RPM service companies
Automated billing across a large monitored population.
RPM Billing and CPT Codes
RPM billing software and CPT code tracking
RPM programs lose revenue when device days, management minutes and consent are not recorded the way each CPT code requires. We build RPM billing software that tracks all three in the product and hands your billing team clean, audit-ready 837P claims.
RPM and RTM CPT codes837P ClaimsAudit LoggedHIPAA-Ready
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What does RPM billing software do?
RPM billing software records the evidence each remote patient monitoring CPT code needs: consent and setup, the days a device sent readings in each 30-day period, and the minutes of management time. Agnotic Technologies builds this tracking into your RPM product, so claims follow the CY 2026 Medicare code rules and hold up in an audit.
For 2026, Medicare pays RPM device supply through CPT 99454 (16 to 30 days of readings) and 99445 (2 to 15 days), and management time through 99470 (first 10 minutes), 99457 (first 20 minutes) and 99458 (each additional 20 minutes).
The codes
What data does each RPM code require?
Each RPM code maps to one piece of program work. 99453 is the one-time setup and patient education. 99454 and 99445 are the monthly device supply codes, split by days of readings, and 99470, 99457 and 99458 cover management time in a calendar month.
Getting paid means proving each element: setup happened once, the device-day count fits the code billed, and the minutes were spent and documented. We build the tracking and evidence for every code, so your billing team checks claims instead of rebuilding them.
RPM billing architecture
See how device readings and clinician time flow through day-count and timer logic into clean RPM CPT claims.
What we automate in RPM billing
Every rule that decides whether an RPM claim gets paid, encoded in the product.
CPT 99453 setup billing
One-time setup and patient education billed once per episode, with logic that prevents duplicate 99453 charges across a patient's monitoring lifetime.
CPT 99454 and 99445 device days
Automatic counting of days with readings in each 30-day period, so the right device supply code applies (99454 for 16 to 30 days, 99445 for 2 to 15) and at-risk patients are flagged before the window closes.
CPT 99470, 99457 and 99458 time capture
A per-patient, per-calendar-month timer that records management minutes and applies 99470 for the first 10 minutes or 99457 for the first 20, then 99458 for each additional 20, with a documented interaction log.
Eligibility & denial guards
Pre-claim checks for consent, established-patient status, and code-combination rules that catch the errors payers deny for, before the claim is submitted.
837P generation & audit trail
Clean X12 837P professional claims with modifiers and ICD-10 linkage, plus an immutable audit trail so every billed minute and reading is defensible under review.
Where it runs
Who needs RPM billing software?
Health system RPM lines
Enterprise billing tied to existing revenue cycle.
Chronic care programs
Recurring monthly RPM billing for chronic conditions.
Physician practices
In-practice RPM billing without a separate biller.
Existing RPM platforms
Bolt-on billing accuracy for a platform missing it.
Value-based programs
RPM billing alongside quality and outcome tracking.
Which thresholds decide RPM revenue?
Days of readings and documented minutes decide which RPM code applies in a month. We count both automatically.
16 to 30
Days of readings for CPT 99454
2 to 15
Days of readings for CPT 99445
10 or 20 min
First management tier: 99470 or 99457
Compliance-First Healthcare App Development Services Backed by Global Standards
15-Minute Scoping Call01
HIPAA
Health Insurance Portability and Accountability Act
Protect PHI with privacy-first architecture, encrypted storage and transmission, strict access controls, and traceable audit logs.
02
GDPR
General Data Protection Regulation
Implement lawful consent flows, data minimization, retention controls, and secure processing for sensitive health data.
03
FHIR
Fast Healthcare Interoperability Resources
Enable standardized health data exchange across apps, care teams, and systems through standards-based FHIR APIs.
04
HL7
Health Level Seven International
Support enterprise-grade interoperability with HL7-based integrations for records, events, and clinical messaging workflows.
05
HITRUST
Health Information Trust Alliance
Align security programs to healthcare-specific control and risk management practices trusted by providers and ecosystem partners.
06
HITECH
Health Information Technology for Economic and Clinical Health Act
Design with breach notification readiness, digital record safeguards, and operational controls that support regulated care programs.
07
SaMD
FDA Software as a Medical Device
Plan software quality, traceability, and documentation pathways for products that may require SaMD review and submission.
08
MDR (EU)
Medical Device Regulation (European Union)
Prepare EU market-ready processes for risk classification, evidence tracking, and lifecycle governance under MDR expectations.
09
SAMHSA
Substance Abuse and Mental Health Services Administration
Apply confidentiality controls and consent-aware sharing models for behavioral and mental health data experiences.
Standards & billing
RPM billing standards
CPTX12ICD-10HIPAANCCI
Our Process
How do we build RPM billing software?
We encode the reimbursement rules as product logic, so clean claims are the default and denials are the exception.
1.
Billing rule discovery
We map your payer mix to the RPM code rules (device-day counts, time tiers and modifier requirements) and design the billing data model.
Rules-mapped
2.
Threshold & timer build
Device-day counting and the per-month management timer, with interaction logging wired to clinician identity.
Threshold-safe
3.
Claim generation
837P output with modifiers, ICD-10 linkage, and eligibility guards, validated against real denial patterns.
Clean claims
4.
Clearinghouse & reconciliation
Connection to your billing system or clearinghouse, remittance (835) reconciliation, and denial dashboards.
Revenue-visible
RPM ROI worksheet
How do you work out RPM ROI?
You work out RPM ROI by counting the patients who meet each code's rules in a month, multiplying each count by your payers' rate for that code, then subtracting device, staff and platform costs. Use your own numbers below; we supply no rates.
| Line | What you enter | How to work it out |
|---|---|---|
| 1. Setup | Patients newly enrolled this month | New patients x your rate for 99453 |
| 2. Device supply | Patients with 16 to 30 days of readings, and patients with 2 to 15 days | Each count x your rate for 99454 or 99445; a patient gets one or the other |
| 3. Management time | Patients with 10 to 19 minutes, patients with 20 minutes or more, and each further 20 minutes | Each count x your rate for 99470, 99457 or 99458; 99470 and 99457 are not billed together |
| 4. Monthly revenue | No new input | Lines 1 + 2 + 3 |
| 5. Device and data cost | Device, cellular data and replacement cost per monitored patient | Cost per patient x monitored patients |
| 6. Clinical staff cost | Minutes per patient per month and the staff hourly cost | Patients x minutes / 60 x hourly cost |
| 7. Platform and billing cost | Software, hosting, support and billing fees | Monthly total |
| 8. Monthly margin | No new input | Line 4 minus lines 5, 6 and 7 |
Rates differ by payer, locality and year, and the codes a patient qualifies for depend on that month's readings and documentation. Check the current CPT descriptors and your contracts; this worksheet is a planning aid, not a quote.
Facts and sources
Which rules shape RPM billing?
Short facts we design RPM billing software around, each linked to its primary source.
Medicare's remote physiologic monitoring codes include CPT 99453, 99454, 99457 and 99458, and the CY 2026 Physician Fee Schedule added 99445 and 99470 for shorter monitoring periods and shorter management time.
Source: Federal Register, November 5, 2025 (CY 2026 Physician Fee Schedule final rule, CMS-1832-F)CMS states in the CY 2026 Physician Fee Schedule final rule that the 2 to 15 day and 16 to 30 day device supply codes are not additive, and that 99470 (first 10 minutes) and 99457 (first 20 minutes) are not billed together: the practitioner picks the code that fits the month.
Source: Federal Register, November 5, 2025 (CY 2026 Physician Fee Schedule final rule, CMS-1832-F)HIPAA adopts ASC X12 standards for electronic transactions, including health care claims (837), payment and remittance advice (835), eligibility inquiries (270/271) and prior authorization requests (278).
Source: 45 CFR Part 162 (eCFR)The HIPAA Security Rule requires administrative, physical and technical safeguards for electronic protected health information.
Source: 45 CFR Part 164 Subpart C (eCFR)
Featured case study
Read Case StudyLera Health: compliant women's health platform
Related proof of compliant delivery: for Lera Health we built precise, auditable data workflows connecting testing to care, the same rigor in tracking and documentation that defensible RPM billing depends on.
Why Partner With Us
15-Minute Scoping CallWhy build RPM billing with Agnotic?
We treat reimbursement as software, so revenue doesn't leak at the thresholds.
Audit-defensible by design
Every reading and minute is logged against identity and time, so claims hold up when a payer looks.
Fewer denials, faster cash
Pre-claim eligibility and code-combination guards catch the errors payers deny for before submission.
Reimbursement depth
We encode the device-day and time-tier rules precisely, not approximately: the difference between paid and clawed back.
Fits your billing stack
837P output and 835 reconciliation into your existing billing system or clearinghouse.
Stop leaving RPM revenue at the thresholds
RPM CPT billing tracked in the product and audit-ready
Frequently Asked Questions
Under the CY 2026 Medicare Physician Fee Schedule, RPM uses 99453 for setup, 99454 or 99445 for device supply depending on days of readings, and 99470, 99457 and 99458 for management time. Your billing team confirms payer rules; we build the software that records the evidence for each code.
Cost depends on scope: device-day tracking, time capture and 837P generation form the core, and it costs less when built alongside a broader RPM platform. Clearinghouse integration and 835 reconciliation add scope. We give a fixed estimate after the scoping call.
It depends on how many codes and payers you bill, whether your monitoring product already records readings and time, and how deep the clearinghouse connection goes. A first release covers device-day tracking, the management timer and clean 837P output, and we give you a dated plan after the scoping call.
Yes. We can build the worksheet lines into your RPM product or admin dashboard and feed them with real enrollment, device-day and time data instead of estimates, so finance sees projected and actual margin side by side.
Your biller can submit claims, but they can't count device days or capture management minutes: those depend on the monitoring product. We build the tracking and evidence in-product, then hand clean 837P claims to your existing biller or clearinghouse.
We generate X12 837P claims and reconcile 835 remittances, connecting to your billing system, EHR, or clearinghouse. Readings and time come from the monitoring platform via a shared FHIR data model, so there's no manual re-entry between clinical activity and the claim.
We log every device reading and every minute of care-management time against a clinician identity with timestamps, in an immutable trail. When a payer audits an RPM claim, the device-day readings and the documented interaction record are there to support it.
RPM codes cover physiologic data from a medical device, such as blood pressure or weight. RTM billing uses its own codes for therapy data (respiratory, musculoskeletal and cognitive behavioral therapy), which can include self-reported data, and for 2026 it gained 98984, 98985, 98986 and 98979. We build automation for both.
Yes. Chronic care management has its own codes and time rules, but the monthly timer, consent capture and audit log we build for RPM extend to it. One product can then support CCM billing alongside RPM and RTM.
Ready to automate RPM billing?
Tell us your codes and payer mix. We'll return a plan to enforce the RPM code rules in the product and generate clean, audit-ready 837P claims.
contact@agnotic.com
Partnerships
contact@agnotic.com