The Centers for Medicare & Medicaid Services (CMS) has delayed by two years its plan to stop paying for remote patient monitoring services delivered by third-party vendor staff. The start date moves from 1 January 2027 to 1 January 2029, under the calendar year 2027 Medicare Physician Fee Schedule final rule, which CMS issued on 4 November 2026.
What CMS Decided
The rule covers remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM), the services that let clinicians track patients between visits using home devices and apps. CMS had proposed that Medicare would only pay for these services when the clinical staff delivering them are directly employed by the billing practice. In the final rule, the agency kept the policy but pushed its start date back by two years, saying the extra time will let practices hire and train staff. CMS also said it plans to issue guidance clarifying which staffing arrangements will count before the deadline.
The delay is narrower than it first sounds. It applies only to clinical staff time: reviewing readings, checking in with patients and managing care. Practices can still buy devices, software, connectivity, data hosting, cybersecurity and technical support from outside companies. From 1 January 2029, Medicare will pay for the clinical work only when the person doing it is a direct employee of the billing practice.
What Still Changes on 1 January 2027
The rest of the remote monitoring package takes effect as proposed on 1 January 2027. Practitioners must hold a face-to-face initiating visit, in person or by telehealth, before they can bill for remote monitoring. Remote therapeutic monitoring will also be limited to established patients. Patients already enrolled before 1 January 2027 are exempt from the initiating visit requirement, but CMS warned practices against using the window before that date to enrol beneficiaries in large numbers.
CMS also chose not to replace the RPM and RTM billing codes with four consolidated Medicare G-codes, though it may return to the idea later. Practice expense values for several device supply and setup codes will fall, phased in so no single-year cut goes above 19%, and the American Medical Association's valuation committee will review practice expense for all 19 remote monitoring codes in January 2027.
Why CMS Paused the Rule
The proposal drew an unusually strong response. More than 43,000 comments arrived, and many organisations said the employment requirement would force them to stop offering remote monitoring. In September, more than 230 healthcare organisations, hospitals and advocacy groups wrote to CMS arguing the change would end the programme for some rural residents and disrupt care for an estimated 1 million Medicare beneficiaries. On 6 October, more than two dozen members of the House wrote separately, calling the proposal an over-reaction: an Inspector General review had found the flagged billing centred on 0.68% of remote monitoring billing.
Senators Mark Warner of Virginia and Marsha Blackburn of Tennessee also wrote to CMS Administrator Mehmet Oz urging the agency to reconsider, arguing the change would limit access for rural Medicare recipients. The House Ways and Means Committee has unanimously advanced the Rural Patient Monitoring Access Act, which would protect rural patients' access to remote monitoring. Medicare payments for the service rose from $408 million in 2023 to $536 million in 2024, a 31% increase, and the programme had nearly 1 million participants in 2024, up 27% on the year before.
CMS tied the changes to Inspector General reports, including one that found 43% of Medicare enrollees who received remote monitoring did not get all three components of the service. The agency calls the employment requirement a programme-integrity measure, and the delay a chance for practices to adapt rather than a change of direction.
Why This Matters for Healthcare Organizations
For practices that run remote monitoring today, the delay removes an immediate deadline but not the underlying decision. The 2029 requirement is final, so a practice that relies on a vendor for clinical staff time has two years to hire and build the workflow in-house, or to restructure the arrangement so the vendor supplies only devices, software and technical support. The January 2027 changes need attention now: every new patient needs a documented initiating visit, remote therapeutic monitoring is for established patients only, and enrolment records should be kept in order, since patients enrolled before 1 January 2027 are exempt from the visit requirement.
Analysis: A Reprieve, Not a Reversal
CMS gave the industry what it asked for on timing and kept what it wanted on substance. The two-year delay answers the loudest complaint, that practices could not hire and retrain staff by January, while the 2029 date keeps the employment requirement firmly in place. That split is consistent with how CMS handled the rest of the rule: it dropped the code consolidation and softened the practice expense cuts, but it held the line on the initiating visit and the established-patient limit.
The open question is whether Congress acts before 2029. The Rural Patient Monitoring Access Act has bipartisan support in the House, and the telehealth flexibilities expire at the end of 2027, so the next year will bring both debates together. If the Act passes, the employment requirement could be revisited. If it does not, practices will need to be ready for a 2029 in which remote monitoring clinical work is done by their own staff.
Clinics reviewing how patient communication and follow-up work can be handled can explore MedClinicX's AI patient portal, see how after-hours calls are handled on our AI medical receptionist page, or explore the demos and request a quote. For related coverage, see our earlier article on CMS finalising the 2027 physician fee schedule.
Sources and References
- Centers for Medicare & Medicaid Services — Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule fact sheet, 4 November 2026: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-final-rule
- Becker's Hospital Review — CMS delays third-party remote patient monitoring ban, 5 November 2026: https://www.beckershospitalreview.com/healthcare-information-technology/digital-health/cms-delays-third-party-remote-patient-monitoring-ban/
- American Telemedicine Association, ATA Action — ATA Action Welcomes CMS Delay of Remote Monitoring Staffing Restriction in CY2027 Physician Fee Schedule Final Rule, Says Significant Work Remains, 5 November 2026: https://www.americantelemed.org/press-releases/ata-action-welcomes-cms-delay-of-remote-monitoring-staffing-restriction-in-cy2027-physician-fee-schedule-final-rule-says-significant-work-remains/
- McKnight's Long-Term Care News — Remote monitoring providers win 2-year reprieve on policy limiting payments, 8 November 2026: https://www.mcknights.com/news/remote-monitoring-providers-win-2-year-reprieve-on-policy-limiting-payments/
- The Daily Yonder — Lawmakers, Hospitals Say Medicare and Medicaid Changes Would Hurt Rural Hospitals, 9 November 2026: https://dailyyonder.com/lawmakers-hospitals-say-medicare-and-medicaid-changes-would-hurt-rural-hospitals/2026/11/09/
Reporting based on the sources above, accessed 9 November 2026. The CMS fact sheet was read directly, and the Becker's, ATA Action, McKnight's and Daily Yonder reports were read directly and cross-checked against it. MedClinicX did not conduct original reporting or interviews for this article. Corrections: contact us via https://medclinicx.com/contact