Medicare is making two major changes to how it pays for cardiac care. Beginning this year, the Centers for Medicare & Medicaid Services (CMS) are moving away from paying solely for services performed and instead emphasizing paying for outcomes achieved.
Historically, Medicare has paid providers based on the number of services performed. Each procedure carried a CPT code, and Medicare set payment amounts using a formula that factored in geography, malpractice costs, and practice expenses. In its 2026 Physician Fee Schedule rule, CMS introduced a subtle but far-reaching phrase, “care managed by the practitioner,” that makes providers eligible for additional payments if they can show their care prevents ER visits, reduces readmissions, or improves recovery.
The rule also changes Medicare’s direct supervision requirement for billing the technical component of monitoring. Until now, a physician had to be physically present in the office for that billing to qualify. Now, that supervision can be provided virtually. With remote oversight, practices can manage monitoring in-house and capture both the professional and technical payments, a shift that threatens the long-standing role of Independent Diagnostic Testing Facilities, or IDTFs.
For providers, the rules mean more control over monitoring and the chance to keep a larger share of reimbursement. For device companies, they create a chance to show measurable value and guide clinicians through a system that is shifting quickly.
The new value-based reimbursement model
Under the new framework, providers continue to be paid for the services they deliver but also earn bonus payments if their care meets quality benchmarks. In effect, reimbursement will be tied not only to volume but also to outcomes such as fewer ER visits, lower readmission rates, and improved recovery.
Medicare has already tested this concept through the Merit-based Incentive Payment System (MIPS), which adjusts payments up or down based on performance on measures like blood pressure control or preventive screenings. The new rule takes that idea further by embedding value-based criteria directly into specific cardiac monitoring codes.
For example, a cardiologist using an ECG patch to detect arrhythmias can show how early intervention avoided a hospital admission. A primary care physician monitoring blood pressure remotely can document how timely follow-up kept a patient stable and out of urgent care.
The end of the IDTF advantage
The shift in payment structure also alters the business model for companies that have long handled cardiac monitoring on behalf of providers. For years, Independent Diagnostic Testing Facilities, or IDTFs, built their businesses on providing what Medicare calls the “technical component” of monitoring. They employed staff to track devices, compile reports, and satisfy Medicare’s requirement for “direct supervision.” Physicians billed for interpreting results, while IDTFs collected payment for the monitoring.
The proposed rule narrows in on a single service: CPT 93296. The code covers the technical component for remote interrogation of implanted cardiac devices such as pacemakers and defibrillators. Until now, billing that code required a physician to be physically present to meet Medicare’s “direct supervision” rule.
For providers, the change means they can manage this work in-house and bill for both the professional and technical components. For IDTFs, it removes the requirement that long sustained their role. While the revision is limited to one code, CMS historically pilots policy changes this way. By 2027, the same supervision model is expected to apply across all major ECG and monitoring codes.
Opportunity for providers
The rule change opens the door for providers to run monitoring programs themselves. By dropping the requirement for in-person supervision, Medicare allows practices to manage services in-house, oversee them virtually, and bill for both the professional and technical components.
The shift also has clinical implications. With in-house monitoring, providers gain direct access to patient data, making it easier to intervene early and prevent complications. Early intervention can keep patients out of the ER and reduce readmissions, which are exactly the outcomes Medicare intends to reward through value-based bonuses.
The rule introduces short-duration billing codes for remote patient monitoring (RPM) and remote therapeutic monitoring (RTM). Previously, providers needed to collect at least 16 days of data in a month to bill. Under new CPT codes, physicians can bill for fewer than 16 days of data and less than 20 minutes of patient interaction each month.
Several medical-grade wearables already support extended recording. With the new codes, that data can be used flexibly, whether collected over two weeks or a shorter stretch, giving providers more options to integrate monitoring into everyday care.
For primary care physicians, who often see patients in shorter bursts, the new codes make monitoring more usable. A family doctor monitoring a patient’s blood pressure for 10 days, for example, can now bill for that service instead of losing reimbursement.
What providers should do now
With the rule now having gone into effect, providers should be working to adapt to the necessary changes. Practices should be bringing monitoring in-house, including setting up workflows for remote oversight, training staff to manage devices, and ensuring clinicians can document outcomes in a way that meets CMS standards.
Choosing the right technology partners is just as important. Practices need more than devices. They need mobile apps that patients can reliably use and dashboards that clinicians can integrate into their daily routines. The most effective partnerships will give providers the tools they need while still allowing them to tailor systems to their own staff, patients, and clinical routines.
Education is also essential. The new short-duration codes for RPM and RTM come with distinct requirements. RPM captures electronic data from devices, while RTM covers patient-reported outcomes such as pain or symptoms. Practices that understand how to apply each code and how they connect to value-based bonuses are better positioned to capture revenue under the new system.
Providers that adapt quickly will keep more of their reimbursement and access new value-based payments. Those that lag risk being left behind by a policy shift that is moving quickly and reshaping the economics of cardiac care.
Photo: hudiemm, Getty Images
With more than 26 years of experience in the health care industry, Ethne Nance is the CEO of Pacific Medical Revenue, a company that provides revenue cycle management, compliance consulting, and medical billing services to health care providers. Her extensive professional experience includes being a national speaker and consultant, where she shares her expertise and insights on health care revenue optimization with diverse audiences.
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