CMS Proposes Sweeping Changes to Medicare Payment for Remote Monitoring Services; Epstein Becker Green Submits Comments on Behalf of Health Care Practices

Comments Oppose Restrictions That Would Reduce Patient Access and Care Quality, Recommend Evidence-Based Oversight Alternatives

CMS proposed sweeping changes to Medicare payment rules for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services in the proposed 2027 Medicare Physician Fee Schedule rule. Many organizations across the health care industry submitted comments on the proposed rule. Epstein Becker Green submitted comments on behalf of health care practices furnishing device-enabled remote monitoring to Medicare beneficiaries, addressing five restrictions that CMS proposed. The comments argue that the proposed restrictions would reduce access to care and create barriers to evidence-based treatment.

Remote monitoring technology enables practitioners to oversee patient recovery at home, using objective device-generated data to detect complications and guide treatment in real time. For musculoskeletal recovery following joint replacement, fracture repair, or soft-tissue reconstruction, where critical progress occurs in the first weeks, this capability directly improves patient outcomes.

CMS's proposed rule contains five restrictions that the comments address:

Employment Mandate

CMS proposes requiring that clinical staff be direct W-2 employees of the billing practice, abandoning a 25-year auxiliary-personnel framework and the remote-monitoring policy it confirmed in 2020. This would eliminate participation by small, rural, and independent practices that use contracted staff under practitioner supervision, consolidating access in large health systems and conflicting with state licensing laws. The comments propose documentation requirements creating visibility into service ordering and practitioner oversight to address CMS's stated integrity concerns without reducing access.

Established-Patient Limits

CMS would restrict monitoring to patients with prior relationships to the billing provider. This delays treatment for post-operative patients referred from surgeons, often "new" to the billing practitioner at the moment monitoring need arises, during the clinically decisive early-recovery window. The comments propose established-patient definitions that account for referral-based, episodic care.

Initiating-Visit Requirement

CMS proposes requiring a separately reportable visit for every patient before monitoring begins. The comments recommend that CMS instead mirror its chronic care management policy, requiring initiating visits only for new patients and those not recently seen, and confirm that therapy evaluation codes qualify. The comments further recommend that CMS place telehealth flexibility on a footing that survives the December 31, 2027 sunset of therapist telehealth authority.

Device Revaluation

CMS proposes pricing therapeutic rehabilitation platforms, which include motorized hardware, integrated sensors, patient software, and clinician dashboards, using the same values as blood-pressure cuffs and event recorders. The comments propose that CMS distinguish device classes and set inputs from invoice-level cost data, rather than commodity pricing.

Code Restructuring

CMS proposes bundled monthly G-codes requiring every service component in every calendar month. This would repeal the episodic flexibility the agency finalized last year. The comments propose that any restructuring retain a separately billable device-supply component and episodic pathways and proceed only through a future proposal with published values.

The comments note that the integrity concerns CMS identified in its OIG reports centered on documentation, transparency, and ordering-provider identification—all addressable through oversight guardrails. An employment mandate does not solve those problems; it simply reduces access where it matters most and burdens compliant practices.

The comments are available for public review at https://www.regulations.gov/docket/CMS-2026-2377.

About Epstein Becker Green

Epstein Becker Green is a national law firm focused on health care and life sciences; employment, labor, and workforce management; and litigation and business disputes. Our attorneys advise clients at every stage of their business lifecycle, delivering practical, results-driven counsel that shapes strategy, accelerates growth, and safeguards what matters most. We serve organizations of every size, from emerging startups to Fortune 100 companies, across the health care, life sciences, financial services, retail, hospitality, and technology industries, with sound legal solutions they can depend on when it counts. www.ebglaw.com