Insurance coverage rules change frequently, and it is up to providers to stay current with evolving reimbursement policies. A similar thing has happened at the start of 2026. UnitedHealthcare, commonly known as UHC, has taken a revolutionary step in claim reimbursement related to RPM (remote physiologic monitoring). If you’re a podiatrist, internist, or related to any of the healthcare disciplines, this blog is for you.
In this guide, we will discuss some of the key UnitedHealthcare 2026 RPM coverage changes that will affect your revenue. If you are offering remote patient monitoring services, this blog contains some of the most valuable details. You can optimize your revenue cycle and improve collections by knowing which categories in patient care are now eligible for reimbursement from UHC. Let’s go.
What is RPM (Remote Patient Monitoring)?
Remote patient monitoring is a term used extensively in medical billing. RPM is a mode of medical care where patients are treated in the comfort of their home, and vital health data is obtained from monitoring devices. There’s a wide list of items that are included in this category that are used for collecting patient health data outside of the clinic setting.
Commonly used RPM devices include:
- Glucose Meters (used for measuring fasting and post-prandial glucose levels in diabetic patients).
- Blood Pressure Monitors (measuring systolic and diastolic blood pressure from the arm and heart rate).
- Continuous Glucose Monitors (CGMs) (wearable sensors providing 24-hour data on glucose levels from the skin).
- Pulse Oximeters (measure oxygen saturation (SpO₂) and pulse rate).
- Digital Thermometers (monitor body temperature remotely).
- Smart Weight Scales (track weight and BMI, often integrated with apps).
- Respiratory Rate Monitors (measure breathing patterns and detect abnormalities).
- Sleep Monitors (track sleep quality, apnea, and rest cycles).
- Smart Rings (e.g., Oura Ring/ Galaxy ring) (track heart rate, oxygen, sleep, and activity).
During the COVID and post-COVID periods, health insurance companies across the US have allowed providers to offer virtual healthcare. Till 2025, Medicare and private insurers have reimbursed billions for such services. Practices utilizing RPM can add the relevant CPT code and clinical notes for medical necessity for claim submission. Now, all this is about to change, which may cause a significant shift in claim reimbursement ratios. Let’s discuss what will happen next.
The Narrowed Focus: The “Two-Condition” Rule
From 2026 onwards, providers across all platforms are permitted to offer remote patient monitoring services in two medical conditions only. Beginning in 2026, UHC will only consider RPM medically necessary for:
- Heart failure (HF)
- Hypertensive disorders of pregnancy (HDP)
In light of this decision, podiatry and other medical specialties cannot bill patients for RPM devices based on medical necessity. Medical conditions that are affected by this new rule include:
- Diabetes mellitus
- Hypertension (outside of pregnancy)
- COPD
- Obstructive sleep apnea
- Mental health conditions
- Gestational diabetes
Since it is an ongoing process, it is utmost important for medical practitioners to take immediate steps to comply with this update. In the upcoming months, this will be the key deciding factor for practices enrolled in the in-network programs. Now they must transfer these patients into chronic care management or its equivalent to keep treating their patients.
The Conflict: UHC vs. CMS
In the post-covid when remote physiological monitoring was the new norm, UnitedHealthcare’s U-turn in this matter is complex and far more consequential than a common change of rules. We will now look at this matter more thoroughly, how the CMS (Center for Medicare & Medicaid Services) and UnitedHealthcare are moving in the opposite direction. Let’s see why two of the most important health insurance entities have polar opposite stances on remote patient monitoring services.
CMS (Medicare)
In 2026, the Medicare Physician Fee Schedule (MPFS) will not only be maintained for RPM services, but it will also be expanded to cover shorter monitoring periods (2–15 days), and new CPT codes have been introduced as well. To further facilitate providers, CMS has reduced the minimum clinical time required to bill for management (from 20 minutes down to 10–19 minutes). This step signals that the CMS health plan will include more programs for virtual patient monitoring and reimburse them adequately. Thus, showing the willingness to expand the RPM to everyone suffering from chronic conditions.
UnitedHealthcare (UHC)
UHC has taken a big decision that will not only impact providers but also millions of patients on their health plan. The new decision, where UnitedHealthcare has declared the remote patient monitoring as a “luxury” or “unproven” for the vast majority of patients. Patients suffering from diabetes or other metabolic/hormonal issues, along with isolated and general hypertension, are excluded from eligibility.
Now, only patients suffering from CHF/HF (congestive heart failure/heart failure) and Hypertensive disorders of pregnancy (HDP) are eligible for RPM devices. This not only closes the door to millions of patients with chronic metabolic conditions, but may also increase the future hospitalization if these patients are not on constant monitoring. Some of the provisions of this decision may be rolled back. For now, providers must prepare themselves for an uphill battle with their patients and claim submissions.
Impact on Podiatry and Specialized Care
There will be many medical disciplines that will face a significant impact on their practice with this decision. Podiatry will be the one that will face the most disruption, especially diabetic foot care clinics and limb salvage programs across the US.
Impact on Diabetic Foot Care
Diabetic patients with neuropathy are not just suffering from one condition; they’re dealing with two at the same time. Patients with diabetic neuropathy may experience a small spike in temperature or glucose, and it may require a visit to the ER.
The gap in RPM services will severely impact the treatment protocols for type-2 diabetes and its billing procedures for a variety of practices, including podiatry and endocrinology. Podiatry clinics have to develop new methods of providing treatment to these patients through alternate methods.
The “Diagnostic Blind Spot
Many foot and ankle care surgeons use specialized monitoring tools like smart socks, thermal insoles, and cellular-connected scales to monitor patients who cannot feel their own feet. Without being able to bill patients for such care services, providers across the US will be forced to cut these monitoring programs. This will create a moral dilemma for them because if they keep offering RPM, it will be at their own expense. If they don’t provide, it’ll increase the complication for their patients, resulting in a decline in the quality of life.
The Medicare Advantage (MA) Legal Friction
Physicians and specialized care providers can face a legal limbo because Medicare Advantage plans (like those run by UHC) cover everything from device to data transfer, etc. Providers who are participants in such programs have to offer RPM to all chronic conditions under CMS rules. If UHC rejects those claims, then there is no way healthcare institutions can recover the reimbursement amount. This ambiguity will further damage the revenue cycle for practices running completely for remote patient monitoring. UHC remote patient monitoring policy delay can put practices on pause and patients in confusion.
The Proactive Response: What Practices Should Do During the Delay
With the changes looming over the podiatry and other medical specialties, it is prudent for them to prepare and make alternate arrangements. The steps they can take to keep offering RPM for diabetes and hypertension in 2026 are as follows:
Audit: Identify Patients on UHC Plans Currently Using RPM
The first step to take for tackling this scenario is to initiate a thorough audit proactively. Providers shouldn’t wait for a denial to find out who is affected. The medical billing team of the practices can create a detailed list of their patients with UHC (Commercial, Medicare Advantage, and Community Plans) who are currently enrolled in your RPM programs for conditions other than Heart Failure or Hypertensive Disorders of Pregnancy (HDP).
In the audit, providers can categorize their patients on RPM by checking their diagnosis codes. If the ICD-10 codes are diabetes (E11.9) or Hypertension (I10), then these are the patients who will be at high risk if they lose insurance coverage. Similarly, this technique can be used for other specialties in the audit process. During an audit, podiatry practices can evaluate the risk impact on the patients’ health and create a strategy to mitigate it.
Pivot: Explore CCM or APCM Codes as Alternatives
In case of RPM claims, UnitedHealthcare stops paying for the device and data transmission; they still have to pay for the time spent managing the patient’s chronic conditions. Physicians can take a few steps, like consultation with patients for transition to CCM.
In chronic care management, podiatry surgeons and physicians can bill for 20 minutes of non-face-to-face care coordination (CPT 99490). Patients can transition with ease if they have two or more chronic conditions that require constant care, like diabetes, nephropathy, amputation, etc.
As a proactive measure, providers can transition patients to APCM (advanced primary care management) for coordinated primary care services. CMS introduced three new HCPCS codes (G0556, G0557, G0558) for a “bundled” monthly payment. Diabetic foot care centers and podiatrists who function as the “principal” manager for a patient’s limb salvage can explore these as a way to receive a flat monthly fee for managing complexity without the rigid “16-day data” requirement of RPM.
Document: Use the Delay to Gather “Clinical Outcomes” Data
As per UHC’s policy, remote patient monitoring for diabetes and its complications is “unproven” and “ineffective”. This is where Healthcare practitioners can prove this statement wrong. Since UnitedHealthcare 2026 RPM coverage changes are due, providers can best utilize this time to their advantage. You must go beyond standard charting. For every UHC patient on RPM, document a “Direct Clinical Correlation” in your SOAP notes. This way, you can present the evidence in the future when insurers refuse to accept your claims.
Example:
“RPM data showed a 3-degree temperature spike in the left hallux on 01/05. Patient was called for an immediate office visit, where a pre-ulcerative lesion was debrided, successfully preventing an infection and possible hospitalization.”
Why this matters
This strategy will pay its benefits later in the future. When UHC’s policy finally goes into effect, you will have a mountain of evidence to support Expedited Appeals. You are essentially building a legal case that RPM is “Medically Necessary” for your specific patient population.
Summary Table: The 2026 Pivot Strategy
| Strategy | Action Item | Goal |
| Audit | Run a report by Payer (UHC) and ICD-10. | Map out your financial risk. |
| Pivot | Cross-train staff on CCM (99490) requirements. | Replace lost RPM revenue with care time. |
| Document | Include “Saved from Hospitalization” notes in charts. | Prepare for high-success appeals. |
Conclusion
The remote patient monitoring rules change is a landmark decision that will have a lasting impact on the revenue cycle of providers. Though lengthy debates have started, which may cause a delay in the implementation of this decision. UnitedHealthcare’s unilateral policy change will result in a long pause in RPM services for medically necessary cases. Patients utilizing these devices will have to change their policy status to be able to use them.
Only two medical conditions will be considered eligible: heart failure (HF) and hypertensive disorders of pregnancy (HDP). Podiatry practices and other specialties must start a transition process for patients on RPM. A short-term plan, like switching these patients to chronic care management, may prove useful. A second option, using advanced primary care management, can also be useful for coordinated care, where providers act as the principal manager for the limb salvage program and charge a flat monthly fee. It is up to healthcare practitioners to better manage the outcome and reduce the chances of disruptions in RPM services.
If you’re a solo practitioner or managing a hospital and feeling overwhelmed with the current rule change in reimbursement policies, Medheave is your best source for staying up-to-date with changing regulations. Our specialized billing and coding team will help you prepare for UHC’s RPM updates and expedite every submitted claim. Outsource today to get the maximum out of your practice.
