The comment period on Medicare's CY 2027 proposed rule closes at 11:59 p.m. ET on September 14, 2026. In the eight weeks since CMS proposed barring contracted clinical staff from performing billable remote monitoring, requiring a face-to-face initiating visit, and revaluing the code families downward, nearly every organization with standing in this debate has filed a response — and they have converged on the same request with surprising consistency.
The American Medical Association opposes the cuts and the employment restriction. ATA Action asked CMS to refine rather than restrict. The Alliance for Connected Care called the pricing crosswalks a misreading of what the service costs. More than 200 health systems, patient groups, and specialty societies signed a single letter to the CMS Administrator. And the House Ways and Means Committee, one day after the rule went on public inspection, voted 39–0 to expand the same benefit CMS proposed to constrain.
None of that decides anything. Comment volume is not a vote, and CMS has finalized unpopular proposals before. But the comment record is the best available read on where remote monitoring is heading, and it is worth reading carefully — including the parts where the objectors agree with CMS.
What did the AMA tell CMS about remote monitoring?
The AMA set out its position in an analysis published September 4, 2026, and it is unusually direct for an organization that typically hedges on payment methodology. It opposes the proposed payment reductions to remote physiologic and remote therapeutic monitoring. It opposes limiting the services to employed clinical staff rather than contractors. And it backs a procedural argument that may matter more than either.
That argument comes from the AMA/Specialty Society Relative Value Scale Update Committee — the RUC, the volunteer body whose valuation recommendations CMS has historically accepted in most cases. The RUC was scheduled to reexamine the remote monitoring codes in January 2028. It is moving that review up a full year, to January 2027, and urging CMS to postpone both the payment reductions and the G-code bundling proposal until there is data to review.
The logic is worth stating plainly, because it is the strongest argument in the record. CMS proposed to cut device and management payments on the grounds that it has received "very little invoice or pricing information" to justify the current practice-expense inputs. The RUC's answer is that the codes are too new for that data to exist yet — the restructured 2026 code set has been in effect for eight months — and that the way to fix an evidence gap is to collect evidence, not to price by crosswalk in the meantime. Whether CMS finds that persuasive is a genuine open question. It is the kind of argument that has produced one-year delays in past fee schedules.
The AMA's broader objections to the rule give this some context. It also opposes the proposed conversion-factor reductions of 1.19 percent for alternative-payment-model participants and 1.68 percent for everyone else, opposes the proposed 50 percent payment cut for separately identifiable evaluation and management visits billed with modifier 25, and asked CMS to defer its proposed changes to indirect practice-cost methodology pending more transparency. Remote monitoring is one front in a wider disagreement about how this fee schedule was built.
Is there a conflict between CMS and the CPT code set?
This is the part of the story that gets the least attention and may have the longest half-life.
The AMA owns CPT. Its Editorial Panel spent 2024 rebuilding the remote monitoring code family, and that work took effect in January 2026: 99445 for 2–15 days of device supply alongside 99454 for 16–30, a shorter treatment-management code at 99470 for the first 10 minutes, 99457 rescoped to 11–20 minutes, and matching changes across the RTM family. That structure exists because clinicians argued for years that all-or-nothing thresholds did not describe real monitoring.
The request for information buried in the CY 2027 proposed rule would replace all seventeen of those codes, for Medicare purposes, with four HCPCS G-codes — two setup codes and two monthly bundles, each requiring device supply, a data minimum, at least one real-time interactive communication, and at least 20 minutes of management time in every billed month. That would erase the 2-day and 16-day distinction the Panel just created and eliminate the shorter management increments entirely.
CMS is legally free to do this; HCPCS Level II is its own code set, and it has used G-codes before to pay for things CPT describes differently. But it would mean a practice describing the same service two ways — CPT for commercial payers, G-codes for Medicare — and it would sideline a code structure organized medicine spent two years building. The RUC's request to hold off is partly a valuation argument and partly a jurisdictional one.
What did the telehealth organizations say?
ATA Action, the advocacy arm of the American Telemedicine Association, filed initial comments the day after the rule dropped and escalated within a week. Kyle Zebley, the ATA's chief executive and ATA Action's executive director, framed the proposal as a "stark contradiction" with the bipartisan congressional support remote monitoring has attracted, and drew the line the industry has held since: "CMS is looking to reduce fraud, waste, and abuse in healthcare, a goal we share. However, it should not be at the expense of providing remote monitoring for patients."
The full comment letter, filed at the end of August, is more useful than the press release, because it does something advocacy letters often skip — it proposes an alternative. ATA Action's position is that CMS should target enforcement at bad actors rather than dismantle clinically integrated care models, and it offers a package of what it calls targeted, evidence-based safeguards: provider accountability measures, required clinical protocols, audit mechanisms, and better data collection on who is actually delivering these services. Its practical warning is about who gets hurt by a blunt rule — smaller and rural practices that rely on contracted or shared staffing because they cannot employ a dedicated monitoring nurse for a panel of forty patients.
The Alliance for Connected Care filed formal comments on September 1 and organized much of the coalition activity around them. Its objections run to four points, and the second is the most technical:
- The direct-employment restriction would disrupt centralized staffing models that health systems use across multiple sites, not only vendor relationships.
- The pricing crosswalks borrow practice-expense inputs from self-measured blood pressure codes and a cardiac rhythm code — services the Alliance argues bear no cost relationship to continuous multi-parameter monitoring, so the resulting rates would not describe what the service costs to deliver.
- The initiating-visit requirement could "create redundant visits and add to existing primary care and specialist access bottlenecks" — an access argument, not a compliance one, and a real problem in markets where the next available appointment is months out.
- Code bundling would force an all-or-nothing monthly unit onto a service whose intensity genuinely varies month to month.
The Alliance also published a report on September 2 documenting state commitments to remote monitoring under the Rural Health Transformation Program — the $50 billion, five-year federal investment states are now allocating — and argued that federal payment policy pulling one direction while federal rural funding pulls the other puts those state programs at risk. That is the sharpest version of the coordination argument in the record.
Who else has weighed in?
On August 24, more than 200 organizations — over 30 major health systems and roughly 50 national patient and provider organizations among them — sent a joint letter to CMS Administrator Mehmet Oz asking the agency not to finalize the remote monitoring proposals as written. The letter's ask is a delay and a stakeholder process rather than outright rejection, and its framing is fiscal: a policy intended to strengthen oversight should not end up increasing costs to taxpayers. The coalition puts the population at stake above one million Medicare beneficiaries currently receiving remote monitoring.
A separate industry campaign, ProtectRPM.org, describes itself as a coalition of clinicians, patients, and monitoring providers and runs on the slogan "fix it — don't end it." It proposes provider registration, outcomes tracking, and prospective gating as alternatives to an employment mandate, and cites an Optum actuarial analysis putting annual per-patient savings between roughly $2,500 and $3,000 for monitored patients versus matched controls, along with rural access figures. Those numbers come from a campaign with a commercial interest in the outcome and have not, as far as we can tell, been through peer review — worth reading, worth discounting accordingly. The structural point underneath them stands on its own: the practices least able to employ monitoring staff are disproportionately the rural ones.
What is Congress doing while this plays out?
Moving in the opposite direction, and quickly.
On July 15, 2026 — the day after the proposed rule went on public inspection — the House Ways and Means Committee approved the Rural Patient Monitoring Access Act (H.R. 3108) by a vote of 39–0. The bill would establish a national minimum reimbursement floor for remote monitoring, eliminate negative payment adjustments in rural areas, set technology and response-time quality standards, and require a report on hospital admissions and inpatient days among monitored patients. A Senate companion is pending as S. 1535. Several other bills are in the queue, including the Expanding Remote Monitoring Access Act (H.R. 3032), the Connected MOM Act, and the KIDNEY Remote Monitoring Act (H.R. 8319).
The timing is the story. A unanimous committee vote to raise the payment floor, one day after the agency proposed to lower it, is about as clean a picture of divided federal intent as this policy area produces.
Two cautions on reading too much into it. A bill approved in committee is not law, and most never become law; the 119th Congress has limited floor time and remote monitoring is not near the top of it. And nothing in H.R. 3108 as drafted would override a finalized staffing requirement — a payment floor and a rule about who may perform the service are different levers. Congressional pressure shapes what CMS finalizes more often through letters and hearings than through enacted statute.
Where does telehealth policy sit alongside this?
Settled, for now — which is a change from the last two years and worth keeping straight.
Medicare's pandemic-era telehealth flexibilities lapsed on January 30, 2026 and were restored days later when the Consolidated Appropriations Act, 2026 was signed on February 3, extending them through December 31, 2027. Geographic and originating-site restrictions stay waived, the home remains a permissible originating site, audio-only remains payable, and FQHCs and RHCs may continue to serve as distant sites. Our breakdown of that extension covers the operational detail.
The relevance here is that the initiating-visit proposal leans on telehealth. CMS would accept a telehealth visit as the required face-to-face encounter, which is only workable because those flexibilities exist. A practice can satisfy a 2027 initiating-visit requirement by video for a patient at home — through 2027. What happens on January 1, 2028 is a separate fight that has not started yet.
The other thing worth holding in view is that this administration is not uniformly hostile to technology-enabled chronic care. CMS's own innovation center announced the ACCESS model in December 2025 — a ten-year voluntary test of outcome-aligned payment for chronic conditions under fee-for-service Medicare, which ATA Action welcomed at the time. An agency building a decade-long model around technology-supported chronic care while proposing to restrict the main way that care is currently staffed is not being incoherent, exactly. It is drawing a distinction between the care and the arrangements that grew up around the billing for it.
What actually happens next, and when?
The sequence from here is fixed even though the outcome is not:
- September 14, 2026 — comments close on docket CMS-1848-P at regulations.gov.
- Early-to-mid November 2026 — the final rule is expected, based on recent years' timing. The CY 2026 final rule was issued November 5, 2025. This is a pattern, not a published date.
- January 1, 2027 — whatever is finalized takes effect. Until December 31, 2026, the current rules and rates apply unchanged.
Three outcomes are plausible, and it is more honest to name them than to pick one. CMS could finalize the package substantially as proposed, which is what the agency does when it believes the program-integrity case is strong and the objections are self-interested. It could finalize the employment and initiating-visit requirements while deferring the revaluation and the G-code work to the RUC's January 2027 review — the split decision, and the one the comment record is most directly asking for. Or it could soften the staffing rule into something narrower, such as a requirement of direct contractual and supervisory control over the clinical staff rather than W-2 employment, which would address the fragmentation concern without eliminating shared staffing.
What will not change in any of those scenarios is the direction of travel. A pending OIG study of remote monitoring use across Medicare fee-for-service and Medicare Advantage is still to come. The scrutiny is durable even if this particular rule is not.
What does this mean for the future of RPM and RTM?
Five things look true regardless of how the final rule lands.
Remote monitoring has stopped being a growth story and become a benefit under management. The utilization curve since 2019, the two OIG reports, and now a rule written in response to them are the ordinary life cycle of a Medicare benefit that got big. Programs that survive that transition are the ones already documenting as though someone will read the chart.
The billing practice moves closer to the service, whatever the mechanism. Even if the employment requirement is softened or dropped, CMS has now said in the Federal Register that it does not believe a billing practitioner has adequate oversight when the clinical work is contracted out. That sentence shapes audits whether or not it becomes a condition of payment.
Payment will be set by evidence or by crosswalk, and the industry chooses which. CMS asked for device invoices and cost data and said it received almost none. The RUC's accelerated review is an attempt to supply that. Vendors and practices that can document real acquisition and support costs will be better represented in the 2028 valuations than those that cannot.
A single monthly bundle is the likely long-run shape. The G-code RFI and the RUC's own review both point toward consolidating a seventeen-code family. Practices whose monitoring months routinely include device supply but no management time should understand that those months are the ones a bundle would stop paying for.
Software and clinical staffing are separable, and the distinction now carries weight. The consistent reading across the law firms following this rulemaking is that CMS targeted contracted clinical staff performing billable service time, not technology platforms, device logistics, or support. A practice that owns its clinical labor and licenses its software sits on the safe side of every version of this proposal that has been floated. Arrangements that bundle the two together carry the regulatory risk of both.
What should a practice do before September 14?
Comment, first — CMS asked directly for data on how often third-party staffing occurs and what an employment requirement would do to access, and a specific letter from a practice describing its own panel is worth more than a form submission. The docket is CMS-1848-P at regulations.gov.
Then the durable work, none of which is wasted if the rule is withdrawn: know precisely which people perform your billable monitoring minutes and under what contract; build an initiating-visit and consent workflow into your scheduling now; keep device acquisition invoices and support-cost records, because that is the evidence CMS says is missing; and avoid multi-year commitments priced on 2026 rates. Model 2027 as a range, not a number.
How Neuvora is approaching this
We run both staffing models today. Some practices use Neuvora's clinical team for monitoring; others run their own nurses and medical assistants inside the same software. The platform, the time tracking, the documentation trail, and the EHR integrations are identical either way.
That is the practical reason we are not in a hurry. If the employment requirement is finalized as written, a practice on the full-service model shifts its monitoring minutes to employed staff working in the same system — a staffing change, not a software migration. We are helping practices size that in advance: how many monitoring hours a given panel actually generates, and what staffing them would require, before 2027 budgets close.
We are reading the comment docket and the final rule when it comes, and will publish an analysis then. Our RPM program overview describes how the practice-staffed model works today, and practices weighing their exposure can talk to our team.
The bottom line
The comment record on the CY 2027 rule is close to unanimous on the ask — slow down, collect the data, target the bad actors rather than the model — and close to unanimous on conceding the premise, that Medicare has a remote monitoring integrity problem worth fixing. That combination usually produces a partial finalization rather than a clean win for either side.
Practices should plan for that. Assume something is finalized on January 1, 2027. Assume the staffing question resolves in the direction of the practice owning its clinical labor. Assume the money moves, and not upward. And do the three things that are correct under every version of the rule — know who performs the minutes, document the initiating visit, and keep the evidence of what the service costs.
This article is general billing information, not billing, legal, or medical advice. Verify current rates and payer policies against the CMS Physician Fee Schedule and your MAC before billing.
