New CMS Proposal Could Restrict Third‑Party Remote Patient Monitoring Services

The Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2027 Medicare Physician Fee Schedule this week, outlining changes to physician payment, value‑based care programs, and remote patient monitoring (RPM) reimbursement.

Among the key proposals, CMS seeks to bar payment for RPM services delivered by third‑party vendors. The agency wants to limit reimbursement to services performed by clinical staff directly employed by the billing practice, and it would require a separate, billable visit to initiate each RPM episode.

Additionally, CMS is considering consolidating the current RPM billing codes into four new codes and is soliciting public comments on this potential overhaul.

CMS stated that these changes aim to update how RPM services are valued, noting that monitoring devices now often cost less than previously estimated.

The push follows reports from the HHS Office of Inspector General (OIG) that identified fraud and abuse in the RPM sector. The OIG found that some companies were contacting Medicare beneficiaries without medical necessity, enrolling them in RPM programs, and billing monthly for setup, education, and monitoring that were never delivered. In certain cases, equipment was not provided or was not FDA‑approved.

The OIG also discovered that vendors sometimes enrolled patients without sufficient staff to monitor their data continuously. A 2024 OIG review revealed that nearly 43% of RPM enrollees did not receive all three required service components—education and setup, device supply, and treatment management. The report highlighted Medicare’s lack of essential oversight information, such as who ordered the monitoring.

The proposed rule also tightens eligibility for remote therapeutic monitoring (RTM), restricting it to patients who already have an established relationship with the billing practice. RTM covers self‑reported, non‑physiologic data like therapy adherence or pain levels, whereas traditional RPM tracks device‑collected physiological data.

CMS emphasized that the changes are intended to tie remote monitoring more closely to a practice’s direct clinical relationship with patients, preventing it from becoming an outsourced service.

The agency is accepting public comments on the proposal for 60 days, with a final version expected later this year ahead of a January 1 effective date.

Photo: Vadym Pastukh, Getty Images

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