Medicare’s 2026 Proposed Rule Doubles Down on RPM. Here’s What That Means for Ortho Practices.
The Centers for Medicare & Medicaid Services (CMS) just released its proposed 2026 Medicare Physician Fee Schedule (PFS), and there’s one clear takeaway: Virtual care models — especially Remote Patient Monitoring — aren’t going anywhere. In fact, they’re getting stronger. If you’re in a private orthopedic practice, this could be a game-changer.
1. CMS Signals Long-Term Commitment to RPM
One of the most practice-friendly aspects of the 2026 proposed Medicare PFS is what CMS didn’t change: it reaffirms that both Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) services can continue to be delivered under “general supervision” when billed as “incident to” services. This means physicians are not required to be physically present during the delivery of these services — a flexibility first introduced during the COVID-19 Public Health Emergency and later made permanent in 2024.
For orthopedic practices, this is crucial. It allows non-physician clinical staff — like Prescribe FIT’s dedicated health coach care coordinators — to deliver lifestyle health coaching and monitor patients remotely, while the supervising provider remains available but not directly involved in every interaction. CMS’s decision reinforces what many orthopedic leaders already understand: virtual care isn’t just a temporary supplement — it’s becoming a core component of modern, proactive MSK care.
2. Focus on Whole-Person Care = Opportunity for MSK Providers
CMS continues to push the healthcare system toward value-based, whole-person care, and the 2026 proposed rule underscores that shift. Specifically, CMS is seeking comments on how to enhance digital care coordination, patient engagement, and equity-focused innovation. In short: they’re looking for scalable ways to treat the root causes of chronic conditions — not just the symptoms.
That’s a clear signal to orthopedic practices. Most MSK issues in older adults — like joint pain, surgical complications, and poor mobility — are exacerbated by obesity, sedentary lifestyles, and metabolic dysfunction. These issues aren’t solved in the OR alone. Programs like Prescribe FIT, which combine remote monitoring with one-on-one health coaching, align exactly with CMS’s direction. They offer a non-invasive, reimbursable pathway to improve outcomes before surgery is even considered — and support recovery afterward.
For orthopedic leaders, this shift is a green light to step outside the traditional reactive model. CMS is creating space and financial incentives for orthopedic providers to take a more proactive role in managing MSK health — especially when it means preventing complications, avoiding unnecessary surgeries, or improving surgical readiness.
3. Two New Codes Could Unleash RPM Growth
CMS is proposing two new CPT codes that could drastically improve how orthopedic practices adopt and bill for Remote Patient Monitoring (RPM) services.
- New “2-Day” Device Code (99XX4): This new code would allow reimbursement for supplying an RPM device for just 2 to 15 days within a 30-day period — not the 16+ day requirement that has historically been a sticking point. It’s also proposed to pay the same rate as the current 99454 code (which applies to 16–30 days of device use).
- New “10-Minute” Time Code (99XX5): Until now, you could only bill 99457 after logging 20 minutes of RPM treatment management. With this proposal, CMS introduces a 10–20 minute code with a proportional reimbursement (half the RVU of 99457). That gives providers more flexibility to bill for shorter-but-still-meaningful clinical touchpoints. CMS rejected a proposal to cut the reimbursement on existing 99457 and 99458 codes — maintaining their current value into 2026.
CMS is acknowledging that value comes from access to monitoring — not just frequency of data transmission. For practices whose patients may miss a few days due to mobility, age, or life — this is huge.
4. Virtual Health = Real Revenue
With CMS’s 2026 proposed updates, RPM compliance is expected to climb significantly — making more patients billable, more often. Today, Prescribe FIT partner practices already see 75% compliance on 99454 (device transmission) and over 90% of patients reaching the full 80 minutes needed to bill 99457 + 99458. With the addition of the new 10–20 minute code (99XX5) and flexibility around shorter monitoring windows (99XX4), our projected compliance rates are expected to rise above 95%.
For orthopedic practices, that means higher monthly reimbursement and more predictable revenue — all while delivering better care. Prescribe FIT’s turnkey RPM solution empowers providers to support patients pre- and post-surgery, reduce pain, and improve outcomes, all without burdening clinical staff.
It’s not just self-sustaining — it’s a high-impact, low-lift ancillary service. Several partner practices are already generating $1M+ in annual RPM revenue with little-to-no change in workflow. And with the 2026 CMS rule changes, those numbers are only going up.
5. Why Now Matters
If your practice isn’t using RPM today, the 2026 rule is a wake-up call. Between increasing payer support and rising digital-first patient expectations, orthopedic care is evolving fast — and tech-enabled optimization solutions like Prescribe FIT are moving beyond practice-building differentiators and quickly becoming the norm. The practices that embrace this shift early will be the ones positioned to grow — financially and reputationally.
Waiting could mean falling behind. CMS is rewarding proactive care models, and commercial payers are following suit. Meanwhile, patients are demanding more engagement, education, and virtual support between office visits. By adopting a compliant, proven RPM solution now, practices can lock in new revenue streams, drive better outcomes, and establish themselves as leaders in modern musculoskeletal care — before it becomes a catch-up game.
Next Steps
Prescribe FIT enables orthopedic practices to educate and enroll their established patients into reimbursable RPM and virtual health coaching programs — with no upfront cost and full support for operations, outreach, remote care and billing. Want to learn how your practice can take advantage of CMS’s renewed RPM strategy and Prescribe FIT’s practice-building protocol?
Request a Custom Pro Forma. We’ll calculate how many of your current patients qualify, what monthly revenue you could earn, and expected health outcomes. Or just schedule a call with our team here: https://www.prescribefit.com/contact-us/
Published on July 28, 2025
