Medicare Physician Fee Schedule seeks to expand virtual care

Per its proposed rule for the 2026 Medicare Physician Fee Schedule, or PFS, CMS plans to permanently allow physician supervision via telehealth and expand payment policies for digital mental health treatment services to include solutions for attention-deficit hyperactivity disorder, or ADHD.

The federal agency issued its PFS proposed rule for calendar year 2026 on July 14, 2025. It has included several proposals that impact virtual care adoption and utilization.

First, CMS proposes permanently adopting a definition of 'direct supervision' that allows the physician or supervising practitioner to provide the supervision through real-time, synchronous telehealth. This would enable virtual supervision for several services that require direct physician supervision, including certain diagnostic tests and pulmonary and cardiac rehabilitation services.

However, this proposal does not extend to teaching physicians for services provided by residents. After Dec. 31, 2025, the agency will revert to its pre-pandemic policy, which requires that teaching physicians maintain a physical presence during critical portions of services provided by residents to receive payment for those services. This policy applies to services provided within Medicare Medical Savings Accounts.

Second, the agency is expanding reimbursement for digital mental health treatment devices. In the 2025 PFS rule, CMS created a new payment pathway for digital mental health treatment devices used in conjunction with ongoing behavioral health treatment. In the newly proposed rule, CMS will add ADHD treatment devices to this payment policy.

The agency is also seeking comments on establishing additional separate coding and payment for more mental health services involving digital tools.

Third, CMS plans to streamline and simplify the process for adding services to the Medicare Telehealth Services List. The proposal includes removing the distinction between provisional and permanent services and limiting the review process on whether a service can be provided using synchronous telehealth. 

Fourth, the agency proposes permanently removing frequency limitations for subsequent inpatient visits, nursing facility visits and critical care consultations.

This would remove the limitations that dictated the frequency of telehealth services in certain settings prior to the COVID-19 public health emergency (PHE). For instance, prior to the PHE, there was a limit of one telehealth appointment every three days for subsequent inpatient visits. These limitations were temporarily lifted during the PHE.

The agency is soliciting feedback on the proposed policy changes via the Federal Register.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.