UBCNews - Business - CCM & RPM Billing Codes Explained: What Every Practice Should Know Now

Episode Date: March 4, 2026

If you've been running a Remote Patient Monitoring program, you've probably run into the same frustration: a patient engages meaningfully with their monitoring device for a few weeks, but falls just short of the thresholds required to bill for the service. Under the old rules, that care often went uncompensated. The 2026 Medicare updates were designed, in part, to fix exactly that problem. Two New Codes, Two Different Gaps. Starting January 1, 2026, CMS introduced two new RPM billing codes that give providers more room to capture reimbursement for care that was already being delivered but previously fell below minimum billing requirements. These are not replacements for the existing code set; they are additions that fill genuine gaps in the billing framework. CPT 99445: Shorter Monitoring Periods Now Count. The first new code, CPT 99445, covers device supply and data transmission when a patient transmits data on 2 to 15 days within a 30-day period. Previously, providers needed a minimum of 16 transmission days under CPT 99454 to bill for device supply. Patients with short-term monitoring needs can now still generate a billable encounter. The national average reimbursement is approximately $47. CPT 99470: Shorter Management Time Gets Recognized. CPT 99470 fills a different gap. Under the previous framework, at least 20 minutes of RPM treatment management time was required each month to bill CPT 99457. Time spent under 20 minutes reviewing data, adjusting care plans, and communicating with patients essentially went uncompensated. CPT 99470 covers the first 10 to 19 minutes of management time, reimbursed at around $26. Rules Worth Knowing Before You Bill. Both new codes come with important restrictions worth understanding. CPT 99445 and CPT 99454 cannot be billed in the same month for the same patient — you choose one based on actual transmission days. Likewise, CPT 99470 and CPT 99457 are mutually exclusive. Getting this right requires solid time tracking, clear documentation, and confirming the real-time communication requirement. The Broader Picture for 2026. It also helps to understand the broader context. These RPM changes come on top of a generally more favorable billing environment for care management in 2026. Across the existing CCM and RPM code set, CMS increased reimbursement rates by roughly 10%. That means programs most practices already have in place are now paying slightly more per patient per month, without any changes to program structure. Running CCM and RPM Together. The existing CCM billing codes remain unchanged for 2026, with slight rate increases across the board. CCM and RPM can still be billed together in the same month, as long as time for each service is tracked separately and not double-counted, which remains one of the most common compliance pitfalls for practices running both programs simultaneously. For practices hesitant to add RPM alongside CCM due to administrative complexity, the new codes may actually lower the barrier to entry. Programs no longer need to be built around daily monitoring or high engagement from day one. Starting with a smaller, targeted patient group and scaling from there is now a more financially viable approach under the updated billing framework. Getting Your Program Set Up to Capture It All. The billing changes are only useful if the underlying program is built to capture them. That means sound documentation workflows, staff trained on time-tracking, and a clear process for real-time patient communication. Consultants who specialize in chronic care management program development can help turn these new billing opportunities into a consistent, recurring revenue stream. Check out the description to learn more! CCM RPM Help City: Herriman Address: 12953 Penywain Lane Website: https://ccmrpmhelp.com/ Phone: [phone] Email: [e-mail]

If you've been running a remote patient monitoring program, you've probably run into the same frustration. A patient engages meaningfully with their monitoring device for a few weeks, but falls just short of the thresholds required to bill for the service. Under the old rules, that care often went uncompensated. The 26 Medicare updates were designed, in part, to fix exactly that problem. Two new codes, two different gaps. Starting January Furrow, 2026, CMS introduced two new RPM billing codes that give providers more room to capture reimbursement for care that was already being delivered, but previously fell below minimum billing requirements. These are not replacements for the existing code set. They are additions that fill genuine gaps in the billing framework.

CPT 99445. Shorter monitoring periods. Now count. The first new code, CPT 994 or 5, covers device supply and data transmission when a patient transmits data on 2 to 15 days within a 30-day period. Previously, providers needed a minimum of 16 transmission days under CPT 99454 to bill for device supply. Patients with short-term monitoring needs can now still generate a billable encounter. The national average reimbursement is approximately $47. CPT-994-Sivendos. Shorter management time gets recognized. CPT-994-Sivingu fills a different gap.

Under the previous framework, at least 20 minutes of RPM treatment management time was required each month to bill CPT 99457. Time spent under 20 minutes reviewing data, adjusting care plans, and communicating with patients essentially went uncompensated. CPT 99470 covers the first 10 to 19 minutes of management time, reimbursed at around $26. Rules worth knowing before you bill. Both new codes come with important restrictions worth understanding.

CPT 994045 and CPT 99454 cannot be billed in the same month for the same patient. you choose one based on actual transmission days. Likewise, CPT 9947 Uro and CPT 99457 are mutually exclusive. Getting this right requires solid time tracking, clear documentation, and confirming the real-time communication requirement. The broader picture for 2026, it also helps to understand the broader context. These RPM changes come on top of a generally more favorable billing environment, for care management in 2026. Across the existing CCM and RPM code set, CMS increased reimbursement

rates by roughly 10%. That means programs most practices already have in place are now paying slightly more per patient per month without any changes to program structure. Running CCM and RPM together The existing CCM billing codes remain unchanged for 2026. with slight rate increases across the board. CCM and RPM can still be billed together in the same month, as long as time for each service is tracked separately and not double-counted, which remains one of the most common compliance pitfalls for practices running both programs simultaneously.

For practices hesitant to add RPM alongside CCM, due to administrative complexity, the new codes may actually lower the barrier to entry. Programs no longer need to be built around daily monitoring or high engagement from day one. Starting with a smaller, targeted patient group and scaling from there is now a more financially viable approach under the updated billing framework. Getting your program set up to capture it all. The billing changes are only useful if the underlying program is built to capture them.

That means sound documentation workflows, staff trained on time tracking, and a clear process for real-time patient communication. Consultants who specialize in chronic care management program development can help turn these new billing opportunities into a consistent recurring revenue stream. Check out the description to learn more.