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What the CY 2027 Proposed Rule Would Cost Patients Who Use Remote Monitoring

Key Takeaways:

• The 2027 PFS Proposed Rule would pay for remote monitoring only when clinical staff are direct employees of the billing practice. 60 to 70 percent of hospitals and health systems use contracted employees today.
• A new required initiating visit would put financial and logistical strain on patients.
• Lower or bundled monthly payments would prevent many smaller or rural practices from offering RPM. 

Remote Patient Monitoring (RPM) allows Medicare patients with some of the most common chronic conditions, such as hypertension, COPD, heart failure, and diabetes, to monitor their conditions with a connected at-home device like a weight scale or blood pressure cuff. Through Medicare’s RPM program, that device data must be automatically transmitted to the care management team, who can respond to changes by following up with the patient and referring them to their provider for medication changes or further support.

This combination of data and clinical action helps lower patients’ risk of costly hospitalizations and ER visits. Patients have greater control over their health, and providers have greater insight into data to help with their medical decision-making. 

But the 2027 Medicare Physician Fee Schedule proposed rule includes four provisions that would make Remote Monitoring substantially harder to access, including restrictions on third-party staff and lowered payments for RPM. If these provisions are passed, many practices could no longer afford to offer RPM, causing patients to lose the connected device data and remote clinical services they’ve come to rely on. 

Let’s explore how these four provisions will impact patients and how patients and providers can provide feedback by September 14, 2026. 

Four provisions that will impact patient access

The 2027 proposed rule contains four changes that could impact Remote Patient Monitoring, three proposed for 2027 and one that may be implemented later. 

1. A restriction on auxiliary personnel

Medicare would pay for RPM and Remote Therapeutic Monitoring (RTM) only when the clinical staff furnishing the service are direct employees of the billing practice. Contracted teams working under general supervision of the provider would not be allowed to offer RPM. This marks a drastic change from CMS’s current policy for RPM, which states “Auxiliary personnel can provide remote monitoring services under the general supervision of the billing practitioner.”

2. Lower payments for supplying and monitoring devices

CMS proposes to re-price the device supply and setup codes against self-measured blood pressure codes, which involve a cuff the patient already owns. The practice would no longer be reimbursed for the cost of sourcing connected Bluetooth or cellular devices and ensuring the software is set up so they can receive data from the patient. 

3. Possible bundling

CMS is accepting comments on collapsing seventeen remote monitoring codes into four G-codes that pay only when every component is delivered in the same calendar month. This means practices would not be reimbursed for time spent shipping devices or monitoring and responding to data if patients choose not to respond to calls or texts that month.

These provisions are inspired by two reports from the HHS Office of the Inspector General, published in 2024 and 2025, that raised concerns about Remote Patient Monitoring fraud, waste and abuse. But the proposed measures will have a dramatic impact on patient access, while doing little to prevent fraud.

4. A separately billed initiating visit

Before monitoring can begin, the patient would need a dedicated visit at which monitoring was discussed. This extra visit places a disproportionate burden on rural or low-income patients and those with disabilities and requires the provider to bill Medicare for an additional visit.

It also places additional pressure on the provider to explain the compliance requirements and estimate cost-sharing for Remote Patient Monitoring, logistics that many providers are not familiar with and that have little to do with practicing medicine.  

Without contracted staff, many practices will no longer be able to offer patients RPM

Currently, the billing provider decides which patients receive monitoring, establishes a relationship with the patient through prior visits, engages in medical decision-making and offers general supervision of the RPM program.

The practice can then use either in-house or contracted clinical staff to:

• Review patient monitoring data
• Engage with the patient regularly
• Determine whether the patient needs to see their provider when readings change

CMS’s regulations define auxiliary personnel as anyone acting under the practitioner’s supervision, “regardless of whether the individual is an employee, leased employee, or independent contractor” (42 C.F.R. 410.26(a)(1)). Historically, this has meant that third-party contractors have been allowed to provide RPM, and the American Telehealth Association estimates that 60-70% of hospitals and health systems employ third-party staff for their RPM programs. 

This statistic makes sense when you consider that turnover for medical practice staff hovers around 2-2.2% a month, or 24-26% a year. Small, independent practices, Rural Health Clinics, and Federally Qualified Health Centers are unlikely to find enough clinical staff to cover their RPM programs if contracted employees are no longer allowed. Even larger health systems may struggle to find enough employees to fully staff an RPM program, and many of those programs will shut down. 

Reductions in payment or bundled payments will hurt smaller or rural practices, RHCs, and FQHCs the most

It will be difficult for a health system of any size to absorb a dramatic reduction in device supply and setup codes. But it will be especially difficult for Rural Health Clinics, Federally Qualified Health Centers, and small or rural practices, who often operate on thin margins already.

If fully connected Bluetooth or cellular devices and the data infrastructure to support those devices is priced the same as a device a patient can purchase at a drugstore, these practices could see a 71% reduction in reimbursements for device supply and setup, from an average of $52 per patient, per month to an average of $15 per patient, per month.

Practices who are already losing money on ordering and setting up devices for patients, and who will no longer have any contracted staff to assist, will almost certainly have to shut down their RPM programs. This could deprive rural and underserved patients of the RPM services they have come to rely on. 

The concept of bundling multiple codes into a single G-code and restricting reimbursement to when every element of the G-code is fulfilled also works against underserved patients. One of the proposed codes would pay a single monthly rate only when the practice delivers, in the same calendar month, the device supply, at least two days of transmitted data, at least 20 minutes of treatment management, and at least one real-time interactive communication.

The device supply presents a challenge here, since it is no longer affordable for practices to provide the device. But so does the requirement for a real-time, interactive communication. 

Even patients benefiting from Remote Patient Monitoring do not respond to outbound outreach every month. If a patient fails to respond, the practice can no longer receive reimbursement for that patient, even if they transmitted data, and the practice may be tempted to unenroll them from RPM. These enrollments would disproportionately impact low-income patients, who are more likely to lose phone service and not have a computer or tablet as a backup. 

The impact on patients’ health if their practice cannot afford RPM

In a 2023 study, patients with hypertension who enrolled in Remote Patient Monitoring saw higher medication refills and fewer acute care encounters. A case study by Validic, now part of ChartSpan, found that rates of hypertension control rose from 46% to 55.3% across a network of FQHCs who offered their patients blood pressure cuffs to use at home.  

Two other case studies by Validic/ChartSpan found an average 0.9-point HbA1c reduction across 6,463 underserved diabetic patients receiving RPM and improved ejection fraction in 66% of heart failure patients in a remote monitoring program. 

When patients had access to their health data, they were better able to adhere to their medication and care plans, track changes in their health, and manage their hypertension, H1c or ejection fraction, preventing their chronic conditions from worsening. If their practices can no longer offer RPM, those patients will lose access to the data and care team support that helped them manage their health. 

The additional RPM visit burdens vulnerable patients

RPM already requires patients to have an established relationship with the billing provider and to give their consent before RPM services begin. Adding an additional visit where their provider must discuss RPM places a burden on patients, providers, and payers.

The greatest burden lies on patients, especially those who have limited access to transportation or live in rural areas. For patients who can’t drive due to illness, disability, or age, reaching their provider’s office for an extra visit can be expensive and require advance planning. Even patients who can drive may struggle to add an extra office visit if they live 20+ miles from the practice or have work, volunteer, or caregiving responsibilities. 

This visit also creates additional work for providers, who must schedule extra appointments solely to explain remote monitoring compliance requirements and co-sharing responsibilities. Many providers currently don’t discuss copays or Medicare compliance with their patients, and time spent on these tasks is time spent away from practicing medicine. 

Extra visits also generate extra bills for Medicare. Nearly 1 million Medicare enrollees received remote monitoring in 2024, according to the HHS OIG report. Requiring an additional office visit for all of those patients would add tens of millions in new Medicare spending, and most beneficiaries carry 20 percent coinsurance on their visits, placing an extra expense on RPM patients as well as taxpayers. 

It’s possible to protect patient access to RPM and prevent fraud

There are multiple methods that could help improve the integrity of RPM, without reducing patient access as the proposed provisions do. A documented practitioner order, with an ordering provider identifier and a device identifier on the claim, could allow the HHS OIG and CMS to track who has ordered RPM for each patient. By calling for real invoices and cost data, CMS could ensure device payments are accurate. 

But restricting third-party staff, cutting and bundling payments, and adding an extra initiating visit would force many practices to end their RPM programs, taking remote care from Medicare patients who rely on it.

If you’re concerned about the proposed changes to care management, we encourage you to join the Save Remote Monitoring Coalition and submit your comment on the Proposed Rule to CMS by September 14, 2026. 

Sources

• CY 2027 Medicare Physician Fee Schedule proposed rule, Section 48 (Remote Monitoring), published July 16, 2026; comments due September 14, 2026. Comment portal.
• 42 C.F.R. 410.26(a)(1), definition of auxiliary personnel.
• HHS Office of Inspector General, “Additional Oversight of Remote Patient Monitoring in Medicare Is Needed” (2024) and Data Snapshot OEI-02-23-00261 (2025): enrollee counts, vendor involvement, median panel size, equity findings, spending totals.
• Becker’s Hospital Review, “CMS’ proposed remote patient monitoring ban, explained”: outsourced-model prevalence, 2024 spending and enrollment growth.
• Tang et al., Annals of Internal Medicine (2023): hypertension control after 90+ days of remote monitoring.