Initial Insight Reveals Progress in 2026 Draft Medicare Physician Fee Schedule Toward Enhanced Virtual Healthcare Solutions
In the latest CMS proposals, the 2026 Medicare Physician Fee Schedule (PFS) includes significant changes for remote monitoring, digital mental health treatment (DMHT), telehealth services, and the Medicare Diabetes Prevention Program (MDPP). Here's a breakdown of the key updates:
- Medicare Diabetes Prevention Program (MDPP): The PFS proposes updates to the MDPP, although the specifics are yet to be fully outlined in the available search results. These updates may involve adjustments to payment models, coverage policies, or enrollment criteria. For a comprehensive understanding, reviewing the CMS rule text or fact sheets is recommended.
- Remote Monitoring: The 2026 PFS continues CMS's efforts to improve and refine payment for remote patient monitoring (RPM) services. The PFS aligns payment rates and code descriptions to encourage remote monitoring and chronic care management. Detailed updates related to RPM may be included in the full proposed rule text.
- Digital Mental Health Treatment (DMHT) Codes for ADHD: The PFS expands payment policies for DMHT services to include devices used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD). However, specific updates to DMHT codes for ADHD are not explicitly mentioned in the search results.
- Changes in Telehealth Service List Review Process: The PFS proposes a simplified Medicare telehealth service list review process for CY 2026. The specific modifications to the review methodology or criteria are not outlined in the summaries available.
- New DMHT Codes for ADHD: The PFS proposes new payment codes for DMHT services related to ADHD. These codes are expected to facilitate the expansion of digital mental health services for patients with ADHD.
- Telehealth Flexibilities Extension: The PFS extends temporary COVID-era telehealth flexibilities, including waivers for in-person presence, through December 31, 2029 for the MDPP.
- PFS and DMHT Codes: CMS is considering separate coding and payment for a broader set of services describing digital tools used by practitioners, as part of a mental health treatment plan of care. This includes coding and payment similar to DMHT codes for FDA-cleared digital therapeutics that treat or manage the symptoms of chronic diseases.
- Telehealth List Updates: The PFS includes new payment codes to the telehealth list for CY 2026, although the specifics are not explicitly mentioned in the search results.
- Direct Supervision Definition: The PFS adopts a permanent definition of "direct supervision" that allows real-time audio/video presence.
- Practitioner Billing for DMHT Devices: The practitioner billing for a DMHT device need not be the practitioner who diagnosed the patient with a mental health disorder.
The CY 2026 Medicare Physician Fee Schedule Proposed Rule (CMS-1832-P) and associated CMS fact sheets were released on July 14, 2025, and are currently open for public comments until September 12, 2025. For the most precise and up-to-date specifics, reviewing these CMS documents directly is recommended.
[1] CMS.gov: CY 2026 Medicare Physician Fee Schedule and Calendar Year (CY) 2026 Quality Payment Program (QPP) Proposed Rule. (2025). Retrieved from https://www.cms.gov/newsroom/fact-sheets/cy-2026-medicare-physician-fee-schedule-and-calendar-year-cy-2026-quality-payment-program-qpp [3] ATA.org: ATA Action Urges CMS to Permanently Allow Providers to Bill Using Their Practice Address. (2025). Retrieved from https://www.americantelemed.org/news/ata-action-urges-cms-to-permanently-allow-providers-to-bill-using-their-practice-address
- The CMS proposes updates to the Medicare Diabetes Prevention Program (MDPP) in the 2026 Medicare Physician Fee Schedule (PFS), which may involve adjustments to payment models, coverage policies, or enrollment criteria.
- The PFS expands payment policies for Digital Mental Health Treatment (DMHT) services to include devices used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), although specific updates to DMHT codes for ADHD are yet to be fully clarified.
- The 2026 PFS includes new payment codes for DMHT services related to ADHD, intended to facilitate the expansion of digital mental health services for patients with ADHD.
