CMS Proposes Wide-Ranging Reforms to Medicare Part B Payments, Including Remote Patient Monitoring (RPM) Reimbursement

CMS's CY 2026 Medicare Physician Fee Schedule Proposed Rule outlines significant reforms to Medicare Part B payments, with a focus on recalibrating remote patient monitoring reimbursement. The proposed rule includes revisions to RPM and remote therapeutic monitoring (RTM) codes, aiming to reduce operational barriers, expand clinical applicability, and reinforce the policy goal of shifting care delivery toward preventive and value-based models.

Key Takeaways:

• The proposed rule includes new codes for RPM and RTM, allowing billing for shorter periods of data transmission and clinical interaction, with reduced work relative value units (wRVUs) to reflect reduced workload.
• CMS aims to modernize RPM and RTM utilization by aligning reimbursement with real-world practice, recognizing that remote monitoring can be clinically useful even when performed intermittently or for acute episodes.
• The new code structure reflects CMS's valuation methodology, which considers actual resource inputs (clinical staff time, supplies, and equipment) and applies proportional reductions in wRVUs for shorter-duration services.
• The proposed revisions have several direct implications for value-based care models, including the Medicare Shared Savings Program (MSSP), including improved attribution and engagement, integration with preventive care metrics, and support for care transition episodes.
• The new codes create financial pathways to monitor patients intensively for a short period following hospital discharge, a use case not previously supported under the 16-day rule.
• Organizations engaged in value-based care will need to ensure their RPM programs maintain strict compliance with device standards and documentation rules, especially given heightened DOJ enforcement.
• CMS has also proposed changes to MSSP participation and benchmark methodologies in the CY 2026 PFS, providing practices and ACOs with expanded tools to manage populations under risk-bearing arrangements.

Statistics:

• The comment period for the CY 2026 PFS Proposed Rule closes on September 12, 2025.
• CMS expects to issue the final rule later this year, with changes scheduled to take effect on January 1, 2026.
• The proposed rule includes new codes for RPM and RTM, with new billing opportunities and reimbursement rates set at approximately half the rates for existing codes.
• The new codes will cover shorter periods of data transmission and clinical interaction, with reduced wRVUs to reflect reduced workload.
• The proposed revisions are intended to modernize RPM and RTM utilization, aligning reimbursement with real-world practice.

Sources:

• Federal Register Notice (July 16, 2025)
• DOJ Press Release (June 26, 2025)
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