House Members Press CMS to Drop the Employees-Only Rule for Remote Monitoring. Check Your Vendor Contract Before the Final Fee Schedule.
A bipartisan letter from 32 House members opposes the proposal to pay for remote patient monitoring only when the billing practice's own employees deliver it. The final 2027 rule, effective Jan. 1, would settle it.
If your practice bills Medicare for remote patient monitoring through an outside company that supplies the clinical staff, one proposal in the 2027 physician fee schedule would end that arrangement on Jan. 1. A bipartisan group of House members is now asking the Centers for Medicare and Medicaid Services (CMS) to drop it.
The proposal is not final. Comments closed Sept. 14, and the agency has not said what it will do.
What CMS proposed
In the calendar year 2027 physician fee schedule proposed rule, published July 16, CMS proposes to pay for remote physiologic monitoring and remote therapeutic monitoring only when the clinical staff whose time is counted are "a direct employee of the practitioner or the practitioner's practice." The staff need not be physically located in the practice, but they must work under the billing practitioner's general supervision and meet the other "incident to" requirements at 42 C.F.R. 410.26. The rule says the codes could not be billed when the service is contracted out to a third-party company. The language targets staffing; the proposal would not bar practices from buying devices, software or data platforms from vendors, the law firm Benesch notes, though many vendors sell technology and staffing as a bundle.
The same section would require a separately billable face-to-face initiating visit, in person or by telehealth, at which monitoring is discussed with the patient. It would extend the established-patient requirement, which already applies to physiologic monitoring, to therapeutic monitoring. CMS also proposes to revalue the practice expense for the setup and device-supply codes, saying it has received very little invoice or pricing information on the devices, and asks for comment on replacing 17 current codes with four new G-codes.
CMS cites two Office of Inspector General reports, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed and Billing for Remote Patient Monitoring in Medicare. It quotes the first: "About 43 percent of enrollees who received remote patient monitoring did not receive all 3 components of it."
The question for practices is not whether remote monitoring is paid. It is who is on your payroll when the time is counted.
The pushback
On Oct. 2, 32 House members wrote to CMS Administrator Mehmet Oz asking the agency to reconsider, Medical Daily reported. Reps. David Kustoff, R-Tenn., and Troy Balderson, R-Ohio, led the letter, and Democratic signers include Reps. Mark Pocan of Wisconsin and Yvette Clarke of New York, according to the report. The members argue the change would cut access for Medicare patients, particularly in rural areas and at small independent practices, and that CMS should target problem billing rather than bar all contracted staff. The letter has not been posted on the lead sponsors' press pages, and The Script Pad has not reviewed it.
What practices should do now
CMS has not said when the final rule will come. Last year it released the 2026 fee schedule final rule on Oct. 31. If the employee requirement survives, monitoring delivered by contracted staff could not be billed from Jan. 1, 2027.
Ask your vendor which of its staff would count as your direct employees, and what happens to the contract if they do not. Build a fallback: in-house staff for treatment management, or a pause in new enrollments after Dec. 31. Confirm that each monitored patient has a documented visit where monitoring was discussed. Our earlier look at the 2027 fee schedule proposal covers the payment changes, and our piece on remote patient monitoring that works covers the clinical workflow.
Reported, fact-checked and edited by The Script Pad's editorial staff.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
