CY2026 opened a billable path for patients who fall short of RTM thresholds

Kavera newsletter — September 2026. Subscribe to get these by email.

Welcome — this is the first issue, so a word on what it is: roughly monthly notes for clinicians and practice administrators running structured programs. Billing and policy changes that affect what you can actually bill, program design that survives a payer review, and occasionally what we have shipped. Skipped entirely in months where there is nothing worth your time.

The CY2026 rule opened a billable path for patients who were falling short

The change most likely to affect a specialty practice this year is in the RTM family. Until now, a patient who engaged with remote monitoring but did not reach the thresholds — 16 days of data in a 30-day period, or 20 minutes of treatment management in a calendar month — generally produced nothing billable, however real the clinical work was.

CY2026 adds short-duration codes covering that band. In practice that matters for exactly the patients who are hardest to keep engaged: the post-concussive patient who logs symptoms for nine days and then stops, the headache patient whose diary lapses mid-month, the older patient working through a cognitive program at their own pace.

Three things worth checking before you change anything:

• Only one device-supply code per patient per 30-day period. Standard or short-duration, not both.
• Only one treatment-management base code per patient per calendar month. The 10–19 minute code and the 20+ minute code are alternatives.
• If your patients already clear the old thresholds, nothing changes for you. The existing codes still apply. This adds a floor, it does not move the ceiling.

One caveat we would rather state than bury: the specific new code numbers are well corroborated across the AMA's CPT 2026 release and the billing press, but confirm them against the CPT 2026 code book or the Federal Register text of CMS-1832-F before you write them into internal billing policy. Payer coverage and medical-necessity rules are unchanged and are still yours to establish.

The longer write-up, including what did not change: /billing/guides/cy2026-final-rule-changes

The neuropsychological testing codes (96116–96146) were untouched by this rule — structure, time rules and supervision requirements all stand.

The thing that makes remote monitoring billable is boring

Practices tend to ask us which codes to use. The more useful question is usually how the data gets collected, because that is what determines whether the codes apply at all. Monitoring that depends on a patient remembering to open something produces gaps; gaps are what cost you the threshold. A schedule the patient does not have to think about is worth more than any code selection.

That is most of what our four programs — concussion, mental health, cognitive health and headache — actually do: send the right instrument at the right interval and put the result in front of the clinician with the billing implications already worked out.

/programs

Briefly

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