Remote Patient Monitoring (RPM): A Practical Guide for Your Practice
Understand how RPM really works: who qualifies, which devices count, how the Medicare codes fit together, and what you have to document to stay compliant.
Evidence You Can Share with Your Team
Give clinicians and researchers the raw numbers behind FairPath's RPM outcomes. The snapshot summarizes reading volume, adherence, and the clinical lift from structured monitoring across a 192-patient panel.
RPM Outcomes Snapshot
See the raw data from a 192-patient family practice study. Includes reading frequency, health improvements, and intervention rates.
Download the Case Study*Data reflects outcomes from a managed RPM program.
What RPM Is – and What It Isn’t
Remote Physiologic Monitoring
RPM uses FDA-defined medical devices to collect physiologic data at home (e.g., blood pressure, weight, glucose, pulse oximetry) and automatically transmit it to your team for review and treatment decisions.
For Acute or Chronic Conditions
Medicare allows RPM for acute or chronic conditions when remote monitoring is medically reasonable and necessary – for example uncontrolled hypertension, high-risk heart failure, brittle diabetes, or high-risk COPD.
Not Just “More Telehealth Visits”
RPM is not a video visit and not self-reported symptoms. It’s continuous physiologic data plus documented clinical management time, billed under a specific set of Part B codes.
In Medicare’s rules, RPM is distinct from other programs: it uses physiologic data only (RTM covers self-reported symptoms and therapy), requires automatic electronic transmission of data from a medical device, can support acute or chronic conditions, and may run alongside programs like CCM or APCM as long as the work and minutes are documented separately.
How a Compliant RPM Program Works
1. Identify Eligible Patients
Start with established patients whose conditions genuinely benefit from home monitoring: uncontrolled hypertension, high-risk heart failure, complex diabetes, COPD, post-discharge risk, etc. RPM is billed per patient, not per diagnosis, and only one practitioner can bill it per month.
2. Consent & Baseline
Explain RPM, including Part B coinsurance, responsibilities, and how long they’ll be monitored. Obtain and document consent (verbal or written) and capture a baseline plan so medical necessity is clear in the chart.
3. Device Setup & Data Capture
Provide a connected medical device (cellular, Wi-Fi, or equivalent) that automatically uploads data. Track usage so you know which patients meet the “16 days of data in 30 days” requirement for the device codes.
4. Ongoing Management & Documentation
Clinical staff and clinicians review incoming data, triage alerts, adjust medications, and communicate with the patient. You log this time so you can bill the 20-minute management blocks and defend those claims in an audit.
Who Typically Qualifies for RPM?
There is no hard “21-diagnosis list” in the rules. The real test is whether physiologic monitoring is medically necessary and used to guide care.
Common Chronic Use Cases
- Hypertension and other cardiovascular disease (heart failure, ischemic heart disease).
- Type 2 diabetes and complex metabolic disease.
- COPD and other chronic lung disease at high risk of exacerbation.
- Chronic kidney disease where weight and blood pressure trends matter.
- Obesity-related conditions where weight trends affect management.
Eligibility & Relationship Rules
- Patient is an established patient of the billing practitioner.
- RPM addresses an acute or chronic condition with a clear care plan.
- Explicit patient consent is documented in the record.
- Only one practice bills RPM for that patient per 30-day period.
Devices That Count for RPM
Under Medicare, RPM devices must be medical devices that automatically upload data. Hand-typed logs and symptom surveys don’t qualify.
Blood Pressure Monitors
Connected cuffs are the backbone of RPM for hypertension, heart failure, and kidney disease.
Weight Scales
Used for heart failure, CKD, and obesity-related programs where daily weight trends matter.
Glucose & Related Devices
Glucose meters or CGM bridges for diabetes management, when trends are actively managed between visits.
Pulse Oximeters & Others
Oximetry and other physiologic sensors where remote monitoring can realistically change decisions.
Devices can be shipped or supplied in-clinic, and many patients can also bring their own devices (BYOD) as long as they meet the medical device and automatic transmission requirements. Just note that the device-supply codes (99445/99454) generally require the practice to supply the device; BYOD scenarios typically support only the management codes, not the device-supply codes.
Who Pays for RPM?
RPM is primarily a Medicare Part B benefit today, with broad but not universal adoption by Medicare Advantage, Medicaid, and commercial plans. You should always confirm specific payer policies, but the high-level pattern is consistent.
Medicare & Medicare Advantage
- Medicare Part B covers RPM for acute or chronic conditions when medically necessary, subject to standard 20% coinsurance.
- Many Medicare Advantage plans mirror Medicare’s structure and often reduce or waive patient copays, depending on the contract.
Medicaid & Commercial Plans
- More than forty state Medicaid programs now reimburse some form of RPM, but covered codes and limits vary by state.
- Most large commercial payers key off Medicare’s RPM framework; local coverage decisions and contract language still matter.
Medicare RPM Codes: Structure, Not Just Dollar Amounts
These descriptions reflect Medicare’s current RPM structure. Approximate 2025 national non-facility rates are shown for orientation – you should always check the latest Physician Fee Schedule for your exact locality and year.
| Code | What It Covers | Billing Period & Thresholds | Approx. 2025 Medicare Rate* |
|---|---|---|---|
| 99453 | Initial setup and patient education for remote physiologic monitoring equipment. | Billed once per episode of care when you on-board the patient. In most Medicare jurisdictions it is only payable when the initial monitoring period yields at least 16 days of transmitted data within the first 30 days, and when setup and education are clearly documented. | ≈ $19 (one-time) |
| 99454 | Supply of the device(s), plus collection and transmission of daily recordings or programmed alerts. | Billed once per 30-day period, per patient, regardless of device count. Requires at least 16 days of transmitted data in that period. | ≈ $47 / 30 days |
| 99457 | Treatment management services – first 20 minutes per calendar month, including interactive communication with the patient or caregiver. | Requires documented time spent by clinical staff/physician/QHCP, and at least one live, two-way interaction during the month – this interactive communication is mandatory for payment. No 16-day rule applies to this code. | ≈ $48 / month |
| 99458 | Each additional 20 minutes of RPM treatment management time in the same month, billed as an add-on to 99457. | Typically billable up to two times (40 and 60 minutes). Time must be distinct, documented, and not double-counted with CCM, TCM, or other care-management services. | ≈ $42 per 20-min block |
| 99091 | Collection and interpretation of physiologic data (e.g., ECG, blood pressure) by a physician/QHCP, with a minimum of 30 minutes of work in a 30-day period. | Can be billed alongside 99457/99458 when the physician-level work is distinct and not already counted in those time blocks. | Varies; used selectively |
*Indicative national averages only. Always confirm current rates for your MAC and year.
What’s Changing for 2026 and Beyond
CMS-1832-F (finalized October 31, 2025) makes RPM more flexible starting January 1, 2026, by splitting the device code and adding a smaller management block. The core structure stays the same, but the thresholds are easier to meet.
99445 & 99454: Device Days Split
The old 99454 is effectively split into two options: 99445 for 2–15 days of transmitted data in a 30-day period and 99454 for 16–30 days. For a given 30-day period you choose one device code that matches the days of data – they are not additive.
99470, 99457 & 99458: Management Options
A new management code, 99470, covers the first 10 minutes of RPM management time when a lighter-weight month is appropriate. When you reach 20+ minutes you use 99457 instead, and 99458 remains the add-on for each additional 20-minute block. Within a month you bill the single management code (99470 or 99457, plus any 99458) that matches total time – you do not stack 99470 and 99457 for the same work.
All RPM codes remain exempt from the -2.5% efficiency adjustment, and 99453’s one-time structure does not change. The fundamentals still apply: medical necessity, real physiologic data, documented time, and clean audit trails.
Compliance: How to Stay Off the OIG’s Radar
Most RPM audit problems come from bad patterns, not one-off mistakes. A small number of rules, enforced consistently, prevent the majority of risk.
Respect the 16-Day Rule
Only bill device codes when you have enough transmitted days of data. For 2025, that means 16+ days for 99454; from 2026 onward you also have 99445 for 2–15 days. Avoid habits like billing device codes month after month for patients who barely use their device.
Document Management Time Honestly
Track who did the work, how long it took, and what changed for the patient. If you can’t defend 20 minutes of real management time, you shouldn’t bill 99457/99458.
Avoid Code-Stacking Conflicts
Don’t double-count the same minutes for RPM, CCM, TCM, or other programs. For each patient, make sure you can explain which program covers which work and why.
Two more guardrails are easy to encode and enforce:
- Only one practitioner should bill RPM for a given patient in a given 30-day period.
- Do not bill RPM and RTM for the same patient in the same period – pick the modality that actually reflects the service.
A modern RPM program should treat these as enforced guardrails, not memory tests for your staff.
RPM Frequently Asked Questions
Use this FAQ as a reference when you’re designing or tuning your program. It focuses on how RPM actually works under current Medicare rules.
No. Medicare allows RPM for acute or chronic conditions when remote physiologic monitoring is medically necessary and will be used to guide treatment. Chronic conditions (hypertension, heart failure, diabetes, COPD, CKD, etc.) are most common, but short-term acute monitoring can also be appropriate when it truly changes care.
The 16-day rule currently applies to 99453 and 99454 – the setup and device supply codes – which require monitoring over at least 16 days in a 30-day period. It does not apply to 99457/99458, which are purely time-based treatment management codes.
Starting in 2026, 99445 will cover 2–15 days of transmitted data and the existing 99454 will be reserved for 16–30 days. For each 30-day period you pick the single device code (99445 or 99454) that matches the days of data; they are not additive.
In many cases, yes – RPM can be billed in the same month as CCM, APCM, or other care-management codes as long as you don’t double-count the same minutes or services.
You cannot bill both RPM and RTM for the same patient in the same period, and you must be able to explain which program covers which work. Within each category you also pick the single code that fits (e.g., 99445 or 99454 for devices; 99470 or 99457 for base management) rather than stacking multiple base codes for the same month. If you can’t clearly separate the minutes, don’t stack the codes.
RPM is a Part B service, so standard Part B cost-sharing applies: Medicare typically pays 80% of the allowed amount and the patient is responsible for 20% coinsurance, plus any unmet deductible. Medigap or secondary coverage may absorb some or all of that, but you can’t assume RPM is “free.”
Clear, upfront communication about coinsurance is critical to avoid patient surprise bills and reputation damage.
For 99457, you must document at least 20 minutes of treatment management time in the calendar month, including interactive communication with the patient or caregiver. From 2026 onward, 99470 gives you a 10-minute management option for lighter-touch months. Each 99458 adds another 20 minutes in the same month when justified.
Time should reflect real work: reviewing data, triaging alerts, adjusting the plan, communicating with the patient, and documenting those decisions. “Rubber-stamping” a dashboard once a month is not defensible.
OIG and payers are focused on patterns such as:
- Device codes billed month after month with little or no actual data.
- No established relationship or obvious medical necessity in the chart.
- RPM and RTM billed together for the same patient and period with no clear distinction in services.
- Multiple practices billing RPM for the same patient in the same period.
- Management codes billed with no credible documentation of time or interaction.
If your documentation can clearly answer “why this patient, why this device, why this amount of time,” you are operating where RPM was intended to be.
