Medicare Pushes Back Remote Monitoring Vendor Restriction to 2029, While New Visit Requirement Begins in January

Medicare beneficiaries who send blood pressure, glucose, or weight readings from home to their doctors through outside monitoring firms will likely be able to stay in those programs for at least a couple more years. In its final 2027 physician fee schedule, the Centers for Medicare & Medicaid Services said it is postponing until Jan. 1, 2029, a policy that would have allowed payment for remote monitoring only when the practice’s own employed clinical staff provide the service.

CMS had originally proposed launching that restriction earlier. In the final rule, the agency said it is delaying the requirement by two years.

Even so, some changes will still take effect at the start of the year. Clinicians will have to hold a separate initiating visit when remote monitoring begins, and remote therapeutic monitoring — which tracks information such as pain levels or therapy use — will be limited to established patients. For older adults managing conditions such as high blood pressure or diabetes at home, the shift means no immediate forced move away from current programs, though new sign-ups may be handled differently.

The Rule CMS Delayed

Remote physiologic monitoring works by connecting patients to devices such as blood pressure cuffs or scales that transmit readings to a care team between office visits. Many practices rely on outside companies to provide the equipment, field patient questions, and review incoming data. Becker’s has reported that an estimated 60% to 70% of hospitals and health systems using remote monitoring depend partly or entirely on vendors.

CMS proposed in July that these services should be reimbursed only when they are delivered by clinical staff employed by the billing practice. Regulators said services provided by entities with only a loose relationship to the treating clinician can undermine long-term, patient-centered care, according to Fierce Healthcare.

The proposal faced strong pushback. More than 200 health care organizations, including over 30 health systems, asked CMS to hold off on finalizing it, Healthcare Finance News reported. CMS kept the policy in the final rule but postponed the effective date to 2029.

What Changes Start in January

The new initiating visit rule is the part patients are most likely to notice soon. Beginning Jan. 1, a clinician billing for remote monitoring must provide a separately billed visit connected to the start of services. In practical terms, a newly enrolled patient will likely need an appointment with their own clinician before monitoring can begin.

Remote physiologic monitoring was already limited to established patients, and the updated rule extends that same standard to remote therapeutic monitoring. CMS says the changes are intended to ensure a patient’s own clinician is involved from the outset rather than an outside company the patient has never met.

The added visit could mean one more step, and possibly an added cost. Under traditional Medicare, remote monitoring and office visits are Part B services, so coinsurance generally applies after the deductible. People with supplemental coverage may owe little or nothing extra.

CMS also received comments about a proposal to merge existing remote monitoring billing codes into four new codes, and said it may revisit that idea in future rulemaking. Separately, the final rule lowers the main Medicare physician payment rate by 2.31% for most clinicians in 2027.

Why CMS Is Tightening Oversight

The policy stems from concerns raised by the HHS Office of Inspector General. The number of traditional Medicare patients using remote monitoring rose sharply from about 55,000 in 2019 to 570,000 in 2022, while spending increased from roughly $15 million to $311 million, according to STAT.

Investigators found cases in which companies made unsolicited outreach to Medicare beneficiaries, enrolled them regardless of medical need, and billed monthly for services that were never actually provided, MedCity News reported. Supporters of remote monitoring argue that many vendors work closely with physicians and help patients who have trouble getting to the office, and that small practices often do not have enough staff to run monitoring programs on their own.

For patients who use it effectively, the service can be valuable. Dianne Williams, a rural Georgia patient, said daily monitoring means she does not have to wait for an office appointment because she can do it every day, according to Physician’s Weekly. About 1% of traditional Medicare beneficiaries use remote physiologic monitoring, the more common form of remote monitoring.

What Medicare Patients Should Ask

Those most affected include older adults with high blood pressure, heart failure, diabetes, or recent hospitalizations, especially people in rural areas who live far from their doctors. Caregivers helping a parent manage daily readings also may be affected.

Patients already enrolled in a remote monitoring program can ask the clinician who reviews their data whether that person is practice staff or an outside vendor, and whether anything will change when the new rule takes effect. People starting a new program can ask whether an initiating visit is required and what they may have to pay for it. Reviewing a Medicare Summary Notice or plan statement can show whether monitoring is billed monthly. Medicare Advantage members should check with their plan, since coverage rules and cost-sharing can differ from traditional Medicare.

People should be wary of unsolicited calls offering free monitoring devices. Before agreeing, they can confirm the offer with their own doctor and report suspicious contacts to 1-800-MEDICARE. Dangerous readings, chest pain, shortness of breath, or stroke symptoms require immediate medical attention, not a wait for the next data review.

It is still unclear whether practices will bring monitoring services in-house or scale back some programs before 2029. MedicalDaily will continue following how CMS handles the code changes in future rules and how providers respond to the new deadline.

Key Questions Answered

What did CMS delay? A rule that would pay for remote monitoring only when a practice’s own employed staff provide it. The policy is now set to begin Jan. 1, 2029.

Can I keep using my current monitoring program? Yes. Programs run with outside vendors can still be billed to Medicare until the 2029 effective date.

What changes in January? A separate initiating visit will be required when monitoring starts, and remote therapeutic monitoring will be limited to established patients.

Will I pay more? Possibly for the initiating visit. Part B coinsurance usually applies, although supplemental coverage may cover it.

Why is CMS tightening the rules? Federal investigators raised concerns about rapid growth, billing practices, and unsolicited enrollment in remote monitoring.

What should I do about unsolicited device offers? Check with your own doctor first and report suspicious calls to 1-800-MEDICARE.