In recent weeks, health care providers and their technology partners have been absorbing a number of payer-related policy announcements that directly or indirectly impact reimbursement for Remote Patient Monitoring and related services. In some cases, these announcements — in particular from the Center for Medicare and Medicaid Services (CMS) CY2026 Final Rule– appear to positively promote increased validation and support for RPM reimbursement, reflecting years of successful patient outcomes and clear return-on-investment across a wide range of programs. At the same time, one significant commercial payer – UnitedHealthcare – has (controversially) announced its intention to roll back reimbursement coverage for RPM in some areas, namely chronic conditions.
A flurry of commentators are wondering what we should make of these (potentially contradictory) signals in the market. Do any call into question the efficacy of remote care management and the use of RPM technologies broadly to enhance patient access and care outcomes outside the “four walls” of the health system? Should we change approaches across some (or many) patient conditions to help care teams maximize their efficiency and patient impact using remote care platforms?
At Locus, we believe that the movement by CMS in the direction of enhanced flexibility for RPM reimbursement reflects credible validation and endorsement for this kind of care — one that reflects real, positive outcomes in the industry across a wide range of use cases. The CMS RPM codes have been in existence for some years and have a wide range of successful case study outcomes tied to them. This greater flexibility in reimbursement for patients who provide valuable biometric data for less than 16 days (between 2-15, to be precise) in a given 30-day period (new CPT code 99445) enables providers who focus on, for example, post-acute populations to enroll more patients, at greater ROI, given their (often) shorter RPM episode durations. Likewise, new CPT code
We believe the policy changes announced by UnitedHealthcare to restrict reimbursement for chronic conditions reflect a myopic view of the wide-ranging benefits of remote care. While targeted at chronic conditions, where patient adherence and compliance are admittedly difficult to manage and where patient selection is sometimes poorly determined, there remain a wide range of published outcomes showing the efficacy of RPM even for these conditions. In addition, we believe the legal challenges to the UnitedHealthcare decisions are likely to put pressure on the payer to reconsider and revert to more equitable reimbursement guidelines across RPM sub-populations.
At Locus, we have a remote care management platform that is highly configurable to specific patient population, and importantly, to specific care teams’ needs. We meet providers and their teams where they are, in the Electronic Medical Record platform, with deep integrations and the ability to manage remote care via a wide range of key medical devices and patient education and tailored communication tools. The platform can be adapted for a more intensive provider-to-patient monitoring approach or as a relatively more passive conduit for patient reported outcomes data. The configurability and adaptability of the Locus approach ensures successful implementations across a wide range of populations, and our consultants help our premier health systems make choices for each target patient population.
In summary, as payer policy choices continue to impact key “value-drivers” for RPM, health systems and providers can increase the quality of RPM programs and manage their integrity when they work with remote care partners that:
- Have a long, sustained track record of success with patient populations at leading Health Systems. Locus works with many world-class Academic Medical Centers and large regional and national IDNs.
- Can configure flexibly to the needs of specific populations and care teams. Locus works with care teams in key post-acute conditions (e.g. NICU, Pediatric CHD, Cardiac Rehab) and longer-term/chronic care (e.g. Cardiology, Oncology, Maternal/Fetal) to ensure that care teams can efficiently manage episodes of remote care, securely within their daily EMR-centric workflows.
- Work consultatively with care teams to select/enroll/onboard patients for RPM. Locus has an industry-leading help desk and logistics team helping care teams set patients up for successful RPM episodes from the start.
- Prove their efficacy both in terms of quality outcome improvement and financial ROI. Locus works with all customers to establish quality and efficiency goals and supports a range of ROI metrics, from incremental revenue generation (e.g. reimbursement codes) to lower preventable utilization and LOS-driven optimization.