The American Medical Association’s (AMA) 2026 Current Procedural Terminology (CPT) code set includes 418 changes, consisting of 288 new codes, 84 deletions, and 46 revisions. Among the most impactful updates are significant expansions to Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM), increasing billing flexibility and introducing new compliance considerations for health plans.

 Key Updates to RPM and RTM Services

New billing codes and revisions to code descriptions now allow RPM and RTM services to be reported for shorter data collection periods, 2-15 days within a 30-day period, as opposed to the previous minimum of 16 days. Additionally, new codes 99470 and 98979 have been introduced for reporting 10-19 minutes of clinical staff time with at least one interactive communication for RPM or RTM treatment management services.

These changes provide greater flexibility for providers by allowing claims for patients who do not require a full month of monitoring. They also offer consistency across remote care services, including respiratory, musculoskeletal, and cognitive behavioral therapy monitoring.

New Codes for RPM and RTM Services

• 99445: Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 2-15 days in a 30-day period
• 98984: Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 2-15 days in a 30-day period
• 98985: Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 2-15 days in a 30-day period
• 98986: Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, 2-15 days in a 30-day period

RPM Enrollment and Billing Risk Considerations

While RPM can be a valuable tool for legitimate medical providers to monitor their patients for signals that denote a change in their condition, unscrupulous or fake providers may seek loopholes in claim systems by submitting claims for RPM that is not medically necessary, or in some cases, never provided. Companies may solicit patients with promises to provide equipment for RPM, such as scales, glucose monitors, blood pressure cuffs, cardiac rhythm devices, and other equipment, some of which may never reach the patient, or it is equipment that is not FDA approved. The claims submitted to a health plan may appear to originate from a legitimate durable medical equipment company or pharmacy.

When codes change, a legitimate provider will update their systems to reflect the new codes and submit appropriate claims for the services provided to their patients. Health plans should be wary of providers that start submitting new codes, especially when the prior service codes and patients were not part of the providers’ history.

How Fraud Scope Can Assist

Advanced analytics tools like Fraud Scope play a critical role in proactively identifying suspicious RPM and RTM billing patterns. Fraud Scope’s proprietary AI technology enables health plans to detect indicators such as services billed for patients without an established provider relationship, RPM services without concurrent treatment management, sudden spikes in provider billings, or multiple devices billed for the same patient within a single month.

Fraud Scope’s AI Query tool can quickly identify providers and claim lines for RPM from providers whose claims history did not include the prior RPM service codes and patients.

Fraud Scope’s peer analysis and pattern-based detection models, such as Suspicious Trends, Time Behavior, or Outlier Abuse, can also assist in identifying outlier utilization such as:

• Providers with a high volume of the same procedure code per patient
• Providers utilizing a code at high frequency when very few peers utilize the code
• Providers whose code utilization is trending or peaking during a specific month

References:

AMA Release of 2026 Code Set

https://www.ama-assn.org/press-center/ama-press-releases/ama-releases-cpt-2026-code-set

CMS Remote Patient Monitoring

https://www.cms.gov/medicare/coverage/telehealth/remote-patient-monitoring