Monday, 24 August 2026 03:00 PM
Regulatory
LIVONIA, MI / ACCESS Newswire / August 24, 2026 / CMS released the Calendar Year 2027 Medicare Physician Fee Schedule (PFS) Proposed Rule on July 14, 2026 (CMS-1848-P), highlighting potential changes to Medicare reimbursement, Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), behavioral health, care management, and other Medicare services. The rule remains proposed, and CMS may modify policies before issuing the final rule.
Proposed RPM and RTM Changes
RPM and RTM are key areas for healthcare organizations. CMS proposes requiring practitioners reporting RPM or RTM services to furnish a separately reportable initiating visit in association with the onset of those services.
CMS also proposes requiring RTM services to be furnished only to established patients. Another major proposal would allow payment for RPM and RTM services only when they are performed by clinical staff employed by the practice rather than contractors.
CMS is also seeking comments on potentially bundling existing RPM and RTM CPT codes and creating four new HCPCS G-codes for remote monitoring services. CMS also proposes downward revaluation of RPM and RTM services, citing lower device costs than initially estimated; these remain proposed changes.
Behavioral Health and Care Management
CMS proposes continuing the transition for timed behavioral health services and including smoking and tobacco-use cessation services and Screening, Brief Intervention, and Referral to Treatment (SBIRT) services in the final year of that transition.
CMS is also proposing separate coding and payment for shared medical appointments, which could provide another approach for supporting patients with chronic conditions and coordinated care needs.
Advance Care Planning
CMS proposes creating two new HCPCS codes for advance care planning services furnished by clinical staff under the direct supervision of the billing physician or other practitioner. The proposed codes are intended to better distinguish the work performed by billing practitioners from time spent by clinical staff providing advance care planning. These changes could affect documentation, staffing, workflows, and technology.
Medicare Payment and Value-Based Care
The proposed 2027 conversion factors are $33.17 for qualifying APM participants and $32.84 for non-qualifying APM participants, representing projected decreases of 1.19% and 1.68% compared with the 2026 conversion factors. The comparison reflects the expiration of the temporary 2.5% payment increase in 2026.
CMS is also proposing changes to the Medicare Shared Savings Program, including modifications to ACO financial methodology intended to strengthen incentives for participation and value-based care.
What Healthcare Providers Should Do Now
Healthcare organizations should assess their RPM and RTM staffing models, initial-visit workflows, documentation, patient eligibility, billing processes, and technology capabilities. Practices should also monitor proposed changes affecting behavioral health, care management, advance care planning, and value-based care.
The CY 2027 PFS Proposed Rule is open for public comment through September 14, 2026. If finalized, applicable policies would generally take effect January 1, 2027.
For organizations delivering RPM, CCM, and other Medicare care-management services, early preparation can help identify potential operational, compliance, staffing, and technology impacts.
HumHealth will continue monitoring CMS developments and providing updates as the CY 2027 policies move toward finalization.
Contact Information
Venkataraman Soundararajan
President, HumHealth
[email protected]
7346660002
SOURCE: Humworld Inc