CMS Proposes 2026 Medicare Telehealth Enhancements Including Behavioral Health and Remote Monitoring
The Centers for Medicare & Medicaid Services (CMS) has released its proposed 2026 Physician Fee Schedule (PFS), with significant updates aimed at embedding telehealth into Medicare's long-term care model. Unlike previous temporary pandemic waivers, these changes seek to integrate telehealth as a standard component of Medicare billing and oversight, emphasizing clinician judgment over administrative requirements.
The proposal expands Medicare's permanent reimbursement for behavioral health telehealth services, including new coverage for ADHD interventions, while withholding expansion for gastrointestinal conditions, sleep disorders, and fibromyalgia. CMS continues to evaluate evidence surrounding digital therapeutics' efficacy in mental health care.
For providers utilizing remote patient monitoring (RPM), CMS introduces several updates and plans to reassess these new remote monitoring codes in 2028, indicating these additions are preliminary. The proposal also aligns with broader public health initiatives by soliciting stakeholder input on digital care expansions focused on preventing and managing chronic conditions, signaling a move toward enhanced digital integration for disease prevention and patient engagement.
A notable policy change includes allowing the Medicare Diabetes Prevention Program (MDPP) to be delivered entirely online through 2029, a shift from previous reimbursement restrictions that excluded virtual delivery. This change could benefit virtual-first healthcare providers aiming to serve Medicare beneficiaries digitally.
Despite these expansions, certain gaps persist, including challenges faced by small practices, educational institutions, and providers with privacy concerns. Additionally, contrasting trends in commercial payer telehealth policies introduce administrative complexities for providers billing across multiple payer types, potentially increasing fragmentation in digital care delivery.
Overall, CMS's 2026 telehealth proposal demonstrates a strategic shift from emergency pandemic responses toward establishing a sustainable Medicare digital care model. It invites public and industry feedback through September 12, 2025, encouraging providers, administrators, and digital health developers to prepare for upcoming billing changes and documentation requirements. These reforms underscore the evolving healthcare landscape shaped by technology-enabled care practices.