Proposed CY2026 Medicare Physician Fee Schedule: Key Virtual Health Provisions

On Monday, July 14, The Centers for Medicare and Medicaid Services (CMS) released its annual proposed rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule. Key proposals related to virtual health include:

Medicare Telehealth Services List

CMS is proposing to:  

• Simplify the process for adding services (at the Current Procedural Terminology (CPT) level) to the Medicare Telehealth Services List. Previously, there was a five-step process for making changes to the Medicare Telehealth Services List. CMS is proposing to retain Steps 1–3 and to remove Steps 4 and 5. CMS “believe[s] that the determination to utilize the complex professional judgement of the physician or practitioner will better allow practitioners to determine if telehealth is appropriate for that specific Medicare beneficiary and that specific clinical scenario.”
• Accept all currently “provisional” services on the Medicare Telehealth Services List on a permanent basis. Because all services currently listed as “provisional” on the Medicare Telehealth Services List satisfy the standards represented in Steps 1–3 of the rulemaking cycle (see paragraph above), CMS does not believe further review is required to justify their inclusion on the Medicare Telehealth Services List, but notes that “the addition of a service to the Medicare Telehealth Services List does not mean that it is appropriate to be furnished via telehealth to every Medicare beneficiary in every clinical scenario.”

Temporarily facilitate payment for non-behavioral health visits furnished via telecommunications technology in federally qualified health centers (FQHCs) and rural health clinics (RHCs). CMS is proposing to temporarily facilitate payment for non-behavioral health visits furnished via telecommunications technology in FQHCs and RHCs. Similar to the methodology used during and after the COVID-19 public health emergency (PHE), RHCs and FQHCs would continue to bill for medical visit services furnished using telecommunications technology (including audio-only), by reporting specific HCPCS codes. This payment methodology would be used on a temporary basis through December 31, 2026.

Direct Supervision

• Make permanent certain supervisory flexibilities that allow for audio-visual supervision.
• CMS is proposing to permanently permit furnishing certain services under direct supervision if that supervision allows “immediate availability” of the supervising practitioner using audio-video real-time communications technology (excluding audio-only). These provisions would apply to all services except those that have select global surgery indicators; those services would require in-person supervision. CMS is seeking comments on the above-described proposal and on whether to apply the proposed definition of direct supervision to cardiac, pulmonary, and intensive cardiac rehabilitation services.
• Sunset virtual oversight of residents and fellows, except for services provided in rural areas and/or when the service is conducted virtually by all parties (patient, resident, and teaching physician). CMS currently allows teaching physicians to bill for services furnished by residents when the teaching physician is virtually present. However, CMS proposes to end this flexibility, citing its statutory obligation to require “teaching physicians to provide appropriate oversight and personal involvement in resident-furnished services for which Medicare payment is sought.” CMS proposes an exception for trainees in rural areas (outside metropolitan statistical areas) who can continue to be overseen by virtual teaching physicians so long as the teaching physician maintains “active, real-time observation and participation in the service.”

Remote Monitoring

Adopt new RPM and RTM CPT codes that provide opportunity for reimbursement of activities conducted over fewer days and a shorter time period during a month. For CY2026, CPT Editorial Panel created two new RPM codes (99XX4, 99XX5) and four new RTM codes (98XX4, 98XX5, 98XX6, 98XX7) to describe services that represent less than 16 days of data transmission per 30-day period and less than 20 minutes of interactive communication per month. CMS is proposing to adopt these new RPM and RTM codes and adjust others to align appropriately.

For code valuation, CMS rejected many of the Relative Value Update Committee’s valuation proposals. Instead, CMS noted a preference for using Hospital Outpatient Prospective Payment System cost data to value RPM and RTM activities. CMS is seeking comment on their valuation proposals and approach and seeking comment on these proposals.

Digital Therapeutics

• Expand payment for digital mental health treatment (DMHT) services to include Food and Drug Administration (FDA)-authorized devices for treating Attention Deficit Hyperactivity Disorder (ADHD). These ADHD devices must meet similar conditions of payment, including being used under a behavioral health treatment plan and requiring the practitioner to incur the cost. CMS clarifies that the billing practitioner does not need to be the practitioner who makes a behavioral health diagnosis, but otherwise proposes no changes to the existing DMHT payment structure.
• Explore whether to establish payment policies for other digital devices, such as those for behavioral therapy treating gastrointestinal conditions, digital therapy devices to reduce sleep disturbance in psychiatric conditions, and behavioral therapy devices for the treatment of fibromyalgia symptoms. CMS is seeking public comment on these potential additions.

CMS declined to establish a national price for the DMHT device supply code—this code will continue to be contractor priced.

CMS is also soliciting input on:

• Whether to create new coding and payment structures for a broader based set of services and digital tools used in behavioral health care, such as general wellness or lifestyle support tools.
• Digital device policies to consider, such as a new add-on code for the use of eye-tracking technology to support Autism Spectrum Disorder (ASD) in pediatric patients.
• Whether to create an add-on code for the administration of an FDA-authorized eye-tracking technology and other technology to aid in the diagnosis of ASD in pediatric patients.
• Whether to create separate coding and payment for FDA-cleared digital therapeutics that treat or manage the symptoms of chronic diseases.

Behavioral Health & Advanced Primary Care Management

Expand and simplify payment for integrated behavioral health services with Advanced Primary Care Management (APCM) models. Specifically, CMS is proposing to allow the use of optional add-on codes for APCM services that would facilitate providing complementary behavioral health integration (BHI) services by removing the time-based requirements and reducing documentation requirements of existing BHI and Collaborative Care Management (CoCM) CPT codes. The three new optional codes—GPCM1, GPCM2, and GPCM3—are intended to be directly comparable to existing BHI and CoCM codes and would be paid at the same rate. CMS welcomes comments on the above proposed approach.

For FQHCs and RHCs, CMS is also proposing to unbundle the existing CoCM code (G0512) and require RHCs and FQHCs to use the individual CPT codes that comprise the G-code (99492, 99493, 99494), beginning January 1, 2026. This shift would align billing for behavioral health with broader APCM reforms and mirror similar changes already finalized for general care management services.

CMS is seeking comment on how to consider the application of cost sharing for APCM services, particularly if CMS were to include preventive services within APCM bundles.

Medicare DPP

Extend the allowance for virtual delivery of DPP services through 2029, test the inclusion of asynchronous delivery of some DPP services, and modify relevant legislative definitions to clarify parameters of virtual services and circumstances. During the COVID-19 PHE, DPP services were conducted virtually, and the allowance of DPP virtual distance learning and virtual self-reporting of weight has since been extended through 2027; this CY2026 rule is proposing to further extend those flexibilities through December 31, 2029. To allow for these flexibilities, CMS is proposing to amend certain definitions (e.g., what constitutes “online” and “distance learning”) and clarify that DPP suppliers are not required to maintain in-person capabilities through 2029. CMS seeks comments on these proposals.

Software as a Service

Soliciting public comment for SaaS and AI devices for payment methodology. Stakeholders have stated that the absence of a consistent payment framework is impeding the adoption and use of these tools, even when the devices are cleared, approved, or authorized by the FDA. In response, stakeholders have requested CMS develop a payment policy that is “stable and consistent across settings of care, payment systems, and types of services.”

(1) Determine whether the service is separately payable under the PFS, (2) determine whether the service is subject to the provisions of section 1834(m) of the Act, (3) review the elements of the service as described by the Healthcare Common Procedure Coding System (HCPCS) code and determine whether each of them is capable of being furnished using an interactive telecommunications system as defined in 410.78(a)(3), (4) consider whether the service elements of the requested service map to the service elements of a service on the list that has a permanent status described in previous final rulemaking, and (5) consider whether there is evidence of clinical benefit analogous to the clinical benefit of the in-person service when the patient, who is located at a telehealth originating site, receives a service furnished by a physician or a practitioner located at a distant site using an interactive telecommunications system.