2026 is the biggest RPM reimbursement unlock in years: the new 99445 (2–15 days) eliminates the 16-day cliff, 99453 becomes easier to capture, and 99470 introduces a 10-minute option for lighter-touch months — all of which dramatically increases the percentage of enrolled RPM patients who generate monthly reimbursement when the program is run well.
1bios delivers a seamless, turnkey solution for every reimbursable virtual care program—including dual enrollment optimization, in-house engineering, device logistics, and clinical staff support. With a decade of experience managing virtual care for hundreds of thousands of patients, we provide expertise across eligibility, enrollment, device deployment, clinical operations, EHR integration, medical billing/RCM, and compliance.
1bios works directly with hundreds of provider groups large and small -- across technical and clinical specialities from primary to cardiology to long term care. We also continue to be the leader in Value Added Reseller (VAR), referral, and white labeling partnership programs for those interested and able to in bringing RPM, CCM and more to multiple practices and clients.
2026 RPM updates — what changed (and why it matters)
In the 2026 Medicare Physician Fee Schedule (PFS) final rule, CMS finalized major Remote Physiologic Monitoring (RPM) updates that remove two of the biggest “cliff effects” in RPM reimbursement. CMS
Below are the three changes that matter most — and how 1bios helps practices turn them into real, repeatable revenue (without “gotcha” fees).
1) New CPT 99445 (2–15 monitoring days): the end of the 16-day cliff
What changed
CMS finalized a new RPM device supply code, CPT 99445, for months where the patient has 2–15 days of readings (measurements/transmissions) within a 30-day period. Medical Economics
This complements CPT 99454 (16+ days), and 99445 and 99454 are reimbursed at the same rate in 2026.
Historically, many practices saw RPM “device month” reimbursement hit only ~60–80% of enrolled patients because missing 16 days meant no device-supply reimbursement for that month — even if the patient took readings and the team did real work.
With 99445, the device-supply reimbursement becomes far more “forgiving”:
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If the patient records 2–15 days, you bill 99445
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If the patient records 16+ days, you bill 99454
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Either way, the practice gets paid at the same device-supply rate in 2026.
The practical result (what we expect in real programs)
For a well-run program, device-supply reimbursement capture should move from “often 60–80%” to “closer to ~98%+” — because nearly every engaged patient month will now qualify (instead of failing the 16-day threshold).
Why 1bios uniquely helps practices realize this upside
99445 doesn’t automatically create revenue — operations do. 1bios drives consistent “day capture” because we combine:
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proactive device logistics + activation workflows
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care-team outreach and accountability loops
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automated nudges + escalation logic (AI + rules)
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tight documentation and billing alignment in one platform
That’s how practices turn “RPM enrollment” into high-confidence monthly reimbursement, not wishful thinking.
Important billing note: CMS has also continued to confirm that as in prior years that the measurement/transmission codes and the care-management time codes are distinct — so for example billing 99445 or 99454 is not required to bill 99457 when time thresholds are met.
2) 99453 is now billable after the first measurement (no more waiting to see if you’ll get a 99454)
What changed
CMS clarified that the RPM setup/education code 99453 now qualifies with at least 2 days of monitoring, rather than being effectively “stuck behind” the old 16-day device-supply threshold in practice. Nixon Law Group
Why it matters
This removes a common pain point:
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Compliant best practices required delayed billing of 99453 until 99454 was met and in some cases it was never met because the patient never took 16+ days of measures in a 30 day period - so even though the patient was clearly "launched and live" on RPM the actual "go live 99453" code was never billable.
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Now, once the patient begins monitoring and you meet the minimum threshold of a single meausrement --practices can capture the setup/education reimbursement more reliably. Nixon Law Group
*Unlike many vendors, 1bios is not trying to “nickel-and-dime” practices on every new code.
We view 2026’s changes as more revenue stability for practices — and our model is built to channel that upside to the practice rather than carving it out as an extra fee line.
3) New CPT 99470 (first 10 minutes): a “starter” RPM management code
What changed
CMS finalized CPT 99470 to cover the first 10 minutes of RPM treatment/management time in a calendar month — essentially filling the gap for months where a patient receives meaningful oversight but doesn’t reach the first 20-minute threshold required for 99457. Nixon Law Group
Why it matters
This is a practical “band-aid” for programs that:
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don’t have mature protocols,
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don’t have consistent workflows,
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or don’t have the focus required to drive patients to the full monthly care-management cadence.
It gives those practices a way to get paid for lighter-touch months — instead of getting $0 for time that still occurred. Nixon Law Group
Where 1bios fits (and why we won’t charge for 99470)
At 1bios, our delivery model is built to drive consistent, compliant patient engagement and documentation — so in many programs, the real goal remains 99457/99458 when clinically appropriate and supported by time + interactive communication requirements.
That said:
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if a practice has a unique workflow or a payer mix strategy where 99470 is the best fit for certain cohorts,
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we can support that model cleanly.
We’re focused on building the most successful program for the patients and the practice.
*We can provide a customized financial analysis for your organization based on your specific MAC rates. Reimbursement typically trends higher in metropolitan areas and lower in rural locations. Contact us to better understand how these rates impact your practice.
4) 2026 CPT Code Descriptions and Rate Table
|
Code |
CMS Description |
2026 Rate |
| Remote Patient Monitoring (RPM) | ||
| 99453 |
Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment) |
$21.71 |
| 99445 |
Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days) [between 2-15 days with at least 1 reading each 30 days] |
$52.11 |
| 99454 |
Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days) [16+ days with at least 1 reading each 30 days] |
$52.11 |
| 99457 |
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes. |
$51.77 |
| 99458 |
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (list separately in addition to code for primary procedure)
|
$41.42 |
| 99470 |
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 10 minutes. (Can't be billed with 99457) |
$26.05 |
| Chronic Care Management (CCM) | ||
| 99490 |
Chronic Care Management (CCM) services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements: Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; Comprehensive care plan established, implemented, revised, or monitored
|
$66.13 |
| 99439 |
Chronic Care Management (CCM) services, each additional 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month
|
$50.44 |
| 99491 |
Chronic Care Management (CCM), provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored
|
$89.18 |
| 99437 |
Chronic Care Management (CCM) services each additional 30 minutes by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)
|
$63.13 |
| Principal Care Management | ||
| 99426 |
Principal Care Management (PCM), for a single high-risk disease first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month (replaces G2065)
|
$67.80 |
| 99427 |
Principal Care Management (PCM) services, for a single high-risk disease each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)
|
$54.11 |
| 99424 |
Principal Care Management (PCM) services for a single high-risk disease first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (replaces G2064)
|
$87.51 |
| 99425 |
Principal Care Management (PCM) services for a single high-risk disease each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)
|
$61.46 |
| Complex Chronic Care Management (CCCM) | ||
| 99487 |
Complex chronic care management (CCCM) services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months,
|
$144.29 |
| 99489 |
Complex chronic care management (CCCM) services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical decision making; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)
|
$78.16 |
| Remote Therapeutic Monitoring (RTM) | ||
| 98975 |
Remote therapeutic monitoring (e.g., respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of equipment
|
$21.71 |
| 98976 |
Remote therapeutic monitoring (e.g., respiratory system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s), manual reporting by patient, and/or programmed alert(s) transmission to monitor respiratory system, each 30 days [16+ days with at least 1 reading each 30 days]
|
$52.11 |
| 98984 |
Remote therapeutic monitoring (e.g., respiratory system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s), manual reporting by patient, and/or programmed alert(s) transmission to monitor respiratory system, each 30 days [between 2-15 days with at least 1 reading each 30 days] |
$52.11 |
| 98977 |
Remote therapeutic monitoring (e.g., musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s), manual reporting by patient, and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days [16+ days with at least 1 reading each 30 days]
|
$51.44 |
| 98985 |
Remote therapeutic monitoring (e.g., musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s), manual reporting by patient, and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days [between 2-15 days with at least 1 reading each 30 days] |
$51.44 |
| 98980 |
Remote therapeutic monitoring treatment management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, requiring at least one interactive communication with the patient/caregiver during the calendar month
|
$54.11 |
| 98981 |
Remote therapeutic monitoring treatment management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure)
|
$41.42 |
| 98978 |
Remote therapeutic monitoring (e.g., behavioral health status, therapy adherence, therapy response); device(s) supply with scheduled (e.g., daily) recording(s), manual reporting by patient, and/or programmed alert(s) transmission to monitor behavioral health, each 30 days [16+ days with at least 1 reading each 30 days]
|
PRICED BY MAC |
|
Behavioral Health Integration (BHI) |
||
|
99484 |
BHI services, at least 20 minutes of clinical staff time (does not require specialized Behavioral Health Care Manager) per calendar month, may be delivered under general supervision of a physician or other qualified health care professional, with the following required elements: registry for time and documentation recording and documentation, initial assessment and follow-up utilizing rating scales (e.g. PHQ-9), coordinating care as needed under the mental health umbrella.
|
$57.45 |
| 99492 |
Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, under general supervision of the treating physician or other qualified health care professional. Includes time-tracking and documentation in registry, initial assessment including rating scales (e.g. PHQ-9), assignment of treatment plan.
|
$160.32 |
|
99493 |
Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of Behavioral Health Care Manager activities, in consultation with a psychiatric consultant, and under general supervision of the treating physician or other qualified health care professional, with the following required elements: registry for time and documentation recording and documentation, initial assessment and follow up utilizing rating scales (e.g. PHQ-9), coordinating care as needed under the mental health umbrella.
|
$144.96 |
| 99494 |
Subsequent psychiatric collaborative care management, each additional 30 minutes in a subsequent month of Behavioral Health Care Manager activities (beyond the 99493 60 minutes), in consultation with a psychiatric consultant, under the general supervision of the treating physician or other qualified health care professional, with the following required elements: registry for time and documentation recording and documentation, initial assessment and follow up utilizing rating scales (e.g. PHQ-9), coordinating care as needed under the mental health umbrella.
|
$61.46 |
Note we've updated our CCM and RPM revenue calculators with the new rates so you can use those to project your eligible patients and potential program revenues for 2025. The 2025 RPM Revenue Calculator is on THIS PAGE and the 2025 CCM Revenue Calculator is on THIS PAGE. (We're also happy to provide full revenue and cost models, just email sales@1bioshealth.com. Or, book a meeting with us below.)
If you're ready to discuss the best approach to start or improve RPM, CCM, and other virtual care programs for your organization, book a virtual meeting with us today!
