RPM · 2026 Medicare final
CPT 99454: RPM device supply, 16 to 30 days of readings
CPT 99454 is the Medicare RPM code for device supply, 16 to 30 days of readings. The CY2026 national non-facility rate is $52.11. A 99454 claim must pass 5 checks under the CY2026 Medicare final rule; each is below with its source.
CPT 99454 documentation checklist
- 16 or more days of readings in the 30-day period
- Readings come from a medical device that uploads them automatically
- Patient consent on file, at the latest when the first service is furnished
- Established patient before monitoring starts
- One practitioner bills device codes per 30-day period; never RPM and RTM together
Why 99454 claims get stopped
- 15 daysRepair
- 1 dayHold
- Readings typed into a portal by the patientHold
- Device type unknown in the exportExpert review
- No consent on fileRepair
- Consent dated after the first serviceHold
- Consent on file without a dateExpert review
- No visit on fileHold
- Two practices bill 99454 in one periodHold
- RPM and RTM device codes in one periodHold
- Same minutes counted for CCM and RPMHold
01 · RPM-DEV-01 · in force from 2026-01-01
16 or more days of readings in the 30-day period
- Days with a reading
- 16–30 of 30
- Period
- 30 days from the first reading
“The 2 to 15 day codes (99445, 98984, 98985, and 98986) and 16 to 30 day codes (99454, 98976, 98977, 98978) are not additive.”
CMS PFS CY2026 final, 90 FR 49397Examples
- 18 days of readingsReady
- 16 days exactlyReady
- 15 daysRepair
- Two readings on one day count onceReady
- 1 dayHold
02 · 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 84543Examples
- Cellular cuff, readings arrive by themselvesReady
- Readings typed into a portal by the patientHold
- Device type unknown in the exportExpert review
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. 13Examples
- 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
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 78884Examples
- Office visit in the prior 3 yearsReady
- No visit on fileHold
05 · RPM-OVL-01 · in force from 2024-01-01
One practitioner bills device codes per 30-day period; never RPM and RTM together
“Only one practitioner can bill CPT codes 99453 and 99454, or CPT codes 98976, 98977, 98980, and 98981, during a 30-day period… RPM and RTM may not be billed together.”
CMS PFS CY2024 final, 88 FR 78883Examples
- Two practices bill 99454 in one periodHold
- RPM and RTM device codes in one periodHold
- Same minutes counted for CCM and RPMHold
- One practice, RPM only, own minutesReady
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.