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RPM · 2026 Medicare final

CPT 99453: RPM setup and patient education

CPT 99453 is the Medicare RPM code for setup and patient education. The CY2026 national non-facility rate is $21.71. A 99453 claim must pass 4 checks under the CY2026 Medicare final rule; each is below with its source.

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CPT 99453 documentation checklist

Why 99453 claims get stopped

  • Readings typed into a portal by the patientHold
  • Device type unknown in the exportExpert review
  • Second 99453 in the same episodeHold
  • 1 day of readingsHold
  • No consent on fileRepair
  • Consent dated after the first serviceHold
  • Consent on file without a dateExpert review
  • No visit on fileHold

  1. 01 · RPM-DEV-03 · in force from 2021-01-01

    Readings come from a medical device that uploads them automatically

    “The device must meet the FDA's definition of a medical device… and should digitally (that is, automatically) upload patient physiologic data (that is, data are not patient self-recorded and/or self-reported).”
    CMS PFS CY2021 final, 85 FR 84543

    Examples

    • Cellular cuff, readings arrive by themselvesReady
    • Readings typed into a portal by the patientHold
    • Device type unknown in the exportExpert review

  2. 02 · RPM-SETUP-01 · in force from 2026-01-01

    Setup billed once per episode of care, after 2 or more days of readings

    Days with a reading
    ≥ 2
    “CPT code 99453 can be billed only once per episode of care… beginning when the remote physiologic monitoring service is initiated and ends with attainment of targeted treatment goals.”
    CMS PFS CY2026 final, 90 FR 49399

    Examples

    • First month, 3 days of readingsReady
    • Second 99453 in the same episodeHold
    • 1 day of readingsHold

  3. 03 · RPM-CONS-01 · in force from 2021-01-01

    Patient consent on file, at the latest when the first service is furnished

    “…allow consent to be obtained at the time that RPM services are furnished.”
    CMS PFS CY2021 final, 85 FR 84544 · MLN901705 p. 13

    Examples

    • Signed consent dated before the first readingReady
    • Verbal consent in a note with date and staffReady
    • No consent on fileRepair
    • Consent dated after the first serviceHold
    • Consent on file without a dateExpert review

  4. 04 · RPM-EST-01 · in force from 2023-05-12

    Established patient before monitoring starts

    “RPM, not RTM, services require an established patient relationship after the end of the PHE.”
    CMS PFS CY2024 final, 88 FR 78884

    Examples

    • Office visit in the prior 3 yearsReady
    • No visit on fileHold

Related RPM codes

This page explains Medicare rules; it is not legal or billing advice. Rates are CY2026 national non-facility amounts; your MAC's locality rates differ.