Remote Patient Monitoring

What it is

Remote Patient Monitoring (RPM) is the collection and interpretation of physiologic data (e.g., blood pressure, weight, glucose, SpO₂) from an FDA-cleared connected device, with treatment management between visits.

RPM bills on a rolling 30-day cycle that starts on the setup date of the patient's first active device, not the calendar month. Each cycle is evaluated independently for the device-data and management-time codes. 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, sensor setup and patient training bill 95249 once (a patient who arrives already on a CGM bills 95251 only), and a practitioner's interpretation of at least 72 hours of glucose data bills 95251 — 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 chronic condition appropriate for physiologic monitoring (v1: HTN, T2DM, CHF, COPD, CKD3).
• An FDA-cleared device of an approved type is assigned (BP monitor, glucose meter, weight scale, pulse oximeter, thermometer, spirometer).
• Established patient — a prior E/M within ~12 months satisfies CMS.
• Consent captured (verbal or written) with copay disclosure (per OIG OEI-02-23-00260, Sept 2024 audit defense).
• RPM and RTM are mutually exclusive for the same patient in the same month.
• CGM: Medicare covers a personal CGM for patients with diabetes treated with insulin, or with a documented history of problematic hypoglycemia (LCD L33822). The qualifying criterion is captured at enrollment.

Codes & when to bill them

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 on the first 30-day cycle that reaches 2 days of device data (CY 2026).
  RequirementsDevice set up and patient educated; ≥ 2 days of device data in the cycle. If the first cycle is thin, the code waits for the first cycle that reaches 2 days.
• 99445RPM device supply with daily recording / programmed alert transmission, 2–15 days within the 30-day cycle (new CY 2026 short-cycle code).
  Requirements2–15 days of FDA-cleared device data transmitted within the cycle; mutually exclusive with 99454.
• 99454RPM device supply with daily recording / programmed alert transmission, each 30 days.
  Requirements≥ 16 days of FDA-cleared device data transmitted within the 30-day cycle.
• 99457RPM treatment management, first 20 minutes of clinical staff/QHP time per calendar month, with interactive communication.
  Requirements≥ 20 min management time in the cycle AND ≥ 1 interactive communication.
• 99458RPM treatment management, each additional 20 minutes (list separately in addition to 99457).
  RequirementsAdd-on to 99457; each additional full 20 min — willowbridge bills two at most (40 and 60 minutes).
• 99470RPM treatment management, 10–19 minutes in the cycle, with interactive communication.
  Requirements10–19 min management time + ≥ 1 interactive communication; mutually exclusive with 99457.

Documentation required every cycle

Each 30-day cycle must show:

1. Device certification — FDA-cleared device, type, serial, 510(k) on file.
2. Device data transmitted within the cycle — 2–15 days gates 99445, 16 or more gates 99454, and the first cycle with 2 or more days carries the one-time 99453.
3. Interactive communication log — at least one live, real-time conversation (a phone call counts) with the patient/caregiver in the cycle (gates 99457/99458/99470). Time on a secure message or a patient case counts toward the management minutes, but never as this conversation.
4. Device-data snapshot for the cycle (readings evidence).
5. Patient consent with copay disclosure on file.
6. Billing-provider sign-off.
7. Signed care plan. RPM is not exempt: a cycle whose care plan has never been signed voids at the freeze.

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.