October 6, 2026
If you run remote therapeutic monitoring in your practice, or you’ve thought about starting, you’ve probably heard CMS proposed a change in July that could affect how Medicare pays for it.
Most of what’s written about it is either too technical to use or written by someone with something to sell.
Here’s the plain version. What the proposed rule says. Who it affects. What it doesn’t change. And what you need to figure out before the final rule lands around November 1.
I own two PT clinics in Traverse City, Michigan and co-founded MovementRx, the remote monitoring platform I built inside my own practice. I have a stake in how this shakes out. I’m also going to tell you exactly what it says, including the inconvenient parts.
What did CMS actually propose?
On July 16, 2026, CMS published the proposed Physician Fee Schedule for 2027. The part that matters most for PT owners: Medicare would pay for remote therapeutic monitoring only when the person doing the monitoring is a direct employee of the billing practice, under general supervision and incident-to rules.
Right now, some practices use an outside vendor whose employees do the monitoring. If the rule is finalized as written, Medicare would stop paying for that arrangement.
There’s more in it: an established-patient requirement, a new initiating-visit requirement, lower values for the device supply codes, and a question about whether remote monitoring codes should be folded into new G-codes. That last one is a question, not a decision. But it tells you CMS is rethinking how these codes are built.
Is the rule final?
No. Comments closed September 14. The final rule is expected around October 30 to November 3. If CMS finalizes it as written, it takes effect January 1, 2027. Until then, nothing changes.
Who does this affect?
The practices hit hardest use a fully outsourced model, where the vendor’s own employees do all the monitoring. As proposed, Medicare wouldn’t pay for that.
If your own licensed PTAs or COTAs already do the monitoring under your supervising PT, the staffing part of the rule doesn’t change much for you. The established-patient and initiating-visit parts still apply to everyone.
What does the monitoring person actually do?
A licensed PTA or COTA does the monitoring under the general supervision of your treating PT. That supervision is what makes it billable under incident-to rules. They review each patient’s home program activity, talk with the patient for at least 20 minutes across the month, document it, and flag problems to the treating PT. They don’t change the plan of care. That’s the PT’s job.
Under the proposal, this person has to be on the billing practice’s payroll. Part time and hourly works. They have to be your employee, not a vendor’s.
What should owners do right now?
Find out which model you’re running. Is your monitoring person on your payroll or a vendor’s? That tells you how exposed you are.
Then decide before December. The practices that come out of November with a plan will have time to set it up. The ones that wait will be scrambling.
The final rule drops around November 1. I’m teaching a free live session the week it lands: what it says, your options, and what to do before January 1. No sales pitch for the first 45 minutes. Save your spot for the free session.
Frequently asked questions
What is the 2027 CMS proposed rule on remote monitoring?
It’s part of Medicare’s proposed Physician Fee Schedule for 2027. It would pay for remote therapeutic monitoring only when a direct employee of the billing practice does the monitoring.
Is it in effect?
No. The final rule is expected around October 30 to November 3, and it would take effect January 1, 2027.
Does it mean practices have to stop remote monitoring?
No. It changes who can do the monitoring, not whether you can bill for it.
What happens to practices that use outsourced monitoring?
If the rule is finalized as written, Medicare wouldn’t pay for monitoring done by a vendor’s employees after January 1. The monitoring person would need to be on the practice’s payroll.
Can the monitoring person be part time?
As proposed, yes. The requirement is that they’re the practice’s direct employee.
Andrew Gorecki, PT, DPT