Key Care Management Updates from Medicare in the 2026 CMS Physician Fee Schedule (PFS) FINAL Rule

By Juli Eschenbach, Custom Solutions Manager and Clinical SME

The Centers for Medicare & Medicaid Services (CMS) delighted care management teams and advocates with the published 2026 Medicare Physician Fee Schedule (PFS) FINAL Rule on Nov 5, 2025.  The final 2026 changes for Remote Patient Monitoring (RPM) are significant and we are very excited that CMS is moving RPM into the mainstream of patient care. 

In addition to new proposed RPM codes, CMS made it clear they will continue to support behavior health with new Advanced Primary Care Management (APCM) add-on codes for Behavioral Health Integration (BHI) — with an emphasis on integrating BHI more heavily into the other care management spaces.

Federally Qualified Health Health Center (FQHC) will also benefit from the focus on behavior health and will be transitioned to PFS code billing for BHI services during 2026.

Here is an overview of the CMS Final Rule 2026 exciting new changes for Care Management:

Remote Patient Monitoring (RPM) updates:

CMS finalized new codes for fewer monitoring days and shorter time requirements.   This means that clinical care for these patients is recognized at a broader level:

• CPT 99445 – for 2-15 days of readings in a 30-day period from a connected physiologic monitoring device. 
• CPT 99470 – for the first 10 minutes of clinical staff/physician time, requiring at least one real-time interactive communication with the patient or caregiver during the month.

CMS has kept existing RPM device code 99454 to cover 16 to 30 days of readings in a 30-day period and RPM time.   They also keep existing RPM time codes 99457 and 99458, which cover increments of 20 minutes.

What does this mean? CMS emphasizes the importance of physiologic data and the value of remote care time spent to patient care and indicates it aims to protect reimbursements in this area.   CMS also clarified that they see RPM as a “longitudinal service” that should continue as long as it is medically necessary with practice dispensed devices.

Advanced Primary Care Management (APCM) Updates

In an expansion of services covered in last year’s new APCM codes, CMS has created an add-on code to APCM specific to BHI services.  This allows providers to bill for service for BHI by interdisciplinary teams complimentary to APCM, without the requirement of time tracking.

• G0568 – add on to G0556
• G0569 – add on to G0557
• G0570 – add on to G0558

Remote Therapeutic Monitoring (RTM) Updates:

CMS is underscoring the value of RTM care time spent and data input from patients for non-physiologic patient data the addition of three new codes:

• CPT 98979 – for the first 10 minutes time as a billable threshold, requiring at least one real-time interactive communication with patient or caregiver during month.
• CPT 98984 – for 2-15 days of readings in a 30-day period for device and data transmission to monitor respiratory system. 
• CPT 98995 – for 2-15 days of readings in a 30-day period for device and data transmission to monitor musculoskeletal system. 

Remote Therapeutic Monitoring time codes and device codes are going to be fully available as part of the suite of services ChronicCareIQ supports in 2026.  Please contact our support for more information about the requirements for these codes.

Federally Qualified Health Center (FQHC) and Rural Health Center (RHC) Updates: 

CMS is sunsetting the FQHC/RHC code G0512 and converting billing to the PFS equivalent codes. This was the case in 2025 for G0511, and will occur in the same manner.   FQHC/RHCs also qualify for add-on codes proposed for BHI services under the APCM umbrella, expanding the care management billing opportunities to some of the most vulnerable populations. 

ChronicCareIQ Action Plan:  Integrate new codes by January 1st, 2026

Our process for integrating annual code updates is meticulous and ensures accuracy and compliance:

• Initial Review: We dive in early, reviewing the Proposals released in July, to evaluate potential software updates, including the next year’s RPM codes.
• Design and Development: Our team will begin to work from the definitive, complete set of regulations.  ChronicCareIQ meticulously reviews the Final Rule to ensure accuracy.
• Information Gathering:  We are working through details regarding exact mechanisms or drop eligibility and will share the full, exciting scope of these features in upcoming communications.
• Billing Engine Updates: The final piece we will include is the 2026 price schedule is also a critical factor and has not been released yet.

Upcoming Communications

We will share specific information about how ChronicCareIQ adds these game-changing codes to our software:

• Annual December Webinar: We will be hosting our annual webinar on December 11th covering billing changes, release notes, and operational updates.
• Ongoing Communications: Expect more communications and ChronicCareIQ University postings about the new codes’ integration and functionality.

We appreciate your excitement and patience as we work diligently to ensure a seamless, compliant, and feature-rich transition into the new 2026 codes.