First Glance at the 2026 Draft Medicare Physician Fee Schedule Shows Encouraging Advancements for Virtual Healthcare Services
In a move aimed at enhancing access to remote and digital health services, the Centers for Medicare & Medicaid Services (CMS) has unveiled the CY 2026 Medicare Physician Fee Schedule (PFS) proposed rule. The rule includes several updates related to the Medicare Diabetes Prevention Program (MDPP), remote monitoring, digital mental health treatment (DMHT), and changes to the telehealth service list review process.
Under the proposed rule, CMS continues to address telehealth and remote monitoring services by maintaining certain telehealth waivers and flexibilities implemented during the public health emergency. The rule proposes applying an efficiency adjustment to non-time-based codes, but telehealth services are excluded from this adjustment, acknowledging their importance in remote patient monitoring and management.
The CY 2026 rule includes updates to payment and coverage policies for digital mental health treatment, emphasizing the role of digital tools in expanding access to behavioral health services. This includes refining services covered under Medicare Part B and potentially updating reimbursement rates to reflect technological advances and provider time associated with digital mental health care.
CMS also proposes modifications to how telehealth services are reviewed and categorized, possibly indicating a more dynamic review process for adding or removing services from the Medicare telehealth list. This could affect flexibilities and waivers related to telehealth service coverage beyond the public health emergency.
The MDPP updates in the CY 2026 PFS are not detailed in the current information, but CMS typically reviews and updates coverage and payment policies for the MDPP in its annual PFS rule. These updates often include adjustments to payment rates, program requirements, and eligibility criteria aimed at expanding and refining access to diabetes prevention services.
The CY 2026 PFS reflects a modest increase in the conversion factor (3.83% for qualifying APM participants) along with efficiency adjustments applied to certain services but not to telehealth or behavioral health codes, supporting the continued use of remote and digital care modalities.
For detailed numeric adjustments, payment methodology changes, and program-specific policy updates, CMS’s official proposed rule text and supporting documents (CMS-1832-P) released July 2025 provide comprehensive information, with a comment period open until September 12, 2025.
Organisations such as ATA Action, a registered 501c6 entity and an affiliated trade organization of the American Telemedicine Association (ATA), are eager to review the just-released PFS and provide more detailed comments in the coming days and weeks. ATA Action aims to support sustainable, quality healthcare delivery in communities across the U.S. through continued work with CMS and the Trump Administration. They also advocate for the expansion of digital health reimbursement, including the addition of more devices to DMHT codes and coding and payment similar to DMHT codes for FDA-cleared digital therapeutics that treat or manage the symptoms of chronic diseases.
In summary, the CY 2026 PFS proposes significant updates to telehealth and digital health services, aiming to expand access to remote and digital care modalities while maintaining the quality of care delivered. For the most accurate and up-to-date information, consult CMS resources and fact sheets.
- The CY 2026 Medicare Physician Fee Schedule (PFS) proposed rule indicates a continued emphasis on science and health-and-wellness, as it focuses on advancing remote and digital health services.
- In the realm of policy-and-legislation, CMS proposes a more dynamic review process for telehealth services, which could potentially impact Medicare coverage and the availability of these services in the future.
- Organisations like ATA Action, active in the politics of digital health, are keen on analyzing the CY 2026 PFS and advocating for general-news updates, such as expanding digital health reimbursement and incorporating digital therapeutics for chronic diseases.
