CMS has proposed significant changes to Medicare payment and coverage policies for remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) beginning in calendar year (CY) 2027. The proposed rule would substantially limit the use of third-party personnel in furnishing billable remote monitoring services, expand existing patient eligibility requirements, and establish a mandatory initiating visit. Collectively, these proposals reflect CMS’s continued focus on strengthening practitioner oversight, responding to recent Office of Inspector General (OIG) findings, reducing program integrity risks, and aligning Medicare payment with the resources required to furnish these services.
Key Proposed Changes
- CMS Would Significantly Restrict Outsourced Remote Monitoring Models.
Perhaps the most consequential proposal would substantially limit the ability of practitioners to rely on third-party vendors to furnish billable RPM and RTM services.
Beginning January 1, 2027, CMS proposes that RPM and RTM services could be billed only when furnished by clinical staff who:
- are direct employees of the billing practitioner or the practitioner’s practice; and
- furnish services under the billing practitioner’s general supervision in accordance with the Medicare “incident to” requirements at 42 C.F.R. § 410.26.
If finalized, the proposal would mean that:
- time furnished by personnel employed by third-party vendors could no longer be counted toward RPM or RTM billing;
- outsourcing arrangements in which vendor personnel have little interaction with the billing practitioner or practice generally would not satisfy Medicare requirements; and
- while clinical staff would not be required to be physically co-located with either the practitioner or the beneficiary, they would be required to be direct employees and all applicable “incident to” requirements are satisfied.
CMS expressed concern that certain outsourced remote monitoring arrangements may fragment patient care, reduce practitioner oversight, and result in incomplete performance of required service elements. CMS specifically requested public comment regarding the prevalence of third-party staffing arrangements and the potential effect these proposed restrictions could have on beneficiary access to remote monitoring services.
- RTM Would Be Limited to Established Patients.
RPM services are currently payable only when furnished to established patients. CMS proposed extending that same requirement to RTM beginning in CY 2027.
Under the proposal, RTM services would be reimbursable only if furnished to a patient with whom the billing practitioner has an established relationship. CMS explained that an established relationship enables the practitioner to obtain an appropriate medical history, perform a physical examination when clinically indicated, understand the patient’s baseline condition, and determine whether RTM is appropriate as part of the patient’s treatment plan.
CMS also noted that the proposal responds, in part, to OIG findings that some practitioners billed remote monitoring services for beneficiaries with whom they had no prior clinical relationship.
- An Initiating Visit Would Be Required Before RPM Begins.
CMS also proposes requiring a separately billable face-to-face initiating visit, conducted either in person or via telehealth, before RPM or RTM services may begin.
The initiating visit would have to:
- include a face-to-face evaluation (services that do not include a face-to-face component or are not separately payable under Medicare would not qualify);
- include a discussion of remote monitoring with the patient;
- provide an opportunity to obtain the beneficiary’s consent; and
- allow the practitioner to determine whether remote monitoring is clinically appropriate.
According to CMS, the initiating visit is intended to ensure that remote monitoring is incorporated into an established plan of care rather than furnished as a stand-alone service.
What This Means for Providers
Although these proposals have not yet been finalized, they would have significant operational implications for providers and suppliers furnishing RPM and RTM services. Organizations should evaluate their existing workflows, staffing models, and vendor relationships, particularly any reliance on third-party remote monitoring companies, to assess the potential impact of the proposed requirements. Providers also should consider submitting comments to CMS addressing implementation challenges, staffing considerations, operational workflows, and the costs associated with furnishing compliant remote monitoring services.
CMS is accepting public comments on the proposed changes through September 14, 2026.
Should you have any questions regarding the above, please contact the author, the Garfunkel Wild attorney with whom you regularly work, or contact us at [email protected].