CMS Lowers Time Thresholds for Remote Patient Monitoring

The Centers for Medicare & Medicaid Services (CMS) is loosening the time requirements for billing remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM), commencing January 1, 2026. 

The Medicare Physician Fee Schedule 2026 Final Rule, published in the Federal Register today, sets forth new and revised billing codes for RPM medical device supply and data transmission and RTM medical device supply and data access or transmission that will allow Medicare payment if data is collected 2 to 15 days in a 30 day period (existing codes require at least 16 days of monitoring) and for 10 minutes of RPM or RTM treatment management in a calendar month  (existing codes require at least 20 minutes).  The revisions will allow billing under either the lower or higher time threshold for supply and transmission or access (2 to 15 days or 16 to 30 days of monitoring) and either the lower or higher threshold for RPM or RTM treatment management (10 minutes or 20 minutes in a calendar month and in 20-minute increments for additional time during the month).

These changes are based on new and revised billing codes approved by the American Medical Association’s Current Procedural Terminology (CPT) Editorial Panel in September 2024. These revisions will take effect January 1, 2026, and will expand RPM and RTM billing opportunities. CMS explained that it is adopting all RPM and RTM descriptors, guidelines, prefatory language, and parenthetical changes to the remote patient monitoring section of the 2026 CPT codebook.

In its commentary on the lower time thresholds CMS emphasized that remote monitoring must be medically necessary for the diagnosis and  treatment of illness or injury in order to bill under the RPM or RTM codes. CMS also provided clarifications in response to questions relating to eligible practitioners, the live interactive communication requirement for treatment management, and the “sometimes therapy” designation for RTM codes.

For more information on remote patient monitoring and related issues, please contact Rick Hindmand