Paid to Watch: A $2.5 Billion Patient-Monitoring Market Is Moving to Machines, and masseuse.ai Is Building One

In one paragraph. masseuse.ai builds a service that watches a person through a camera and microphone during electrical stimulation of the kind physical and occupational therapists apply (transcutaneous electrical nerve stimulation, TENS, for pain; neuromuscular electrical stimulation, NMES, for muscle contraction), adjusts the stimulator within limits a licensed clinician sets, and produces the time-stamped record payers require for a supervised session or a month of monitoring. The video is decrypted only on the user's devices and inside a confidential-computing enclave whose code is public. Today, individuals pay for the sessions as wellness sessions. The market the service is built for is the $2.5 billion a year Medicare and Medicaid pay, by measured claims, for a human to watch a patient or a patient's device data: growing 14 percent a year since 2018, and in its highest-priced tiers already handed to cleared software.

The problem the payer has

A monitoring code buys a stream of data, a person's minutes and a judgment; the minutes are the cost and the audit surface. The HHS Office of Inspector General (OIG) found that in 2022, 43 percent of Medicare enrollees receiving remote physiologic monitoring were missing one of its three required components: Medicare paid for data nobody reviewed, or for review of data no device sent.³

In physical medicine the person is priced out. Unattended electrical stimulation (code G0283) paid $6.78 a session in Medicare in 2024; the same stimulation with a clinician in constant attendance (97032) paid $8.85 per 15 minutes, while 15 minutes of therapeutic exercise (97110) paid $17.54. Medicare's contractor asks the record to justify "the medical necessity of the constant contact."^1,6 Almost nobody attends: 97032 fell from $8.6 million on 876,000 units in 2018 to $4.5 million on 512,000 in 2024.¹ The payer has a code for watching a stimulation session, a stated reason for wanting it watched, and no economical way to get it watched or documented.

The market

Ten families of codes pay a person to watch a patient or a device. Original Medicare paid $2.1 billion for them in 2024 fee-for-service claims, up from $963 million in 2018, 13.9 percent a year; Medicaid paid $407 million in 2023, from $182 million in 2018, 17.5 percent a year, and an estimated $422 million in 2024.^1,2 About $2.5 billion, measured code by code. Neither file sees Medicare Advantage or commercial insurers; with those modeled, the all-payer market is an estimated $4.7 billion to $7.0 billion a year, base $5.8 billion.⁷

The money pays for presence: a day of EEG pays $165 unmonitored and $671 with a technologist watching; a cardiac patch analysis $216 to $231 and mobile telemetry with an "attended surveillance center" $801 an episode.¹ It is labor at scale, 7.9 million paid hours of staff review in 2024, about 3,800 full-time people, plus telemetry, sleep and EEG episodes.⁷ And it has room: remote monitoring reaches 1.4 percent of fee-for-service beneficiaries; about 65 percent have hypertension.^1,4

Between 2018 and 2024, technician-scanned Holter monitoring fell from $34.7 million to $10.7 million while algorithm-scored patch analysis reached $166 million; iRhythm, which sells the patch, grew revenue 26 percent to $747 million in 2025.^7,8 In 2021 Philips paid about $2.8 billion for BioTelemetry, an attended-surveillance operator, and Boston Scientific $925 million upfront for Preventice.⁹ The FDA lists 1,524 AI-enabled devices, a record 333 authorized in 2025.¹⁰

What masseuse.ai builds, who pays today, who pays next

The service runs where the session happens, on a phone's camera or, through the open-source connector masseuse-camlink, a computer's or a fixed camera. The stream is decrypted in two places only: on the user's devices and inside a Google Cloud Confidential Space enclave (Intel TDX, H100) whose infrastructure, image and verifier are published in masseuse-video-tee, so anyone can read what happens to the video and verify the machine runs it.¹¹ Inside the enclave a person detector (RT-DETRv4) finds the person, a keypoint model (Sapiens2-1B) estimates body position, regional motion descriptors measure movement, the microphone is classified into breathing and other non-speech vocalizations, and an annotated view returns only to the device that sent the video. A spoken guide conducts the session; a connected stimulator is adjusted by a closed-loop controller within limits set in advance. The operator never sees the picture.

The output is the record the codes ask for. For an attended session (97032): who was present and whether continuously, each parameter change with its time, electrode placement, the patient's visible and audible response, start and stop. For a monitoring month (98977 with 98980, the musculoskeletal RTM pair): the days the device was used, the session logs that are the therapeutic data, the minutes of review and who spent them, and the interactive communication, logged.

Who pays. Today, individuals pay to extend their own sessions, wellness sessions that make no medical claim. Next, licensed physical and occupational therapy practices license it as software for their patients, in the clinic and at home, under the therapist's plan of care. The practice bills the codes, about $105 per patient-month for the RTM pair at 2026 rates; 100 patients for three months bill about $31,500 a year.⁵ masseuse.ai is paid a flat subscription by the practice, not a share of what it bills.

Why now

From January 1, 2026, two days of device data instead of sixteen and ten minutes of staff time instead of twenty earn a monitoring payment, and therapy and RTM were exempted from a 2.5 percent efficiency cut.⁵ On July 14, 2026, CMS proposed the 2027 fee schedule (final by November 1): monitoring payable only when the practice's own employees perform it, not contractors; an initiating visit; lower practice-expense values; and, for comment, seventeen codes collapsed into four monthly bundles.¹² The proposal ends the rented nurse pool and puts the work inside the practice, by its own people, with software from whoever makes it. The Peterson Health Technology Institute (PHTI) wants episodes time-limited, which favors whoever runs an episode at the lowest labor cost.⁴

Why masseuse.ai

Four claims, each checkable. The stack is built and running; the enclave and connector are public.¹¹ The privacy architecture a camera in a treatment room or a home needs is the default: attested hardware, published code, media never visible to the operator. The target is the one attended code no vendor has automated, while RPM and RTM vendors sell the staffing model the 2027 rule would end. And the record it produces, who watched, what they saw, when, and what they did about it, is structurally the record every attended code pays for; those human-minutes and attended-surveillance codes were $1.5 billion of Medicare's $2.1 billion in 2024.⁷ The musculoskeletal RTM path alone, at 5, 10 or 20 percent of the 3.04 million fee-for-service beneficiaries who received therapeutic exercise in 2024, is an estimated $64 million, $239 million or $766 million a year of billing across payers, and $13 million, $60 million or $230 million of software subscription.⁷

What could go wrong

The 2027 rule could cut practice-expense values by up to 19 percent a year and bundle a month at one price however much a machine did. Payers could cap episodes, as PHTI recommends. New code families get repriced fast: in 2021 Hillrom tried to abandon its $375 million purchase of patch maker Bardy after a Medicare contractor priced the new codes low, and closed only under court order.⁹ Attended stimulation itself is $4.5 million a year in Medicare; the business is the monitoring month, not the attendance premium. A payer could rule a machine-watched session unattended. The RTM path requires the software to meet the FDA's definition of a device. And the move from individuals paying for wellness sessions to practices licensing clinical software is unproven.

Disclosure and data

masseuse.ai publishes this piece and benefits if the market is large, growing and open to software. Measured figures come from the CMS and HHS claims files in references 1 and 2; every modeled figure is labeled with a low, base and high case, with code lists and assumptions in reference 7. The model is available on request.

References

1. CMS, Medicare Physician & Other Practitioners – by Geography and Service, 2018–2024, national rows; paid = services × average payment; Part B non-institutional claims only. data.cms.gov · methodology
2. HHS, Medicaid Provider Spending by HCPCS, February 9, 2026 release; claim lines; small cells suppressed, so floors; 2024 partial, scaled by 12/10.5. opendata.hhs.gov
3. HHS Office of Inspector General, OEI-02-23-00260, September 2024, and OEI-02-23-00261, August 2025.
4. Peterson Center on Healthcare and PHTI, Evolving Remote Monitoring, April 16, 2025. phti.org · report. Hypertension prevalence (65 percent, 2022): CMS Office of Minority Health, Health Equity Data Book, 2025. cms.gov
5. CMS, CY 2026 Physician Fee Schedule Final Rule, CMS-1832-F, October 31, 2025. fact sheet · Federal Register. 2026 national amounts, approximate: 98977 $51, 98980 $54. fee schedule look-up
6. Medicare Administrative Contractor article A56566, Outpatient Physical and Occupational Therapy Services. cms.gov
7. Method. Codes: RPM 99091, 99453, 99454, 99457, 99458; RTM 98975–98981; care management 99424–99427, 99437, 99439, 99484, 99487–99496, G0019–G0024, G0140, G0146, G2058, G3002–G3003; ambulatory cardiac 93224–93229, 93241–93248, 93268–93272, 93784–93790; implanted-device remote 93294–93299; long-term EEG 95700–95726; sleep 95800, 95801, 95805–95811, G0398–G0400; continuous glucose monitoring 95249–95251; intraoperative neuromonitoring 95940, 95941, G0453; constant-attendance physical medicine 97032–97039; G0283 and 97110 for comparison. Hours are descriptor minimums (floors); 2,080 per full-time equivalent. All-payer estimate (low/base/high, 2024): Medicare Advantage at 0.50/0.75/1.00 of fee-for-service, RPM anchored to the OIG's all-Medicare total; commercial at 0.50/1.00/1.50 for the diagnostic families, 0.10/0.25/0.50 for RPM and RTM, 0/0.05/0.10 for care management; Medicaid as reported/scaled/grown 15 percent; cost sharing as allowed minus paid. Scenario: 5/10/20 percent of the 3,040,325 beneficiaries with 97110 in 2024, 2/3/4 months at $105, Advantage 0.75/1.0/1.0 and commercial 0.25/0.5/1.0 of fee-for-service, subscription $21.00/$26.25/$31.50 per patient-month. Enrollment: CMS, Medicare Monthly Enrollment. data.cms.gov
8. iRhythm Holdings, full-year 2025 results, February 19, 2026. investors.irhythmtech.com
9. Philips, Form 6-K, February 9, 2021. sec.gov. Boston Scientific, Preventice agreement, January 21, 2021, closed in the first quarter. news.bostonscientific.com. Hill-Rom, Form 8-K, August 6, 2021, after Bardy Diagnostics v. Hill-Rom, Del. Ch. 2021. sec.gov
10. FDA, Artificial Intelligence-Enabled Medical Devices list as of March 31, 2026. fda.gov · Paragon Health Institute tabulation, August 20, 2026. paragoninstitute.org
11. FemLed public repositories: masseuse-video-tee · masseuse-camlink.
12. CMS, CY 2027 Physician Fee Schedule Proposed Rule, fact sheet, July 14, 2026. cms.gov

masseuse.ai's sessions today are wellness sessions and make no medical claims; the clinical use described here is the company's planned market and depends on the conditions above. Nothing here diagnoses or treats a condition. Modeled figures are estimates and labeled as such; nothing here alleges a violation of law except where a cited court filing or settlement says so. Medicare and Medicaid are programs of the U.S. Centers for Medicare & Medicaid Services; masseuse.ai is not affiliated with, endorsed by or authorized by CMS or HHS.