clinicians.build · interactive

The Quarter-Billion Reshuffle

CMS's proposed CY2027 Physician Fee Schedule would reshuffle the remote-monitoring codes — five years after those same codes quietly grew from a $5.4M experiment into a $259M standardized-payment line item. Before the renumbering, here is the map worth memorizing: every state's RPM footprint as one dot. Hover the dots, then drag the provider slider and watch the wildest "adoption" stories dissolve into small-n noise.

Built on ↓ CMS — CY2027 Physician Fee Schedule proposed rule (comment window open) · companion to today's Curbside
Data: Medicare Physician & Other Practitioners by Geography (FFS), RPM/RTM codes, CY2024 · mimi_ws_1.datacmsgov.mupphy_geo + medicare_monthly_enrollment via MIMI Labs

The boom, in four numbers

From rounding error to line item

In 2019, the year the dedicated RPM codes went live, standardized Medicare payment was $5.36M across three of them. In 2024 it was $259.1M across nine RPM + RTM codes — a 48x rise in five years, with 389,342 patients on device-supply billing and 17,379 clinicians billing monthly management. That is the base CMS now proposes to renumber.

$259.1M

standardized Medicare payment, RPM+RTM codes, 2024

48x

growth since 2019 ($5.36M standardized)

389,342

patients with device-supply months billed (99454)

380x

spread in per-capita adoption between states

Standardized Medicare payment, RPM + RTM codes · national endpoints

2019 = first year of dedicated RPM codes (99453/54/57); 99458 and RTM codes arrived later. Endpoints are verified standardized payment (not CMS actual outlays), in $M, fee-for-service only.

The explorer

One dot per state — and a 380-fold spread

Across (log scale): RPM patients per 10,000 traditional-Medicare beneficiaries — how much of the state's Medicare population is on a monitored device. Up: management sessions billed per patient (99457) — how intensively each enrolled patient is worked. Dot size: total 2024 dollars. If RPM adoption were driven by chronic-disease burden, this cloud would be tight. It isn't — red dots are states where fewer than 150 clinicians produce the entire number.

RPM adoption vs intensity, CY2024 · 51 states incl. DC

min clinicians billing≥ 1 · 51 shown

states shown

–

median patients / 10k FFS benes

–

highest adoption (state)

–

2024 $ in view (99454+99457)

Hover a dot for the full state ledger. Slider = minimum clinicians billing either code in the state; watch which "leaders" survive it.

The Connecticut dot is the whole lesson. CT shows 856 patients per 10k FFS beneficiaries — 3x California — produced by just 122 clinicians, roughly 190 RPM patients per billing clinician (CA: ~50). That isn't a state full of enthusiastic doctors; it's a handful of large monitoring programs concentrated in one place. Vermont, at the other end, has 22 device-supply patients statewide. Per-capita "adoption maps" flatten organizational stories into geographic ones — drag the slider to 150 and see which states still have a story.

What the fee-schedule fight is actually about: a benefit this concentrated — geographically and organizationally — is exactly the kind CMS reshuffles. The proposed CY2027 rule points toward fewer codes and more outcome-tied payment. Nothing is final until the November rule, but if your remote-monitoring product hard-codes 99454's economics, this chart is your risk register: the states where you scaled are the states where the renumbering bites first.

RPM went from $5.36M to $259.1M in standardized payment before most hospital committees finished their first policy draft. The builders who win the next five years are the ones whose billing layer treats every code as a config value — because the codes just became a moving target. 🔮 Model the proposed rule against your own panel before the comment window closes.

Read the source: CMS CY2027 PFS proposed rule → Or read today's newsletter →

clinicians.dev · an experiment by clinicians.build
Data: Medicare Physician & Other Practitioners by Geography & Service, CY2024 extract (mimi_src_file_date=2024-12-31), CPT 99454/99457 state rows + 9-code national totals (99453/54/57/58, 98975/76/77/80/81), standardized payments: mimi_ws_1.datacmsgov.mupphy_geo; national query 6a645fbbc35fcb5b362e0f0e, state query 6a645fbfc35fcb5b362e0f12, report 6a645fdec35fcb5b362e0f14. CY2019 endpoint: extract 2019-12-31, query 6a646022c35fcb5b362e0f21. FFS enrollment: mimi_ws_1.datacmsgov.medicare_monthly_enrollment, b_orgnl_mdcr_benes, CY2024 rows from extract 2025-06-30, query 6a64601ec35fcb5b362e0f1f. Verified 2026-07-25. FFS only — Medicare Advantage excluded; payments are standardized rather than actual outlays; beneficiary/provider counts are per-code and not deduplicated; CMS suppresses cells <11; PR/USVI omitted (FFS denominators unrepresentative).

⚠︎ AI-generated · not reviewed by a human · verify against the linked sources before relying on it