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ITAS Health

Remote patient monitoring

Paid for the data, and for the time you spend on it.

RPM has two revenue axes and two entirely different failure modes. Device supply is decided by a day count you either have or you don't. Management time is decided by whether a real human had a real conversation with the patient. Both are auditable, and both are where practices lose claims they earned.

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Home monitoring devices and a glass of water on a kitchen table in late afternoon light

How it pays

Two axes, stacked monthly

Understanding RPM means keeping these two apart. The device axis is a counting problem. The time axis is an evidence problem. ITAS treats them as separate gates because CMS does.

Counting problem

Device supply

Paid on distinct transmission days within a 30-day period. The device has to send the data itself — that is what makes the day count real rather than asserted.

  • 99453Device setup & education~$22

    Once per episode, and only payable if the first 30-day period reaches its data threshold.

  • 99454Device supply, 16–30 transmission days~$43

    The full tier. Requires sixteen or more distinct transmission days.

  • 99445Device supply, 2–15 transmission days~$43

    Added for 2026. Covers periods with two to fifteen transmission days — months that used to pay nothing.

Evidence problem

Treatment management

Paid on documented clinical time, and gated on at least one synchronous conversation with the patient during the period. No call, no management code — regardless of how much time was spent.

  • 99457First 20 minutes + live touchpoint~$52

    The first twenty minutes, plus at least one live interactive communication.

  • 99458Each additional 20 minutes~$41

    Each additional twenty minutes, billable up to twice per month.

  • A shorter tier exists for 2026

    CMS added a management code for ten to nineteen minutes, so a period with real but brief clinical work is no longer unbillable. It cannot be combined with the additional-time add-on.

CY2026 published national averages. Amounts vary by locality and payer, and the CY2027 proposed rule would materially reduce device-supply payment if finalized as written — we model conservatively for that. What CMS proposed.

The hardest gate

Sixteen days is not a target. It is a threshold.

A 30-day period with fifteen transmission days is not 94% of a 99454 — it is a different code entirely. Getting this wrong in either direction is a problem: undercounting leaves money on the table, overcounting is a false claim.

So we never estimate it. The day count is reconciled against the device feed itself, and the period resolves to whichever code the count actually supports. If a patient is drifting toward missing the threshold, that becomes an outreach task while there is still time to fix it — which is the only intervention that actually changes the outcome.

16–30 days99454

Full device-supply tier

2–15 days99445

Partial tier, added for 2026

0–1 days

Not billable for device supply

Manual entry

Not a transmission day at all

An older woman sitting at her kitchen table at home in afternoon light

The requirement everyone underestimates

Management time needs a real conversation. Nothing else counts.

CMS requires at least one synchronous, real-time interactive communication with the patient during the period before management time becomes billable. Practices routinely do the clinical work, log the minutes, and then bill on evidence that will not survive a review.

Opens the gate

  • A live phone call the patient actually answered
  • A real-time video visit
  • Any synchronous audio conversation, documented with date, duration, and clinical description

Does not

  • A text message, however clinical
  • A voicemail the patient never returned
  • A portal message answered the next day
  • A patient uploading readings manually
  • Reviewing the data thoroughly and calling nobody

How we handle it: the code stays locked

Management codes remain unavailable until a synchronous touchpoint is logged against the period, with its own record attached to the evidence file. Time accrues in the background regardless — but the claim will not assemble until the conversation has happened. It is a genuinely annoying constraint, which is the point.

RPM questions

The ones with real money attached

What counts as a distinct transmission day?
A calendar day on which the device transmitted at least one valid reading digitally. Sixteen of them in a 30-day period unlocks 99454. Between two and fifteen puts the period on 99445 instead. The two device-supply codes are mutually exclusive — one or the other, never both.
Can a patient just type their readings into an app?
Not for billing. A billable RPM device must meet the FDA definition of a medical device and must transmit data automatically and digitally. Patient-entered numbers, phone photographs of a cuff display, and readings copied from a consumer health app are engagement data. They do not establish a transmission day.
Does a text message count as the interactive communication?
No. CMS is explicit that the requirement for 99457, 99458, and the 10–19 minute code is synchronous, real-time audio or video. Text messages, voicemails with no patient response, and asynchronous portal messages do not satisfy it. This is the single most common reason a management claim is indefensible.
Who is allowed to furnish the management time?
Clinical staff under general supervision, following the December 2021 CMS update — the billing practitioner does not have to review every reading personally, but must maintain the supervisory relationship. Note that CMS has proposed changing who those staff may be from January 1, 2027.
Is RPM Medicare-only?
No, and this is what makes it the largest of our programs for most practices. RPM is widely reimbursed by commercial plans and Medicare Advantage. Since a typical primary care panel is only 30–40% traditional Medicare, RPM roughly doubles the population you can monitor and bill for compared with APCM alone. Coverage does vary by plan and must be verified.
Does the patient need a recent visit with us?
Yes. RPM requires an established patient — a face-to-face service by the billing practitioner, or someone in the same billing group, within the prior year — plus a valid practitioner order for every enrollment.

See which of your patients RPM actually fits

Device monitoring is not right for every chronic patient, and enrolling the wrong ones is how programs collapse in month three. The scan sorts your panel by who will realistically transmit.

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