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 $5.5M experiment into a $268M Medicare 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, Medicare paid $5.5M across three of them. In 2024 it paid $267.8M across nine RPM + RTM codes — a 49x 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.

$267.8M
Medicare paid, RPM+RTM codes, 2024
49x
growth in payments since 2019 ($5.5M)
389,342
patients with device-supply months billed (99454)
380x
spread in per-capita adoption between states
Medicare payments, RPM + RTM codes, by year · national
2019 = first year of dedicated RPM codes (99453/54/57); 99458 added 2020, RTM codes 2022. Payments 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
51
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 $5.5M to $268M 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 →
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Data: Medicare Physician & Other Practitioners by Geography & Service, CY2024 vintage (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; FFS Part B enrollment: mimi_ws_1.datacmsgov.medicare_monthly_enrollment, CY2024 yearly state rows. Via MIMI Labs, queried 2026-07-24. FFS only — Medicare Advantage excluded; beneficiary counts are per-code; 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