CMS Proposes Major Digital Health Enhancements in 2026 Fee Schedule

2025-07-16 digitalcare

Washington, D.C., Wednesday, 16 July 2025.
CMS’s proposed 2026 physician fee updates prioritize digital health, aiming to integrate telehealth permanently and streamline remote monitoring, reflecting a shift towards technology-driven care solutions.

Emphasizing Digital Health

The Centers for Medicare and Medicaid Services (CMS) released its proposed 2026 physician fee schedule rule on 14 July 2025, marking a substantial shift towards digital health. The rule prioritizes the permanence of telehealth services and the simplification of remote monitoring processes [1][2]. By doing so, CMS intends to enhance care delivery through technology-driven solutions, increasing efficiency and accessibility [1].

Telehealth and Remote Monitoring

In the proposed rule, CMS has emphasized the role of telehealth by suggesting permanent waivers for its use in federally qualified health centers, extending telehealth billing waivers through 2026 [4][6]. This approach means that more types of medical services can now be provided without an in-office visit, expanding access and convenience for patients [5]. Additionally, new codes for remote physiologic monitoring (RPM) have been introduced, which facilitate reimbursement for less than 20 minutes of patient data review [6].

Digital Therapeutics and Mental Health Technologies

Digital mental health technologies (DMHTs) receive significant attention in CMS’s proposal. The rule proposes expanding payments for DMHTs to include therapies for conditions such as Attention Deficit Hyperactivity Disorder (ADHD) while excluding coverage for gastrointestinal disorders, sleep conditions, and fibromyalgia [4][1]. This targeted expansion aims to leverage digital therapeutics in effectively treating chronic conditions within standardized care practices [4].

Implications and Future Prospects

The proposed physician fee schedule reflects CMS’s adaptive strategy to integrate modern healthcare technologies into its payment systems. By incorporating digital health tools and continuously updating telehealth policies, CMS is creating pathways for improving patient outcomes and optimizing care efficiency post-pandemic [6]. The broader implications suggest a healthcare ecosystem increasingly reliant on digital solutions to meet emerging challenges in chronic disease management and preventive care [5][3].

Bronnen

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