CMS just dropped the CY 2027 Physician Fee Schedule, so here’s (mostly) everything you need to know about what made it into the final cut.
First things first. Medicare payment rates for most doctors are getting a 2.3% cut in 2027, while docs enrolled in alternative payment models will see rates drop 1.8%.
- Both cuts are deeper than originally proposed, and as you might expect, providers slammed them immediately.
Now, about those RPM changes. Third-party RPM vendors are still “offside,” even if the soccer metaphors are already feeling a bit dated since we first covered the proposed changes during the World Cup.
The proposed rule pinned skyrocketing Medicare costs and widespread waste primarily on vendors:
- Medicare would only reimburse RPM and RTM when they’re performed by clinical staff employed by the billing practice, not third-party companies (pretty much every RPM company we’ve ever covered).
- Medicare would also require a separate visit to kick off any remote monitoring episode, limiting the service to patients that have an established relationship with the billing practice.
That’s still happening. It’s just not happening for two more years:)
- Direct Employee Proposal: “After consideration of public comments, we are finalizing that for the purposes of billing Medicare, beginning January 1, 2029, the RPM and RTM codes cannot be billed in cases where the service is not performed by clinical staff that is a direct employee of the practitioner or the practitioner’s practice and contracting out to third-party companies will not be allowed after that time.”
- Established Patient for RTM Proposal: “We continue to believe that an established patient requirement ensures that the practitioner would possess information needed to understand the current medical status and needs of the patient prior to ordering RTM services.”
- Initiating Visit Proposal: “RPM or RTM services must furnish a separately reportable initiating visit in association with the onset of RPM or RTM services….” The initiating visit doesn’t have to be for the sole purpose of discussing RPM or RTM.
The Takeaway
Pay cuts and can kicking, not sure what else you could have expected.
