The annual release of Medicare’s Physician Fee Schedule (PFS) generated more attention than usual this year among practices that have considered or are already offering remote patient monitoring (RPM) to their patients. CMS’ release of its proposed rule on July 14, outlining revisions to payment policies and rates, was considered particularly significant for RPM.
Key changes to RPM under the The 2026 PFS includes the introduction of a code for 2 to 15 days of data collection and another that allows billing for 10-19 minutes of monitoring, lowering the threshold from the current requirement of 20 minutes. These additions would expand access to the program to a larger population of patients with a broader range of conditions. One of the existing guidelines, known as the 16-day rule, has frustrated the healthcare industry for years by limiting provider reimbursement to cases in which patient data is recorded and transmitted for at least 16 out of 30 days. Updates that could change this, largely shaped by the American Medical Association’s CPT editorial panelIt will likely usher in some exciting opportunities to improve care, as well as new coding, billing, and reimbursement factors to consider.
Greater flexibility supports better care delivery and innovation
Allowing billing for shorter or intermittent monitoring (such as a few weeks of postoperative vital signs monitoring or periodic hypertension checks as part of a broader care plan) demonstrates that clinical value is not determined solely by the frequency or duration of monitoring. The impact of expanded billing options goes far beyond correcting reimbursement inequities. The move will improve the delivery of high-quality care and foster innovation, ensuring that the benefits of policy change are felt throughout the healthcare ecosystem.
More patients will benefit from remote monitoring programs and receive effective, well-tailored care to assist with efforts such as medication adherence and lifestyle adjustments. A one-size-fits-all approach rarely works in healthcare, and RPM is no exception. Customizing interventions based on specific patient needs, conditions, and levels of engagement will improve individual care outcomes and improve the industry as a whole. Additionally, leveraging collected data for predictive analytics could facilitate advances in preventive care and chronic disease management and better understanding of specific patient populations or clinical conditions that benefit from this intervention performed under different protocols and program designs.
Including remote monitoring in specific patient interventions, such as lifestyle or medication adjustments, can create a positive feedback loop and insights for the patient and provider to make those interventions more impactful. For example, a new Generative AI model that predicts how a person’s glucose levels will respond to changes in diet. is increasing the precision of the nutrition plan and allowing doctors to make therapeutic adjustments sooner. The project supports personalized care and could significantly reduce healthcare spending, alleviating the global economic burden of diabetes, which is expected to reach $2.5 trillion by 2030. This technology, designed to proactively save lives and reduce costs of care, was trained on just 14 days of glucose data from more than 10,000 study participants wearing continuous monitoring devices. Clearly, two weeks of monitoring data can have a tremendous impact, underscoring the value of shorter RPM programs.
New requirements will affect documentation, compliance and audits
In addition to promoting flexibility, the new RPM billing codes will introduce higher standards of accuracy in compliance and reporting. Adapting internal workflows accordingly will help providers avoid common mistakes and streamline reimbursement processes. To align with best practices, healthcare organizations should focus their efforts on:
- Clear documentation: Each component of RPM, including monitoring days, device use, and patient interactions, must be accurately recorded. Recording monitoring cycles of 2 to 15 days, whether continuous or intermittent over a 30-day span, will require the same thoroughness as the traditional 16-day periods and 20-minute requirements.
- Education and training: Staff should be well-versed in the nuances of CPT coding, including the differences between billing for 2 to 15 days versus 16 or more, and 10 to 19 minutes of follow-up versus 20 minutes or more. Incorrect codes or accidental use of outdated methods could lead to audits or lost refunds.
- Audit test: CMS has emphasized the need for strong compliance safeguards, such as maintaining records that demonstrate medical necessity, transmitting data, and clinical justification of care plans. Increased scrutiny and continued emphasis on transparency is expected in the months following a PFS rule change and typically occurs when codes are updated to expand reimbursement. For example, Recent CMS Risk Adjustment Data Validation Updatesaimed at strengthening oversight of Medicare Advantage payments, led to an increase in audits from 35 records per plan annually to up to 200 per year, illustrating how CMS typically responds to program changes with tighter oversight.
Update creates pivotal moment for RPM’s sustainable growth
The 2026 Medicare PFS proposal marks a turning point for the use of RPM. CMS’s decision to make reimbursement more inclusive and clinically relevant will enable providers to create robust and efficient remote care programs that greatly improve patient access and outcomes. However, these achievements are not a fact. Organizations must invest in their RPM models by dedicating time and resources to developing adaptive processes that prioritize compliance and resilience.
With the right technology and expertise, providers can simplify RPM while maximizing patient and financial outcomes. These changes present a real opportunity to close long-standing gaps in treatment plans and reimagine care delivery. Approaching it as a moment for innovation, rather than a policy change, will help unlock RPM’s full potential to deliver value and create sustainable growth.
About Lucienne Marie Ide, MD, PH.D.
Lucienne Marie Ide, MD, PH.D.is the founder and CEO of rimidia digital health company that supports healthcare providers in delivering remote patient monitoring and chronic disease management with EHR-integrated software, services and connected devices. She brings her diverse experiences in medicine, science, venture capital and technology to lead Rimidi’s strategy and vision. Motivated by the belief that we can do much better as individuals, in the industry and in society. After completing her internship in Obstetrics and Gynecology at UPMC, Dr. Ide left clinical medicine to join the ranks of healthcare entrepreneurs trying to revolutionize an industry.
