Remote Physiologic Monitoring, RTM + CGM
Device programs for hypertension, heart failure, diabetes and COPD
Remote Physiologic Monitoring (RPM) pays a practice to collect patients' physiologic readings between visits and act on them. Continuous glucose monitoring (CGM) has its own codes and runs as a track within the program. RPM can be billed in the same month as APCM or CCM when time and documentation are kept separate.
- RPM 99453 · 99445 · 99454 · 99470 · 99457 · +99458
- RTM 98975–98981
- CGM 95249 · 95250 · 95251
Who it's for
Built for the organizations that carry this work
Practices running APCM or CCM
RPM is the natural add-on to a care management program: it stacks in the same month when time and documentation are distinct.
Hypertension and heart failure panels
Cellular blood pressure cuffs, scales and pulse oximeters for established patients where monitoring is medically necessary.
Diabetes care
Personal CGM for insulin-treated diabetes or problematic hypoglycemia, and professional CGM wears for patients whose therapy is being adjusted, including non-insulin.
COPD and post-discharge follow-up
Pulse oximetry for COPD, and 30 to 60 days of condition-specific monitoring after a hospital discharge.
What we do
What you receive
- 01
Readiness report and revenue model
Your condition registry, current CGM users, existing RPM, CCM and APCM billing, and the payer policies that apply.
- 02
Device sourcing recommendation
Turnkey vendor, leased devices with a platform, or practice-owned devices, modeled side by side with your actual vendor quotes.
- 03
Monitoring model and alert thresholds
Who reviews readings and makes the monthly calls (in-house, vendor or hybrid), and starting alert thresholds for your medical director to approve.
- 04
Build: contract, EHR and billing logic
Supervision language in the vendor contract, order and consent templates, data-day and minute tracking, and billing logic for 30-day and calendar-month periods.
- 05
CGM track
Personal and professional CGM workflows, including the path from a professional wear to a personal CGM order when the patient meets Medicare criteria.
- 06
Launch and ongoing operations
A hypertension cohort first, then every pathway. After launch, a KPI dashboard, monthly billing QA and quarterly sample audits of orders, consent, transmission and time logs, run with your staff or overseen by us.
How it works
How an engagement runs
Hypertension first, then every pathway.
- 1Weeks 1–2
Readiness
Condition registry, CGM users, existing billing and payer policies.
- 2Weeks 3–5
Design
Target conditions, sourcing option, monitoring model, alert thresholds and CGM track rules.
- 3Weeks 6–9
Build
Vendor contract, EHR integration, order and consent templates, data-day and minute tracking, billing logic.
- 4Weeks 10–17
Pilot
Hypertension cohort, adherence and claims QA, then a go / no-go decision.
- 5Month 5 on
Scale
Additional conditions and the CGM track, KPI dashboard and quarterly audits.
Typical sequence from our RPM + CGM program guide; timing depends on vendor contracting and EHR integration.
Program facts
Codes, requirements and rules
Medicare fee-for-service program rules for RPM and CGM.
From order to claim in six steps
1 · Identify
Established patients by condition, from the registry or problem list.
2 · Order and consent
Provider order with medical necessity; documented patient consent, separate from APCM or CCM consent.
3 · Set up
Device setup and patient education (99453, once per episode).
4 · Transmit
Readings upload automatically. Manual entries do not count.
5 · Review and act
Review against approved alert thresholds, with at least one real-time phone or video conversation each month for management codes.
6 · Bill
Device supply per 30-day period; management time per calendar month.
RPM codes
99453
- What it covers
- Device setup and patient education, once per episode
- Period
- Episode
99445
- What it covers
- Device supply, 2–15 data days (new for CY 2026)
- Period
- 30 days
99454
- What it covers
- Device supply, 16 or more data days
- Period
- 30 days
99470
- What it covers
- Treatment management, 10–19 minutes (new for CY 2026)
- Period
- Calendar month
99457
- What it covers
- Treatment management, first 20 minutes
- Period
- Calendar month
+99458
- What it covers
- Each additional 20 minutes
- Period
- Calendar month
99445 or 99454 per 30-day period, never both. 99470 or 99457 per calendar month, never both; 99458 only after 99457. Data days count once per day across all devices.
CGM codes and the two tracks
95249
- What it covers
- Start of patient-owned (personal) CGM: placement, hookup, training, printout
- Limit
- Once per patient-owned receiver
95250
- What it covers
- Professional CGM with practice-owned equipment, 72+ hours of data
- Limit
- Once per month
95251
- What it covers
- Analysis, interpretation and report (physician, PA or NP)
- Limit
- Once per month
Personal CGM: the device and sensors come from a DME supplier, which bills Medicare separately; the practice bills 95249 once and 95251 monthly. Professional CGM: practice-owned reader, sensors are a practice cost, 95250 + 95251 per wear. Modifier 25 applies to an E/M billed the same day as a CGM code.
Condition pathways
Hypertension
- Device
- Cellular blood pressure cuff
- Typical codes
- 99453, 99454, 99457
- Duration
- Ongoing
Heart failure
- Device
- Scale + BP cuff (± pulse oximeter)
- Typical codes
- 99454, 99457 + 99458
- Duration
- Ongoing
Diabetes
- Device
- Personal CGM or glucometer (± BP cuff)
- Typical codes
- 95249 / 95251 ± 99457
- Duration
- Ongoing
COPD
- Device
- Pulse oximeter (± peak flow)
- Typical codes
- 99454, 99457
- Duration
- Ongoing or seasonal
Post-discharge
- Device
- Condition-specific
- Typical codes
- 99445, 99470
- Duration
- 30–60 days
Alert thresholds are set and approved by your medical director; we provide starting defaults, not clinical guidance.
Remote Therapeutic Monitoring (RTM)
RTM monitors non-physiologic data, such as respiratory or musculoskeletal system status, therapy adherence and therapy response, and can be furnished by practitioners such as physical and occupational therapists as well as physicians and NPPs.
98975
- What it covers
- Initial setup and patient education on the RTM device
98976 · 98977 · 98978
- What it covers
- Device supply with scheduled recordings or programmed alerts: respiratory, musculoskeletal, or cognitive behavioral therapy
98980 · +98981
- What it covers
- Treatment management, first 20 minutes and each additional 20 minutes per calendar month, with an interactive communication
RPM and RTM are not billed for the same patient in the same period. The CY 2026 fee schedule also added shorter-duration RTM device and management codes, paralleling 99445 and 99470; confirm current RTM codes and rules in the CMS PFS before billing.
Same-month billing rules
- RPM can be billed in the same month as APCM or CCM when time and documentation are kept separate.
- APCM cannot be billed with CCM, PCM or TCM by the same practitioner for the same patient in the same month.
- 95251 (CGM interpretation) and 99457 (RPM management) may be billed in the same month.
- RPM device codes are not billed for a CGM that Medicare already pays a DME supplier for.
- RPM and RTM (therapeutic monitoring) are not billed for the same patient in the same period.
- Only one practitioner may bill RPM per patient per 30-day period.
What the patient pays
Medicare Part B only
- Patient share
- Coinsurance, usually 20% of the Medicare amount, for months monitored; the Part B deductible may apply.
Medicare + Medigap
- Patient share
- The supplemental plan may pay some or all of the patient's share.
Medicare + Medicaid, or a Medicare Savings Program
- Patient share
- The patient should not be charged.
CGM from a medical supply company
- Patient share
- The supplier bills Medicare for sensors separately.
FAQs
Common questions
Which patients are eligible for RPM?
Established patients with chronic or acute conditions where monitoring is medically necessary, with a provider order, documented consent, an FDA-defined device and automatic transmission. Codes cover acute conditions too, so short post-discharge monitoring qualifies.
Can RPM be billed in the same month as APCM or CCM?
Yes, when time and documentation are kept separate and each service meets its own requirements. RPM consent is also documented separately from APCM or CCM consent.
What changed for 2026?
Two codes took effect January 1, 2026: 99445 pays device supply for 2 to 15 data days in a 30-day period, and 99470 pays 10 to 19 minutes of monthly management. Lighter-touch patients and short monitoring periods can now be billed.
Do manually entered readings count?
No. Readings must transmit automatically from the device. Data days are counted once per day across all of a patient's devices.
Can a vendor's nurses do the monitoring?
Yes. Vendor time counts toward the management codes only under your practitioner's general supervision, and that supervision must be written into the contract and the documentation.
Can we bill RPM device codes for a patient's CGM?
Not when Medicare already pays a DME supplier for that CGM. Bill 95249 and 95251 instead, and use RPM device codes only for the patient's non-CGM devices. Confirm the policy with your Medicare Administrative Contractor.
What does the patient pay?
Usually a 20% coinsurance for months monitored, and the Part B deductible may apply. A Medigap plan may cover some or all of it, and patients with Medicaid or a Medicare Savings Program should not be charged.
Ready to simplify the complex?
Let’s look at your program together.
A consultation is a working conversation about your panel, payers and EHR, and whether this service fits. Please do not send patient information.
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