With the finalized 2026 Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) has introduced 2 important changes that reshape how ophthalmology practices can use at-home vision monitoring. Commercial payer responses vary, including recent remote patient monitoring (RPM) coverage restrictions from UnitedHealthcare, but CMS has established a clear direction. RPM now has both clinical support and a more sustainable reimbursement framework.

These 2 changes expand patient eligibility, improve billing predictability, and make integration of at-home monitoring more achievable.

• Revised, clinically appropriate thresholds for RPM: CMS finalized a new RPM device-supply code (99445) for patients who transmit physiologic data for 2 to 15 days in a 30-day period, complementing 99454, which continues to require 16 or more days. This new code is more aligned with typical physician-recommended vision monitoring intervals. CMS also finalized a new RPM management code (99470) for 10 to 19 minutes of staff/clinician time in a month with at least 1 interactive communication with the patient, alongside the existing 99457 pathway for 20 or more minutes. The new code gives practices more flexibility and should improve both reimbursement and patient eligibility.
   

• Reimbursement for at-home optical coherence tomography (OCT): Although CPT 0606T has existed for physician interpretation of home OCT data, adoption has been limited by the lack of a clearly defined, nationally priced technical pathway. In the 2026 final rule, CMS acknowledges that home OCT does not fit neatly into traditional RPM models and requires a distinct approach. CMS finalized a national payment rate for CPT 0605T, which covers the technical components of home OCT monitoring over a 30-day period, including data acquisition, system setup, technical support, analysis, and reporting. The valuation is modeled on CPT 93229, a cardiac remote monitoring code designed for continuous surveillance. Together, 0605T and 0606T establish a clearer, more sustainable reimbursement framework that may improve the practicality of home OCT adoption for ophthalmology practices.

RPM Improves Personalization and Patient Confidence

Vision deterioration between office visits can be difficult to detect and often results in irreversible loss if not caught early. Many eye diseases affect more than central vision, making subjective symptom reporting unreliable. RPM provides objective interval monitoring, allowing clinicians to detect early signs of progression and intervene sooner. Patients feel reassured knowing that their vision is continuously being monitored rather than relying on self-awareness alone.

The technology is also patient friendly. Most systems run on familiar devices like smartphones or tablets and guide users through short, game-like tests. This stands in contrast to the Amsler Grid, which has long-recognized limitations in sensitivity, specificity, and patient adherence.

At partner retina clinics, our teams have used RPM through the MyVisionTrack (mVT) app for nearly 2 years. Adoption has been strong: nearly half of eligible patients opt in, and 90% say they would recommend the tool. The platform notifies care teams of changes that may indicate disease activity.

Advance and Differentiate Your Practice

At-home monitoring tools allow practices to act quickly on relevant vision changes while reducing unnecessary visits for stable patients. Studies show that home OCT alerts and other monitoring solutions can help identify patients needing timely intervention while safely spacing visits for those who remain stable.

Monitoring programs can also improve compliance, bolster patient satisfaction, and support practice financial performance. A Health Affairs study using national Medicare claims found that primary care practices that began billing RPM between 2019 and 2021 saw about a 20% increase in Medicare revenue over the following 2 years compared with matched nonadopters.¹ In ophthalmology, remote monitoring and principal care management programs can create reliable, diversified reimbursement pathways that promote long-term sustainability. These services generally come at little or no cost to Medicare beneficiaries, depending on supplemental coverage, further reducing patient barriers to participation.

Best Practices for Adoption and Making the Most of New Codes

Thoughtful implementation is essential for at-home monitoring to succeed in a practice setting.

• Consider your options: Review the available vision monitoring solutions and compare their clinical evidence, ease of use, patient support, and operational requirements. Select tools that align with your clinical philosophy and workflow.
   

• Prepare your clinical team: Educate staff on eligibility criteria for RPM, how to introduce the service to patients, and how to discuss out-of-pocket costs. Stay aware of payer-level RPM coverage policies. Establish clear protocols for billing, workflows, and responding to alerts.
   

• Prepare your billing team: Coverage changes can be confusing for patients and staff. Review chronic care management and remote monitoring codes with your billing team to ensure confidence in documentation and reimbursement expectations. Train staff on how to discuss billing transparently and consistently.
   

• Thoughtfully operationalize: Strong triage protocols ensure that clinical alerts receive timely and appropriate responses. Many practices partner with third-party services to manage monitoring operations, handle data, and support patients without straining in-clinic workflow. External support can help maintain adherence and troubleshoot equipment.

The 2026 CMS updates mark a turning point for at-home vision monitoring. With revised RPM thresholds, improved time-based reimbursement, and meaningful payment for home OCT, practices now have the regulatory and financial foundation needed to adopt these tools confidently. When implemented thoughtfully, at-home monitoring strengthens disease management, enhances patient satisfaction, and supports sustainable practice growth—while aligning with CMS’s broader movement toward continuous, proactive care. OM

Reference

1. Tang M, Stern AD, Marcondes F, Mehrotra A. Practices that adopted remote physiologic monitoring increased Medicare revenue and outpatient visits. Health Aff (Millwood). 2025;44(11):1386-1394. doi:10.1377/hlthaff.2025.00683

Landon Grace, PhD is CEO of Lumata Health, where he leads the company's strategic vision, growth initiatives, and research and development endeavors. Lumata Health partners with clinics that utilize remote vision-monitoring tools, including MyVisionTrack (mVT) and similar technologies. Dr. Grace receives no personal financial incentives tied to the adoption, utilization, or performance of these specific products.