The Calendar Year 2026 Medicare Physician Fee Schedule (PFS) proposed rule (see Orrick’s analysis of the proposed rule here) contains important signals for the future of remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) under Medicare. RPM and RTM services allow providers to monitor and manage patient care remotely and can help decrease costs and improve access and outcomes. Healthcare innovators and stakeholders should proceed carefully, however, as key healthcare enforcement authorities continue to scrutinize RPM for potential fraud and abuse.
2026 PFS Proposed Rule Introduces Path to Payment for Less Time-Intensive Treatment
The Centers for Medicare & Medicaid Services (CMS) has historically reimbursed RPM and RTM services only for patients meeting certain thresholds regarding 1) the days of continuous monitoring services and 2) the overall time spent by care teams to deliver the treatment they need. The proposed rule expands opportunities for reimbursement to include patients requiring fewer days and less management time in any given month.
Payment for 2-15 Days of Data.
Currently, Medicare only pays for RPM and RTM devices if the patient requires 16 or more days of data transmission in a given month. If finalized, the proposed rule would establish payment for RPM and RTM services, only requiring 2-15 days of data transmission in a 30-day period in the respiratory care (CPT 98976), musculoskeletal (CPT 98977), and behavioral health (CPT 98978) spaces.
Payment for 10-19 Minutes of Management Time.
Currently, Medicare only pays for RPM and RTM services if the patient receives 20 or more minutes of treatment management in a given month, whether through monitoring time, data review, or patient coaching. If finalized, the Proposed Rule would establish payment for RPM and RTM services requiring 10-19 minutes of care management in a 30-day period.
Comments on the proposed rule are due September 12, 2025.
OIG Fraud Concerns Regarding RPM
The Department of Health and Human Services’ Office of Inspector General (OIG) has identified RPM, in particular, as an area of concern for fraud and abuse. As such, stakeholders should carefully review and have a clear understanding of all RPM and RTM requirements when submitting claims to CMS.
In September 2024, OIG issued a report recommending additional oversight of RPM due to concerns about fraudulent use and billing. OIG found that 43% of Medicare enrollees did not receive at least one of the three components required for RPM services (which include patient education and device set up, device supply, and treatment management), and reiterated its concerns from a November 2023 consumer alert, which warned that unscrupulous companies attempt to order RPM services for Medicare enrollees regardless of medical necessity and often without providing proper monitoring or follow-up treatment. Additionally, in December 2024, OIG announced that it will undertake audits of claims for RPM services submitted under Medicare Part B and reiterated its concerns about the need for additional oversight and the susceptibility of RPM services to fraud, waste and abuse. More recently, OIG entered into a settlement for over $500,000 in May 2025 in connection with self-disclosed conduct from a health system regarding RPM claims that did not meet the requirements for coverage and payment,
In light of these developments, stakeholders should continue to pay close attention to upcoming congressional action, and CMS rulemaking and guidance for any related updates.
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