A proposed rule from the U.S. Centers for Medicare and Medicaid Services (CMS) would bar Medicare payment for remote patient monitoring (RPM) services delivered by external vendors starting Jan. 1, 2027. Physicians could only get reimbursed if they or other employees working directly for the medical entity doing the billing are performing the services. 

The CMS has covered remote patient monitoring (RPM) since 2018. Remote patient monitoring tracks patients’ health through technology outside of clinical settings–such as an electronic blood pressure cuff or continuous glucose monitor–and intervenes when necessary. Many providers use third-party vendors to manage these services.  

Many physician offices are using outside vendors to help perform these services so the proposed rule could significantly change how remote patient monitoring is delivered and paid for. 

Health systems and other primary care providers can currently bill for remote patient monitoring when they use an outside vendor to help patients manage conditions like hypertension or diabetes, according a STAT article. Arrangements vary, but vendors could collect information and relay it to the clinician for patient outreach, or the vendor’s staff could conduct direct patient outreach to provide guidance and refer patients back to their doctor as needed. 

In particular, Medicare regulators cited a 2024 report from the Office of Inspector General that found billing irregularities around remote patient monitoring services, the STAT article said. It found that 43% of beneficiaries who received remote monitoring did not receive all of its three components: device setup, data monitoring and treatment management.

The proposal would also require that remote patient monitoring services be for established patients only and mandate a separate initial visit before billing, Becker’s Health IT reported. 

Additionally, the proposed rule would collapse the current CPT billing codes for RPM into four new codes, according to MedCity News. CMS is accepting public comments on the proposed rule through Sept. 14. 

If implemented as proposed, the rule “would have a huge chilling effect on remote monitoring … it’ll probably impact the high value stuff and the low value stuff because practices might just say this isn’t worth it anymore,” according to Ateev Mehrotra, M.D., MPH, chair of the Department of Health Services, Policy and Practice at the Brown University School of Public Health, in Providence, R.I.

Remote patient monitoring vendors can play many different roles according to Mehrotra:

• Small physician offices may contract with vendors to supply devices and teach patients how to use them. They may field patient calls after hours.
• They may parse data sent to EHRs to help providers better understand and respond, like making medication adjustments.

If the rule is “fully implemented as [proposed], I think it would really have a huge negative impact in terms of the number of practices in the United States offering remote monitoring of any kind,” Mehrota said, noting that if physician offices don’t have the capacity to handle RPM in-house, they may give it up entirely.