2026 Physician Fee Schedule final rule is here: What it means for RPM and remote care

The Centers for Medicare & Medicaid Services (CMS) has released the 2026 Physician Fee Schedule (PFS) final rule, and it has confirmed what many providers had hoped: the agency is doubling down on remote care. From new remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) codes, to permanent virtual direct supervision, to behavioral health integration updates for federally qualified health centers (FQHCs) and rural health clinics (RHCs), the rule further cements remote monitoring as a permanent pillar of care delivery.

To help practices and other providers offering or interested in remote care digest the details from this significant development, I'll be hosting a webinar on November 20 to explore the final rule and its wide-ranging impact. But first, here's a high-level summary of what providers need to know about how these changes will shape remote care in 2026.

New RPM and RTM codes offer greater flexibility

After years of consideration by the American Medical Association (AMA) CPT Editorial Panel, CMS has finalized two new codes for RPM. These additions give providers the flexibility they've long requested.

• CPT 99445: Device supply for 2–15 monitoring days per 30-day period, reimbursed at the same rate as CPT 99454.
• CPT 99470: Time-based management for 10–19 minutes per month, reimbursed at roughly half the 99457 rate.

In plain terms, clinicians can now bill for fewer monthly vital readings and shorter management time. For patients, this means RPM programs can finally match clinical reality, whether they need daily vitals for a month or a short-term data burst during medication titration. For providers, this means more viable clinical applications for remote monitoring, especially in cases where the 16-day measurement requirement was a barrier.

These changes are mirrored for RTM as well, expanding opportunities for physical therapy, pulmonary care, and chronic disease management programs that previously fell outside RPM's scope.

Virtual direct supervision becomes permanent

Another long-awaited update is CMS's decision to permanently adopt a definition of direct supervision that allows "immediate availability" through real-time audio-video technology. This rule applies broadly to incident-to services, except for those with 010 or 090 global indicators.

Practically speaking, supervising physicians and advanced practitioners can now remain immediately available via live video rather than being physically present in the same location. For many remote care programs, especially those using distributed clinical teams, this confirmation removes one of the biggest operational barriers that emerged during the COVID-19 public health emergency.

CMS emphasizes that this is an option, not a mandate. Supervising clinicians still retain discretion to decide which modality best safeguards patient safety on a case-by-case basis.

FQHCs, RHCs, and the advanced primary care management program

In addition, CMS introduced new advanced primary care management (APCM) behavioral health add-on codes — G0568, G0569, and G0570 — which allow FQHCs and RHCs to bill for collaborative care and behavioral integration without time-based requirements. This change simplifies billing for integrated behavioral health and ensures reimbursement alignment through direct crosswalks to standard CPT RVUs.

Together, these provisions represent a meaningful step toward parity between traditional practices and community health providers, reinforcing CMS's long-term commitment to integrated primary and behavioral care models.

Compliance pressure remains high

While the new codes and flexibilities expand opportunities, CMS and the U.S. Department of Health and Human Services Office of Inspector General (OIG) have made clear that oversight will remain intense. Following the OIG's 2024 report highlighting widespread RPM billing inconsistencies, audits have accelerated, and several RPM vendors have faced settlements for fraudulent billing practices.

That scrutiny deepened this year. In an August report, the OIG analyzed national RPM claims data and outlined key compliance priorities for the year ahead, including improper billing under physician national provider identifiers (NPIs), insufficient documentation of medical necessity, and misuse of time-based management codes. OIG identified a subset of high-volume, dedicated "RPM clinics" who accept patients through referrals and bill under their own NPI as among the chief culprits.

For compliant programs, the message is clear: continue to document thoroughly, use technology that enforces payer rules, and partner only with vendors that maintain strict medical-necessity standards. The expansion of codes and supervision flexibility will not insulate programs from scrutiny. If anything, it increases the incentive for enforcement.

What the PFS final rule means for 2026

The 2026 PFS final rule validates remote care as an essential component of medical practice. Providers gain more options to align monitoring intensity and interaction time with clinical need, while CMS gains the data it needs to continue refining valuation in the years ahead.

For physicians practices and other providers with remote care programs, 2026 offers both opportunity and accountability — new revenue potential through expanded code use, but also the need to maintain airtight compliance and operational efficiency. RPM and related care management programs are here to stay, and in 2026, they're finally structured to better meet patients where they are.

Daniel Tashnek is the co-founder of Prevounce Health, a health care software and services company that simplifies the provision of preventive medical services, chronic care management and remote patient management. Daniel is also a practicing health care attorney specializing in regulatory compliance, reimbursement, scope of practice, and patient care issues