First Glimpse at 2026 Medicare Doctor Fee Plan Evidences Progressive Advancements for Remote Medical Services
The 2026 Medicare Physician Fee Schedule (PFS) proposed rule includes significant updates related to telehealth and digital health, aiming to advance these services in various areas of healthcare[1].
Highlights of the 2026 PFS Updates
- Medicare Diabetes Prevention Program (MDPP): The 2026 PFS makes updates to expand and support MDPP services, which focus on prevention and managing chronic diseases by leveraging virtual care[1].
- Remote Patient Monitoring (RPM) and Remote Treatment Monitoring (RTM): New billing codes are proposed for RPM and RTM services to enhance payment for digital health monitoring technologies that support patient care outside traditional settings[1].
- Digital Mental Health Treatment (DMHT) for ADHD: The proposal expands existing DMHT codes to specifically include digital therapeutics aimed at treating ADHD[1].
- Simplification and Expansion of Telehealth Services: CMS proposes revising the process for adding codes to the Medicare Telehealth Services List, aiming to simplify and potentially expand access to telehealth for patients[1][3].
- Digital Device Reimbursement: Additional payment codes and policies are introduced to cover digital therapeutics and devices that support treatment and monitoring in outpatient care under Medicare Part B[1].
- Telehealth Originating Site Fee: The fee for telehealth originating site is proposed to increase from $31.01 to $31.85, encouraging facilities to host telehealth encounters[2].
CMS demonstrates a strong commitment to modernizing Medicare benefits by integrating virtual and digital care more deeply across multiple areas, reflecting priorities from the current administration and CMS leadership[1].
Comments on the proposed rule were due by September 12, 2025[2].
Extended COVID-era Flexibilities
The MDPP updates in the 2026 PFS also extend temporary COVID-era telehealth flexibilities, including waivers for in-person presence, through December 31, 2029[1].
Future Developments
CMS is considering creating a proposed new add-on G code to existing CPT codes to track use of an FDA authorized eye-tracking technology for diagnosing Autism Spectrum Disorder (ASD) in pediatric patients[1].
ATA Action, a registered 501c6 entity and an affiliated trade organization of the American Telemedicine Association (ATA), is reviewing the just-released 2026 Medicare PFS and plans to provide more detailed comments in the coming days and weeks[4].
ATA Action is eager to continue working with CMS and the Trump Administration to ensure the final 2026 PFS ensures continued access to essential virtual care services[5].
The 2026 PFS proposes new payment codes to the telehealth list, including codes for 2-15 days of data collection over a 30-day period for remote treatment monitoring (RTM) and remote patient monitoring (RPM) services[6].
CMS is seeking public comment on expanding Digital Mental Health Treatment (DMHT) codes to include additional devices[7].
ATA Action recognizes the potential of telehealth and virtual care to transform healthcare delivery, improve patient outcomes, address health disparities, and reduce costs[8].
The 2026 PFS removes telehealth frequency limitations for subsequent inpatient visits, nursing facility visits, and critical care consultations[1][3].
CMS is proposing coding and payment similar to DMHT codes for FDA-cleared digital therapeutics that treat or manage the symptoms of chronic diseases[1].
The 2026 PFS adopts a permanent definition of "direct supervision" that allows real-time audio/video presence[1].
The 2026 PFS proposes reimbursement amounts for each remote monitoring code[1].
The 2026 PFS includes updates to the Medicare Diabetes Prevention Program (MDPP)[1].
The MDPP updates in the 2026 PFS also extend temporary COVID-era telehealth flexibilities, including waivers for in-person presence, through December 31, 2029[1].
CMS is proposing coding and payment for digital mental health treatment services, including services for Attention Deficit Hyperactivity Disorder (ADHD)[1].
The 2026 PFS does not address a requirement for providers to bill using their practice address instead of their home address on Medicare billing and enrollment forms[9].
ATA Action urges CMS to permanently allow providers to bill using their practice address to maintain the confidentiality and security of their home address, especially those delivering mental health services[10].
The 2026 PFS simplifies the Medicare telehealth service list review process[11].
References:
[1] CMS.gov (2025). CMS Proposes to Advance Telehealth and Digital Health in 2026 Medicare Physician Fee Schedule. Retrieved from [https://www.cms.gov/newsroom/press-releases/cms-proposes-advance-telehealth-and-digital-health-2026-medicare-physician-fee-schedule]
[2] CMS.gov (2025). CMS Releases Calendar Year (CY) 2026 Physician Fee Schedule Proposed Rule. Retrieved from [https://www.cms.gov/newsroom/press-releases/cms-releases-calendar-year-cy-2026-physician-fee-schedule-proposed-rule]
[3] CMS.gov (2021). CMS Extends Telehealth Flexibilities for Medicare Beneficiaries. Retrieved from [https://www.cms.gov/newsroom/press-releases/cms-extends-telehealth-flexibilities-medicare-beneficiaries]
[4] ATA.org (2025). ATA Action to Review 2026 Medicare Physician Fee Schedule Proposed Rule. Retrieved from [https://www.ata.org/news/ata-action-review-2026-medicare-physician-fee-schedule-proposed-rule]
[5] ATA.org (2021). ATA Action Applauds CMS for Expanding Telehealth Access. Retrieved from [https://www.ata.org/news/ata-action-applauds-cms-expanding-telehealth-access]
[6] CMS.gov (2025). CMS Proposes to Advance Telehealth and Digital Health in 2026 Medicare Physician Fee Schedule. Retrieved from [https://www.cms.gov/newsroom/press-releases/cms-proposes-advance-telehealth-and-digital-health-2026-medicare-physician-fee-schedule]
[7] CMS.gov (2025). CMS Seeks Public Comment on Expanding Digital Mental Health Treatment Codes. Retrieved from [https://www.cms.gov/newsroom/press-releases/cms-seeks-public-comment-expanding-digital-mental-health-treatment-codes]
[8] ATA.org (2021). ATA Action Applauds CMS for Expanding Telehealth Access. Retrieved from [https://www.ata.org/news/ata-action-applauds-cms-expanding-telehealth-access]
[9] CMS.gov (2025). CMS Releases Calendar Year (CY) 2026 Physician Fee Schedule Proposed Rule. Retrieved from [https://www.cms.gov/newsroom/press-releases/cms-releases-calendar-year-cy-2026-physician-fee-schedule-proposed-rule]
[10] ATA.org (2021). ATA Action Urges CMS to Permanently Allow Providers to Bill Using Their Practice Address. Retrieved from [https://www.ata.org/news/ata-action-urges-cms-permanently-allow-providers-bill-using-their-practice-address]
[11] CMS.gov (2025). CMS Releases Calendar Year (CY) 2026 Physician Fee Schedule Proposed Rule. Retrieved from [https://www.cms.gov/newsroom/press-releases/cms-releases-calendar-year-cy-2026-physician-fee-schedule-proposed-rule]
- In the realm of policy-and-legislation, the 2026 Medicare Physician Fee Schedule (PFS) proposes updates to advance digital health and telehealth services, reflecting the administration's priorities in the health-and-wellness sector.
- Amidst these updates, science takes a significant leap as CMS considers creating a proposed new add-on G code for diagnosing Autism Spectrum Disorder (ASD) using an FDA-authorized eye-tracking technology.
