Turning Remote CGM Monitoring Into Revenue: How 2026 CMS Changes Boost Diabetes Programs
- SweetSpot Team
- Nov 10
- 6 min read
Each year, the Centers for Medicare & Medicaid Services (CMS) releases the Physician Fee Schedule (PFS), which determines how Medicare reimburses physicians and other qualified healthcare professionals for their services. Beyond setting payment rates, the PFS can be a strong indicator of where healthcare policy is heading.
Over the past several years, CMS has emphasized virtual care and data-driven remote monitoring as essential tools for improving chronic disease outcomes and reducing costs1. The 2026 PFS Final Rule, published in October 2025 and effective as of January 1, 2026, continues that trend. Specifically, the final rule includes two new remote patient monitoring (RPM) codes that expand flexibility and access for both clinicians and patients.
For clinics already running remote CGM monitoring programs (or thinking about starting in 2026), this is a very meaningful update. Below is a breakdown of what changed for the upcoming year, why it matters for diabetes care, and how SweetSpot can help you make the most of it.
Remote Diabetes Care Is Here to Stay
Over the past few years, CMS has steadily expanded coverage for remote monitoring, virtual care management, and telehealth. The 2026 PFS final rule:
Adds new RPM codes that recognize shorter monitoring periods and shorter management time.
Locks in telehealth flexibility, including virtual supervision and fewer limits on telehealth visit frequency.
What’s New for Remote Diabetes Monitoring in 2026?
1. Two New RPM Codes: Shorter Days, Shorter Time
Historically, to bill for remote diabetes monitoring, clinicians needed to meet the following thresholds:
16 or more days of device data in a 30-day period to bill the main device code.
20 or more minutes of documented management time per month to bill the main management code.
In practice, a lot of good clinical work happens just shy of those thresholds, and the 2026 rule, finally recognizes that. 2
New Code #1: Device Supply for 2–15 Days (CPT 99445)
Covers 2–15 days of device data in a 30-day period.
Designed for patients who don’t hit 16 days but still have clinically meaningful monitoring.
Pays at about the same level as the existing 16–30 day device code (99454) on the Medicare national average.
New Code #2: Management Time for 10–19 Minutes (CPT 99470)
Covers the first 10–19 minutes of remote management time in a calendar month.
Requires at least one real-time interactive communication with the patient or caregiver.
Valued at roughly half of the 20-minute management code (99457).3
2. Existing RPM Codes Are Still Here
The “classic” RPM codes remain in place:
99454 – Device supply & transmission, now clearly defined as 16–30 days of data
99457 – First 20 minutes of management time per month
99458 – Each additional 20 minutes
You still choose between:
99445 vs 99454 for each 30-day period (2–15 days vs 16–30 days of data), and
99470 vs 99457 for the “first slice” of management time (10–19 minutes vs 20+ minutes).
They are not stacked together for the same patient in the same month, you pick the one that matches what occurred.
3. Parallel Changes for Remote Therapeutic Monitoring (RTM)
On the RTM side (e.g., for MSK, respiratory, behavioral applications), CMS made similar updates:
New codes for 2–15 days of device data.
A new 10-minute management code to mirror RPM.4
If your clinic also runs RTM programs, these changes offer the same kind of flexibility.
4. Telehealth and Supervision: Flexibilities Made Permanent
The 2026 rule also cements several telehealth policies that matter for remote care programs:
Virtual direct supervision is now permanent: supervising clinicians can meet “direct supervision” requirements via real-time audio/video for many incident-to services.
Telehealth visit frequency limits for inpatient, nursing facility, and critical care visits are lifted, making it easier to fold virtual visits into ongoing care.
Teaching physicians can continue to supervise residents virtually when services are provided via telehealth.5
For diabetes practices, this means more freedom to build team-based workflows that use:
CGM and RPM data
Remote nurse / CDCES outreach
Virtual provider visits
What Does This Mean for Endocrinology Practices?
1. The Potential for Fewer “Unbillable” Months
Before 2026, you might have seen:
A patient who only wore their CGM 10 days out of the month, or a disrupted connection just shy of 16 days.
Or a month where your team spent 15 minutes but didn’t quite get to 20.
Clinically, that work still matters. Financially, it often went uncompensated.
With 99445 (2–15 days) and 99470 (10–19 minutes), those months can now be billable when medical necessity and documentation requirements are met.
2. Stronger Business Case for Remote Diabetes Monitoring
Combine the trends:
New short-duration codes that capture more of the work you’re already doing, and
Permanent telehealth flexibilities that support virtual, team-based workflows…
…and you get a much stronger business case for remote diabetes programs.
For many endocrinology and diabetes clinics, this is no longer a ‘nice to have’ if patients are perfectly adherent. It is becoming a core and sustainable part of diabetes care to better support patients.
3. Better Clinical Fit for How Diabetes Care Actually Works
Diabetes doesn’t always require 30 days of perfect device wear to make a good clinical decision.
The new codes support:
Short, targeted monitoring during insulin titration or medication changes.
“Check-in” periods when you need 2–3 weeks of data to answer a specific clinical question.
Flexibility for patients who can’t always hit 16 days (due to cost, life events, or technology issues).
For patients, that can translate to more timely adjustments, faster feedback, and fewer “wait until your next visit” delays.
Where SweetSpot Fits In
At SweetSpot, we partner with endocrinology and diabetes clinics to turn these kinds of policy changes into real, operational programs.
Here’s how we can help your team take advantage of the 2026 PFS updates:
1. Program Design Acknowledging the New Codes
We help you design remote diabetes workflows that:
Map clearly to clinical and billing guidelines for optimal reimbursement.
Align staffing and documentation with proper time management thresholds.
Integrate CGM data review, outreach, and provider escalation into a single, coherent process.
The goal: more patients supported, less guesswork for your team, and clean documentation that matches the codes you’re billing.
2. Clinical Staff as an Extension of Your Practice
SweetSpot serves as a dedicated partner to our practices. Our team of Certified Diabetes Care and Education Specialists (CDCESs) works directly with your patients and staff to support remote monitoring, education, and communication.
Acting as an extension of your practice, our clinical team:
Reviews CGM and insulin pump data regularly.
Reaches out to patients for education and troubleshooting.
Flags concerning trends and coordinates with your providers for medication or plan changes.
We operate under your supervision and preferences. When your practice succeeds, we succeed. That means we’re constantly looking for ways to optimize your clinical efficiency, enhance patient care, and ensure you’re properly reimbursed for the important care your team provides.
3. Reimbursement and Compliance Support
Because SweetSpot works with practices across the country, we keep a close eye on:
How Medicare and payers are interpreting the new rules.
Best practices for documentation and time tracking.
Common pitfalls that lead to denials or recoupments.
We collaborate with you to develop a program that is clinically meaningful and operationally feasible. We also ensure that the program is financially sustainable and compliance-minded from day one.
Looking Ahead
The 2026 PFS final rule doesn’t just tweak reimbursement; it confirms where care is headed. That includes more monitoring between visits, more team-based support, and more care delivered virtually. Ultimately, this means more recognition of the real work that goes into diabetes care.
If you’re already running a remote diabetes monitoring program, these changes can help you expand and strengthen what you’re doing. If you’ve been on the fence, this may be the time to take a fresh look.
Want to Talk Through What This Means for Your Clinic?
If you’d like to understand how these codes could impact your revenue, and design or refine a remote diabetes program that fits these new rules, we’d be happy to talk. Reach out to us at info@sweetspot.health.
Sources:
American Telemedicine Association (ATA Action) – “First Look at 2026 Draft Medicare Physician Fee Schedule Demonstrates Positive Steps Forward for Virtual Care.” americantelemed.org
Fierce Healthcare – “AMA Removes RPM 16-Day Reporting Requirement, Effective January 2026.” fiercehealthcare.com
Prevounce Health – Daniel Tashnek, “Medicare’s 2026 PFS Proposed Rule Supercharges RPM: What It Means for Your Practice.” blog.prevounce.com
Ibid.
Ibid.
Additional Resources:
Centers for Medicare & Medicaid Services (CMS). Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Final Rule Fact Sheet. November 2025. cms.gov
McDermott + Consulting – “CMS Releases CY 2026 Physician Fee Schedule Proposed Rule.” mcdermottplus.com
American Medical Association (AMA) – “AMA Comments on 2026 Medicare Fee Schedule.” ama-assn.org
American College of Cardiology (ACC) – “Dive Into the 2026 PFS Final Rule.” acc.org
SweetSpot is a remote diabetes management platform that supports all major diabetes devices and insulin delivery systems to provide physicians with a single view of their patients’ data. SweetSpot's intelligent algorithm identifies the most optimal CPT codes for both remote and in-person diabetes management, and a dedicated team of Certified Diabetes Care & Education Specialists provide ongoing support.
As a company founded and powered by physicians and diabetes care providers, we place a strong emphasis on ensuring that there are no obstacles to getting started with SweetSpot. That’s why SweetSpot is easy to set up and designed to seamlessly integrate into your existing workflows and comes with no setup costs or subscription fees.
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