Remote Patient Monitoring · Chronic Care · Policy
RPM
Chronic Care
Reimbursement
Remote Patient Monitoring (RPM) has become a central part of chronic disease management in the United States, especially after telemedicine expanded rapidly during the COVID-19 pandemic. RPM programs capture physiological data in the home and transmit it to clinicians to support care decisions between office visits.
Adoption has accelerated, but questions remain about sustainability, workflow integration, reimbursement stability, and long-term outcomes.
A 2025 review in the Journal of Medical Internet Research (JMIR), authored by a team at Mayo Clinic, examines the current state of RPM for chronic disease management in the US. This article summarizes that review and adds current regulatory and billing context from the Centers for Medicare & Medicaid Services (CMS) and the U.S. Food and Drug Administration (FDA).
Why RPM Matters for Chronic Disease Management
Chronic diseases such as diabetes, hypertension, heart failure, and chronic kidney disease account for a large share of health care use in the United States. The JMIR review notes that telemedicine and RPM expanded quickly during the pandemic, supported by temporary policy changes.
Evidence cited in the paper links higher telemedicine use to better medication adherence and shifts in utilization, including fewer emergency department (ED) visits for some conditions. RPM helps bridge the space between virtual visits and between-visit care, letting clinicians monitor patients between encounters and respond to changes in status. RPM is a monitoring service and does not replace in-person evaluation or emergency care.
Key Stakeholders in RPM Programs
The review identifies several groups whose interests shape RPM adoption and sustainability.
Patients
RPM can add convenience, engagement, and communication with care teams. Device costs and cost-sharing, however, can affect participation and equity.
Health Systems and Payers
These groups focus on quality, outcomes, and efficiency, especially in value-based care. Uncertainty about long-term reimbursement can limit investment and scale.
Policymakers and Regulators
Federal and state officials balance innovation with safety, equity, and sustainability, including payment for the clinical work of reviewing RPM data, not just device deployment.
Digital Tools Used in RPM
The review groups RPM technologies by how often and what kind of data they collect.
Intermittent Monitoring Devices
Blood pressure monitors
Glucometers
Pulse oximeters
Common for hypertension, diabetes, chronic kidney disease, and heart failure.
High-Frequency and Wearable Devices
Wearable activity trackers
Continuous glucose monitors
Remote ECG systems
Fall detection sensors
Increasingly used for higher-risk patients and conditions needing closer monitoring.
The RPM devices discussed are medical devices as defined by the FDA, many of which moved from pandemic-era emergency use authorizations to standard regulatory pathways.
Implementation Challenges in Clinical Practice
Workflow and staff burden. RPM adds asynchronous messaging and data-review work, requiring new workflows for in-basket management and non-visit care. Without redesign, this can add to clinician workload and burnout.
Technology access and equity. Barriers include device access, broadband, digital literacy, and language, which disproportionately affect rural and low-income patients and can widen disparities if not addressed.
Cost and sustainability. Programs carry upfront and ongoing costs for devices, staffing, and infrastructure, and cost-sharing can limit access for economically disadvantaged patients.
Coverage and Reimbursement Landscape
RPM services are covered by Medicare Part B and billed under specific CPT codes. The review notes that, as of late 2023, 37 state Medicaid programs also reimbursed RPM in some form.
• An established clinician-patient relationship. These requirements have evolved since the pandemic, so confirm current CMS rules.
• The device supply code (99454) requires at least 16 days of data in a 30-day period.
• The device must be a medical device as defined by the FDA, with secure data transmission.
• The management codes (99457 for the first 20 minutes, 99458 for each additional 20 minutes) are time-based and are not subject to the 16-day rule.
For 2026, the CY 2026 Medicare Physician Fee Schedule Final Rule added two codes that expand billing options: 99445 for device supply covering 2 to 15 days of data, and 99470 for the first 10 minutes of management time. Billing has also continued to evolve for FQHCs and RHCs following the retirement of the bundled G0511 code.
Variation across payers and states still creates uneven access and uncertainty for long-term program planning.
Regulatory Considerations for Quality and Safety
RPM devices and platforms are regulated based on risk classification. In October 2023, the FDA issued a final guidance, Enforcement Policy for Non-Invasive Remote Monitoring Devices Used to Support Patient Monitoring, which updated the enforcement approach for these devices after the COVID-19 public health emergency (PHE).
The review underscores the need for:
✓ HIPAA-compliant data platforms
✓ Secure integration of multiple data streams
✓ Quality management systems for device manufacturers
Knowledge Gaps and Opportunities
Despite rapid adoption, the review points to important gaps:
Limited long-term outcome data for sustained RPM use
Insufficient evidence on cost-effectiveness across conditions
Gaps in understanding patient and provider experience
Ongoing challenges with interoperability and administrative burden
The authors highlight opportunities to use artificial intelligence to reduce clinician workload, improve triage, and manage growing data volumes, while stressing the need for careful implementation with a clinician in the loop.
How DrKumo Aligns With the Evidence
The review emphasizes that RPM works best when it is integrated into clinical workflows, supported by appropriate reimbursement, and designed around care-team workload and patient equity. These principles align with how DrKumo approaches remote patient monitoring.
DrKumo supports RPM as part of structured care management, providing secure, HIPAA-compliant platforms that help clinicians receive, review, and act on patient-generated health data within established workflows. Rather than treating RPM as a standalone product, DrKumo focuses on supporting care teams as they integrate remote data into chronic disease management programs consistent with regulatory and reimbursement requirements.
DrKumo is not a clinical entity and does not provide clinical, billing, or coding services. Providers and their care teams retain full responsibility for clinical decisions, code selection, and claim submission. DrKumo supplies the secure infrastructure behind the data.
Key Takeaways
The 2025 JMIR review shows that RPM has moved from a pandemic response tool to a sustained part of chronic disease management in the United States.
Its future depends on resolving reimbursement uncertainty, improving workflow integration, addressing equity barriers, and strengthening long-term outcome evidence.
RPM’s value lies not in devices alone, but in how technology, policy, and clinical practice are aligned to support ongoing care. DrKumo is a technology provider, not a clinical entity, and supports the workflows behind these programs.
Sustainable RPM Programs
Integrate remote monitoring into workflows that hold up over time.
To learn how DrKumo supports secure, HIPAA-compliant remote patient monitoring aligned with evidence-based chronic care workflows, contact us today. Our team is ready to support organizations implementing RPM responsibly and sustainably.
Frequently Asked Questions
Common questions about RPM for chronic disease management and how it is billed.
References
Paul MM, Khera N, Elugunti PR, et al. The State of Remote Patient Monitoring for Chronic Disease Management in the United States. J Med Internet Res, 2025.
Centers for Medicare & Medicaid Services. Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F). CMS.gov.
U.S. Food and Drug Administration. Enforcement Policy for Non-Invasive Remote Monitoring Devices Used to Support Patient Monitoring. Federal Register, 2023.
