A caregiver holds a phone up to a child’s face during a virtual visit, trying to describe a rash, a persistent cough, or new ear pain. The clinician can listen carefully, ask focused questions, and provide guidance. But without clinical-grade data, the encounter may still end with uncertainty, an in-person referral, or a delayed decision. That is the practical difference at the center of remote exams vs video visits: one is primarily a conversation, while the other can support a clinician-directed physical assessment.

For healthcare organizations expanding access across pediatric, rural, community, and home-based settings, this distinction affects more than technology selection. It shapes staffing models, care pathways, patient experience, clinical confidence, documentation, and financial sustainability.

Remote Exams vs Video Visits: The Core Difference

A video visit connects a patient and clinician through live audio and video. It is well suited for history-taking, medication follow-up, behavioral health, care planning, education, symptom triage, and many low-acuity concerns. The clinician can observe the patient’s appearance, breathing effort, movement, speech, and home environment, but the encounter depends largely on what can be seen or described through a standard camera.

A remote exam adds connected diagnostic tools and a structured clinical workflow to the live encounter. Depending on the care model and available devices, clinicians may be able to assess clinically relevant findings such as heart and lung sounds, temperature, oxygen saturation, blood pressure, pulse rate, ear images, throat images, or skin conditions. The clinician remains in control of the assessment, directing a caregiver, nurse, medical assistant, community health worker, or other trained facilitator in real time.

The distinction is not that one modality is inherently better. A video visit may be exactly the right intervention for a medication check or post-discharge conversation. A remote exam becomes more valuable when a clinical decision depends on objective data or a closer physical assessment that video alone cannot provide.

Why Video Visits Can Reach Their Clinical Limit

Video visits have earned an important place in virtual care because they reduce travel, shorten wait times, and make it easier for caregivers to participate. For rural patients, families without reliable transportation, and people managing chronic conditions, that access can be meaningful. They also allow organizations to preserve in-person capacity for patients who truly need it.

Still, a standard video connection does not turn a phone or laptop into an exam room. Camera quality, lighting, internet reliability, patient positioning, and caregiver comfort all influence what a clinician can observe. Even when a rash, wound, or respiratory concern is visible, visual observation may not be sufficient for a confident diagnosis or treatment decision.

This limitation can create an avoidable loop: a patient completes a video visit, receives a recommendation for an in-person evaluation, and travels to a clinic or emergency department that may be hours away. The video visit was not wasted. It may have identified the need for escalation. But it did not always resolve the care need at the first point of contact.

For organizations serving dispersed populations, the goal should not be to replace every office encounter with video. The goal is to determine which encounters can be resolved safely and appropriately through a virtual pathway, and which need device-enabled assessment, local facilitation, or in-person care.

What a Clinician-Directed Remote Exam Changes

A remote exam extends the clinician’s ability to gather findings during a virtual encounter. Rather than relying only on a patient or caregiver’s interpretation of symptoms, the care team can capture information that helps guide clinical judgment.

This can be particularly useful in pediatric care. A young child may not be able to describe wheezing, ear discomfort, dizziness, or throat pain. Caregivers often provide essential context, but they should not be expected to perform a clinical assessment without support. With a connected exam system and clear clinician direction, a caregiver or trained local facilitator can participate meaningfully without being asked to diagnose.

The setting matters as well. A child with autism or special healthcare needs may tolerate an assessment better in a familiar home, school, pediatric practice, or community clinic than in an unfamiliar office. Lower-stress settings can improve cooperation and help caregivers share more complete observations. Remote examination tools do not eliminate the need for trauma-informed, patient-centered care, but they can make care delivery more adaptable to the patient.

For chronic care management and remote patient monitoring programs, the value is often continuity. A clinician may use recurring data and virtual assessments to identify changes earlier, reinforce a care plan, and determine when an in-person evaluation is warranted. The most effective programs connect these activities to established clinical protocols rather than treating data collection as a separate technology task.

Choosing the Right Virtual Care Model

Care leaders should begin with the clinical use case, not the device. The question is not simply whether an organization wants telehealth. It is whether the organization needs communication, clinical assessment, ongoing monitoring, or a combination of all three.

Video visits are often appropriate when the expected outcome is counseling, education, medication management, behavioral health support, care coordination, or follow-up where no new objective findings are needed. They can also be an effective first step for symptom triage, provided the organization has a clear escalation process.

Remote exams are more appropriate when the care pathway frequently requires vital signs, auscultation, visualization beyond a consumer camera, or other objective clinical inputs. Common examples include pediatric sick visits, respiratory follow-up, chronic disease check-ins, transitional care, school-based care, home health, and rural outreach. The specific tools should match the services being delivered and the competencies of the people supporting the patient.

A hybrid model is often the most practical approach. A clinic might start with video for access and triage, schedule a remote examination when findings are needed, and reserve in-person appointments for cases requiring hands-on procedures, imaging, laboratory testing, or a higher level of evaluation. This approach helps avoid forcing every patient into the same pathway.

Operational Requirements Matter as Much as Clinical Capability

A remote exam program succeeds when technology, workflow, and accountability are designed together. Buying connected devices without defining who supports the patient, how data reaches the clinician, and what happens after an abnormal result can create operational friction rather than improved access.

Healthcare organizations should establish protocols for patient eligibility, informed participation, device cleaning and inventory, staff training, documentation, escalation, and follow-up. The workflow must also clarify whether the examination is facilitated by a caregiver, school nurse, community health worker, medical assistant, or another member of the care team. Each role needs appropriate training and a defined scope of responsibility.

HIPAA-compliant technology and secure data handling are foundational, but compliance should not be treated as a finish line. Leaders also need to consider interoperability, clinical documentation practices, user permissions, device connectivity, and the burden placed on frontline teams. A technically capable platform that adds multiple disconnected steps may not scale across a rural network, federally qualified health center, or multi-site pediatric program.

Reimbursement planning belongs in the early design phase. CMS policies, payer requirements, state rules, eligible practitioner types, and documentation expectations can vary by service and care setting. Organizations should align their virtual exam and remote monitoring workflows with current reimbursement guidance and compliance policies, while recognizing that coverage rules can change. A reimbursement-aware implementation helps leaders build programs that are clinically meaningful and financially supportable.

Designing for the Circle of Care

The strongest virtual care models recognize that the patient is rarely alone. A child may be supported by a parent, school nurse, pediatrician, specialist, therapist, and care coordinator. An older adult may depend on family, home health staff, and a primary care team. Remote care works best when these participants are connected around a shared plan rather than asked to navigate isolated encounters.

Dr. Miltie’s Circle of Care™ model reflects this operational reality. A connected-care approach can bring the clinician, patient, caregiver, and local support person into the same care process, allowing relevant information to be captured where the patient is and reviewed by the appropriate clinical team. That model is especially valuable where workforce shortages and distance make traditional access difficult.

The objective is not to make every visit virtual. It is to give care teams more options to deliver the right level of assessment in the right setting. When a video conversation is sufficient, it should be easy to provide. When clinical findings are needed, a remote exam can help the team move from observation to informed action without making travel the default answer.

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Telehealth reimbursement trends 2026 are not simply about whether a video visit is paid. They are shaping which virtual care models can endure, where clinicians can serve patients, and how organizations document the clinical work that happens between appointments. For pediatric practices, rural health clinics, federally qualified health centers, and community-based providers, the stakes are practical: reimbursement policy can determine whether a family receives timely care close to home or faces another long trip for a follow-up that could be managed safely at a distance.

The direction of travel is clear even when individual payer rules differ. Reimbursement is becoming more closely tied to clinical purpose, documented patient engagement, data capture, care coordination, and measurable outcomes. Organizations that treat telehealth as a standalone video platform may find their programs harder to sustain. Those that build connected-care workflows around virtual exams, remote patient monitoring, and longitudinal care management are better positioned to adapt.

Telehealth Reimbursement Trends 2026 Favor Connected Care

The most durable reimbursement opportunities increasingly sit beyond a single real-time virtual encounter. Synchronous telehealth remains valuable for access, triage, behavioral health, follow-up, and specialist consultation. Yet virtual care programs are gaining greater operational value when they support a broader care pathway: assess the patient, collect relevant clinical data, coordinate the next step, monitor change over time, and engage the caregiver or care team.

This distinction matters because a video visit alone may not answer the clinical question. A clinician evaluating a child with respiratory symptoms, ear pain, skin concerns, or chronic-condition changes may need more than conversation and observation through a consumer camera. Device-enabled virtual physical exams can help clinical teams capture findings that support more informed decisions, while remote monitoring can extend observation between visits.

For healthcare leaders, the strategic question is not, “Which telehealth code can we bill?” It is, “What care pathway can we deliver reliably, document appropriately, and sustain across our payer mix?” The answer varies by specialty, state, payer contracts, patient population, and clinical staffing model.

Medicare Policy Still Sets the Operational Tone

Medicare policy continues to influence commercial payer expectations and program design, even for organizations with a mixed or predominantly Medicaid population. Annual CMS rulemaking, congressional action, and temporary extensions can affect originating-site requirements, geographic limitations, eligible practitioners, audio-only allowances, and how certain telehealth services are recognized.

That uncertainty requires discipline. Organizations should avoid building financial projections around a single temporary policy or assuming that a Medicare allowance will be mirrored by every Medicaid managed care plan or commercial payer. Instead, reimbursement teams should maintain a current policy matrix that identifies, by payer, the eligible service, modality, patient location, provider type, documentation standard, modifier, place-of-service requirement, and authorization rule.

Rural health clinics and federally qualified health centers need especially close monitoring. Their payment structures and telehealth rules can differ from those applied to physician offices, hospital outpatient departments, or independent practitioners. A workflow that works well for a health system specialty clinic may not translate directly to a safety-net setting without changes to staffing, billing, or cost reporting processes.

Audio-Only Care Remains Useful but Narrower

Audio-only services remain essential for patients who lack broadband, private video access, or comfort with digital tools. They are particularly relevant in rural communities and for families managing transportation, work, language, or technology barriers. However, coverage and payment for audio-only care are inconsistent across payers and service types.

Programs should preserve audio access where clinically appropriate, but not rely on it as the entire virtual-care strategy. When clinical assessment requires vital signs, visual inspection, auscultation, or other physical findings, a connected device model may offer a more complete alternative. The goal is not to force every encounter into video. It is to match the modality to the patient’s needs and the clinical standard of care.

RPM and Care Management Are Becoming More Operationally Important

Remote patient monitoring, chronic care management, and related care-coordination services can create recurring reimbursement pathways when they are clinically appropriate and carefully administered. These services can support chronic disease management, post-discharge follow-up, preventive interventions, medication adherence, and escalation of emerging concerns.

They also require real operational capacity. Monitoring data without a defined clinical response process can create risk rather than value. Teams need clear protocols for enrollment, consent, device distribution, patient and caregiver training, data review, clinical escalation, documentation, and billing oversight. They must also understand requirements related to device use, data transmission, time thresholds, qualified personnel, and supervising practitioners where applicable.

For pediatric populations, the model often needs further adaptation. A parent, guardian, school nurse, or other caregiver may be central to device use and patient engagement. Children with autism or special healthcare needs may benefit from familiar settings and predictable routines, but the care pathway should account for sensory preferences, caregiver capacity, and the child’s developmental needs. Success is not measured by device deployment alone. It is measured by whether the care team receives actionable information and the family experiences less disruption.

Documentation Is a Revenue-Cycle Issue and a Clinical Issue

Telehealth documentation should demonstrate the same clinical logic as in-person care. It should establish why virtual care was appropriate, what information was obtained, what technology or modality was used, who participated, what assessment was performed, and what plan or follow-up was established.

For remote monitoring and care management, documentation must connect clinical work to the billed service. Record enrollment and consent when required, identify the relevant condition or care goal, capture the qualifying activities performed, and document time accurately. Generic notes that state “reviewed data” may not be enough to support internal audit standards or payer review.

Clinical, compliance, and revenue-cycle teams should agree on templates before scaling. Retrofitting documentation after denials appear is expensive and disruptive, particularly for organizations already operating with limited administrative capacity.

Payers Are Looking More Closely at Value and Site of Care

The reimbursement conversation is increasingly connected to total cost of care, avoidable utilization, access measures, and patient experience. Payers may support virtual models that reduce unnecessary emergency department visits, improve chronic-condition control, shorten time to specialist input, or strengthen post-discharge follow-up. But they may scrutinize programs that appear duplicative, lack clear clinical protocols, or produce little evidence of engagement.

That creates both opportunity and pressure. A virtual primary care pathway supported by remote examination tools can help organizations bring clinically relevant assessment closer to patients in homes, schools, community clinics, and partner sites. At the same time, the program needs data that shows how it affects access, clinician capacity, referral patterns, no-show rates, travel burden, and outcomes.

For rural providers, site-of-care strategy deserves particular attention. A virtual care encounter facilitated in a local clinic, school, long-term care setting, or community location may solve a different access problem than a patient connecting independently from home. Both models can be valuable, but they involve different staffing, connectivity, privacy, workflow, and reimbursement considerations.

What Healthcare Organizations Should Do Now

Leaders preparing for 2026 should begin with a service-line assessment rather than a technology purchase. Identify the patient groups experiencing the greatest access barriers, the conditions most suitable for virtual follow-up or monitoring, and the points in the care journey where missing clinical information creates delay or unnecessary referral.

Next, map each pathway to its reimbursement and compliance requirements. Include the service code families that may apply, but also the practical prerequisites: eligible clinicians, payer enrollment, patient consent, modality rules, device workflow, time capture, documentation, and claim edits. This is where a reimbursement-aware implementation partner can help prevent a promising pilot from becoming an unfunded operational burden.

Organizations should also measure baseline performance before launch. Track travel distance, appointment wait time, missed appointments, emergency utilization, referral completion, staff workload, and patient or caregiver experience. These measures make it easier to improve the model and demonstrate value in payer discussions.

Finally, build for flexibility. Payer rules will continue to change, and not every patient needs the same virtual-care pathway. Dr. Miltie’s Circle of Care™ approach reflects this reality by connecting clinicians, patients, caregivers, and community care settings around a customized model of care rather than a one-size-fits-all virtual visit.

The most financially sustainable telehealth programs in 2026 will be clinically grounded first. When virtual care helps a clinician make a better decision, helps a caregiver participate with less burden, and helps an organization deliver the right service in the right setting, reimbursement becomes more than a billing question. It becomes a foundation for extending high-quality care to the communities that need it most.

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A missed follow-up appointment can mean very different things for different patients. For a family in a rural community, it may mean hours of driving and missed work. For an autistic child, it may mean navigating an unfamiliar clinical environment that creates distress before the visit even begins. For a patient managing multiple chronic conditions, it may mean a worsening symptom goes unnoticed between appointments. From telemedicine to remote patient monitoring, AI is transforming healthcare delivery by helping care teams identify needs sooner, extend clinical reach, and bring more of the care experience into the settings where patients live, learn, and recover.

The real change is not simply that more appointments happen by video. It is that virtual care is becoming more clinically informed, continuous, and operationally connected. When healthcare organizations combine clinician-directed virtual examinations, connected devices, remote patient monitoring, and carefully governed AI, they can create care pathways that are more responsive without treating technology as a substitute for clinical judgment.

Telemedicine Is Moving Beyond the Video Visit

Early telemedicine models solved an immediate access problem: they gave patients and clinicians a way to speak without being in the same room. That remains valuable, particularly for behavioral health, medication follow-up, care navigation, and triage. But video alone has limits when a clinician needs objective information to evaluate a patient confidently.

A high-quality virtual visit may require more than a visual conversation. Depending on the clinical use case, the provider may need vital signs, heart and lung sounds, ear images, throat images, skin observations, or other relevant findings. Device-enabled virtual physical exams help close that gap by allowing trained staff, caregivers, or patients to capture appropriate clinical data under a clinician-directed workflow.

This distinction matters for organizations building sustainable virtual primary care programs. A basic video platform can expand appointment availability, but a connected-care model can support clinical assessment, care coordination, and follow-up across homes, schools, community sites, long-term care settings, and rural clinics. The goal is not to replicate every in-person visit remotely. It is to determine which patients, conditions, and moments of care can be safely and effectively supported outside a traditional exam room.

How AI Supports Better Remote Patient Monitoring

Remote patient monitoring produces a stream of information that can be clinically useful but operationally difficult to manage. Blood pressure readings, weight trends, oxygen saturation, glucose values, symptom check-ins, and device-generated observations can quickly exceed what a care team can review manually at scale. AI can help organize this information so clinicians and care coordinators can focus their attention where it is most needed.

In practical settings, AI can identify trends, prioritize abnormal readings, flag missing data, and support outreach workflows. For example, a patient whose readings have changed gradually over several days may need attention even when no single measurement crosses a preset threshold. Pattern recognition can help surface that change earlier for clinical review.

AI can also improve the usability of remote monitoring programs by helping tailor patient communications. A reminder that reflects a patient’s preferred language, schedule, risk level, or care plan may be more effective than a generic message. For caregivers of children with special healthcare needs, guided prompts can clarify what information to capture and when to contact the care team.

None of this makes AI the clinician. It makes the workflow more capable of handling the volume and variability of data that connected care creates. Clinical teams still establish protocols, evaluate alerts, decide on treatment, and determine when an in-person assessment or escalation is appropriate.

AI Must Be Designed Around Clinical Governance

Healthcare leaders should be cautious of any claim that AI can independently diagnose, replace examination, or eliminate the need for accountable clinical oversight. Algorithms can reflect gaps in their training data, and remote measurements can be affected by device use, connectivity, patient adherence, and context. A concerning reading may be an urgent clinical signal, a technical error, or something that needs confirmation.

That is why deployment must include clear escalation pathways, clinician review standards, documented workflows, and ongoing performance monitoring. Organizations should understand what an AI-enabled feature does, what data it uses, how alerts are generated, and how staff are expected to respond. HIPAA compliance, role-based access, data security, and patient consent are not secondary implementation details. They are foundational to trust.

AI-Enabled Healthcare Delivery Must Work for Real Communities

The strongest virtual care programs begin with the realities of the populations they serve. Rural health clinics, federally qualified health centers, critical access hospitals, and community health organizations often face staffing constraints, specialist shortages, transportation barriers, and inconsistent broadband access. Technology that assumes every patient has a reliable connection, a private space, and high digital confidence can widen the very gaps it aims to address.

A practical model offers multiple ways to participate. Some patients may use connected devices at home with caregiver support. Others may receive virtual care through a school-based program, community clinic, mobile care setting, or local practice equipped to facilitate the encounter. A care coordinator may be central to helping patients complete onboarding, understand device instructions, and stay connected to their care plan.

Pediatric care makes this especially clear. Children are not simply smaller adult patients, and the circumstances of the visit matter. A child may communicate more openly at home, while a caregiver can provide observations that may not emerge during a short office visit. For autistic children and children with complex needs, familiar settings can reduce sensory stress and enable more meaningful caregiver participation. Virtual care should be designed to support families, not add another technical task to an already demanding care routine.

From Telemedicine to Remote Patient Monitoring: AI Changes the Care Model

The most meaningful opportunity is not one isolated application of AI. It is the connection between virtual access, clinical data, care coordination, and follow-through. A patient can begin with a telemedicine consultation, complete a clinician-directed virtual exam, enter a remote monitoring pathway, and receive timely outreach when the care team identifies a concern. Each element supports the next.

This connected approach can improve continuity for chronic care management and preventive services. It may help organizations monitor patients after discharge, support medication adherence, detect deterioration earlier, or reduce unnecessary travel for follow-up. It can also help care teams use their limited time more effectively by separating routine outreach from cases that need faster clinical attention.

The appropriate model depends on the patient population and service line. A pediatric practice may prioritize episodic virtual exams and caregiver engagement. A rural health system may focus on extending specialty access through local clinical partners. A community health center may build remote monitoring pathways for hypertension, diabetes, or post-discharge follow-up. Technology should adapt to the pathway, reimbursement environment, staffing model, and clinical goals rather than force every program into the same template.

Reimbursement and Workflow Determine Whether Programs Last

Virtual care cannot remain a pilot that depends on extraordinary staff effort. Sustainable programs need reimbursement-aware design, operational ownership, training, and measures that demonstrate value. CMS reimbursement policies and payer requirements can affect how remote patient monitoring, chronic care management, telehealth services, and care coordination are documented and delivered. Requirements evolve, so organizations need processes that keep clinical and billing workflows aligned.

Leaders should also measure more than enrollment. Useful indicators may include completed monitoring days, response time to clinically significant alerts, avoidable travel reduced, follow-up completion, patient and caregiver experience, staff workload, and outcomes tied to the specific condition being managed. A program with impressive enrollment but poor adherence or unclear escalation processes is not yet delivering its intended value.

The Dr. Miltie N9+ is designed for this broader connected-care need: clinician-directed virtual examinations, actionable patient data, and customizable workflows that can help organizations extend care beyond the facility. Within a Circle of Care™ model, the technology can connect clinicians, caregivers, local support staff, and patients around a coordinated pathway rather than a one-time virtual interaction.

A More Human Standard for Healthcare Technology

AI will be most valuable in healthcare when it makes care more attentive, not more distant. It should reduce the administrative burden that pulls clinicians away from patients, bring relevant changes to the surface sooner, and give families clearer ways to participate in care. It should also preserve the moments when a clinician needs to listen closely, examine carefully, and make a judgment that no automated system can make alone.

For healthcare organizations, the next step is to build virtual care around the patients who have the most to gain from it: people facing distance, mobility, workforce, transportation, or access barriers. When connected devices, remote patient monitoring, virtual exams, and AI are implemented with clinical rigor and compassion, care can reach farther while still feeling personal.

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A child with sensory sensitivities may tolerate a brief in-home assessment far better than a long trip to a specialty clinic. A rural patient with heart failure may need closer follow-up than geography allows. These are the moments when remote patient assessment technologies move from interesting to operationally necessary.

For healthcare leaders, the question is no longer whether virtual care has a role. The real question is which technologies support clinically meaningful assessment, fit reimbursement and workflow requirements, and help care teams reach patients who are otherwise hard to serve. That distinction matters, especially in pediatric, rural, and community-based care, where access barriers are not abstract. They affect whether an exam happens at all.

What remote patient assessment technologies actually include

The term covers more than video visits. In practice, remote patient assessment technologies combine connected exam tools, patient monitoring devices, data capture, software workflows, and communication pathways that allow clinicians to assess a patient without requiring every encounter to happen in a traditional exam room.

Some tools focus on physiologic monitoring over time, such as blood pressure, pulse oximetry, weight, or glucose collection. Others support remote physical assessment by enabling a clinician to listen to heart and lung sounds, visualize the ear or throat, review skin conditions, or gather other clinically relevant findings during a guided virtual encounter. The strongest models bring these functions together rather than treating them as separate programs.

That difference is especially important for organizations serving children, patients with chronic conditions, and populations with transportation, mobility, or specialist access challenges. A standalone video platform may increase convenience, but it does not always increase clinical confidence. An integrated assessment model can.

Why clinical relevance matters more than virtual convenience

Healthcare organizations are under pressure to improve access, manage workforce shortages, and reduce avoidable utilization. Virtual care can help, but only when the technology supports decision-making instead of adding another fragmented touchpoint.

A remote assessment platform should help a clinician answer a real clinical question. Is this child improving after treatment? Does this respiratory patient need escalation? Can this follow-up happen safely at home, school, or a community site? If the technology does not improve the quality of those decisions, it may still create activity, but not necessarily value.

This is where many programs hit a ceiling. They launch telehealth, gain initial adoption, and then realize the care team still lacks the exam data needed to manage patients confidently. Video alone has limits. So do remote monitoring programs that collect numbers without enough clinical context. The better approach is to connect virtual exams, monitoring, care coordination, and follow-up into one operational pathway.

Where remote patient assessment technologies deliver the most value

The highest-value use cases tend to be settings where access is limited, follow-up is difficult, or the care experience itself creates barriers. Pediatrics is a strong example. Children, especially autistic children and pediatric patients with special healthcare needs, may do better in familiar environments with caregivers present. A lower-stress setting can improve cooperation, reduce missed appointments, and support more complete participation in care.

Rural health is another major fit. Critical access hospitals, rural health clinics, and community providers often face specialist shortages, long travel distances, and staffing constraints. Remote assessment tools can extend clinical reach without requiring every patient to travel for every touchpoint. That does not eliminate the need for in-person care. It helps organizations reserve in-person capacity for the cases that truly require it.

Safety-net settings also benefit when the technology is designed around real-world operations. Federally qualified health centers and community clinics often manage high-need populations with limited resources. In those environments, technology has to do more than impress in a demo. It must support continuity, work across distributed sites, and fit financially sustainable models of care.

What healthcare leaders should evaluate before adoption

Not every virtual care platform is built for assessment. For decision-makers, the first screening question should be whether the system enables clinically relevant data capture or simply facilitates communication.

That means looking closely at device integration, virtual exam capability, data quality, and workflow design. Can clinicians gather useful findings during the encounter? Can those findings be documented in a way that supports care planning? Can the program adapt to different service lines, from pediatric follow-up to chronic disease management to school-based care?

The next issue is operational fit. Technology that works in a pilot can still fail at scale if training demands are too high or workflows are too rigid. Organizations should examine who will support the patient during the encounter, how data moves into care coordination processes, and whether the model can function across homes, clinics, schools, and community settings.

Financial alignment also matters. Reimbursement-aware deployment is not a side consideration. It is central to long-term success. Healthcare leaders need clarity on how remote patient monitoring, chronic care management, telehealth, and related services may fit their billing strategy, compliance obligations, and staffing model. A platform can be clinically strong and still be difficult to sustain if implementation ignores the realities of CMS requirements, documentation standards, and payer variation.

The trade-offs organizations should expect

Remote assessment is not a replacement for all in-person care, and it should not be presented that way. Some conditions still require hands-on examination, imaging, testing, or procedures that cannot be replicated remotely. The goal is not to virtualize everything. The goal is to make care more responsive, more targeted, and easier to access when remote evaluation is appropriate.

There are also trade-offs around adoption. More advanced assessment capabilities may deliver better clinical value, but they often require stronger onboarding, clearer protocols, and greater staff engagement. Programs serving medically complex patients may need customized workflows rather than a one-size-fits-all rollout.

Patient and caregiver readiness can vary as well. In pediatrics, caregiver participation is often a strength of the model, but it still requires support and clear communication. In rural and underserved communities, broadband access, device availability, and digital comfort can affect utilization. These are not reasons to avoid deployment. They are reasons to design for reality.

Why connected care models outperform point solutions

Healthcare organizations increasingly need systems that support an ongoing relationship, not just isolated visits. That is why connected care models are becoming more relevant than single-purpose tools. When assessment devices, monitoring, care coordination, and patient engagement function together, teams can manage patients across settings with greater continuity.

This model is particularly effective when multiple stakeholders are involved in care. Pediatric patients may depend on parents, school nurses, primary care clinicians, specialists, and community programs. Rural patients may receive services across local clinics, regional hospitals, and home-based follow-up. A connected framework helps each participant contribute to a more complete view of the patient.

That is also where a platform approach becomes more valuable than a device-only approach. The technology should support the broader circle around the patient, including caregivers, clinicians, and operational teams. When organizations build around that principle, remote assessment becomes part of a durable access strategy rather than a temporary digital add-on.

How to think about scale

The most successful programs usually start with a clear clinical and operational use case, then expand. That may mean pediatric follow-up, chronic disease monitoring, school-based access, rural triage support, or post-discharge assessment. What matters is choosing a model where better access and better clinical visibility can be measured.

From there, scale depends on standardization without rigidity. Teams need defined protocols, training, documentation pathways, and performance metrics. They also need flexibility to adapt the model for different populations and sites of care. A platform such as Dr. Miltie N9+ is most useful when it helps organizations extend clinically guided virtual exams and monitoring into the settings where patients actually live, learn, and receive support.

For many provider organizations, the long-term value of remote patient assessment technologies is not just visit substitution. It is better reach, earlier intervention, more effective caregiver engagement, and a stronger ability to deliver care beyond the walls of the clinic.

The organizations that benefit most will be the ones that treat remote assessment as part of care redesign, not just technology adoption. When the model is clinically grounded and operationally practical, it gives care teams something more valuable than convenience. It gives them a way to bring care closer to the people who have historically had the hardest time reaching it.

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As the adoption of telehealth, remote monitoring, and connected care technologies continues to increase, it’s important for healthcare leaders to stay on top of the latest updates in telehealth reimbursement. 

Some of the most significant updates come from the Centers for Medicare & Medicaid Services (CMS), which released its final rule for Medicare payments under the Physician Fee Schedule (PFS) in 2024. Let’s delve into the eight key updates impacting telehealth and remote patient monitoring (RPM) services:

1. Established Patient Requirement: A fundamental change concerns new patients seeking RPM services. Before initiating these services, a new patient evaluation and management (E/M) or similar service is now mandatory. This ensures a clear care plan is established during an in-person visit. However, exceptions exist for patients who utilized RPM during the Public Health Emergency (PHE) as they already have an established patient-provider relationship. Additionally, this established patient rule doesn’t apply to remote therapeutic monitoring (RTM) reimbursement.

2. 16-Day Data Collection for RPM: The billing guidelines for RPM data collection have been revised. Now, healthcare providers need to collect data for at least 16 of the 30-day episode of care period, excluding calendar month days, for CPT codes 99453 and 99454. This clarifies the data collection requirements for accurate reimbursement of these specific codes.

3. Clarity on RPM/RTM “Time Spent”: CMS has provided further clarity regarding time spent billing guidelines for specific CPT codes. Codes 99457, 99458, 98980, and 98981, representing “time spent” for treatment management, are not subject to the 16-day data collection requirement. They maintain their existing billing guideline of a 30-day calendar month.

4. One Provider for RPM/RTM Billing: A significant update concerns the number of providers permitted to bill for RPM and RTM services. According to the new guidelines, only one provider can bill for either RPM device codes (99453 and 99454) or RTM codes (98976, 98977, 98980, and 98981) within a 30-day episode of care. This means the provider who submits the claim first will be reimbursed, whereas subsequent claims from other providers for the same patient during that period will be denied.

5. Concurrent Billing with Other Services: Reimbursement for RPM and RTM cannot be combined with similar services within the same month. However, specific services like Chronic Care Management (CCM), Transition Care Management (TCM), Behavioral Health Integration (BHI), Principal Care Management (PCM), and Chronic Pain Management (CPM) can be billed concurrently with either RPM or RTM.

6. Billing During Global Surgery Periods: The 2024 Physician Fee Schedule clarifies the permissible timeframe for billing RPM/RTM services during a surgical global period, defined as the time during which a physician cannot bill for related office visits. Now, if the billing provider for RPM or RTM services is different from the provider receiving the global payment, these services can be billed. Additionally, if RPM or RTM services were already in place before the surgery, CMS allows payment outside the surgical global period.

7. FQHCs and RHCs Gain Reimbursement: This update presents new opportunities for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). They can now receive reimbursement from CMS for either RPM or RTM services (not both) when billed alongside Care Management CPT code G0511. This code can be billed multiple times per calendar month, offering additional financial support for these healthcare facilities.

8. New Cost Fee Structure: The final update concerns changes to the cost fee structure. While the specific details are outside the scope of this article, it’s important to be aware that individual CPT code reimbursement rates for RPM, CCM, and RTM have been slightly adjusted.

These updates highlight the ongoing evolution of telehealth and remote patient monitoring regulations. By staying informed about these changes, healthcare providers and facilities can ensure they are delivering compliant and reimbursable care to patients while optimizing their practice efficiency.

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If you are a medical professional interested in leveraging remote technology to optimize patient health, this guide outlines remote therapeutic monitoring codes for 2024 and how to bill using RTM CPT codes. Remote therapeutic monitoring (RTM) is similar to remote patient monitoring. However, RTM is used to acquire non-physiological patient data for the respiratory and musculoskeletal systems.

This data can monitor medication and exercise adherence, functional status, response to therapy, and musculoskeletal and respiratory activity. Patients use RTM devices to collect health data for musculoskeletal and respiratory system status, therapy, and medication response and adherence. Unlike in remote patient monitoring CPT Codes, the RTM patient data is self-reported and communicated to their physician. 

Remote Therapeutic Monitoring Codes

Healthcare providers can improve patient outcomes while establishing additional revenue streams with an established and efficient remote therapeutic monitoring service model. However, it is essential to note that regulations exist regarding which remote therapeutic monitoring codes can be billed together with remote patient monitoring. Providers are not allowed to double bill for RTM and RPM.

In 2022, The Center for Medicaid and Medicare (CMS) established remote therapeutic monitoring codes to help make billing for physical, occupational, and speech-language pathologists more accessible. Before 2022, these qualified healthcare professionals were not reimbursed for collecting data and educating patients using remote health devices. These new RTM CPT codes allow healthcare systems to increase revenue while improving patient outcomes and recovery programs.

RTM CPT codes are general management codes that qualified healthcare professionals, like physical and occupational therapists, can use to bill for their services, unlike RPM codes. The most commonly used RTM devices are a scale and spirometer. The 2024 RTM CPT codes, descriptions, payment rates, and billing frequency are listed below. 

2024 Remote Therapeutic Monitoring Codes

In this section, you will find a quick overview of remote therapeutic monitoring codes for 2024. All remote therapeutic monitoring services can be provided under general supervision. Physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) can provide RTM services. RTM CPT codes can be used for “sometimes therapy,” allowing physicians, nurse practitioners, physician assistants, and clinical nurse specialists to perform RTM. 

CPT Code 98975

This code covers initial setup and patient education on the use of equipment. It can be billed once by one practitioner only when at least 16 days of data have been collected on at least one medical device. The average national payment rate for CPT 98975 is $19.65.

Respiratory CPT Code 98976

Billing CPT code 98976 pays for respiratory devices supplied with daily scheduled recordings and programmed alerts and transmission for monitoring the respiratory system. The code can be used every 30 days by one practitioner only when at least 16 days of data have been collected on at least one medical device. The average national payment rate for CPT code 98976 is $46.83.

Musculoskeletal CPT Code 98977

Code 98977 reimburses musculoskeletal devices supplied with daily scheduled recordings and programmed alerts and transmission for monitoring the musculoskeletal system. This can be billed once every 30 days by one practitioner only when at least 16 days of data have been collected on at least one medical device. The average national payment rate for CPT code 98977 is $55.72.

CPT Code 98980

RTM CPT code 98980 bills for the initial 20 minutes of treatment time per calendar month. Time must include at least one interactive communication via phone or video with the patient during the month. New in 2023, CPT 98980 can be billed “incident to” or under general supervision. CPT 99457 is billed every 30 days. The average national payment rate for CPT 98980 is $49.78.

CPT Code 98981

In 2024, CPT 98981 covers each additional 20 minutes of treatment time per calendar month. It requires at least one interactive communication during the calendar month. This code has the exact requirements as CPT 98980.  The average national payment rate for CPT 98981 is $39.30.

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Executive Summary

Digital health advocates believe remote monitoring—the use of digital technologies to collect and relay patient data to health care professionals—has the potential to transform disease management, health outcomes, and patient care, especially for individuals with multiple chronic conditions who lack convenient access to providers. Medicare, most state Medicaid agencies, and many private health insurance plans cover remote monitoring services.

For the purposes of this report, we define remote monitoring as an umbrella term for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM). RPM refers to the monitoring of physiologic data—such as weight, blood glucose, or blood pressure—while RTM refers to the monitoring of patients’ self-reported non-physiologic data, such as pain levels or medication adherence. Currently, the Centers for Medicare & Medicaid Services (CMS) limits RTM reimbursement to cases involving the respiratory system, musculoskeletal system, and cognitive behavioral therapy.

Although the percentage of patients using RPM remains relatively low (594 monthly claims per 100,000 Medicare enrollees in 2021), the use of RPM increased among Medicare beneficiaries more than sixfold from 2018-2021. In part, this increase was due to CMS’ expanded coverage rules during the COVID-19 public health emergency. Thirty-four state Medicaid programs covered RPM services as of March 2023; however, many Medicaid programs restrict RPM use in some way. RTM uptake has also steadily increased since its introduction in 2022, yet billing and documentation requirements can hinder its widespread adoption.

The evidence base on remote monitoring, particularly for RPM tools, is growing. Yet some policy experts cite a lack of robust evidence on the optimal use of remote monitoring, including its duration and target patient groups. In the absence of such evidence, these experts question whether we are effectively “rightsizing” the use of these services. Underuse could limit access to beneficial care, while overuse could unnecessarily increase spending in federal health care programs. Additionally, providers cite the need for tools—such as generative artificial intelligence (AI)—to manage streams of data, otherwise the volume of patient-generated information can become overwhelming and unmanageable.

Over the past year, the Bipartisan Policy Center undertook an extensive effort to develop evidence-based, federal policy recommendations for the appropriate use and coverage of remote monitoring services. BPC assessed patients’ access to and use of remote monitoring technologies and their impact on health outcomes and cost. We conducted a series of interviews and hosted a private roundtable with health policy experts, federal officials, technology leaders, medical providers, payers, consumers, and academics to gain insight into the opportunities and challenges regarding remote monitoring.

This report looks broadly at ways to improve the use of remote monitoring services, ensure equitable access to these services across populations, and enhance data security and privacy standards. Now is the time for payers and providers to refine their approach and maximize appropriate adoption for patients who stand to benefit from remote monitoring.

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In November 2023, CMS issued final rules for the 2024 Medicare Physician Fee Schedule (MPFS) and the 2024 Medicare Outpatient Prospective Payment System (OPPS). Both of these rules contained finalized policy proposals that will impact rural health clinics (RHCs) beginning in January 2024:

• Telehealth Flexibilities
• Medicare Coverage of Marriage and Family Therapists and Mental Health Counselor Services
• Intensive Outpatient Program (IOP) Services Billable in RHC Under Special Payment Rule
• Expansion of RHC Care Management Services
• Definition Change to Nurse Practitioner

Telehealth Flexibilities

CMS has officially extended some telehealth flexibilities that were allowed during the public health emergency (PHE) to continue through December 31, 2024. Specifically, CMS finalized the following:

• RHCs may be reimbursed for telehealth services utilizing CPT code G2025
• Removed the originating and geographic site requirements, which allows patients to be located in any location during the telehealth visit. This would include the patient’s home. It should be noted that telehealth services are to be provided during the RHC’s operating hours
• Delayed the in-person requirement for mental health visits performed via telehealth
• Extended audio-only coverage allowance for telehealth services
• Expanded the list of telehealth distant site providers to include Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs)

New Billable RHC Provider Types

MFTs and MHCs have now been officially added as qualified RHC provider types. An MHC is an individual who:

• “(A) possesses a master’s or doctor’s degree which qualifies for licensure or certification as a mental health counselor, clinical professional counselor, or professional counselor under the State law of the State in which such individual furnishes the services described in paragraph (3);
• (B) is licensed or certified as a mental health counselor, clinical professional counselor, or professional counselor by the State in which the services are furnished;
• (C) after obtaining such a degree has performed at least two years of clinical supervised experience in mental health counseling; and
• (D) meets such other requirements as specified by the Secretary.”

Effective January 1, 2024, MFTs and MHCs will be able to generate Medicare encounters and be reimbursed for those services at the RHC’s all-inclusive rate (AIR). MFTs and MHCs also have the ability to meet the requirement that a provider must be available to provide care to patients at all times the clinic is open.

Intensive Outpatient Program (IOP) Services

IOP services are outpatient mental health services that are designed for patients who require more complex mental health care than would be able to be accomplished during a typical office visit, but not so severe that an inpatient mental service would be required. These services are intended for patients with acute mental illnesses such as depression and substance abuse disorders who require a higher level of care. In its proposal, CMS specified the services eligible to be provided and reimbursed under an IOP may include:

• Individual and group therapy with physicians, psychologists, and other mental health professionals as available under state law
• Occupational therapy
• Furnishing of drugs and biologicals for therapeutic purposes that are not self-administered
• Family counseling (as part of treatment of the patient’s condition)
• Patient training and education
• Individualized activity therapies
• Diagnostic services
• Other related services for diagnosis and active treatment intended to improve or maintain the patient’s condition and function

To quality a patient for IOP services, a physician is required to certify that a patient needs behavioral health services for at least nine, but no more than 19 hours per week. That certification must be completed by a physician at least once every other month for the patient to continue to qualify for services and the plan of care must demonstrate that the patient:

• Requires at least nine hours of therapeutic services per week
• Is likely to benefit from coordinated services rather than individual sessions of outpatient treatment
• Does not need 24-hour care
• Has a support system outside of the IOP
• Has received a mental health diagnosis
• Is not a danger to themselves or others
• Has the cognitive and emotional ability to tolerate the IOP

IOP services will not be reimbursed at the RHC’s AIR, but rather under a special rule that would allow for a flat payment of approximately $280 per day. RHCs will be allowed to perform up to three services per day and to qualify for the special payment, at least one of the three services must be from Table 44 Proposed Partial Hospitalization and Intensive Outpatient Primary Services found on page 367 of the HOPPS Proposed Rule.

Because IOPs are a new service for RHCs, there is an expectation of future rulemaking outlining how services may be provided and reimbursed.

Expansion of RHC Care Management Services

Historically, RHCs have only been allowed to bill and be reimbursed for Care Management Services, including Remote Patient Monitoring, Remote Therapeutic Monitoring, or using CPT code G0511 or G0512 once per month per beneficiary. Under the new final rule, RHCs may now bill G0511 multiple times per month as long as the services rendered are “medically reasonable and necessary, meet all requirements, and not be duplicative of services paid to RHCs and FQHCs under the general care management code for an episode of care in a given calendar month.” In addition, CMS has finalized the establishment of new care management codes for Community Health Integration (CHI) and Principal Illness Navigation (PIN), which also will be billed to Medicare using the G0511 code and those services will be reimbursed as long as a qualified provider performs the service.

Definition Change to Nurse Practitioner

CMS has changed the definition of a nurse practitioner to state that an individual must “be certified as a primary care nurse practitioner at the time of provision of services by a recognized national certifying body that has established standards for nurse practitioners and possesses a master’s degree in nursing or a Doctor of Nursing Practice (DNP) doctoral degree.” This change allows individuals certified by additional certifying boards, including the American Academy of Nurse Practitioners Certification Board, American Nurses Credentialing Center Certification Program, Pediatric Nursing Certification Board, and the National Certification Corporation, to now meet the definition of a nurse practitioner as long as the other requirements are met.

These changes may result in significant operational, revenue cycle, and regulatory reimbursement impacts for RHCs beginning in January 2024. If you have any questions about the new requirements or would like assistance in evaluating the organization’s readiness and potential impact, please reach out to a professional at FORVIS.

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