Medicare’s 2026 Final Rule Doubles Down on RPM: What It Means for Our Ortho Practices
The Centers for Medicare & Medicaid Services (CMS) CY‑2026 Physician Fee Schedule (PFS) final rule introduces two new Remote Patient Monitoring (RPM) codes—CPT 99445 and CPT 99470—and increases national payment amounts for the four existing RPM codes (99453, 99454, 99457, 99458). For our orthopedic partner practices, that means an increase in the number of compliant patients plus a potential ~$18 per‑patient monthly increase in reimbursement. All changes take effect January 1, 2026.
Two new RPM codes = more flexible, billable care
CPT 99445 — 2–15 day device supply & transmissions (per 30‑day period)
When a patient records 2–15 days of physiologic data (e.g. weight reading) in a 30‑day window with daily recordings or programmed alerts. CMS priced this on the same general approach as 99454, landing near ~$47 nationally (non‑facility, unadjusted).
CPT 99470 — first 10 minutes of RPM management (per calendar month)
Covers the first 10 minutes of clinical time in a month and requires one real‑time, two‑way interaction with the patient/caregiver. CMS priced it proportionally to 99457 (half the time ⇒ half the RVU), producing a national average around ~$26 (non‑facility, unadjusted).
2026 payment amounts for the existing RPM codes
CMS’s CY‑2026 Proposed Rule Addendum B lists the following national non‑facility amounts (unadjusted for geography). Final Addendum B will confirm the exact dollar values.
| Code | What it pays for | 2025 national avg | 2026 proposed | Change |
|---|---|---|---|---|
| 99453 | One‑time device setup & patient education | $19.73 | $21.71 | +$1.98 |
| 99454 | Device supply & transmissions (16–30 days) | $43.02 | $47.06 | +$4.04 |
| 99457 | First 20 min RPM management/month | $47.87 | $51.77 | +$3.90 |
| 99458 | Each additional 20 min/month | $38.49 | $41.42 | +$2.93 |
On national non-facility rates, a standard month of RPM (through one unit of 99458) increases by about $12.80 compared to 2025. And because 99458 can be billed up to three times for patients who require more engagement (up to 60 additional minutes), the total monthly increase can reach approximately $18.71.
Notes: Dollar amounts shown are national, non‑facility estimates (2026 proposed for the existing codes) and will vary by locality/GPCI. 99445 and 99454 are alternatives in the same 30‑day device period (not billed together). 99470 and 99457 are time‑tiered alternatives within a month (not billed together). 99458 is per additional 20 minutes and may be billed up to three times in a month when time is supported. Documentation and an interactive communication remain required.
Supervision flexibilities keep RPM low‑lift for surgeons
CMS finalized that virtual direct supervision (real‑time audio/video) qualifies as “immediately available” for applicable incident‑to services, supporting staff‑led day‑to‑day RPM operations while surgeons stay focused on clinic and OR.
Quick code recap (est. 2026 national, non‑facility)
-
- 99453 — One‑time setup & education: ~$21.71
- 99445 — Device supply & transmissions 2–15 days / 30 days: ~$47.06
- 99454 — Device supply & transmissions 16–30 days / 30 days: ~$47.06
- 99470 — RPM management, first 10 minutes with 1 real‑time interaction: ~$25.89
- 99457 — RPM management, first 20 minutes: ~$51.77
- 99458 — Each additional 20 minutes: ~$41.42
All figures above reflect CY‑2026 proposed national non‑facility amounts; CMS’s Final Addendum B will confirm final dollar values and your MAC/GPCI will vary local payment.
Where RPM fits in orthopedics
- Pre‑op optimization: short‑window activity monitoring and nutrition coaching to hit targets and document readiness.
- Post‑op safety net: daily trends, nutrition improvements, and activity monitoring to improve recovery.
- Non‑operative: frequent, focused coaching and monitoring that improves function and surgical preparedness.
How Prescribe FIT makes this turnkey for ortho
We handle device logistics, patient outreach, one‑on‑one health coaching, adherence tracking, documentation, and compliant coding—so your team stays focused on clinic and the OR. Request a custom pro forma and we can show you how many of your established patients qualify and what 2026 reimbursement looks like under the new code mix.
Sources and Additional Reading:
- CMS — CY‑2026 PFS Final Rule Fact Sheet (CMS‑1832‑F)
- CMS — CY‑2026 PFS Proposed Rule page (CMS‑1832‑P)
- McDermott+ Consulting — “CMS proposes RPM reimbursement updates…”
- PYA — “Providing and Billing Medicare for Remote Patient Monitoring” (Feb 2025)
- FederalRegister.gov – Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
CPT® is a registered trademark of the American Medical Association. Descriptions are paraphrased for general guidance. Always verify final payment amounts with CMS’s CY‑2026 MPFS Final Addendum B and your MAC.
Published on November 17, 2025
