Analysis performed by CareSimple with the collaboration of AI Agent: Copilot Researcher

Effective January 1, 2026, CMS’s final policies significantly expand reimbursement and open new pathways to scale tech‑enabled care—especially Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), and outcomes‑based chronic care models. Together, these changes make it easier to enroll more patients, bill appropriately for shorter monitoring windows and briefer management time, and participate in new national models that reward measurable outcomes.1 

Key Changes in 2026 

• New RPM Codes (99445 & 99470) let you bill for 2–15 days of device‑based monitoring and for 10–19 minutes of monthly management, filling long‑standing gaps created by the 16‑day/20‑minute thresholds. 

• RTM Expansion adds 2–15 day device codes and a 10–19 minute management code, plus updated national average payments across the RTM family. 

• ACCESS Model (10‑year, voluntary) introduces Outcome‑Aligned Payments for technology‑supported chronic care (CKM, MSK, BH, and early CKM), with the first cohort starting July 1, 2026. 2 

• MAHA ELEVATE funds up to $100M in three‑year cooperative agreements to test lifestyle/functional medicine interventions not currently covered by Medicare (first cohort Sept 1, 2026). 3 

• Telehealth Flexibilities remain in place via CMS MLN resources and updates, sustaining hybrid care momentum into 2026. 4 

• ACO REACH (PY2026) Updates tighten risk score growth caps, adjust benchmark weights, and narrow risk corridors—further incentivizing home‑based and virtual care capabilities. 5 

RPM Code Expansion & Payments for 2026

For years, RPM billing hinged on two cliffs: ≥16 days of data to bill device supply (99454) and ≥20 minutes of management time (99457). In 2026, CMS adds two codes that acknowledge real‑world adherence and briefer but meaningful clinical touchpoints. 

 

New RPM Device Supply Code: CPT 99445 

• What it covers: Device supply + data transmission when a patient records 2–15 days of physiologic readings in a 30‑day period. Cannot be billed together with 99454 in the same 30‑day cycle (choose one). 

• National average payment (2026): Approximately $47; CMS finalized equal valuation for 99445 and 99454 to reflect similar device supply costs regardless of days monitored. Actual payment varies by locality. 

New RPM Management Code: CPT 99470 

• What it covers: The first 10–19 minutes of monthly treatment management time; requires ≥1 real‑time interactive communication (phone/video). Not billed alongside 99457 in the same month. 

• National average payment (2026): Approximately $26; valuation is about half of 99457, offering a bridge for lighter‑touch care. Actual payment varies by locality. 

Foundational RPM Codes (Unchanged Structure) 

• 99453 (initial setup & patient education, one‑time) – ~$22 national average in 2026 (varies by locality). 

• 99454 (device supply, 16–30 days in a 30‑day period) – ~$47 national average. 

• 99457 (first 20 minutes of monthly management) – ~$52 national average. 

• 99458 (each additional 20 minutes) – ~$41 national average. 

Compliance reminders: All RPM management codes (99470/99457/99458) require at least one real‑time patient interaction monthly; device codes and management codes are distinct services; track time and documentation separately if co‑billing with CCM/RTM where permitted. 

RTM Code Expansion & Payments for 2026

RTM (for non‑physiologic data such as therapy adherence, response, MSK or respiratory status) gains the same flexibility as RPM with new codes for shorter monitoring and management: 

New RTM Codes 

• 98985 (MSK device supply): 2–15 days of transmissions in a 30‑day period; ~$40 national average (APM vs non‑APM), locality dependent. 

• 98984 (Respiratory device supply): 2–15 days; ~$40 national average. 

• 98979 (first 10–19 minutes of RTM treatment management): ~$26.50 national average. 

 

Existing RTM Codes (Key 2026 Payments) 

• 98975 (initial set‑up & education, once per episode): ~$21.75 

• 98976/98977/98978 (device supply 16–30 days for respiratory/MSK/CBT): ~$40 

• 98980 (first 20 minutes management): ~$54 

• 98981 (each additional 20 minutes): ~$41.50 

Why the valuation shift matters: CMS is increasingly relying on OPPS geometric mean cost data to value these codes; the introduction of 2–15 day device options and 10–19 minute management reflects a practical reimbursement pathway for patients who don’t meet longer thresholds.  

ACCESS Model: Outcome‑Aligned Payments for Tech‑Enabled Chronic Care 

ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a national, voluntary, 10‑year model for Original Medicare beneficiaries that pays participating organizations based on measurable outcomes—not volume of activities. The first cohort starts July 1, 2026; applications are due by April 1, 2026 (rolling applications thereafter). 6 7 

How ACCESS Works 

• Tracks & Conditions: Early CKM (hypertension, dyslipidemia, obesity/central adiposity, prediabetes), CKM (diabetes, CKD, ASCVD), MSK (chronic MSK pain), and Behavioral Health (depression, anxiety). 8 

• Payment Approach: Outcome‑Aligned Payments (OAPs)—recurring payments linked to the share of patients who meet condition‑specific outcome targets (e.g., BP control, HbA1c, lipid levels, pain/function scores) relative to baseline. 9 

• Care Modality: Integrated, technology‑supported care—in‑person, virtual, asynchronous—plus device/software use where clinically appropriate. 10 

• Eligibility: Medicare Part B‑enrolled providers/suppliers (excluding DMEPOS and labs). Patients voluntarily enroll or are referred by a clinician; CMS will publicly report risk‑adjusted outcomes via a national directory to promote transparency and competition. 11 

Provider takeaway: ACCESS gives health systems, ACOs, and care organizations a predictable, non‑FFS revenue stream tied to outcomes—ideal for teams already operating RPM/RTM programs, integrated care management, and lifestyle coaching. 12

ACCESS & RPM, in a nutshell 

FINANCIAL STABILITY VS. PERFORMANCE RISK 

• ACCESS: Steady monthly payments tied to outcomes, boosting revenue predictability – but no payment if targets aren’t met. 

• RPM: Pay for activity (minutes logged, data transmitted) yields guaranteed income when billing criteria are met but can fluctuate with patient compliance. 

OPERATIONAL & TECH FLEXIBILITY 

• ACCESS: Any device/app, any intervention – unlimited flexibility to tailor care (CMS cares about results, not how you get there). Less “checkbox” admin on device usage, but new data reporting duties (outcomes submission to CMS, HIE integration). 

• RPM: Structured around specific CPT tasks (e.g. 16→2 readings, 20→10 min staff time in 2026). Admin focus on billing compliance (tracking readings, minutes) rather than outcome analytics. 

PATIENT ENGAGEMENT & ACCESS 

• ACCESS: $0 co-pays remove cost barriers, driving higher enrollment and adherence. 

• RPM: 20% co-pay (~$20/month) deters ~30% of patients, limiting program reach and impact. 

STRATEGIC & LONG-TERM CONSIDERATIONS 

• ACCESS: Aligns with Medicare’s value-based future (10-year national pilot thru 2036). Early adoption can position the system as an innovator, but model details still evolving and some patients will be in a control group. 

• RPM: Known quantity with recent improvements (2026 fee increases, relaxed requirements). Lower short-term risk, but FFS payments may decline if CMS shifts fully to models like ACCESS over time. 

 

Other CMS programs in 2026

MAHA ELEVATE: $100M for Lifestyle & Whole‑Person Care Pilots

MAHA ELEVATE (Make America Healthy Again: Enhancing Lifestyle and Evaluating Value‑based Approaches Through Evidence) is a CMS Innovation Center initiative funding up to 30 cooperative agreements over three years (~$3M per project) to evaluate whole‑person, lifestyle medicine interventions not currently covered by Original Medicare. NOFO releases early 2026; first cohort launches Sept 1, 2026 (second cohort in 2027). 13 14 

• Required components: Nutrition or physical activity must be included; several awards reserved for dementia‑focused interventions. Funding supports services and data collection but cannot pay for food or services already billable to Medicare. 15 

• Objective: Build the U.S. evidence base on effectiveness, cost, and quality of lifestyle interventions to inform future Medicare coverage decisions and new models. 16 17 

Provider takeaway: Health systems, ACOs, and tech‑enabled care organizations can partner on proposals that integrate RPM data with coaching on nutrition, physical activity, sleep, stress, and social connection—creating a pipeline for potential future coverage. 18 

Telehealth Flexibilities & MLN Guidance 

CMS’s MLN Telehealth & RPM booklet keeps providers current on flexibilities and billing rules (origin site, distant site, audio‑only allowances, consent, and RPM best practices). The 2025 update extended several flexibilities and clarified RPM documentation—useful context as you design 2026 hybrid care programs. 19 

ACO REACH: PY2026 Financial Methodology Adjustments 

For value‑based organizations, PY2026 updates are aimed at sustainability and accuracy: 

• Risk score growth constraints: Additional 3% cap applied to growth 2019→2026 (after existing caps/CIF), plus CIF ceiling increased to 2% for High Needs ACOs and an 8% cap for newly voluntarily aligned High Needs beneficiaries. 20 

• Benchmark blend shifts: Greater weight on historical vs regional expenditures across ACO types (e.g., Standard ACOs move toward 60/40 historical/regional in PY2026). 

• Narrowed risk corridors: Global risk option’s first risk corridor narrows from 25% to 10%—CMS shares in savings/losses sooner. 21 

Provider takeaway: These adjustments reward appropriate coding, emphasize historical performance, and increase the importance of home‑based, virtual, and RPM‑supported care to achieve quality and savings. 22 

What This Means for Providers: Practical Benefits 

• Enroll more patients, sooner
  Short‑duration RPM/RTM codes (99445, 98985/98984) legitimize post‑discharge, episodic, and near‑adherent scenarios that previously went unreimbursed. 

• Capture revenue for briefer work
  Management codes for 10–19 minutes (99470, 98979) ensure clinically meaningful touchpoints are paid—even when you don’t hit 20 minutes. 

• Operate hybrid programs confidently
  MLN guidance and telehealth flexibilities support compliant, scalable workflows that blend in‑person, video, phone, and asynchronous engagement. 23 

• Add outcomes‑based revenue streams
  ACCESS enables recurring OAP payments tied to outcomes across CKM/MSK/BH tracks—ideal for teams with mature RPM/RTM data pipelines. 24 25 

• Fund lifestyle integration
  MAHA ELEVATE grants provide capital to test nutrition, activity, sleep, stress interventions—building evidence and new capabilities that can dovetail with RPM alerts and coaching. 26 

• Strengthen value‑based care positioning
  ACO REACH’s PY2026 changes heighten the role of virtual and remote monitoring to hit quality targets and manage total cost of care. 27 

Implementation Guide: How to Win in 2026 

1. Tier your monitoring pathways
   Create short‑duration RPM/RTM tracks (2–15 days) for post‑discharge or episodic use cases; maintain standard tracks (16–30 days) for chronic conditions. Ensure your platform captures days‑monitored and supports automated code selection (99445 vs 99454; 98985/84 vs 98977/76). 
2. Log interactive time meticulously
   Configure workflows to log real‑time communications and categorize minutes into 10–19 (99470/98979) vs ≥20 (99457/98980) with overflow to 99458/98981. Train staff on mutually exclusive combinations in a month.
3. Prepare for ACCESS outcomes
   Align care teams to track condition‑specific metrics (BP control, HbA1c, lipids, pain/function, PHQ‑9/GAD‑7) and report baseline‑to‑target improvements. Establish EHR/HIE integrations and patient enrollment/referral pathways ahead of the April 1, 2026 application deadline; first cohort July 1, 2026. 28
4. Position for MAHA ELEVATE grants
   Identify lifestyle intervention partners; co‑design proposals that integrate RPM signals with nutrition/activity/sleep/stress coaching. Plan for outcomes + cost + quality data collection; remember funding cannot cover food or services already billable to Medicare. NOFO early 2026; first cohort Sept 1, 2026. 29
5. Value‑based alignment
   For ACOs and risk‑bearing groups, map PY2026 ACO REACH changes to your benchmark strategy and expand virtual/RPM capacity to improve quality and manage total cost trends. 30 

The Bottom Line

CMS’s 2026 changes finally match how modern, tech‑enabled care is delivered. With flexible RPM/RTM codes, a decade‑long outcomes model (ACCESS), and funded lifestyle pilots (MAHA ELEVATE), providers have the tools—and reimbursement—to engage more patients continuously, document value, and scale sustainable hybrid care. 

Empowering providers to deliver smarter, more flexible, and patient-centered care—while maximizing revenue, reducing barriers, and driving real health outcomes for every patient

References 

1. https://www.cms.gov/medicare/payment/fee-schedules/physician
2. https://www.cms.gov/priorities/innovation/innovation-models/access
3. https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate
4. https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf
5. https://www.cms.gov/priorities/innovation/aco-reach-model-performance-year-2026-model-update-quick-reference
6. https://www.cms.gov/priorities/innovation/innovation-models/access
7. https://www.acofp.org/news-and-publications/news/full-news-article/2025/12/05/cms-announces-access-model
8. https://foleyhoag.com/news-and-insights/publications/alerts-and-updates/2025/december/cms-announces-access-advancing-chronic-care-with-effective-scalable-solutions-model/
9. https://foleyhoag.com/news-and-insights/publications/alerts-and-updates/2025/december/cms-announces-access-advancing-chronic-care-with-effective-scalable-solutions-model/
10. https://foleyhoag.com/news-and-insights/publications/alerts-and-updates/2025/december/cms-announces-access-advancing-chronic-care-with-effective-scalable-solutions-model/
11. https://www.cms.gov/priorities/innovation/innovation-models/access
12. https://www.nortonrosefulbright.com/en/knowledge/publications/c0469ab9/cms-access-tests-outcome-aligned-tech-enabled-chronic-care
13. https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate
14. https://www.beckershospitalreview.com/hospital-management-administration/cms-launches-maha-elevate-to-test-lifestyle-medicine-in-medicare/
15. https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate
16. https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate
17. https://www.nixonlawgroup.com/resources/cms-announces-maha-elevate-model-a-new-opportunity-to-shape-reimbursement-for-lifestyle-functional-and-whole-person-care-services
18. https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate
19. https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf
20. https://www.cms.gov/priorities/innovation/aco-reach-model-performance-year-2026-model-update-quick-reference
21. https://www.fiercehealthcare.com/regulatory/cms-outlines-tweaks-aco-reach-2026-performance-year
22. https://www.cms.gov/priorities/innovation/aco-reach-model-performance-year-2026-model-update-quick-reference
23. https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf
24. https://www.cms.gov/priorities/innovation/innovation-models/access
25. https://foleyhoag.com/news-and-insights/publications/alerts-and-updates/2025/december/cms-announces-access-advancing-chronic-care-with-effective-scalable-solutions-model/
26. https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate
27. https://www.cms.gov/priorities/innovation/aco-reach-model-performance-year-2026-model-update-quick-reference
28. https://www.cms.gov/priorities/innovation/innovation-models/access
29. https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate
30. https://www.cms.gov/priorities/innovation/aco-reach-model-performance-year-2026-model-update-quick-reference