RPM Reimbursement: One Step Forward, Two Steps Back?

CMS is expanding coverage for remote patient monitoring in its 2026 Medicare Physician Fee Schedule, while a major payer is scaling back reimbursement to two specific use cases.

Remote Patient Monitoring (RPM) has taken a step forward with the 2026 Medicare Physician Fee Schedule (MPFS), opening new doors to reimbursement. But a large payer's plan to reduce coverage could blunt that enthusiasm.

The final 2026 MPFS, released late last month by the Centers for Medicare & Medicaid Services, kept in place most of the proposed improvements in coverage for both remote physiological monitoring and remote therapeutic monitoring, the two types of RPM defined by CMS. These improvements will enable care providers to bill for shorter RPM programs, as well as for some therapeutic services that are included in RPM programs.

In a blog post, Carrie Nixon and Olivia Goldner of the Nixon Law Group called the MPFS "one of the most consequential rulemaking cycles" for RPM.

In short:

Coverage for shorter programs. RPM and RTM codes for 2 to 15 days of monitoring have been approved, supplementing the already existing codes for 16 to 30 days of monitoring. This meets a request from clinicians that they be covered for shorter RPM programs.

"These codes cannot be billed concurrently within a 30-day period," Nixon and Goldner note, "but they create new flexibility for episodic, acute, or transitional care monitoring models—such as post-discharge recovery, weight management, or behavioral interventions."

In addition, CMS added management codes for 10-minute periods of engagement, adding to the 20-minute codes already covered. And the agency reaffirmed that "live, interactive communication" only covers audio-only, video, or secure-messaging interactions if they meet CPT guidelines.

Approval for 'sometimes therapy.' CMS has clarified that CPT codes 98979, 98984 and 98985 can now cover ‘sometimes therapy' services, opening the door for billing by both physicians and other non-therapist providers outside a therapy plan of care. (In contrast, ‘always therapy' covers when a therapist is furnishing the RTM service.

Nixon and Goldner pointed out that CMS isn't expanding provider eligibility because of statutory constraints, and while it made no changes around concurrent RPM/RTM billing, multi-device use or global period overlap, the agency has indicated it may revisit those ideas in the future.

Moving toward SaaS. In deciding valuations for RPM and RTM device supply codes, CMS will be using OPPS (Outpatient Prospective Payment System) GMC (Geometric Mean Cost) data, rather than practice-based invoices. In doing so, the agency feels OPPS data is more consistent and comparable across different care settings.

"This shift toward OPPS-based valuation reflects a broader modernization of CMS' Practice Expense (PE) methodology, which increasingly aims to capture software-as-a-service (SaaS) costs, cloud storage, and cybersecurity expenses as critical components of digital care infrastructure," Nixon and Goldner wrote.

RPM and RTM parity. The new codes represent a move toward parity between the two types of CMS coverage for remote patient monitoring. Nixon and Goldner note that there are critics of this idea.

"Stakeholders remained divided in their comments; some advocated parity to support adoption and workflow integration, while others argued that therapeutic monitoring requires distinct staffing and technology," they wrote. "For now, CMS will monitor utilization and revisit the issue as data accumulates, particularly with RTM still on the New Technology list for three years."

While this offers good news for healthcare organizations developing RPM programs, the road ahead is still rocky. Many question whether RPM can be sustainable in more than a few distinct chronic care programs.

A Question of Value

That point was highlighted with UnitedHealthcare's recent announcement that it is limiting RPM coverage to only two chronic care treatments – chronic heart failure and hypertension during pregnancy. The insurer argues that RPM is "proven and medically necessary" for only those two conditions.

In its new policy document, the payer lists several uses cases in which RPM "is unproven and not medically necessary due to insufficient evidence of efficacy." They include COPD, diabetes, other instances of hypertension other than during pregnancy, obstructive sleep apnea, anxiety and depression.

The decision didn't sit well with some digital health advocates.

"UnitedHealthcare's decision to limit RPM coverage based on a perceived lack of efficacy, as referenced in the Peterson Report, misses an important distinction," Lucienne Ide, CEO of Rimidi, an RPM and chronic disease management company, said in an e-mail. "The issue isn't that patients fail to benefit from remote monitoring – it's that success depends on identifying the right patients and applying thoughtful clinical criteria. Rather than eliminating access, the focus should be on strategic patient selection, such as individuals with hypertension who consistently struggle to stay below 140/90, or those with diabetes whose A1c remains above 9%."

The report referenced by Ide was conducted by the Peterson Center on Healthcare and released earlier this year. It notes the challenges of RPM reimbursement and calls for a realignment of RPM policy.

Others, meanwhile, say United Healthcare's decision isn't surprising.

Daniel McCaffrey, a digital health investor and advisor, commercial and product strategy executive for Oura, and member of the American heart Association's Health technology Advisory Group, noted in a LinkedIn post that RPM isn't working well for many companies.

McCaffrey listed four challenges: Limited to nonexistent margins, inconsistent payer coverage, low adherence and engagement rates, and lack of meaningful outcome differentiation.

"I've watched (and helped) companies build impressive RPM infrastructure and patient engagement systems, but without scalable economics or payer alignment, it's a treadmill (maybe even a hamster wheel) not a growth engine," he wrote.

"That's not to say remote monitoring can't create value," McCaffrey concluded. "It absolutely can, especially when deeply integrated into care delivery or research models that generate clinical and economic proof. But we need to stop pretending this is an easy or universal business model."