In the 2026 Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) established new regulations that affect the financial viability of remote patient monitoring for small medical practices. Two specific changes by CMS alter the economic structure of those programs. CMS introduced codes for remote patient monitoring (RPM) that cover shorter time periods and require less data. CMS increased the payment rates for chronic care management (CCM) by approximately 10% because the conversion factor is at its highest point in five years. By using the new rules, a medical practice with six providers can establish a program that generates revenue without requiring every patient to provide 16 days of data or receive 20 minutes of clinical interaction.
In 2026, the following changes occurred
To a small medical practice, two updates are most significant.
As a first change, the requirements for time and data decreased. In previous years, providers could only bill for the primary RPM data code if a device sent readings for 16 days within a 30-day window. Providers could only bill for management if they documented 20 minutes of clinical time. By the 2026 rules, a new option exists for a shorter duration, which is a code that covers approximately 10 minutes of management. Because of this change, patients who require less than 20 minutes of care are no longer excluded from billing. According to Prevounce, this update allows RPM to include patients who receive less frequent care and were previously ineligible.
And as a second change, the payments for CCM increased — according to Nsight Health, CMS finalized a 10% increase for CCM codes in 2026 because of the higher conversion factor. There are no changes to the structural requirements of the program. If a practice already operates a CCM program, it receives higher payments for the same clinical tasks performed this year.
The primary billing codes are described here
For a small practice, the following codes are used to manage remote care:
- 99453 is the code for the initial setup and education provided to the patient regarding the monitoring device.
- 99454 is the code for the supply of the device and the transmission of data, which occurs monthly — this code still requires 16 days of data transmission within a 30-day period.
- 99457 is the code for the initial 20 minutes of management and interaction with the patient each month.
- 99458 is the code for every additional 20 minutes of management.
- New short duration code is the code for approximately 10 minutes of management during months with less interaction.
- CCM (99490 and related) are the codes for managing patients who have two or more long term health conditions.
On a technical level, RPM and CCM are billable at the same time for one patient if the staff meets the specific time and service requirements for each program independently. As the Lara Health remote-care cheat sheet lays out, the time spent on RPM and the time spent on CCM are tracked as separate activities. With this method one patient with chronic conditions supports two different sources of revenue.
To understand the monthly financials for 80 patients
In this example a group of 80 patients is monitored — because Medicare rates change based on the geographic location of the practice, those numbers are estimates for planning purposes.
| Code | Service provided | Estimated monthly value | Number of patients | Total per month |
|---|---|---|---|---|
| 99454 | Device and data | ~$45 | 65 | ~$2,925 |
| 99457 | 20 minutes of management | ~$48 | 55 | ~$2,640 |
| New short code | 10 minutes of management | ~$25 | 20 | ~$500 |
| CCM (99490) | Chronic care | ~$62 | 40 | ~$2,480 |
By the calculations, the total is approximately $8,500 every month or $100,000 every year for a medium sized group of patients — but the most important factor is the number of minutes required from the clinical staff.
To run a program of this size, clinical staff generally spend 20 to 30 hours each month on review, patient outreach and documentation. If a registered nurse or a medical assistant performs this work under general supervision, the practice maintains a profit. If a physician performs the monitoring review personally, the profit margin decreases significantly.
By the rule, the profit of the practice is determined
The most influential factor for the financial gain of a small practice in RPM is the rule for general supervision. When clinical staff furnish RPM management services under general supervision, the billing provider is not required to be in the same physical location while a nurse or medical assistant reviews data and communicates with patients.
For a program to be financially viable, the delegation of tasks is necessary. In a practice that assigns monitoring to clinical staff with lower hourly costs under general supervision, the staff can manage 80 patients without the addition of another provider — but if a practice directs every data reading to a physician, the practice uses high cost time for tasks that are reimbursed at the rate for clinical staff. To maintain efficiency, the design of the workflow is based on the legal permissions of the staff.
Operational factors that lower revenue
There are three specific ways that programs lose money despite appearing functional in theory:
- Device logistics. When a practice ships, activates and replaces connected devices, the practice incurs costs and patients often stop participating. If a patient does not transmit data, the practice is unable to bill for that patient.
- The 16-day data requirement. Code 99454 requires that patients provide readings for 16 days. If patients transmit data for only 10 or 12 days, they receive medical benefits but the practice receives no revenue for the device code. Outreach for patient adherence is necessary to protect this revenue.
- Documentation gaps. If time logs, records of consent and notes on interactions are insufficient for an audit, the revenue that is billed becomes a financial risk for repayment. In successful programs, documentation is a core part of the workflow.
Internal development versus external solutions
For most practices, the creation of original monitoring software is not required. It is necessary to decide whether to add a specialized RPM vendor or to perform monitoring within the existing platform used for scheduling, communication and coordination of care.
By using a specialized RPM vendor, a practice manages devices and data but the staff must often combine different tools for communication, appointments, intake and records for audits — this lack of integration is the reason for gaps in documentation. Many practices now choose a comprehensive white label telehealth platform that is equipped for messaging, scheduling, intake and management of tasks for the care team. As a result the monitoring program uses existing infrastructure.
On this platform based approach, there is more focus because the activities for monitoring, like outreach and secure messaging, are the same as the daily tasks for patient access. The platform from Healee is used by over 1 million patients and for 5 million appointments across more than 200 clinics. It is built for communication and coordination of care with a single tenant architecture and infrastructure that is HIPAA-compliant for the records that those programs require.
The final assessment
In 2026 the codes do not provide a large profit but they make remote monitoring possible for smaller groups of patients and patients who require less frequent contact. And the codes pay approximately 10% more to current CCM programs for the same tasks. If a program is profitable, it is because management is assigned to clinical staff under general supervision, adherence outreach protects the 16-day data requirement and the infrastructure keeps documentation ready for audits. To see how a unified platform for patient access supports this workflow, you can request a demo.
Sources:
- 2026 Remote Patient Monitoring CPT Codes: What’s New and What to Know – Prevounce, 2026
- Remote Care Cheat Sheet: 2026 CPT Billing Codes for RPM, CCM, APCM, PCM, TCM, RTM, AWV – Lara Health, 2026
- CCM CPT Codes 2026: Billing & Reimbursement Guide – Nsight Health, 2026