Medicaid RPM Spending Trends: 2018–2024 Year Over Year

Remote patient monitoring arrived in Medicaid claims data quietly — a handful of procedure codes, a few hundred thousand dollars, and a patient population that had historically been underserved by digital health innovation. Then the pandemic hit, and everything changed. Between 2019 and 2023, Medicaid RPM spending grew from under $900,000 to more than $12 million, a trajectory that few analysts predicted and that carries significant implications for how state Medicaid programs think about technology-enabled chronic disease management. But the story doesn't end with a triumphant growth curve. The 2024 data introduces a complication — the first year-over-year spending decline in the dataset — that demands careful interpretation.

This analysis examines six years of Medicaid claims data across four RPM procedure codes (99453, 99454, 99457, and 99458), tracing not just the headline spending numbers but the shifting composition of the RPM billing mix and what it reveals about how providers and patients are actually using these services.

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The Growth Trajectory: From Niche to Notable

The aggregate spending and claims data tells a story of explosive early adoption followed by a more complex maturation phase.

The 2020 inflection point is unmistakable. Claims volume surged 459% in a single year — a figure that reflects both genuine adoption and the regulatory environment that made it possible. The COVID-19 public health emergency prompted CMS and state Medicaid agencies to expand telehealth and remote monitoring flexibilities, and providers who had been watching RPM from the sidelines moved quickly to implement programs. The spending growth of 177.3% in 2020, while dramatic, actually lagged the claims growth rate, suggesting that early adopters were billing a relatively lean mix of codes — primarily the lower-complexity management codes rather than the full suite of device and monitoring services.

The 2021 and 2022 numbers reveal a program deepening rather than just widening. Claims continued to grow at triple-digit rates in 2021 (+155.5%) and strong double-digit rates in 2022 (+86.8%), but spending growth in 2022 actually re-accelerated to +108.7% — outpacing claims growth for the first time. This divergence is a meaningful signal: the average revenue per claim was rising, which points to providers billing more complex or comprehensive combinations of RPM codes per patient encounter.

By 2023, the growth rates had moderated substantially — +46.2% in spending and +33.3% in claims — consistent with a market moving from early-adopter expansion into broader but more measured utilization. Total spending crossed $12 million and claims approached 950,000, establishing RPM as a meaningful line item in Medicaid's technology-enabled care portfolio.

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The 2024 Reversal: Contraction or Correction?

The 2024 data is the most analytically interesting entry in the dataset. Both spending (-16.3%) and claims (-11.4%) declined year over year — the first contraction since the dataset begins. Total spending fell from $12.2 million to $10.2 million, and claims dropped from 943,469 to 835,937.

Several structural factors are worth considering when interpreting this decline. The expiration of COVID-era telehealth flexibilities created regulatory uncertainty for RPM programs in many states, and some Medicaid managed care organizations tightened prior authorization requirements for remote monitoring services as utilization review practices caught up with the rapid adoption of prior years. Additionally, the 2024 data in this dataset may reflect incomplete claims adjudication — a common artifact in Medicaid data where claims submitted late in the calendar year are processed and finalized in subsequent periods. Given that today's date is February 2026, the 2024 figures are likely more complete than a snapshot taken in mid-2025 would have been, but some degree of run-out lag may still apply.

What the data cannot tell us is whether the 2024 decline represents a genuine pullback in RPM utilization — providers discontinuing programs, patients disengaging from monitoring — or a billing and reimbursement adjustment that reduced claims volume without necessarily reducing the underlying care activity. The answer matters enormously for policy: a utilization pullback in a population with high rates of chronic disease and limited access to in-person care would be a concerning outcome, while a reimbursement correction might simply reflect more accurate coding practices.

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Code-Level Dynamics: Who's Driving the Spending?

The aggregate numbers obscure a fascinating shift in the composition of RPM billing. Looking at the four procedure codes individually reveals how the clinical and administrative infrastructure around RPM has evolved.

Annual Spending by Procedure Code

Note: 2024 data reflects partial code-level reporting available in the dataset.

Share of Total RPM Spending by Code

The 2019 baseline is striking in its simplicity. Nearly 88.4% of all RPM spending flowed through 99457 — the treatment management code for the first 20 minutes of provider time — while 99454 (the device and physiological monitoring code) accounted for just 11.1%. The setup code 99453 was essentially negligible at 0.52%, and 99458 (additional management time) did not appear in the data at all. This profile suggests a very early-stage market where a small number of providers were billing primarily for their time managing remote patients, without the full device-and-monitoring infrastructure that a mature RPM program requires.

The transformation between 2019 and 2021 is dramatic. By 2021, 99454 had become the single largest code by spending share at 47.7%, surpassing 99457 (41.0%) for the first time. This inversion is clinically meaningful: it indicates that providers were no longer just billing for management time but were standing up the device provisioning and data collection infrastructure that makes RPM a continuous monitoring service rather than an episodic check-in. The rapid growth of 99454 from $97,368 in 2019 to $1.9 million in 2021 — a nearly 20-fold increase in two years — reflects the scaling of device programs across the Medicaid RPM provider base.

The Rise of 99458: Extended Engagement

Perhaps the most telling trend in the code-level data is the trajectory of 99458, the add-on code for each additional 20 minutes of treatment management beyond the initial period billed under 99457. This code was absent from the 2019 data entirely, appeared at just 3.33% of spending in 2020, and climbed steadily to 20.47% of total RPM spending by 2023 — representing $2.5 million in absolute terms.

The growth of 99458 as a share of the billing mix suggests that RPM encounters are becoming more complex and time-intensive over time. Providers are spending more than 20 minutes per patient on remote monitoring management, which could reflect a more clinically complex patient population, more sophisticated monitoring protocols, or simply greater provider familiarity with billing the full scope of services they are delivering. In a Medicaid context — where patients often have multiple comorbidities, social determinants of health challenges, and limited access to supplementary care — longer management encounters are clinically plausible.

Incremental Dollar Growth: Which Codes Drove the Expansion?

Looking at the incremental spending growth between 2020 and 2023 — the core expansion period — the code-level contributions are clear:

99454 contributed the largest absolute dollar increment — $4.16 million — between 2020 and 2023, followed by 99457 at $3.07 million and 99458 at $2.42 million. The setup code 99453 contributed a comparatively modest $128,639 in incremental spending, consistent with its role as a one-time billing event per patient enrollment rather than a recurring service.

The near-equal contribution of 99457 and 99458 to incremental growth is notable. Together, the two management codes added $5.49 million in spending between 2020 and 2023, slightly more than 99454 alone. This suggests that the growth story is not simply about more devices being deployed — it is equally about more provider time being invested in managing the data those devices generate.

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Policy Implications and Open Questions

The six-year arc of Medicaid RPM spending raises several questions that aggregate data alone cannot answer but that should inform state and federal policy discussions.

Equity and access: Medicaid's RPM growth is occurring in a population that has historically faced significant barriers to digital health adoption — including device access, broadband connectivity, and health literacy. The rapid claims growth between 2020 and 2022 suggests that at least some of these barriers were being overcome, but the 2024 contraction raises questions about whether access gains are durable or fragile in the face of regulatory and reimbursement changes.

Program integrity: The speed of the 2020–2022 expansion — particularly the 459% claims surge in 2020 — warrants scrutiny. Rapid growth in any Medicaid service line attracts attention from program integrity units, and RPM has been the subject of fraud alerts from OIG in the broader Medicare context. State Medicaid programs should be examining whether the claims growth reflects genuine patient enrollment in monitoring programs or billing anomalies.

The 2024 question: Whether the spending decline in 2024 represents a temporary correction or the beginning of a sustained contraction will be one of the more important questions in Medicaid digital health policy over the next two to three years. The answer will depend heavily on how states respond to the expiration of pandemic-era flexibilities and whether CMS provides durable coverage guidance for RPM in Medicaid.

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Key Takeaways

• Medicaid RPM spending grew from $879,844 in 2019 to a peak of $12.2 million in 2023, representing a roughly 14-fold increase over four years, driven by pandemic-era regulatory flexibilities and rapid provider adoption.

• The 2020 claims surge of 459% was the single largest year-over-year jump in the dataset, reflecting the immediate impact of COVID-19 telehealth expansions on RPM utilization.

• The billing mix shifted fundamentally between 2019 and 2021: 99457 (management time) fell from 88.4% to 41.0% of spending share, while 99454 (device monitoring) rose from 11.1% to 47.7%, indicating the maturation of device-based monitoring infrastructure.

• 99458 (additional management time) grew from 3.3% to 20.5% of spending between 2020 and 2023, suggesting increasingly complex and time-intensive remote monitoring encounters.

• 2024 marked the first year-over-year decline in both spending (-16.3%) and claims (-11.4%), a reversal that may reflect regulatory headwinds, reimbursement adjustments, or claims run-out lag — and that deserves close monitoring as 2025 data becomes available.

• The four RPM codes collectively represent a small but rapidly scaled line item in Medicaid's technology-enabled care portfolio, with significant implications for chronic disease management in a population with high clinical complexity and historically limited access to continuous monitoring.