Health care doesn’t stop when patients leave the clinic. Patients manage their health at home, at work, and in their communities, and comprehensive care extends beyond the traditional office visit. Remote patient monitoring (RPM) brings care beyond the exam room by giving health care teams the ability to track patient data, recognize meaningful changes, and intervene before a concern becomes a crisis.
RPM uses digital devices to collect patient data, which is electronically transmitted to a provider and used to manage health conditions. RPM can benefit patients and providers, for example, by improving patient engagement and care coordination and facilitating early intervention when problems arise.
The potential applications of RPM in clinical practice are vast.1 In sleep medicine, RPM can be used to guide interventions that support positive airway pressure (PAP) therapy adherence.2
While RPM can be an effective tool to support patients and providers, developing an RPM program may present challenges because it requires integrating technology, clinical workflows, and patient engagement in a coordinated way. Financial implications associated with operating an RPM program must also be considered.
The Centers for Medicare and Medicaid Services (CMS) designates a specific set of requirements for RPM services to be reimbursed.3 In sleep medicine, a variety of current procedural terminology (CPT) codes may be used to bill for sleep-related services supported by RPM.4 Under CMS guidelines, RPM services can be billed by a physician or advanced practice provider (APP), which presents an opportunity to structure RPM as an APP-led program.
APPs can bring value to sleep medicine teams by increasing access to care, optimizing efficiency, and enhancing continuity of care, and are therefore uniquely positioned to lead an RPM program. An exemplar APP-led RPM program from a community-based sleep clinic is described below.5
APP-led RPM
This RPM program was developed with the goal of supporting patients on their PAP therapy journey. A respiratory therapist (RT) schedules phone visits with patients to review the PAP report and identify barriers to therapy adherence. The RT then provides targeted education and care coordination via established clinic protocols. Services provided by the RT fall within their scope of practice and may include mask fit, equipment utilization, therapy acclimation, and clarification of processes or expectations. The visit documentation is reviewed by an APP who adds management recommendations, if indicated. This program started with telephone check-ins two to three weeks following PAP initiation but has expanded to include provider-requested visits after therapy adjustment or mask fitting.
The billing structure for this RPM model uses CPT code 99457, which can be billed once in a 30-day period for RPM services of at least 20 minutes that include interactive, real-time communication with the patient or caregiver.3,4 This code also allows for services to be furnished by clinical staff with general supervision by the billing provider, which is leveraged in this model to use the services of an RT. Experience with this model has been that reimbursement for RPM visits is more consistent with Medicare but varies with Medicaid and commercial insurance plans. Implementing RPM therefore may require some trial and error to understand reimbursement patterns for your payer mix.
Other RPM models could be considered to enhance clinic services depending on patient needs and personnel resources. Patients using noninvasive ventilation (NIV) can receive longitudinal support via RPM. Patients with neuromuscular disease in particular require more frequent follow-up, and RPM visits with an RT could supplement provider visits and durable medical equipment services. In addition to equipment-related RT services, they could assist with NIV setting changes, nocturnal oximetry, and transcutaneous carbon dioxide monitoring in collaboration with the provider.6 If an RT is unavailable, an APP could perform these visits, providing access to NIV or PAP support without utilizing an exam room or clinic staff resources.
Another example might be an APP who provides inpatient NIV management conducting RPM visits to expand access to a greater number of patients. The frequency of RPM visits should be tailored to patient needs and preferences, considering complexity and independence with therapy. Additionally, approaching RPM visits as intentional visits with a scheduled time and focus is important to optimize the workflow and reinforce the model as a billed service.
RPM: The path forward
Implementing an RPM program is more than adopting new technology; it’s an opportunity to rethink how care is delivered outside the sleep clinic. When thoughtfully designed and supported by strong clinical leadership, RPM has the potential to benefit patients, providers, and systems. As health care continues to evolve toward more value-based models, RPM could play an important role in the delivery of effective and efficient patient-centered sleep care.
References
1. Kruklitis R, Miller M, Valeriano L, Shine S, Opstbaum N, Chestnut V. Applications of remote patient monitoring. Prim Care. 2022;49(4):543-555. doi:10.1016/j.pop.2022.05.005
2. Patil SP, Ayappa IA, Caples SM, Kimoff RJ, Patel SR, Harrod CG. Treatment of adult obstructive sleep apnea with positive airway pressure: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019;15(2):335-343. doi:10.5664/jcsm.7640
3. Centers for Medicare and Medicaid Services. Telehealth and remote monitoring. MLN901705. Published December 2025.
4. American Academy of Sleep Medicine. Remote monitoring services implementation guide. Published 2026.
5. Bebawy GS, Patel AS, Patel AM. Expanding access to otolaryngologic care: The growing role of advanced practice providers in Medicare. Laryngoscope Investig Otolaryngol. 2026;11(2):e70411. doi:10.1002/lio2.70411
6. Geronimo A. Remote patient monitoring in neuromuscular disease. Muscle Nerve. 2022;66(3):233-235. doi:10.1002/mus.27658
