CMS's CY 2027 fee schedule proposal (91 FR 43842, July 16, 2026) creates BB and BC modifiers for telehealth through contracted or paid-for platforms and incident-to telehealth, would require RPM and RTM clinical staff to be the practice's direct employees, adds an initiating-visit rule for remote monitoring, and widens teaching physician virtual presence. The final rule is expected in November.
CMS published the CY 2027 Physician Fee Schedule proposed rule on July 16, 2026 (91 FR 43842, file code CMS-1848-P), with comments due September 14, 2026. For telehealth companies, four proposals matter: new claim modifiers required by Congress, a ban on counting contracted staff time for remote monitoring, an initiating visit for remote monitoring, and a change to teaching physician billing. All of them are proposals. The final rule usually appears in early November and takes effect January 1.
What are the BB and BC modifiers?
They implement section 6209(g) of the Consolidated Appropriations Act, 2026, which requires CMS, by January 1, 2027, to require codes or modifiers on two kinds of telehealth claims: services furnished through a telehealth virtual platform where the practitioner contracts with the platform's owner or pays for its use, and telehealth services furnished incident to a practitioner's professional service. In the proposal, CMS says it is "creating modifiers BB and BC," that the modifiers "do not affect payment," and that guidance will be posted on the CMS website and updated through subregulatory guidance under section 6209(h).
The operational question is which of your claims fit. A practitioner employed by a telehealth company that owns its platform, a contractor paid per visit through a vendor's platform, and a clinic using a licensed video tool may all be in different positions. Read the definitions against your contracts, then wait for CMS's guidance before hard-coding anything in billing rules. Claim-level setup is work for your billing team or our sister company White Glove Medical Billing.
What would change for remote patient monitoring staff?
This is the biggest proposal for telehealth operators. CMS proposes that, to count clinical staff time toward RPM or remote therapeutic monitoring (RTM) management, "the clinical staff must be a direct employee of the practitioner or the practitioner's practice." The rule says that, if finalized, from January 1, 2027 the codes "could not be billed in cases where the service is not performed by clinical staff of the billing practitioner and will not allow contracting out to third-party companies." Staff could still work remotely and the patient need not be on site, but they would need to be the practice's employees under general supervision, meeting the incident-to rules at 42 CFR 410.26.
CMS ties the proposal to OIG's work, including the September 2024 report OEI-02-23-00260, which found that 43 percent of Medicare enrollees who received RPM did not receive all three components of the service. A program that runs on an outsourced nurse call center billed under the practice's NPI would need restructuring. See the direct-employee proposal in detail.
What other RPM and RTM changes are proposed?
- An initiating visit. RPM or RTM would have to be started by the billing practitioner at a separately reportable face-to-face visit, in person or by telehealth, at which remote monitoring is actually discussed. That visit is also where CMS expects consent to be obtained.
- Established patients for RTM. RPM already requires an established patient. CMS proposes the same for RTM.
- Valuation. CMS questions whether current values for several device supply codes, including 99445 and 99454, reflect resource costs, and proposes changes to practice expense inputs.
The 2026 rule's new short-period codes are covered in RPM's 2-to-15-day codes.
What about teaching physicians?
The CY 2026 final rule (90 FR 49266) allowed teaching physicians a virtual presence only when the service is a three-way telehealth visit, with teaching physician, resident and patient in different places. CMS now proposes to allow billing when either the teaching physician or the resident is in the same room as the patient, for services on the Medicare Telehealth Services List.
Anything on the telehealth services list?
No additions. CMS says it received no requests to add or remove services for CY 2027. It does propose clearer descriptors for telehealth critical care consultations, G0508 and G0509, now that the CY 2026 rule removed their frequency limit.
What should a telehealth company do before November?
- Inventory remote monitoring staffing. List every person whose time is counted toward RPM or RTM codes and who employs them. If the answer is a vendor, model what bringing them in-house would cost, or what happens to revenue if you cannot.
- Map platform arrangements. For each clinician who bills Medicare telehealth, record who owns the platform and whether anyone is paid for its use.
- Write the initiating-visit workflow, including how consent is captured and documented in that visit.
- Watch for the final rule. Our Compliance Calendar & Rule Watch ($495 per month) flags it the day it posts. If RPM needs to be rebuilt, our Remote Patient Monitoring Program Setup ($5,950) covers staffing, consent and documentation.
The rest of Medicare's 2027 picture, including the December 31, 2027 end of the telehealth flexibilities, is on the Medicare telehealth hub.
Common questions
- When will the 2027 fee schedule be final?
- CMS usually publishes the final Physician Fee Schedule rule in early November, effective January 1. The CY 2027 proposal was published July 16, 2026 with comments due September 14, 2026.
- Can RPM still be outsourced in 2027?
- Under current rules, yes. If CMS finalizes its proposal, time spent by contracted third-party staff could not be counted toward RPM or RTM codes from January 1, 2027. Staff would need to be direct employees of the billing practitioner or practice.
- Do the BB and BC modifiers change payment?
- CMS says they do not. They identify telehealth claims furnished through a contracted or paid-for virtual platform and telehealth furnished incident to a practitioner's service, as section 6209(g) of the Consolidated Appropriations Act, 2026 requires.
- Does the proposal add services to the Medicare telehealth list?
- No. CMS says it received no requests to add or remove services for CY 2027. It proposes revised descriptors for the telehealth critical care consultation codes G0508 and G0509.
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