RPM and Medicare in 2026: Changing required days per month to gain flexibility

Currently, the Medicare Physician Fee Schedule requires patients to transmit data to physicians at least 16 out of every 30 days. That could change for 2026, which could allow greater flexibility and thus more physicians and patients using remote monitoring for health care. Lucienne Marie Ide, MD, PhD, is founder and CEO of Rimidi, a company that works with RPM, and the author of an analysis of the 2026 schedule. Here she explains one potential change in the time requirement.

Lucienne Marie Ide, MD, PhD: There are really two main activities that comprise RPM programs. One as you just referenced is the 99454 activity, which is the connective device and the transmission of data and alerts from that device to the physician or the physician practice, and currently that requires that there's data transmitted 16 out of every 30 days. So that means, in practicality, if a patient has a blood pressure cuff, they need to be taking their blood pressure, that data needs to be transmitting to their physician practice 16 out of 30 days. This is an exciting area where there's a proposed change in the 2026 Physician Fee Schedule to allow for two to 15 days as a separate billable code. Those of us who've worked in the industry for a number of years are excited about this because 16 was a little bit arbitrary, right? Of how they came up with that number originally, when they came out with RPM codes. We can all presume it was because it was more than half of the 30 days, right? So they came up with 16. But that may not be medically necessary for every patient, and so allowing for greater flexibility will allow for more patients to benefit from these programs.