Remote Phys. Monitoring

Remote Patient Monitoring

Q: Who qualifies for Remote Patient Monitoring (RPM)?

Patient has ≥ 1 condition appropriate for physiologic monitoring (HTN, T2DM, CHF, COPD, CKD3, or another condition picked from the problem list), recorded by its ICD-10 code, which leads the claim. A practice-supplied medical device of an approved type is assigned (BP monitor, glucose meter, weight scale, pulse oximeter, thermometer, spirometer); its model and 510(k) number are recorded where the kit has one. Established patient — seen by the practice within three years; when no visit is on the synced record, the RPM card warns and staff record the visit date. Consent to this billing practitioner (verbal or written) with copay disclosure (per OIG OEI-02-23-00260). Time, calls and readings count only from the consent and the enrollment on. RPM and RTM are mutually exclusive for the same patient: a switch in one month holds for the practice to choose which program bills. CGM: Medicare covers a personal CGM for patients with diabetes treated with insulin, or with a documented history of problematic hypoglycemia (LCD L33822). The DME supplier documents the criterion; willowbridge tracks the six-monthly visit.

Q: Which codes does willowbridge bill for RPM, and when?

Two parts on two clocks. Device supply, per 30-day device window from setup: bill 99445 for 2–15 days of readings or 99454 for 16 days or more, on the claim of the month the window ends in. Management time, per calendar month: bill 99470 for 10–19 minutes or 99457 at 20 minutes, each with at least one live interactive communication with the patient or caregiver in the month, then 99458 for each additional 20 minutes (three at most, at 40, 60 and 80 minutes). 99453 bills once per patient, with the first device window that reaches 2 days of readings.

RPM Period: Calendar month + 30-day device window Source: CMS-1832-F (CY 2026 PFS Final Rule); OIG OEI-02-23-00260 (Sept 2024)

What it is

Remote Patient Monitoring (RPM) is the collection and interpretation of physiologic data (e.g., blood pressure, weight, glucose, SpO₂) from a connected medical device the practice supplies, with treatment management between visits. Every RPM device is the practice's own; a device the patient brings, or a phone health app, is never counted.

RPM bills on two clocks: the management codes per calendar month, the device codes per 30-day device window that starts on the setup date of the patient's first active device. Each window's device code goes on the claim of the month it ends in, dated to its last day; the month's management codes are dated to the month's last day. willowbridge handles device pairing and reading thresholds. Patients see their own readings, and can share a personal CGM, in the willowbridge app for iPhone and Android.

Personal CGM rides the RPM program on its own billing rail: when this practice starts the patient on the CGM in person, sensor setup and patient training bill 95249 once, dated to that day (a patient who arrives already on a CGM bills 95251 only), and the practitioner's signed interpretation of at least 72 hours of glucose data bills 95251, dated to the signature — read from the patient's own CGM. The CGM codes are distinct from the RPM codes; willowbridge keeps their minutes and evidence separated so the pair audits cleanly.

Who qualifies

Patient has ≥ 1 condition appropriate for physiologic monitoring (HTN, T2DM, CHF, COPD, CKD3, or another condition picked from the problem list), recorded by its ICD-10 code, which leads the claim.
A practice-supplied medical device of an approved type is assigned (BP monitor, glucose meter, weight scale, pulse oximeter, thermometer, spirometer); its model and 510(k) number are recorded where the kit has one.
Established patient — seen by the practice within three years; when no visit is on the synced record, the RPM card warns and staff record the visit date.
Consent to this billing practitioner (verbal or written) with copay disclosure (per OIG OEI-02-23-00260). Time, calls and readings count only from the consent and the enrollment on.
RPM and RTM are mutually exclusive for the same patient: a switch in one month holds for the practice to choose which program bills.
CGM: Medicare covers a personal CGM for patients with diabetes treated with insulin, or with a documented history of problematic hypoglycemia (LCD L33822). The DME supplier documents the criterion; willowbridge tracks the six-monthly visit.

Codes & when to bill them

How the minutes add upTwo parts on two clocks. Device supply, per 30-day device window from setup: bill 99445 for 2–15 days of readings or 99454 for 16 days or more, on the claim of the month the window ends in. Management time, per calendar month: bill 99470 for 10–19 minutes or 99457 at 20 minutes, each with at least one live interactive communication with the patient or caregiver in the month, then 99458 for each additional 20 minutes (three at most, at 40, 60 and 80 minutes). 99453 bills once per patient, with the first device window that reaches 2 days of readings.

Each billable code, with the requirements that must be on file to bill it.

99453RPM setup and patient education on use of the device(s). Once per patient, billed with the first 30-day device window that reaches 2 days of device data (CY 2026).

RequirementsDevice set up and patient educated; ≥ 2 days of device data in the window. If the first window is thin, the code waits for the first window that reaches 2 days.
99445RPM device supply with daily recording / programmed alert transmission, 2–15 days within the 30-day device window (new CY 2026 short code).

Requirements2–15 days of data from the practice's devices within the window; mutually exclusive with 99454.
99454RPM device supply with daily recording / programmed alert transmission, each 30 days.

Requirements≥ 16 days of data from the practice's devices within the 30-day device window.
99457RPM treatment management, first 20 minutes of clinical staff/QHP time per calendar month, with interactive communication.

Requirements≥ 20 min management time in the calendar month AND ≥ 1 interactive communication. One per calendar month.
99458RPM treatment management, each additional 20 minutes (list separately in addition to 99457).

RequirementsAdd-on to 99457; each additional full 20 min — up to three (40, 60 and 80 minutes, Medicare's unit limit).
99470RPM treatment management, 10–19 minutes in the calendar month, with interactive communication.

Requirements10–19 min management time + ≥ 1 interactive communication; mutually exclusive with 99457.

Documentation required every cycle

Each month must show (device data per 30-day device window):

The device — practice-supplied, type, serial, model, and the 510(k) number where the kit has one.
Device data transmitted by the device itself within each device window — 2–15 days gates 99445, 16 or more gates 99454, and the first window with 2 or more days carries the one-time 99453.
Interactive communication log — at least one live, real-time conversation (a phone call counts) with the patient/caregiver in the month (gates 99457/99458/99470). Time on a secure message or a patient case counts toward the management minutes, but never as this conversation.
Device data behind the management code — a management month with no reading from a practice device, or with only the patient's CGM, holds for the practitioner's review.
Patient consent to this practitioner, with copay disclosure on file.
The billing practitioner's sign-off, attesting the month's own facts: the monitoring is under their order and the device data, the live call (its date and who made it) and the time are accurate; for 95251, that they analyzed the CGM data and signed the report; for 95249, the in-person start-up under their direct supervision.
Signed care plan for the management codes: with the plan unsigned the month holds; then the supply and CGM lines bill and management is withheld.

What's new in CY 2026

CY 2026 adds a short-cycle device-supply code (99445) for 2–15 days of data, mutually exclusive with 99454, and a short-management code (99470) for 10–19 minutes of treatment management with interactive communication.

Built-in patient consentwillowbridge exclusive

Every program ships with compliant, CY-2026 patient consent language — read verbatim into the in-app consent capture flow, captured with date + modality, and version-pinned to each claim, so the consent on file always matches the consent that was billed. No more chasing signatures or re-papering when the rule changes.

Common questions

Who qualifies for Remote Patient Monitoring (RPM)?

Patient has ≥ 1 condition appropriate for physiologic monitoring (HTN, T2DM, CHF, COPD, CKD3, or another condition picked from the problem list), recorded by its ICD-10 code, which leads the claim. A practice-supplied medical device of an approved type is assigned (BP monitor, glucose meter, weight scale, pulse oximeter, thermometer, spirometer); its model and 510(k) number are recorded where the kit has one. Established patient — seen by the practice within three years; when no visit is on the synced record, the RPM card warns and staff record the visit date. Consent to this billing practitioner (verbal or written) with copay disclosure (per OIG OEI-02-23-00260). Time, calls and readings count only from the consent and the enrollment on. RPM and RTM are mutually exclusive for the same patient: a switch in one month holds for the practice to choose which program bills. CGM: Medicare covers a personal CGM for patients with diabetes treated with insulin, or with a documented history of problematic hypoglycemia (LCD L33822). The DME supplier documents the criterion; willowbridge tracks the six-monthly visit.

Which codes does willowbridge bill for RPM, and when?

Two parts on two clocks. Device supply, per 30-day device window from setup: bill 99445 for 2–15 days of readings or 99454 for 16 days or more, on the claim of the month the window ends in. Management time, per calendar month: bill 99470 for 10–19 minutes or 99457 at 20 minutes, each with at least one live interactive communication with the patient or caregiver in the month, then 99458 for each additional 20 minutes (three at most, at 40, 60 and 80 minutes). 99453 bills once per patient, with the first device window that reaches 2 days of readings.

What changed for RPM in CY 2026?

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