CMS released its proposed rule for the 2027 Medicare Physician Fee Schedule this week, which included changes to physician payment and value-based care programs, as well as major overhauls to remote patient monitoring reimbursement.
Notably, the agency is seeking to bar payment for remote monitoring services delivered by third parties, limiting reimbursement to services that are performed by clinical staff directly employed by the practice doing the billing. CMS also wants to require a separate, billable visit to kick off any remote patient monitoring episode.
And in a signal that more disruption could be coming, the agency is soliciting comments on collapsing the current remote patient monitoring billing codes into four new codes altogether.
These efforts are meant to update how these services are valued, CMS said in its announcement, noting that monitoring devices now often cost less than its original estimates had assumed.
The push traces back to a string of reports from the HHS Office of Inspector General that flagged fraud and abuse in the remote monitoring space. The office found that companies were making unsolicited outreach to Medicare beneficiaries to enroll them in remote monitoring programs regardless of medical necessity, then billing the program monthly for setup, education and monitoring that was never actually performed. In some cases, the equipment was never delivered, or it wasn’t FDA-approved to begin with.
Additionally, the OIG determined that vendors were sometimes signing patients up for monitoring programs without the staffing capacity required to actually monitor their data on an ongoing basis.
OIG’s 2024 review pointed out that nearly 43% of enrollees receiving RPM weren’t getting all three required components of the service — education and setup, device supply and treatment management. The report also uncovered that Medicare lacks basic information, like who ordered the monitoring, needed to properly oversee how it’s being billed.
The proposed rule also tightens eligibility for remote therapeutic monitoring specifically, limiting this program only to patients who already have an established relationship with the billing practice. Unlike traditional remote patient monitoring, which tracks device-collected data like blood pressure or glucose levels, remote therapeutic monitoring covers self-reported, non-physiologic data — such as therapy adherence or pain levels.
CMS said the changes are part of a broader effort to tie remote monitoring more closely to a practice’s direct clinical relationship with the patient, rather than allowing it to run as an outsourced service line.
The agency is accepting public comments on the proposed rule for 60 days, with a final version expected later this year ahead of a January 1 effective date.
Photo: Vadym Pastukh, Getty Images
