CMS plan would stop Medicare paying for outsourced remote monitoring

Medicare would stop paying for remote patient monitoring when a practice hands the monitoring work to an outside company, under a proposal CMS released on July 14. If CMS finalizes it, the change starts January 1, 2027.

The proposal sits inside the CY 2027 Physician Fee Schedule proposed rule, which the Federal Register published on July 16. Comments closed on September 14. The final rule is now under White House review and is due by November 1.

What the proposal changes

Medicare pays for two kinds of remote monitoring under the fee schedule. Remote physiologic monitoring (RPM) tracks readings such as weight, blood pressure and pulse oximetry. Remote therapeutic monitoring (RTM) tracks how a patient follows a home therapy, with device codes for respiratory, musculoskeletal and cognitive behavioral therapy. Each has three parts: setup and education, the device supply, and treatment management.

CMS proposes four changes.

Staff must work for the practice. Today a practice can contract RPM or RTM work to a third-party company. Under the proposal, clinical staff time would count toward these codes only if the staff member is a direct employee of the billing practitioner or practice. The staff could still work remotely under general supervision. CMS wrote that outside companies working by phone and online “can fragment care” and leave the billing practitioner with too little oversight. It asked commenters how often third-party billing happens now and how the change could affect access.

A starting visit comes first. The billing practitioner would have to hold a face-to-face visit, in person or by telehealth, before RPM or RTM begins. The visit has to cover remote monitoring, check that it fits the patient and give the patient a chance to consent. A visit that never mentions monitoring would not count. The practice could bill the visit separately.

RTM would be for established patients only. RPM already has this rule. CMS proposes the same for RTM and says it answers an OIG finding that some practices billed monitoring for patients they had no prior relationship with.

Lower values for setup and devices. CMS says it has received “very little invoice or pricing information” on the devices and thinks the current values may overstate costs. It proposes to price RPM and RTM setup codes (99453 and 98975) like self-measured blood pressure training (99473). RPM device codes (99445 and 99454) would follow self-measured blood pressure monitoring (99474). RTM device codes would follow an external heart rhythm monitor recording (93270). For the six treatment management codes (99470, 99457, 99458, 98979, 98980 and 98981), CMS would remove practice expense inputs and keep the current work values and times.

The bundling idea

CMS also asked for comments on replacing 17 RPM and RTM codes with four new HCPCS codes in the proposed rule published July 16, 2026. GRPM1 and GRTM1 would cover setup and education. GRPM2 and GRTM2 would be monthly codes that bundle the device, at least 2 days of data and at least 20 minutes of treatment management, including at least one live conversation with the patient or caregiver. For the monthly codes, CMS floated work values of 0.61 for RPM and 0.62 for RTM, taken from existing codes 99457 and 98980.

This part is a comment request, not a formal proposal. CMS wrote that it “could finalize payment for these codes” after reading comments.

The reason CMS gives is an OIG number. In a September 2024 report, OIG found that about 43% of Medicare enrollees who got remote patient monitoring did not receive all three parts. A single monthly code would make the device, the data and the treatment management one billable unit.

Who it affects

The rule sets payment under the Medicare Physician Fee Schedule. The groups CMS names are billing practitioners and their practices, third-party monitoring companies whose staff do the work today, and rural health clinics and federally qualified health centers, where CMS asked how the G-codes would apply. Patients would see a visit before monitoring starts.

What comes next

The White House Office of Information and Regulatory Affairs received the final rule for review on September 29, 2026, and lists it as pending. The federal Unified Agenda gives the final rule a statutory publication date of November 1, 2026, and an effective date of January 1, 2027. The Regulations.gov docket for the whole rule, which covers far more than remote monitoring, showed 43,113 posted comments on October 20.

CMS can finalize each piece as proposed, change it, delay it or drop it. We’ll cover the final rule’s remote monitoring section the day it posts.

Why it matters

If the employment rule is finalized as written, practices that use outside monitoring companies would need to hire that staff or stop billing these codes by January 1, so the final rule’s wording on contractors is the line to watch.

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