CMS's 2027 RPM Staffing Proposal: What Care Managers Must Do

The Short Answer (Status: PROPOSED)

PROPOSED, not final. CMS's CY 2027 Physician Fee Schedule proposed rule (CMS-1848-P, displayed 2026-07-14, published 2026-07-16 at 91 FR 43842, comments closed 2026-09-14) would let Medicare pay for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) only when the clinical staff doing the work are direct employees of the billing practitioner or practice, starting January 1, 2027. Chronic Care Management (CCM), Principal Care Management (PCM) and Advanced Primary Care Management (APCM) are not included in that staffing limit. CMS has not dated the final rule. For reference, the CY 2026 final rule was published on 2025-11-05.

This is engineering and operations guidance, not legal or billing advice. Confirm with healthcare counsel before changing staffing, contracts or claims.

What CMS Actually Proposed

In the remote-monitoring section of the proposed rule (91 FR 43892–43895), CMS says it would "only allow payment for RPM or RTM services when furnished by clinical staff employed by the practice." To count clinical staff time, the staff member "must be a direct employee of the practitioner or the practitioner's practice," under general supervision and all other incident-to rules at 42 CFR 410.26. Staff do not have to be physically located in the practice, and the patient does not have to be on site. CMS cites OIG findings about outsourced programs, including "cold calling" of beneficiaries.

That reverses a position CMS has held since CY 2021, when its final-rule fact sheet said auxiliary personnel furnishing RPM device and setup services "may include contracted employees."

The same section also proposes:

• A separately billable initiating visit. RPM or RTM would have to start with a face-to-face (in-person or telehealth) visit by the billing practitioner at which remote monitoring is discussed. CMS says the visit is also a chance to obtain the required patient consent.
• RTM for established patients only, matching the rule RPM already follows.
• Revaluation. Device and setup codes would be repriced, and practice-expense inputs removed from the treatment-management codes, because CMS believes several are overvalued.
• A comment request on consolidation. CMS asked whether to replace 17 RPM and RTM codes with four HCPCS G-codes: GRPM1 and GRTM1 (setup and education) and GRPM2 and GRTM2 (monthly monitoring, requiring 2 or more days of data transmission and at least 20 minutes of management with at least one real-time interaction). CMS says it "could finalize" these after comments.

Separately, the "Redesigning Primary Care" request for information in the same rule asks about care management as a whole, including the right initiating visit, whether supervision requirements should change, and "what proportion of care management services must be delivered by the supervising provider, versus auxiliary personnel?" That is a question, not a proposal.

Staffing Rules by Service: Today, Proposed, Status

• RPM / RTM — today: clinical staff time counts under incident-to rules, which include contractors (42 CFR 410.26(a)(1)); CMS said in CY 2021 that RPM auxiliary personnel may include contracted employees — proposed: direct employees of the billing practitioner or practice only, from 2027-01-01 — status: proposed; final rule not yet published.
• CCM — today: CMS's CCM booklet (MLN909188, June 2025, p. 4) says clinical staff are "employees or people working under contract with the billing practitioner" — proposed: no change in CMS-1848-P — status: unchanged; covered only by the primary-care RFI questions.
• PCM — today: same incident-to and general-supervision framework as CCM (42 CFR 410.26(b)(5) for designated care management services) — proposed: no change — status: unchanged.
• APCM — today: CMS's APCM page says auxiliary personnel "can be employees, leased employees, or independent contractors of the billing provider," under general supervision — proposed: no change — status: unchanged.
• TCM — today: auxiliary personnel may furnish the non-face-to-face parts under general supervision and incident-to rules (MLN908628, August 2025, p. 3) — proposed: no change — status: unchanged.

The regulation itself is the anchor: 42 CFR 410.26(a)(1) defines auxiliary personnel "regardless of whether the individual is an employee, leased employee, or independent contractor." The RPM proposal carves remote monitoring out of that general rule; it does not rewrite it.

The Operating Models Being Discussed

"Direct employee" is not clearly defined in the proposal. Shumaker, Loop & Kendrick, writing in the National Law Review, notes that the rule "does not clearly define what qualifies as a 'direct employee,'" and lists in-between cases such as staff employed by an affiliated Management Services Organization and on-site independent contractors. Benesch, Duane Morris, Sheppard Mullin (also in the National Law Review) and Nixon Law Group all describe the same core effect: contracted third-party clinical staff would no longer count.

Two models come up repeatedly in these alerts:

• Practice-employed staff on a vendor platform. The practice employs the monitoring staff; the vendor supplies devices, software and analytics. Nixon Law Group notes CMS is not proposing to stop practices "purchasing technology, devices, software, analytics, or administrative services from vendors."
• MSO or leased-staff arrangements. Staff sit in an affiliated entity or are leased to the practice. Whether these count as direct employment is exactly the open question, and 42 CFR 410.26 already treats "leased employee" as a separate category from "employee."

Nixon Law Group also argues that if the RPM proposals are finalized, similar CCM restrictions are "just a question of timing." That is their view, not a CMS proposal, but a reasonable planning assumption for companies that rely on contracted staff.

What We'd Build or Verify in the Software

This is a checklist, not a list of shipped features. For either outcome, we would build or confirm:

• Staff and employer attribution on every time entry. Each minute is tied to a staff member and to the entity employing that person on that date, so "was this a direct employee of the billing practice?" is a query, not an investigation.
• Initiating-visit capture. Record the visit date, billing practitioner, visit type and whether remote monitoring was discussed, and block RPM/RTM start until it exists.
• Consent capture per patient and per service, with date and method.
• Thresholds as effective-dated, configurable rules. Transmission days and management minutes have already changed once: CMS reviewed new 2-to-15-day and 10-minute codes in the CY 2026 final rule. The G-code option would change them again. These belong in configuration with start and end dates, not in code.
• Per-practice tenancy, so practice-employed staff can work on a vendor's platform while each practice's patients, staff and billing stay separated.
• Billing rules versioned by effective date, so a December 2026 claim and a January 2027 claim are evaluated under the rules in force for each.
• Audit-ready exports per practice per month: who did the work, who employed them, which visit initiated the service, and how the billed codes were derived.
• Revenue-mix reporting, separating CCM, PCM and APCM from RPM and RTM, so leadership can see how much revenue sits under the proposed staffing limit.

The audit-trail principles behind the first and seventh items are covered in Why CCM Programs Fail CMS Audits.

What Opexia Has Built That Is Relevant

We built a multi-tenant CCM/PCM operations platform for a US care-coordination organization that grew from roughly 3,200 to 8,000+ patients. It runs on PostgreSQL, FastAPI and Flutter web, keeps a per-coordinator time log, and generates reports and invoices from CPT paycode counts. It also integrates with an external RPM system through an enrolled-patient export. We have not built RPM billing logic. The full story is in the CCM/PCM operations platform case study.

Timeline

• 2026-07-14 — proposed rule displayed; CMS fact sheet released.
• 2026-07-16 — published in the Federal Register (91 FR 43842).
• 2026-09-14 — comment period closed.
• Final rule — not published as of 2026-09-26; CMS has not given a date. Last year's final rule was published 2025-11-05.
• 2027-01-01 — proposed start of the staffing requirement, if finalized.

What to Decide Before January 1 Under Each Outcome

• Finalized as proposed. Decide which RPM staff move to practice employment and which programs pause. Make sure no contracted-staff minutes count toward RPM/RTM claims with 2027 dates of service. Capture initiating visits for new starts, and ask counsel how the requirement applies to patients already enrolled.
• Finalized with changes (for example, a later start date, a transition period, or a definition that includes leased or MSO staff). If employer attribution and effective-dated rules are in place, this is a configuration change. If they are not, it is a rebuild on a deadline.
• G-codes finalized. Plan to bill two code sets across the changeover, with thresholds tied to effective dates.
• Not finalized. RPM staffing stays as it is. The attribution and audit-export work still pays off, because the RFI shows CMS is asking who delivers care management.

Update Log

• 2026-09-26 — First published. Status: PROPOSED. No CY 2027 final rule found on the CMS-1848-P page or in the Federal Register as of this date. We will update this article when the final rule is published.

If you run CCM, PCM or RPM programs and need to sort out what changes before January, talk through your RPM transition with us.

Sources

• CMS, CMS-1848-P rule page
• Federal Register, CY 2027 PFS proposed rule, 91 FR 43842 (remote monitoring at 43892–43895; primary care RFI at 43935–43939)
• CMS fact sheet, CY 2027 PFS proposed rule
• Federal Register, CY 2026 PFS final rule, 90 FR 49266 (published 2025-11-05)
• CMS fact sheet, CY 2021 PFS final rule
• 42 CFR 410.26
• CMS MLN909188, Chronic Care Management Services (June 2025)
• CMS MLN908628, Transitional Care Management Services (August 2025)
• CMS, Advanced Primary Care Management Services
• Nixon Law Group
• Benesch
• Duane Morris
• National Law Review (Shumaker, Loop & Kendrick)
• National Law Review (Sheppard Mullin)