What’s changing for remote patient monitoring in 2027
CMS’s proposed 2027 Physician Fee Schedule would bring the biggest changes to RPM since the codes were created: who can perform the monitoring, how patients are enrolled, and how much Medicare pays. Here’s what’s proposed, what isn’t changing, and how to prepare before January.
Proposed rule released
CMS publishes the CY 2027 Physician Fee Schedule proposal.
Comments closed
Practices, vendors and associations sent feedback to CMS.
Final rule expected
CMS decides what to keep, change or drop.
Changes take effect
Whatever is finalized applies to 2027 claims.
Five changes CMS has proposed for RPM and RTM.
CMS says the changes respond to a federal Office of Inspector General review, which found that 43% of Medicare RPM enrollees didn’t receive all three components of the service that were billed.
Monitoring staff must be employed by the practice
RPM and RTM would only be payable when furnished by clinical staff employed by the billing practice. Monitoring done by contracted third-party staff would no longer qualify.
An initiating visit before monitoring starts
The billing practitioner would need a separate face-to-face visit, in person or by telehealth, before RPM or RTM begins.
RTM limited to established patients
Remote therapeutic monitoring would require an established patient relationship, matching the rule RPM already follows.
Lower payment for device codes
CMS proposes revaluing the setup and device-supply codes (99453, 99454 and the related codes) against lower-cost services. Industry estimates put the device-code cut as high as about 80%, with cuts over 20% phased in across two years.
Lower payment for management time
CMS proposes removing clinical staff practice expense from the treatment management codes (99457, 99458 and 99470), which would reduce what they pay.
A possible future code overhaul
CMS also asked for comments, not yet a proposal, on replacing 17 remote monitoring codes with four simpler monthly codes, two each for RPM and RTM.
Separately, the overall Medicare conversion factor is proposed to drop about 1.7%, to $32.84 for most clinicians ($33.17 for qualifying APM participants), as a one-time 2026 increase expires.
Some things stay the same.
- 2026 rules apply through December 31. Nothing changes before January 1, 2027.
- RPM is still covered. The proposal changes how it’s delivered and paid, not whether Medicare pays for it.
- CCM and APCM aren’t affected. Contracted care management staff remain allowed for chronic care management and advanced primary care management.
- Nothing is final yet. CMS often adjusts proposals after the comment period.
What it would mean for a typical practice
Practices that rely on an outside company’s staff for daily monitoring would need to bring that work in-house to keep billing RPM. Every practice would see lower device payments, and new patients would need an initiating visit before enrollment.
Six steps to prepare now.
- Watch for the final rule around November 1. Plan for the proposal, but don’t make changes until it’s final.
- Map who performs your RPM time today. List which monitoring minutes come from employed staff and which come from contracted staff.
- Plan initiating visits. Identify which patients would need one, and check the final rule for whether patients already enrolled are affected.
- Re-run your numbers. Model 2027 revenue with lower device payments before renewing device or vendor contracts.
- Review CCM and APCM. Patients who qualify can be enrolled in care management alongside RPM, and those programs aren’t affected by the staffing proposal.
- Tighten documentation. Record consent, the ordering practitioner, reading days, minutes and every interactive communication.
Training your team to keep payments steady.
If the rule is finalized, more of the monitoring work will need to be done by staff your practice employs. We’ll train your team to do it well: how to review readings in The Bridge, when and how to reach patients, what to document each month, and how to bill each code correctly. The goal is simple: clean claims, fewer denials and steady reimbursement through the transition.
- Hands-on staff training on daily monitoring workflows, patient outreach and escalation.
- Billing and documentation training on consent, initiating visits, reading days, minutes and interactive communication.
- Ongoing support as CMS publishes the final rule and Medicare contractors issue guidance.
We’ll update this page and contact our clients as soon as the final rule is published. Talk with us about training for your team.
This article summarizes a proposed rule and is general information, not billing or legal advice. Confirm requirements with your Medicare Administrative Contractor before making changes. Sources: DLA Piper, Health Management Associates, Prevounce, Prevounce webinar takeaways.
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