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Anthem has quietly made an important update to its clinical policy CG-MED-91, effective December 18, 2025. The change aligns Anthem with CMS’s 2026 Physician Fee Schedule and formally recognizes the new “short-cycle” Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) CPT codes.
This is not a cosmetic revision. It materially expands what can be billed, when it can be billed, and how episodic or lower-engagement remote monitoring programs can be structured under commercial coverage.
What Anthem Added
The updated policy now explicitly includes:
• Short-cycle RPM device supply for 2–15 days of data capture in a 30-day period
• Short-cycle RPM treatment management recognizing the first 10 minutes of interactive management time
• Parallel short-cycle RTM device supply codes for non-physiologic data
• Updated RTM treatment-management recognition for first-tier monthly time
In practical terms, Anthem is acknowledging that remote monitoring does not always look like a 30-day, 16-day-minimum, fully continuous program. Acute monitoring, transitional care, post-discharge follow-ups, and adherence-focused interventions now have a viable reimbursement path under Anthem’s commercial policies.
Why This Matters Operationally
For practices and health systems, the biggest impact is not just “more codes.” It’s flexibility.
Historically, anything that failed to hit the traditional RPM thresholds simply went unbilled, even if the work was clinically meaningful and documented. Anthem’s adoption of these short-cycle codes closes that gap. It also signals that other large commercial payers are likely to follow the same trajectory, especially as CMS continues to normalize shorter-engagement remote care models.
That said, payer alignment is still uneven. Coverage inclusion does not mean every code is payable in every scenario, for every plan, in every state. This is where most RPM and RTM programs quietly fall out of compliance.
Where to Learn More
If you’re trying to keep track of how different payers are handling RPM, RTM, and the new 2026 CPT landscape, we maintain a growing set of payer-specific breakdowns and operational guidance on the FairPath resources page. That includes summaries of commercial payer policies, Medicare rules, and how these codes actually behave in real billing workflows, not just in CMS tables.
How FairPath Handles This
FairPath was built for exactly this kind of change.
When Anthem updates a policy like CG-MED-91, nothing about your workflow should require manual intervention. FairPath’s compliance engine automatically generates claim-ready data based on actual device usage, time capture, and interaction events. The system selects the correct RPM or RTM billing codes—including the new short-cycle codes—based on eligibility and documented activity.
More importantly, FairPath is payer-aware. If a specific Anthem plan, region, or policy variation does not support a given code, the platform can enforce that restriction or surface a warning before a claim is ever generated. That prevents the common failure mode where practices discover payer incompatibilities only after denials, audits, or recoupments.
This is not about chasing new codes for marginal revenue. It’s about encoding payer policy reality directly into your operating system so compliance is automatic and exceptions are visible early.
Anthem’s update is another clear signal of where remote care reimbursement is going in 2026. The organizations that treat these changes as configuration, not chaos, will be the ones that scale safely.