Remote Patient Monitoring (RPM) Billing Services
RPM billing includes coding and claims filing services related to RPM billing coding, billing claims submission, and denial defense. These services ensure that the provider gets maximum Medicare reimbursement on the RPM services which he/she is providing already through the use of RPM devices.
UControl Billing offers all-inclusive RPM billing for practices, health systems, RHCs, and FQHCs throughout the United States.
Coverage All 50 states, non-facility PFS rates
Code family 99453, 99454, 99445, 99457, 99470, 99458, 99091
New for 2026 99445 and 99470 lower the entry thresholds
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What our RPM billing services include
Each of the following is a billing function, not a physiologic monitoring function. We analyze the logs generated by your monitoring platform to create clean claims.
Patient eligibility is determined by having one acute or chronic condition as well as an established physician-patient relationship for physiologic monitoring.
Device Order and Consent Review
Review of the documentation of the device order and patient consent for the day the service is performed.
Daily Transmission Measurement
Count of measurement days reviewed against the floor of 2 days and 16 days threshold per 30-day period.
The 99445 versus 99454 and 99470 versus 99457 determination based on actual transmission days and minutes.
Claims Submissions and Scrubbing
Perform clean claim edits prior to submission in order to assure device days and place of service agree with the code billed.
Review for concurrent enrollment so there is no double billing across programs and between physicians.
Reasons behind denials reviewed along with reworking of the denial for RPM claims. See Denial Defense for Remote Monitoring Claims.
Time Log Review
Minutes per treatment management reviewed against 10-minute and 20-minute thresholds per calendar month.
RPM Billing Versus A Device Vendor Or Monitoring Company
There are normally three different companies involved with an RPM program. We own one seat, and that is the revenue seat.The device vendors provide the equipment along with the cellular connection service. The clinical monitoring companies provide the monitoring staff that watches the incoming data. UControl provides the revenue cycle process that converts everything to paid claims.
We integrate with any RPM device platform or even in-house monitoring staff. In the case of practices that use any monitoring vendor, they still need an audit on the billing side. The transmission logs and time logs of the platform are precisely what the Medicare auditing process looks at.
| Device Vendor | Provides the equipment | FDA cleared devices along with the connection used for automated transmission of information to a safe place. |
| Monitoring Company | Provides the care staff | The care staff responsible for reviewing physiological information and the live interaction every month. |
| UControl Billing | Provides the revenue cycle | Selection of codes, claims filing, concurrency evaluation, and appeal services throughout the entire process. |
RPM CPT Codes and 2026 Medicare Reimbursement
Seven codes carry an RPM program in 2026. Two of them are new, and each new code sits in a mutually exclusive pair with an older one.RPM code family · 2026 national non-facility rates
| Code | Descriptor | Time threshold | 2026 rate |
|---|---|---|---|
| 99453 | Setup and patient education on device use | Once per episode of care, at least 2 days of monitoring | ~$22 |
| 99454 | Device supply with daily transmission | 16 or more days of data per 30-day period | ~$52 |
| 99445 | Device supply with daily transmission | 2 to 15 days of data per 30-day period | ~$52 |
| 99457 | Treatment management, first increment | First 20 minutes per calendar month | ~$52 |
| 99470 | Treatment management, first increment | 10 to 19 minutes per calendar month | ~$26 |
| 99458 | Treatment management, each additional increment | Each additional 20 minutes, up to 2 units | ~$41 |
| 99091 | Collection and interpretation of physiologic data | 30 minutes, physician or QHP only | ~$58 |
One provider is eligible to bill for RPM for each individual for each 30 days. Codes 99445 and 99454 for devices are mutually exclusive, while 99470 and 99457 for management are mutually exclusive; therefore, they bill only once. The supply of devices runs on a rolling 30-day basis, while the management codes run on a monthly basis.
What changed for RPM billing in 2026?
The CY 2026 PFS final rule, released on November 5, 2025, was the biggest structural change to RPM billing that was seen since the creation of codes. New codes brought down the floors for entering into payment.
Code 99445 allows reimbursement for device supply between 2 to 15 days of data collection, compared to the previous 16-day floor. Code 99470 allows reimbursement for 10 to 19 minutes of management, compared to the previous 20-minute floor. Payment for the new device code will be the same as 99454. According to CMS, the practice expense in supplying the device does not differ depending on the transmission days.
New codes enable payment in cases where no revenue was possible before 2026. Cases involving post-surgical monitoring, adjustment periods for medications, and episodes will become eligible for RPM billing. A patient, who was transmitting 14 days of data, did not receive payment for the device prior to 2026; he/she received full reimbursement under 99445. Device setup under 99453 remains one-time per episode of care. This code now requires at least 2 days of monitoring.
RPM or RTM: Which Applies And Can You Bill Both?
Remote Physiological Monitoring (RPM) involves capturing physiological data like blood pressure, weight, blood glucose, and pulse oximetry automatically through an FDA-cleared device.
On the other hand, Remote Therapeutic Monitoring (RTM) involves the capture of non-physiological and, more importantly, self-reported data. Self-reported data includes musculoskeletal function, respiratory function, medication adherence, and therapy response. The only data that can be reported are those related to remote therapeutic monitoring.It is the key point of differentiation because this is the fork not the stack. RPM and RTM services cannot be billed for the same patient in the same month. In the case of RPM, there has to be an established relationship with the patient while this is not the case in RTM.
RPM Billing For RHCs and FQHCs After G0511
RHCs and FQHCs do not submit billing for care management and remote monitoring under the single G0511 code anymore. Such facilities will submit billing under the RPM CPT codes on a national non-facility basis under PFS rates.
The G0511 code has sunsetting by CMS effective September 30, 2025, and submission will start using individual codes beginning January 1, 2026 [VERIFY both dates against CY 2026 PFS final rule]. It was only one bundled code covering the entire program. It is now necessary to choose itemized codes and measure day and minute thresholds per patient.
This made the amount of work related to coding much more difficult for the exact facilities which had fewest coders. One code turned into seven codes with mutual exclusion logic and two billing cycles. This is why outsourcing code choice and measuring thresholds should be considered, not as a marketing statement but as fact. Critical Access Hospitals submit billing for Part B RPM under patient assignment to an outpatient billing practitioner.
Concurrency rules: What RPM Can And Cannot Be Billed With
RPM stacks with all case management software programs except where time is not counted twice. RPM never stacks with RTM. The table below provides the limit for each combination.
| Paired program | Verdict | Condition |
|---|---|---|
| Chronic care management (CCM) | Allowed | Time never double-counted. The highest-value and most common stack. |
| Transitional care management (TCM) | Allowed | Time not double-counted across the two services. |
| Behavioral health integration (BHI) | Allowed | Separate documentation for each program. |
| Principal care management (PCM) | Allowed | Time tracked independently per program. |
| Advanced primary care management (APCM) | Allowed | New pairing for 2026 |
| Remote therapeutic monitoring (RTM) | Not allowed | Never the same patient in the same month. |
| Global surgery period | Conditional | Only by a practitioner not receiving the global service payment. |
Why RPM Claims Get Denied And How We Prevent It
RPM denial can be linked to a threshold, a document, or the choice of the code used. Each of the below causes will include the billing mechanism associated with it and control measures we put in place before billing.
| Denial | Reason for denial | How UControl prevent it |
|---|---|---|
| Device-data day threshold not reached | Below 2 measurement days of data invalidates any device billing claims. Below 16 measurement days invalidate 99454 even if 99454 has been claimed. | We count the number of days of measurement in a 30-day period. We route claims to either 99445 or 99454 on the measurement days count prior to billing. |
| No live interactive communication documented | Live interactive communication of management codes requires at least one session per calendar month. Text, voicemail, and manual upload of data does not qualify. | We verify the existence of documented synchronous contact in the month before billing 99457, 99470, and 99458. |
| Manual data entry instead of automated transmission | The device should automatically send data in digital form. Readings manually keyed in by the patient are not typically billable. | We check whether the system logs indicate automatic data transmission and not manual entry in all billed measurement days. |
| Inconsistent or missing consent | The patient's consent must be properly documented at the time of delivery of service. Undated consent results in an audit denial. | We ensure that a dated consent is present in our files prior to the first billing cycle. |
| Time management for CCM not differentiated from RPM | Both CCM and RPM management time cannot be billed using the same amount of time. | We ensure that minutes of RPM and CCM are recorded separately in the log in order to prevent the same minute from being logged twice. |
| Billing wrong code out of two mutually exclusive codes | Coding 99445 and 99454 in the same bill or 99470 and 99457 in the same bill will be a denial, since each pair of codes is not additive. | We select one code out of each pair based on the number of transmission days and management minutes. |
| Duplicate practitioner billing | One practitioner can bill RPM per patient within a 30-day period. Second practitioner billing leads to duplicate denial. | Our enrollment screen determines one practitioner per patient and denies the second RPM submission. |
| RPM billed in a month RTM was also billed | RPM and RTM cannot be billed for the same patient in the same month. A claim for both fails on the concurrency rule | Concurrency screening checks for an RTM claim in the same month before an RPM claim is submitted. |
Who We Serve
RPM Billing Issues Differ by Practice Type. The logic of how the code works does not change. But the volume, the payer mix, and the strain on the staff vary according to the practice type.
Primary Care & Internal Medicine
Overlapping RPM + CCM in a big Medicare panel, where time separation is the major risk for audits.
Cardiology and Pulmonary Practices
Daily monitoring in hypertension and COPD patient populations, where daily counting defines the device coding.
Multispecialty practices
Patient conditions and multiple practitioners involved in billing, where the duplicate practitioner check avoids denial.
RHC and FQHC
Itemized-coding after the sunset of G0511, where the minimal billing staff deals with code selection work multiplied.
Large health systems
RPM is stacked with CCM across thousands of patients, where the correct concurrency logic saves the largest revenue line
Post-Acute and Episodic programs
Monitoring of short duration that is now billable with 99445 and 99470 codes, where 2026 year thresholds account for zero-revenue months.
How Onboarding Works With UControl
Four steps take the practice through current state audit and on to stable monthly reporting. The timeline estimates will be valid only if the operation is confirmed.
RPM claims audit
Review current claims, device transmission logs, and time logs to identify missed thresholds and codes.
Payer configuration and programs
Configuring the payer rules and RPM+CCM stacking program for your patient pool.
First-cycle parallel processing
Processing the first billing cycle in parallel to ensure that the coding is selected and thresholds met prior to handover.
Stable state reporting
Switching to monthly reporting of submission, denied and resubmitted claims.
Medical Billing Certifications and Compliance Standards
We hold the certifications that payers and auditors look for, and our coders carry the right credentials. It’s not the most exciting part of the work, but it’s the part that keeps your claims on solid ground.
Explore Frequently Asked Questions
RPM billing comprises coding, claim filing, and documentation adherence to RPMs. It translates transmission logs and clinical time logs into Medicare claims and ensures that those claims do not get denied.
For the 2026 RPM suite, the codes are 99453 for set-up, 99454 and 99445 for device provision, 99457 and 99470 for the first increment of management, 99458 for subsequent increments of management, and 99091 for physician's data analysis. Both pairs of the device and management are mutually exclusive.
Yes. Both RPM and CCM can be billed for one patient in a single month if the clinical time is separately logged. No minutes contribute to both programs. This is the most valuable RPM bundle.
CMS introduced 99445 for device supply with 2 to 15 days of monitoring, and 99470 for 10 to 19 minutes of therapy management. The codes are effective January 1, 2026, and are mutually exclusive with their high threshold counterparts.
No. Neither RPM nor RTM can be billed together in the same month for the same patient. The selection of the codes should be based on whether the data collected is physiologic or therapeutic.
The cost of RPM outsourcing services depends on the billing structure and amount of program activity of your practice. There is no more accurate way of pricing than to see your existing RPM claims and device logs and identify how much money you are losing due to the improper coding.