What Medicare’s 2026 proposed rule signals for remote care

Medicare’s 2026 proposed physician fee schedule (PFS) brings forward some of the most meaningful updates to remote care in years. Spanning more than 1,800 pages, the draft rule signals a clear shift from remote care as an optional add-on to an essential component of care delivery, especially for chronic and high-risk populations.

With major updates to remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) as well as expanded support for digital health tools, the proposed rule introduces long-anticipated changes that could significantly reshape how providers engage with patients, deliver care, and capture reimbursement. For health care organizations already offering remote care and those preparing to start, these updates create new opportunities for clinical flexibility, broader eligibility, and scalable, sustainable models of virtual care.

Looking back to move forward

Understanding the current RPM framework helps put these proposed changes into perspective. Since CMS introduced the initial CPT codes for RPM in 2019, providers have had a reliable but sometimes rigid pathway to deliver reimbursable remote care.

Here’s how RPM is currently structured:

• CPT 99453 – Covers patient onboarding, including training and device setup. To bill, the patient must record 16 days of data in a 30-day span.
• CPT 99454 – Covers the supply of the monitoring device and transmission of data. Billable only with 16 days of data.
• CPT 99457 – Applied to the first 20 minutes of clinical interaction, patient communication, and care planning each month.
• CPT 99458 – Adds additional time in 20-minute increments.

This structure has supported the growth of remote care but has also created challenges including strict time thresholds and barriers to enrollment, particularly for patients who could benefit from shorter-term or intermittent monitoring.

What’s changing in 2026

The proposed rule directly addresses several longstanding pain points in the structure and reimbursement of RPM services. These changes aim to give providers greater flexibility, make remote monitoring more accessible, and support more clinically meaningful interactions.

1. Shorter monitoring periods: a new 2- to 15-day device code

Under the current structure, CPT 99454 (device supply and data transmission) requires patients to record at least 16 days of physiologic data within a 30-day period for the service to be billable. While that worked for many use cases, it created barriers for patients who didn’t need — or weren’t able to complete — 16 full days of data.

CMS is proposing two changes to address this:

• New code (99XX4): Covers RPM services when 2 to 15 days of data are collected in a 30-day period.
• Revised code (99454): Would now officially represent the 16 to 30-day data range.

Importantly, CMS proposes reimbursing both codes at the same rate, reinforcing the idea that value lies in the availability and clinical use of monitoring rather than just the number of transmissions. For practices, this could mean fewer denials, greater billing flexibility, and more patients eligible for care.

2. Improved time-based billing: a new 10-minute management code

Currently, RPM care management time must hit a full 20-minute threshold to be billed under CPT 99457. That all-or-nothing rule has made it harder for clinicians to capture the value of shorter but still meaningful patient interactions.

Here’s what’s proposed:

• New code (99XX5): Would allow billing for 10 to 20 minutes of RPM treatment management services in a calendar month.
• The proposed reimbursement rate is approximately half of 99457’s, but it offers a way to account for smaller touchpoints without losing value.

Also important: CMS has opted not to reduce reimbursement for existing codes 99457 and 99458, despite external recommendations to do so. This ensures continued stability for organizations already running RPM programs while enabling new efficiency for those just starting out.

Continued momentum for remote care

The 2026 proposed rule signals that CMS is listening to the evolving needs of providers and patients. Several updates support a broader, more flexible future for remote care, including:

• The extension of key telehealth flexibilities through 2029
• New RPM codes that allow for shorter monitoring durations (2 to 15 days within a 30-day period), increasing applicability across different patient populations
• The removal of outdated requirements for online-only diabetes prevention programs to maintain in-person components
• Expanded coverage for digital therapeutics, including treatments for ADHD and other behavioral health conditions
• The elimination of frequency limits for inpatient, nursing facility, and critical care telehealth visits
• Open discussion around expanding reimbursement for a wider range of digital tools that support chronic disease management and mental health

These changes reflect a growing understanding of how care is actually delivered and the importance of ensuring uninterrupted access to remote care services that improve outcomes and extend reach, especially for patients with chronic or complex needs.

What this means for providers

If finalized, the 2026 PFS rule will further solidify remote care as a core component of Medicare’s delivery model. These changes are more than administrative; they reflect a growing shift toward modern, proactive care delivery where digital tools, continuous engagement, and team-based support are foundational.

Now is the time for health care organizations to:

• Evaluate readiness to scale or optimize RPM programs
• Align workflows to meet general supervision requirements
• Prepare for updated billing structures and documentation
• Partner with platforms that support ease of use, engagement, and compliance

With notable updates to RPM and expanded support for digital health tools, the proposed rule highlights CMS’ commitment to making virtual care more accessible, flexible, and sustainable. For organizations already delivering remote care or those just beginning to explore it, these updates create new pathways to expand access, improve outcomes, and reduce patient risk.

NRHA adapted the above piece from Kangaroo Health, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.
 

About the author: Sesily Maness is the head of marketing at Kangaroo Health with over 10 years of experience in digital health marketing. She holds a bachelor of science degree from Campbell University and specializes in connecting innovative care technologies with the needs of rural health care providers. Sesily is passionate about using data to drive proactive care and improve health equity in underserved communities.