CMS 2026 Final Rule: What Changed for Remote Patient Monitoring

For years, the single biggest complaint about remote patient monitoring (RPM) billing was the 16-day rule: unless a patient transmitted data on at least 16 days in a 30-day period, the device-supply code simply couldn’t be billed. Real patients don’t always cooperate with a calendar — someone recovering from a hospital stay, or being monitored for a short, acute episode, might transmit for a week and then stabilize. Under the old rules, that week earned the agency nothing.

The CY2026 Medicare Physician Fee Schedule (PFS) final rule — published in the Federal Register on November 5, 2025 and effective January 1, 2026 — changes that. It’s one of the most consequential rounds of RPM rulemaking since the codes were first created. Here’s what actually changed, and just as importantly, what it means (and doesn’t mean) for agencies serving Texas Medicaid.

First, the important distinction: Medicare vs. Texas Medicaid

The CY2026 PFS is a Medicare rule. It governs how Medicare pays clinicians — it does not automatically change how Texas Medicaid (TMHP) pays for monitoring under codes like S9110. TMHP sets its own policy, and Medicaid has historically diverged from Medicare on both codes and coverage.

So why should a Texas home care agency care? Two reasons:

• CMS direction signals where Medicaid tends to head. When Medicare formally recognizes that short-duration monitoring has clinical and financial value, it strengthens the case for state Medicaid programs to follow.
• Many agencies bill across payers. If you serve any Medicare or dual-eligible patients, these changes apply to that portion of your panel today.

Treat what follows as the Medicare picture, with a Texas lens — not as confirmation that TMHP has adopted the same changes.

The headline change: the 16-day rule is no longer the only path

CMS finalized a new RPM device-supply code, CPT 99445, covering 2–15 days of physiologic data transmitted in a 30-day period. It is reimbursed at the same rate as the existing 99454 (the 16-or-more day code).

The two are mutually exclusive — for a given patient in a given month you bill one or the other, never both. But the practical effect is significant: monitoring that used to fall off the cliff at day 15 now has a legitimate billing pathway. That opens the door to episodic and transitional models — post-discharge recovery, short medication-titration windows, acute flare-ups — that never fit the old structure.

One related tightening to note: the setup code 99453 now requires at least 2 days of monitoring to qualify.

Getting paid for shorter management sessions

The second big change is on the treatment-management side. New CPT 99470 covers 10–19 minutes of RPM management time in a calendar month, valued at roughly half the work of the existing 20-minute code (on the order of 0.31 work RVUs).

Before this, a care-team session that ran 12 or 15 minutes — short of the 20-minute threshold — was uncompensated. Under 99470, that time now generates revenue. For agencies whose monitoring touches are frequent but brief, this is a meaningful gap being closed.

RTM got the same treatment

Remote therapeutic monitoring (RTM) received parallel updates:

• New short-duration device-supply codes (98984–98986) for 2–15 days of data in a 30-day period, designated “sometimes therapy” services.
• New CPT 98979 for 10–19 minutes of RTM treatment management.

If your program includes RTM (for musculoskeletal, respiratory, or adherence monitoring), the same short-duration logic now applies.

What did not change

It’s worth stating plainly, because there’s a lot of noise online: no existing RPM or CCM codes were removed or cut. Everything that billed in 2025 — 99453, 99454, 99457, 99458, and the CCM families — continues at prior rates. The 2026 changes are additive: new options layered on top of the existing structure, not a replacement of it.

RPM and chronic care management (CCM) also remain co-billable for the same patient when documentation supports genuinely separate services — a point we cover in more depth in our Chronic Care Management Essentials post.

What this means for a Texas agency, practically

1. For your Medicare and dual-eligible patients, you can begin using the short-duration pathways now — which makes previously unbillable episodic monitoring viable.
2. For your Texas Medicaid (S9110) patients, confirm current TMHP policy directly before changing anything. The Medicare rule does not rewrite Medicaid billing.
3. Watch the direction of travel. CMS validating short-duration monitoring is a useful data point when advocating for or anticipating Medicaid coverage expansion.

The operational challenge is the same one that has always separated profitable RPM programs from stalled ones: capturing the right data-transmission days and management minutes as the work happens, and routing each patient to the correct code for their payer and their month. When 2–15 day and sub-20-minute scenarios suddenly become billable, the agencies that benefit are the ones whose system already tracks that detail — rather than reconstructing it from memory at the end of the month.

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This is an educational overview, not billing guidance. Code descriptors, valuations, and coverage rules change over time and vary by payer — and Texas Medicaid (TMHP) policy differs from Medicare. Always confirm current requirements with authoritative sources and your own compliance team before billing.

Sources: CMS CY2026 PFS Final Rule Summary; Federal Register, Nov 5, 2025.