How Cloud-Connected Devices Unlock New Reimbursement Streams
Your up-to-date quick reference guide for every Remote Physiologic Monitoring (RPM), Remote Therapeutic Monitoring (RTM), and virtual check-in code—what Medicare pays in 2025 and the new codes already proposed for 2026. (July 2025 CMS draft update)
Market Momentum
CMS Part B paid an estimated $910 million for RPM/RTM services in 2024, up from $712 million in 2023. (CMS Physician & Other Practitioners Utilization Data)
1. Remote Physiologic Monitoring (RPM) Codes — CY 2025 status
| Code | Descriptor | CY 2025 national avg. rate* | Key billing rules |
|---|---|---|---|
| 99453 | Device set-up & education | $19.73 | Once per episode (≥ 16 days of use in first 30 days) |
| 99454 | Device supply & transmission | $48.79 | ≥ 16 days of data every 30 days |
| 99457 | RPM management ≥ 20 min | $47.87 | Includes ≥ 1 live communication; per calendar month |
| 99458 | Add’l ≥ 20 min | $43.02 | Add-on to 99457; stackable |
2. Remote Therapeutic Monitoring (RTM) Codes — CY 2025 status
| Code | Descriptor | CY 2025 national avg. rate* | Typical data stream |
|---|---|---|---|
| 98975 | RTM set-up & education | $19.73 | Respiratory or musculoskeletal devices |
| 98976 | RTM supply — respiratory | $47.12 | PEF, inhaler-usage counters |
| 98977 | RTM supply — MSK | $47.12 | Motion sensors, orthopedics |
| 98980 | RTM management ≥ 20 min | $47.30 | Includes ≥ 1 interactive session |
| 98981 | Add’l ≥ 20 min | $39.65 | Stackable add-on |
3. New & Revised Codes Proposed for CY 2026 (July 14 2025 CMS draft)
| Code change | Effective Jan 2026 | Draft national avg. rate* | Why it matters |
|---|---|---|---|
| 99XX4 (RPM 2-15 days) | Short-term device supply | ≈ $48.79 (parity with 99454) | 2–15 day studies now reimbursed at full rate |
| 99XX5 (RPM mgmt 10-19 min) | Mgmt bracket below 99457 | ≈ $29 | Shorter touch-points; 20-min codes remain intact |
| Unified RTM supply | Merges 98976/77 | ≈ $47 | Simplifies digital therapeutics billing |
| HCPCS G0X12 (virtual check-in 11-20 min) | Replaces G2012 | ≈ $37 | Maintains short tele-visit pathway |
*Medicare national-average, non-facility payment rates for CY 2025. 2026 figures reflect the July 14 2025 CMS draft proposal; final rates will be published in the CY 2026 Physician Fee Schedule (Nov 2025).
4. Revenue Snapshot — Monthly Potential per Patient
| Use-case | Codes billed | Medicare $/30 days* | Data requirement |
|---|---|---|---|
| Hypertension RPM | 99454 + 99457 | $96.66 | ≥ 16 BP readings + ≥ 20 min review |
| Post-op MSK RTM | 98975 + 98977 + 98980 | $114.15 | Exercise counts & adherence logs |
| Cardiac patch (est. 2026) | 99XX4 + 99XX5 | $78-79 | 2–15 days ECG data + ≥ 10 min review |
Conclusion
Remote-care reimbursement keeps expanding. Align your device data streams with the correct CPT codes, meet the day-count and time requirements, and you’ll open durable revenue channels for providers and device makers alike.
Abbreviations
CPT – Current Procedural Terminology | HCPCS – Healthcare Common Procedure Coding System | RPM – Remote Physiologic Monitoring | RTM – Remote Therapeutic Monitoring | MSK – Musculoskeletal | DTx – Digital Therapeutics | PEF – Peak Expiratory Flow | CMS – Centers for Medicare & Medicaid Services | AMA – American Medical Association | PFS – Physician Fee Schedule
