Custom Remote Patient Monitoring Software
We build RPM platforms that connect Bluetooth and cellular devices, count billable days for 99454 and 99445, route alerts to your care team, write readings to your EHR over FHIR and export charges to your RCM system.
The challenge behind the brief
Updated September 2026.
Custom remote patient monitoring software is the platform a provider group, care management company or digital health team uses to run an RPM program under its own brand and rules. We build it end to end: device onboarding, data capture from Bluetooth devices, cellular hubs and vendor APIs, day counting against the 16-day rule and the new 2 to 15 day code, clinician-approved alert thresholds and triage queues, time tracking for treatment management, FHIR write-back to your EHR and a monthly billing export to your RCM system.
The difficult part of RPM software is not the dashboard. It is proving each billable month: that the device meets the FDA definition of a medical device, that readings arrived on enough distinct days in the 30-day period, that a real-time interactive conversation happened, that minutes were not also counted for CCM, and that only one practitioner billed the patient. We engineer that evidence into the data model, so billing is a query, not a reconstruction.
Running CCM or APCM as well? See our chronic care management software service. Need the device or EHR connection alone? Start with medical device integration or EHR integration services, delivered on Interoply, our integration platform.
Primary sources: CY 2026 Physician Fee Schedule final rule, CMS Telehealth and Remote Patient Monitoring booklet (MLN901705), FDA policy for device software functions, US Core Vital Signs profile, FHIR R4 Device and Bluetooth Blood Pressure Profile.
Define the right scope
Assign a device to a patient, ship or hand it over, pair it, confirm the first reading and record the education session. The setup record carries the device serial, the ordering practitioner, the diagnosis and the date, so 99453 is billed once per episode of care with evidence attached.
Bluetooth Low Energy devices through a patient app using the standard GATT profiles for blood pressure, glucose, weight and pulse oximetry; cellular-embedded devices and cellular hubs that need no phone; and vendor cloud APIs such as Tenovi, Smart Meter, Withings and Dexcom, plus Apple HealthKit and Google Health Connect for consumer wearables. Every reading keeps its device, timestamp and source.
Each patient runs on a rolling 30-day device period. The platform counts distinct days with a transmitted reading and maps the period to 99454 for 16 to 30 days or 99445 for 2 to 15 days, one device code per patient per period however many devices they use. Patients at risk of missing their days get a reminder before the period closes.
Per-patient thresholds set by the ordering clinician, trend and missed-reading rules, and queues ranked by clinical priority. Duplicate readings are merged, repeat alerts are suppressed until acknowledged, and every alert records who reviewed it, what they did and when.
A time ledger per calendar month for clinical staff and practitioner time, with the real-time interactive communication that 99457 and 99470 require logged as its own event. 99470 covers the first 10 minutes, 99457 the first 20 and 99458 each additional 20. The same ledger is shared with CCM, so no minute is billed twice.
Readings written to the EHR as FHIR Observation on the US Core Vital Signs profiles with LOINC codes (85354-9 blood pressure panel, 8867-4 heart rate, 29463-7 body weight, 59408-5 SpO2), linked to a FHIR Device and Provenance, or sent as HL7 v2 ORU where the EHR expects messages. Clinicians see RPM data in the chart they already use.
At period and month end the platform produces charge-ready lines with codes, dates of service, rendering and billing provider and diagnosis, and sends them to your practice management system or clearinghouse as HL7 DFT, FHIR ChargeItem or through your 837P workflow.
Pairing, reading reminders, trend views, education content and secure messaging, designed for older patients with large type, few steps and caregiver access.
Explore the service in detail
Device integration layer
One normalized device API in front of Bluetooth devices, cellular hubs and vendor clouds.
RPM EHR integration
Readings, alerts and monthly summaries in the EHR your clinicians already use.
Clinical monitoring and alert triage
Queues that surface the patients who need a call today.
RPM billing and RCM export
Monthly evidence and charges that stand up to a payer audit.
RPM with CCM and APCM
One patient record and one time ledger across care management programs.
Regulatory boundary and device selection
Decisions that keep the software out of unplanned FDA scope.
What to evaluate in your partner
Buy or white-label when you need a program running this quarter with standard devices and one EHR. Build when RPM is your product, when you run it across many practices or EHRs, when you combine RPM with CCM and APCM, or when per-patient platform fees and data terms no longer fit. Many teams keep a device vendor for logistics and build the clinical, billing and EHR layers they want to own.
Cellular devices send readings with no setup on the patient's side, which raises the number of days with data, at a higher device cost. Bluetooth devices cost less but depend on the patient's phone and app. Most programs use cellular for older patients and Bluetooth for app-first populations; our device layer supports both behind one API.
Decide whether your own nurses, a contracted monitoring team or both work the queue, their hours, and what happens after hours. The software enforces the escalation path you approve and records every hand-off.
Cost follows the number of device types and vendors, the EHRs you write back to, whether the platform is multi-tenant, the billing path and the patient app. We give a fixed-scope estimate after discovery, broken down by module and integration, with no per-patient fees on software you own.
We sign BAAs, and Nirmitee is ISO 27001:2022 certified. Readings are encrypted in transit and at rest, access is role based, and audit logs record every view, alert acknowledgement and change to a patient's record.
Client names are withheld; each is a real engagement. An offline-first screening EMR that captures readings from connected devices and reconciles when the network returns (live in production). A contactless health-check kiosk with private results for public venues (live). A consumer health-records app that unifies provider records with the user's wearable data (live in the app stores). A chronic pain platform with patient-reported outcomes and a clinician portal (live in production). Our open-source RPM platform foundation, nirmitee-rpm, provides multi-tenant workspaces, role-based access, single sign-on, audit logging, patient and device views and time logging. And our open-source headless EHR on FHIR R4, which passed 47 of 47 ONC (g)(10) SMART App Launch tests in Inferno on 11 June 2026 (github.com/Nirmitee-tech/headless-ehr-fhir).
A reviewable delivery approach
Device layer first, clinical workflow second, billing proven on a pilot cycle before scale.
Map the program: conditions, devices, who orders and who triages, the EHRs and the billing path. Confirm device vendors and integration access.
Deliverables: program workflow, device and vendor shortlist, EHR interface list, billing rules inventory, fixed-scope estimate.
Device onboarding, Bluetooth, cellular and vendor API ingestion, and the patient, device, reading and 30-day period model the rest depends on.
Deliverables: normalized device API, day counting, patient app pairing and reminders.
Thresholds, triage queues, time ledger and interactive communication logging, then FHIR or HL7 write-back to the EHR.
Deliverables: care team workspace, alert rules, EHR interface tested against real payloads.
Billing export to RCM, a pilot cohort through one full billing cycle, reconciliation, then more practices and devices.
Deliverables: audit pack per billed month, reconciled first cycle, monitoring and support.
Evaluating an integration or product partner? Explore the systems, workflows, and technical decisions behind our work.
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Explore the implementationA working model for your priorities
Define the scope, ownership, and delivery responsibilities together. Commercial terms and team availability follow that conversation.
Bring a product or integration milestone. Agree the dependencies, deliverables, and acceptance criteria before implementation.
Explore engineering, integration, design, and QA support that works with your existing product and technical leads.
Before you choose a partner
It is an RPM platform built for your program rather than rented from a vendor: device onboarding and data capture, day counting for billing, alert thresholds and triage, time tracking for treatment management, EHR write-back and billing export, under your brand and rules. You own the code, the data model and the patient history.
Cost depends on the number of device types and vendors, the EHRs you write back to, whether the platform serves one organization or many, the billing path and the patient app. We give a fixed-scope estimate after discovery, broken down by module and integration, so you can phase the build.
99453 for setup and education, 99454 for device supply with 16 to 30 days of data, 99445 for device supply with 2 to 15 days, 99457 for the first 20 minutes of treatment management, 99458 for each additional 20 minutes, 99470 for the first 10 minutes, and 99091 for 30 minutes of practitioner data review. Remote therapeutic monitoring uses separate 989xx codes and is not billed with RPM for the same period.
The CY 2026 Physician Fee Schedule final rule added 99445 for 2 to 15 days of device data in a 30-day period and 99470 for the first 10 minutes of treatment management in a calendar month, both from 1 January 2026. Programs no longer lose the device payment when a patient transmits on fewer than 16 days, and short months of management time are billable. Software has to count days and minutes against both thresholds.
99454 is billable only when the patient transmits data on at least 16 days in a 30-day period. From 2026, periods with 2 to 15 days are billed with 99445 instead. The platform counts distinct days per patient per period and reminds patients before a period closes.
Blood pressure cuffs, weight scales, pulse oximeters, glucose meters, continuous glucose monitors, thermometers and spirometers, over Bluetooth Low Energy, cellular connections or hubs, and vendor APIs such as Tenovi, Smart Meter, Withings and Dexcom. Consumer wearables come in through Apple HealthKit and Google Health Connect.
Medicare requires the monitoring device to meet the FDA definition of a medical device, and most programs use FDA-cleared devices. Software that only transfers, stores, converts or displays device data falls outside FDA device oversight under section 520(o)(1)(D) of the FD&C Act. Software that analyzes readings to diagnose or drives time-critical alarms can be a device function, so we design alerting around clinician-set thresholds and plan any regulated feature explicitly.
We write readings as FHIR Observation resources on the US Core Vital Signs profiles with LOINC codes, linked to a FHIR Device, through the EHR's FHIR API where it accepts writes, or as HL7 v2 ORU messages through an interface engine. Monthly RPM summaries can be filed as a document, and clinicians can open the RPM workspace from inside the EHR with SMART on FHIR.
Thresholds are set per patient by the ordering clinician, repeated readings are merged, alerts stay suppressed until acknowledged, and trend rules replace single-reading alarms where the clinician agrees. Queues are ranked by clinical priority, and each alert records who reviewed it and what they did.
Yes. Medicare allows RPM in the same month as CCM, PCM or APCM, provided each minute of work is counted toward one service only. RPM and remote therapeutic monitoring cannot be billed for the same patient in the same period, and only one practitioner can bill RPM for a patient in a 30-day period.
Buy or white-label for speed with standard devices and one EHR. Build when RPM is your product, when you run it across several practices or EHRs, when you combine it with CCM and APCM, or when per-patient fees and data terms stop making sense. A common path keeps a device logistics vendor and builds the clinical, billing and EHR layers.
A first release with device onboarding, data capture, alerts, time tracking and billing export for one program is planned in months. EHR write-back and additional device vendors follow in phases. EHR vendor access and device vendor contracts run on outside calendars, so we start them in the first week.
Let’s make the next step useful
Discuss your workflows, systems, and delivery priorities with the Nirmitee team.
