Understanding Reimbursement from the Centers for Medicare and Medicaid Services (CMS) for Remote Patient Monitoring

Remote Patient Monitoring (RPM) has emerged as a critical tool in modern healthcare, enabling providers to track patients' health data outside of traditional clinical settings. The Centers for Medicare and Medicaid Services (CMS) has played a pivotal role in shaping the adoption of RPM by establishing reimbursement policies that make these services more accessible. As of 2024, CMS continues to refine its reimbursement guidelines, ensuring that RPM remains a viable and sustainable healthcare solution. This blog explores the current state of CMS reimbursement for RPM, highlighting key updates, challenges, and opportunities for healthcare providers.

Understanding RPM and Its Importance
The use of RPM has been particularly beneficial for managing chronic conditions like diabetes, hypertension, and heart disease, while reducing hospital readmissions, in-office visits, and allowing patients to be better informed and more involved in their health journey.

CMS recognizes RPM as a valuable tool for improving patient outcomes and reducing overall healthcare costs. As a result, CMS has established reimbursement codes that allow healthcare providers to receive payment for delivering RPM services to Medicare beneficiaries. Any healthcare professional with a National Provider Identifier (NPI) number can submit for reimbursement of RPM services.

Why Cellular RPM is Better Than Bluetooth RPM
When a patient uses a cellular RPM device, the reading from that device is sent immediately, through a cellular network, to their provider. Bluetooth RPM requires a wireless internet network, and the device must be properly synched and paired in order for the reading to be sent. This places more burden on the patient, many of whom are elderly. In addition, cellular RPM benefits value-based care by enhancing patient engagement, improving clinical outcomes, reducing healthcare costs, and empowering providers with real-time data to make informed decisions.

CMS Reimbursement for RPM: Key Codes and Policies
Current Procedural Terminology (CPT) Codes for RPM
CMS has designated specific CPT codes for RPM reimbursement, allowing providers to bill for different aspects of remote monitoring. The key CPT codes include:

• CPT 99453: Covers the initial setup of RPM equipment, patient education, and onboarding. This code can only be billed once per patient.
• CPT 99454: Covers the provision and maintenance of RPM equipment and the transmission of patient data. It is reimbursable once every 30 days.
• CPT 99457: Covers the first 20 minutes of RPM data review, interpretation, and patient communication by a qualified healthcare professional per calendar month.
• CPT 99458: Covers additional 20-minute increments of RPM data review and patient interaction beyond the initial 20 minutes covered by CPT 99457.

Additionally, CMS recognizes CPT 99091, which allows physicians to bill for the collection and interpretation of patient-generated health data but requires the physician’s direct involvement.

Each code has a specific reimbursement rate. Please download our 2025 CMS Reimbursement flyer for more information.

Medicare’s Coverage Requirements
To qualify for reimbursement, RPM services must meet the following requirements:

• Patient Eligibility: RPM services are covered for Medicare beneficiaries with at least one chronic condition.
• Medical Necessity: Providers must document that RPM is medically necessary for managing the patient’s condition.
• Device Requirements: The monitoring device must meet FDA standards and automatically transmit patient data.
• Time Spent on RPM: CMS mandates a minimum of 20 minutes per month of interactive communication between the provider and patient to qualify for reimbursement under CPT 99457.
• Consent and Supervision: Patient consent must be obtained before initiating RPM services, and services must be provided under the supervision of a physician or qualified healthcare professional.

Recent Updates and Changes in CMS RPM Reimbursement
In recent years, CMS has refined its RPM policies to enhance accessibility and efficiency. Some key updates include:

1. Expansion of Eligibility: While CMS initially limited RPM reimbursement to patients with chronic conditions, there has been growing flexibility, with some provisions allowing RPM for acute conditions such as COVID-19.
2. Clarification on Service Providers: CMS has clarified that non-physician practitioners, such as nurse practitioners and physician assistants, can furnish RPM services if permitted by state regulations.
3. Increased Focus on Data Transmission: CMS has emphasized the importance of using automated data transmission devices rather than manual data entry by patients to ensure accurate and timely reporting.
4. Integration with Chronic Care Management (CCM): CMS has acknowledged that RPM can complement CCM services, allowing providers to bill for both services concurrently under specific conditions.

Challenges in CMS RPM Reimbursement
Despite the progress, providers face several challenges when implementing RPM services under CMS guidelines:

• Reimbursement Requirements: Some providers say that the reimbursement requirements can be too stringent, but changes to billing requirements may be coming in 2026 (see below).
• Device Compliance: CMS mandates that RPM devices must automatically transmit data, but using cellular RPM devices makes this easier for providers.
• Proper Administration: Documentation and compliance with CMS regulations require proper administration but can be easily managed when using the proper technology.

Opportunities and Future Outlook
In 2024, the American Medical Association (AMA) CPT Editorial Panel made recommendations to CMS to expand the number of CPT reimbursement codes for RPM. The recommendations are to add codes that reimburse for capturing fewer than 16 days of readings in a 30-day period and for performing less than 20 minutes of clinical review in a 30-day period, among others. These recommendations are typically enacted by CMS, so it is expected these new CPT codes will go into effect in January 2026. These changes will help extend the many proven benefits of remote patient monitoring to a much wider patient base to help manage chronic conditions.

Other trends include:

1. Advancements in Technology: As technology improves, the costs of RPM devices and software are expected to decrease, making RPM more affordable and widely adopted.
2. Increased Patient Adoption: As patients become more accustomed to digital health solutions, RPM utilization is expected to rise, driving demand for reimbursable services.

Conclusion
CMS has made significant strides in recognizing and reimbursing Remote Patient Monitoring services, facilitating broader adoption among healthcare providers. While challenges such as reimbursement limitations, talk of cuts to Medicare, and administrative burdens persist, ongoing policy refinements and technological advancements could lead to a more integrated and sustainable future for RPM. Providers who stay informed on CMS updates and strategically implement RPM solutions will be well-positioned to leverage these opportunities and improve patient outcomes in the evolving healthcare landscape.

As RPM continues to evolve, healthcare providers must remain adaptable and proactive in navigating CMS policies to maximize reimbursement potential and deliver high-quality remote care to patients.