that used to reimburse $52.10.
Which Code, Which Patient
| Patient scenario | Days of readings | Management minutes | Codes to bill |
|---|---|---|---|
| New enrollment, first month, mid-month start | 11 | 24 | 99453, 99445, 99457 |
| Established patient, stable, low touch | 22 | 14 | 99454, 99470 |
| Established patient, active titration | 28 | 46 | 99454, 99457, 99458 x1 |
| Short-term post-discharge monitoring | 9 | 12 | 99445, 99470 |
| Patient disengaged mid-month | 1 | 6 | Nothing billable |
The last row matters most operationally. A single day of readings and six minutes of work produces no billable service under any 2026 code. Catching that pattern early, while there is still time in the period to re-engage the patient, is where a monitoring program either holds its economics or does not.
Documentation and Audit Exposure
New codes attract scrutiny. The OIG has signaled increased oversight of RPM billing, and the addition of two lower-threshold codes gives auditors a clear pattern to test against.
Four things need to be defensible per patient, per month:
- Day count for device supply. Timestamped transmission records showing which days carried readings. This is what separates 99445 from 99454 and what an auditor will reconstruct first.
- Minute count for treatment management. Time logged against the specific clinical activity, not a monthly estimate entered after the fact.
- Interactive communication. 99457 requires it. Document the date, the participant, and the substance.
- Provider order and consent. The provider orders the monitoring and remains the decision-maker on the care plan. Consent is documented before the first billable period.
Practices running RPM without automated time tracking tend to discover the gap during an audit rather than during the month. Building the day count and the minute count into the workflow, rather than reconstructing them at billing, is the difference.
Reference: National Law Review, Volume XV, 2025.
Actionable Steps for Practices
- Update your charge master and EHR code list to include 99445 and 99470. Neither will bill if the code does not exist in the system.
- Re-run last quarter against the new thresholds. Months that produced nothing under the old floors may now be billable. That is the fastest read on what the change is worth to your panel.
- Set an automated day-count and minute-count flag so the correct tier is selected before the claim goes out, not after a denial.
- Brief the clinical team on the 2-day and 10-minute floors. The thresholds only work if the people doing the work know where they sit.
- Verify your locality rates using the CMS Physician Fee Schedule Look-Up Tool. The figures above are national averages.
The Rest of the RPM Code Set
Detailed guides for each foundational code: 99453, 99454, 99457, and 99458. For what monitoring looks like from the patient side, read some patient success stories.
Where the New Codes Get Denied
The first two quarters of any new code set produce avoidable denials. Four patterns account for most of them.
- Both device supply codes on one claim. 99445 and 99454 cannot appear for the same patient in the same 30-day period. Systems that auto-populate from a template rather than from the actual day count will trigger this.
- 99470 billed alongside 99457. These are tiers of the same service, not a base and an add-on. Billing both is a duplicate-service denial.
- Missing interactive communication on 99457. The requirement did not change for 2026, but practices moving patients between tiers month to month lose track of which months require it. 99470 has its own communication requirement, confirm it against the final rule for your scenario before assuming the tiers behave identically.
- Day count not reconstructible. A claim for 99445 that cannot produce timestamped transmission records for the specific days is the weakest position in an audit. This is the one that costs the most on post-payment review.
The pattern behind all four: the codes are threshold-driven, so the claim is only as defensible as the counting behind it.
Frequently Asked Questions
What is CPT 99445?
CPT 99445 reimburses device supply and data transmission for Remote Patient Monitoring when the patient records 2 to 15 days of readings in a 30-day period. It took effect January 1, 2026 and pays $52.10 at the national non-facility rate.
Can I bill 99445 and 99454 in the same month?
No. The two codes are mutually exclusive per patient per month. Count the days of transmitted readings, then bill 99445 for 2 to 15 days or 99454 for 16 or more.
What is CPT 99470?
CPT 99470 reimburses 10 to 19 minutes of RPM treatment and management time in a calendar month. It took effect January 1, 2026 and pays $26.05 at the national non-facility rate.
Does 99470 stack with 99458?
No. 99470 covers 10 to 19 minutes. Once the month reaches 20 minutes, bill 99457 instead, and add 99458 for each additional 20-minute increment beyond that.
How much do the new 2026 RPM codes pay?
Under the 2026 Medicare Physician Fee Schedule, national non-facility rates are $52.10 for 99445 and $26.05 for 99470. Rates adjust by geographic locality.
What is the minimum number of days needed to bill RPM device supply in 2026?
Two. A patient with fewer than two days of transmitted readings in the 30-day period supports neither 99445 nor 99454.
Did RPM reimbursement go up in 2026?
Yes. Device supply under 99454 rose 21.1 percent year over year to $52.10, the largest increase in the RPM code set. 99453 rose 10.1 percent, 99457 rose 8.2 percent, and 99458 rose 7.7 percent.
What This Means for Your Program
The 2026 code set rewards programs that can measure themselves. Day counts and minute counts now determine which tier a month falls into, and the difference between tiers is real money across a panel. Practices that track both automatically bill the correct code the first time. Practices that reconstruct at month end leave revenue on the table or invite a denial.
Vivo Care supports both Practice-Managed and Managed Clinical programs, with care navigators working as an extension of the provider team. The provider directs the care plan. Click here for a quick, free consult.