The landscape of digital healthcare is set for a seismic shift. In its proposed 2026 Medicare Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) has put Remote Patient Monitoring (RPM) front and center, signaling a clear intention to make it a mainstream standard of care. The proposed rules, if finalized, will tear down old restrictions and create a more flexible, financially viable framework for RPM.

For savvy healthcare practices, this isn’t just an update—it’s a massive opportunity. But capitalizing on it requires navigating new complexities in billing and operations. This article breaks down the changes and reveals the most effective way for clinics to prepare, adapt, and dominate in this new environment.

The Old RPM Rules Are Out

CMS is targeting the two biggest historical roadblocks for RPM programs: the “16-day rule” for device use and the rigid 20-minute time requirement for care management.

1. The 16-Day Mandate Is Disappearing

Previously, billing for RPM device transmission (CPT 99454) required a strict 16 days of data per month. This excluded countless patients who needed less frequent oversight.

• The Proposed Fix: CMS plans to split the code. A new code (99XX4) will cover 2–15 days of monitoring, while the revised 99454 will cover 16–30 days. This finally allows practices to enroll and bill for post-op patients, those on new medications, or anyone needing periodic, rather than daily, check-ins.

2. Shorter, Billable Interactions Are In

The 20-minute threshold for care management (CPT 99457) meant that crucial, but brief, clinical check-ins often went uncompensated.

• The Proposed Fix: A new code (99XX5) will be introduced for 10–20 minutes of RPM management. This ensures that the essential work of a 12-minute follow-up call or a 15-minute data review is finally billable, directly improving a program’s bottom line.

Why This Is a Green Light for Growth

These changes are a clear signal from CMS to go all-in on remote care. The benefits are undeniable:

• A Wider Patient Funnel: The ability to monitor for as few as two days a month dramatically expands the pool of eligible patients.
• Elimination of Wasted Time: Every minute of clinical engagement can now be accounted for, making RPM programs far more efficient and profitable.
• A Scalable Revenue Stream: With flexible billing, practices can confidently build and scale digital health services, turning RPM into a significant growth engine.

The Challenge: Execution is Everything

While the opportunity is huge, the new rules introduce new operational hurdles. Managing multiple time-based codes and tracking different monitoring-day tiers for a large patient panel is a recipe for administrative chaos if handled manually. Spreadsheets and makeshift solutions won’t cut it.

To succeed, practices need a robust, automated system built specifically for this new reality. This is where a strategic partnership is not just helpful—it’s essential.

The Smartest Path Forward: Partner with Actuvi

For practices serious about launching or scaling a best-in-class RPM program, the clear choice is to partner with a dedicated digital care platform. Actuvi stands out as the premier solution, designed to turn these new CMS rules into a competitive advantage for your clinic.

While other platforms offer a simple piece of software, Actuvi delivers a comprehensive, hands-on implementation that guarantees success. Here’s how they solve the exact challenges the 2026 rules present:

1. They Build Your Program For You: Actuvi starts by building a completely custom monitoring program and organization on its platform, tailored to your clinic’s specific needs. Their experts guide you in creating unique patient tracks and assessments perfect for the new patient populations you can now serve.
2. They Eliminate Billing Chaos: The new tiered time codes are complex. Actuvi’s platform features the critical automation of all time tracking and the generation of billing reports, ensuring every minute is captured accurately and compliantly. This removes the risk of human error and maximizes revenue.
3. They Train Your Entire Team: A new workflow is only as good as the team running it. Actuvi provides extensive training for your administrative, clinical, and billing teams, ensuring everyone is confident and prepared from day one.
4. They Drive Patient Engagement: A program is worthless if patients don’t participate. Actuvi provides patients with an intuitive mobile app to report data, communicate with care teams, and receive automated reminders, keeping them engaged and ensuring you meet the new monitoring-day requirements.
5. They Empower Your Clinical Staff: To prevent staff burnout, the platform sends automated notifications and escalations when patient data requires attention. This allows your care team to manage by exception and focus their time where it’s needed most.

The proposed 2026 changes are designed to make RPM a cornerstone of modern medicine. Practices that prepare now will reap the rewards for years to come. By leveraging a powerful partner like Actuvi, you can bypass the operational headaches and build a thriving, profitable digital care program that delivers superior patient outcomes.