On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule (PFS Proposed Rule). The PFS Proposed Rule proposes to reduce requirements for several physician services as discussed in a recent McGuireWoods Consulting alert. The PFS Proposed Rule suggests updates to remote patient monitoring (RPM) and remote therapeutic monitoring (RTM), which align with providers’ expanded use of remote monitoring in the delivery of healthcare by reducing operational hurdles and increasing flexibility for providers. The PFS Proposed Rule demonstrates CMS’ support for remote monitoring and promotes the expectation that providers will be able to bill for more services in this space.
Key Proposed Changes to RPM Billing Requirements
CMS proposes changes related to RPM after the American Medical Association Current Procedural Terminology (CPT) Editorial Panel created and revised the CPT code set for RPM last year.
1. Elimination of 16-Day Data Transmission Requirement
Since first adopted, CMS required 16 days of data transmission in a 30-day period to receive reimbursement for RPM, meaning a patient had to log data for 16 out of 30 days in order for the provider to bill for the services. The PFS Proposed Rule discusses a new device code, 99XX4, which would cover RPM for two to 15 days in a 30-day period, expanding usage and reimbursement when a patient logs a lower amount of time for RPM services. A patient can log as little as two days of data in a 30-day period, and the provider can receive reimbursement, in stark contrast to the previous requirement in which a patient needed to log at least 16 days’ worth of data for the provider to receive reimbursement. Further, the new code, 99XX4, will receive the same rate as 99454. If finalized later this year, this change would demonstrate CMS’ acknowledgement that RPM has value regardless of how much data is transmitted each month. Currently, treatment management codes 99457, 99458, 98980, and 98981 already do not require 16 days of data in a 30-day period.
2. Expansion of Reimbursable Time for Clinical Interactions
Similarly, a new time code, 99XX5, would cover 10 to 20 minutes of treatment management services as opposed to the current code, 99457, which requires a minimum of 20 minutes of interactive communications in a calendar month. This means a provider could bill for the time spent between 10 and 20 minutes in the event communications with the patient or other clinical interactions (e.g., responding to alerts, reviewing data or adjusting medication) do not last 20 minutes, again reducing the time restriction currently associated with billing for RPM. Unlike the new code for two to 15 days of RPM services discussed above, the new treatment management code would pay approximately half of the current code, which makes sense as there would be half as much clinical interaction.
3. Expanded Codes for RTM
The PFS Proposed Rule also discusses changes to RTM, generally in line with the changes for RPM. It would add new codes for reporting respiratory, musculoskeletal and cognitive behavioral therapy for two to 15 days of data transmission and revises CPT 98980 to include 11 to 20 minutes of services to reduce the time providers need to engage in interactive communication with patients to be reportable. The PFS Proposed Rule discusses the valuation for RTM billing as well. Instead of billing at the same rate despite shorter time periods for services, the PFS Proposed Rule discusses a decrease in work relative value units (wRVUs) because of the decrease in time. This difference in approach is likely attributable to practitioners’ broader use of RTM and their focus on non-physiological data, such as medication adherence or pain levels. However, CMS notes an interest in gaining more information on the differences in work, clinical staff time, supplies and equipment to make informed decisions on valuation for RPM versus RTM.
RPM is becoming an increasingly critical piece of healthcare technology. Its growth is due in part to the increased prevalence of chronic disease, a growing aging population, greater demand for home-based care and a shift towards value-based care focused on prevention. Technological advances, such as AI and wearable devices, along with patient demands for convenience also play a role in the expansion of RPM. The PFS Proposed Rule demonstrates CMS’ support for remote monitoring and promotes the expectation that providers will be able to bill for more services in this space in years to come.
While the proposed changes make it easier to implement and bill for RPM, increased oversight and scrutiny of certain RPM models remain a priority. McGuireWoods recently published an article reporting on a $1.29 million False Claims Act settlement involving a company providing RPM services improperly.
The comment period for the PFS Proposed Rule ends on Sept. 12, 2025. For more information related to an RPM or RTM model, please consult one of the authors. McGuireWoods attorneys are happy to assist.
The authors thank McGuireWoods summer associate Cleo M. Medina for assistance preparing this legal alert. She is not licensed to practice law.
