RTM: established patients
Starting in 2027, RTM must be furnished to an established patient. Confirm and document the treating relationship before enrollment.
Talk with us MEDICARE POLICY UPDATE · NOVEMBER 5, 2026
What changed for remote monitoring in 2027?
CMS issued its final CY2027 Physician Fee Schedule rule on November 4, 2026. The practical changes, rate examples, and launch checklist are summarized below. Most changes start January 1, 2027. Current 2026 claims and the rate lookup still use 2026 rules and prices.
FINAL POLICY · DIFFERENT EFFECTIVE DATES
The four decisions that matter to a monitoring program
For dates of service beginning January 1, 2027, RTM becomes an established-patient service, both RPM and RTM require a separately reportable initiating visit, and CMS changes the valuation of the code families. The contractor-staff restriction has a later effective date.
A separately reportable initiating visit
At the onset of RPM or RTM, the reporting practitioner must furnish a separately reportable initiating visit. Build the visit and documentation into the launch workflow.
Revised valuation
CMS finalized changes to how RPM and RTM are valued. A current-year fee is not a 2027 projection. The national examples below show direction; verify the final carrier amounts by code, locality, setting, and qualifying APM status before quoting a practice-specific 2027 rate.
Contracted clinical staff: 2029
CMS delayed the direct-employee requirement for clinical staff who perform RPM or RTM services until January 1, 2029. Do not describe this as a 2027 ban on contractors. Review supervision, clinical integration, and contracts now, and plan for the future rule.
2027 RATE DIRECTION · SELECTED NATIONAL EXAMPLES
Device-supply values fall more than management values in these examples.
CMS projects a 2027 non-qualifying APM conversion factor of $32.63, down from $33.40 in 2026 (about 2.3%). Code-specific changes can be larger because practice-expense RVUs also changed. These are non-facility national illustrations, not California locality rates or payment guarantees.
| Code | Service | 2026 national | 2027 illustration | Change |
|---|---|---|---|---|
| 99454 | RPM device supply, 16–30 days | $52.11 | ≈ $41.11 | ≈ −21% |
| 99457 | RPM management, first 20 minutes | $51.77 | ≈ $51.56 | ≈ −0.4% |
| 98977 | Musculoskeletal RTM device supply, 16–30 days | $51.44 | ≈ $40.79 | ≈ −21% |
Method: 2027 Addendum B total non-facility RVU × the final-rule fact sheet’s rounded $32.63 non-QP conversion factor, rounded to cents; compared with the site’s verified October–December 2026 national non-QP examples. These are illustrative calculations, not the official 2027 national payment file or a locality-specific carrier amount. Facility setting, QP status, modifiers, locality GPCI, final carrier files, coverage, and other claim rules can change payment. The 2027 Addendum B values for short device-supply bands 99445 and 98985 are also available, but the table does not imply the short and long bands are billed together. Verify the full 2027 files before quoting a practice-specific amount.
PROPOSED IDEA · NOT ADOPTED
The RPM/RTM code families were not replaced.
CMS asked for comment on bundling existing CPT codes and creating four new HCPCS G-codes. The final-rule summary says CMS may consider that feedback in future rulemaking. Do not swap codes or forecast a new payment pathway from that request for comment.
RELATED SPECIALTY MODEL
Cardiology teams should also check the Ambulatory Specialty Model.
Separately from ordinary RPM billing, CMS’s mandatory Ambulatory Specialty Model begins January 1, 2027 for selected specialists caring for patients with heart failure or low back pain in selected areas. Participation is determined by CMS; a cardiology diagnosis alone does not enroll a practice. The model emphasizes longitudinal management and coordination with primary care.
Check CMS participant and model resources →PRACTICE CHECKLIST
What to review before January 2027
- Identify which patients are new versus established for RTM, and assign the initiating visit to the actual billing practitioner.
- Confirm the patient’s condition, device or software, data-day band, interactive communication, clinical ownership, and the code being considered.
- Map which clinical staff are practice employees, direct contractors, or supplied through another entity; confirm the applicable 2027 rules and prepare for 2029.
- Retest payer contracts and 2027 locality rates. Original Medicare changes do not set Medicare Advantage, Medicaid, or commercial reimbursement.
- Keep 2026 and 2027 dates of service separate in revenue models and patient conversations.
This is a policy summary, not a billing determination. The official final rule, code text, Medicare contractor guidance, and payer contracts govern individual claims. Review date: November 5, 2026.
RELATED PRIMEVITAL GUIDES
Apply the rule to your workflow
RPM and RTM
Payment
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