Medicare’s 2026 fee schedule just got louder about remote care, and it’s basically a green light for the Welby model

Medicare’s 2026 fee schedule just got louder about remote care, and it’s basically a green light for the Welby model

If you run a primary care group, an ACO, or a Medicare Advantage plan, you’ve felt the tension: chronic disease is eating your day alive, but the “visit-based” system still rewards you for the moment, not the month.

The 2026 Medicare Physician Fee Schedule (PFS) changes don’t magically fix that. But they do something important: they reinforce that CMS is not treating remote care like a side quest. CMS is doubling down on ongoing, outcomes-driven virtual care that keeps people stable at home, while making it easier for practices to operationalize it at scale.  

And that is exactly where Welby plays.

2026 is a signal: remote monitoring is not “telehealth,” it’s real care

One of the biggest misunderstandings in the market is treating Remote Patient Monitoring (RPM) as “telehealth.” CMS is explicit that RPM and RTM are inherently non-face-to-face services and sit outside the statutory definition of “Medicare telehealth services.”  

That matters because it keeps RPM from getting whiplashed by telehealth politics and temporary waivers. It positions remote care as a durable part of how Medicare expects chronic disease to be managed: continuously, proactively, and measurably.

The remote care codes got more precise, and CMS protected the clinical work

In 2026, CMS finalized major updates to remote monitoring valuation, including new RPM codes created by CPT to describe data transmission and updated valuation approaches for device supply.  

A few highlights that should matter to any operator building serious virtual care:

• CMS maintained the current work RVU for the core RPM treatment management time code (CPT 99457), rather than adopting a lower RUC recommendation. That’s CMS protecting the clinical work of reviewing trends, adjusting care plans, and engaging patients.  
• CMS finalized valuation for the new “first 10 minutes” RPM code (CPT 99470). That’s a practical acknowledgement that meaningful monitoring work happens even before you hit the traditional time thresholds.  
• CMS also finalized a new pathway for valuing the device supply side of RPM (including the device supply codes like 99454 and the newer short-duration data transmission code 99445) using OPPS cost data, rather than relying on thin survey-based inputs. In plain English: CMS is trying to make the economics more grounded and auditable.  

This is why I keep saying: “RPM isn’t a gadget business.” The most valuable part is the care. Medicare is paying to support the work of keeping someone stable between visits, not just shipping a cuff.

Medicare is raising the baseline for “good virtual care”

Here’s the hard truth: plenty of RPM programs have been little more than billing engines.

The industry created a cottage economy of:

• low-engagement call centers,
• device-only rollouts with minimal clinical decisioning,
• workflows that dump more tasks on already-buried practices,
• and “reports” that look impressive but don’t change outcomes.

Medicare’s 2026 direction pushes against that. When CMS protects clinical work RVUs for monitoring time and invests in more structured code definitions, they’re implicitly saying: this is supposed to be real longitudinal care.  

That reinforces a simple idea: if your virtual care vendor isn’t moving clinical metrics and reducing downstream utilization, you’re not running a care program. You’re running a spreadsheet.

“Medicare values this more than regular codes” (and why that’s rational)

Traditional office-based care is episodic by design: a visit, a plan, a hope that life cooperates.

Remote care codes pay differently because they represent a different kind of medicine: frequent measurement, fast feedback loops, and proactive intervention. The reimbursement structure is built around the month, not the moment. And in 2026, CMS didn’t retreat from that. They strengthened it with new RPM code structure and valuation decisions that reinforce ongoing care delivery.  

There’s also a bigger macro-signal in the 2026 PFS: conversion factors increased, and CMS is now applying two separate conversion factors beginning in 2026 (with a higher update for qualifying APM participants). That’s CMS telling the market, “we will pay more for accountability.”  

If you’re a customer deciding whether to build high-performing virtual care, that’s not noise. That’s the runway getting longer.

What this means financially for customers

Let’s talk dollars in a way that actually maps to decisions.

For a practice or value-based organization, remote care programs create three financial levers:

1. New revenue aligned to work you’re already doing (or should be doing)
2. RPM and related remote care codes pay for monitoring and management work that used to be invisible, uncompensated labor. CMS protecting those values supports program sustainability.  
3. Better risk performance and quality outcomes
4. BP control moves Stars measures, HEDIS, and shared savings performance. That shows up as real margin in MA and ACO models.
5. Reduced downstream utilization (the big one)
6. Preventing avoidable ED visits and admissions is where the compounding effect lives.

And we should be honest: if your program isn’t improving utilization, the rest of the economics will eventually get squeezed.

The outcome story that changes minds

One of our clients launched an RPM hypertension cohort with Welby, and the results have been decisive:

• Their RPM cohort moved to stable blood pressure in under 60 days.
• They are tracking to zero elevated blood pressures within four months.

That is not “nice engagement.” That is risk coming under control.

Here’s why that should make any CFO and any CMO lean in.

AHRQ’s HCUP analysis puts the average cost of a treat-and-release ED visit at about $750 (2021 national estimate).  

CDC’s “Health, United States” reports the average adjusted cost per inpatient stay at community hospitals at $14,101 (2019).  

So even with conservative math, the savings potential is meaningful.

A simple, transparent savings frame (illustrative):

• If improved BP control prevents just 10 treat-and-release ED visits in a year across a population, that’s roughly $7,500 in avoided ED cost.  
• If it prevents just 2 inpatient admissions in a year, that’s roughly $28,202 in avoided inpatient cost.  

That’s ~$35,700 in avoided acute-care cost from a relatively small utilization shift. And hypertension is not a small problem. CDC notes 1.1 million ED visits where essential hypertension is the primary diagnosis (national estimate).  

Now scale that logic across thousands of members, and you see why CMS is bullish: the “expense” of proactive monthly care is tiny compared to the cost of preventable acute events.

Access is the headline for 2026, but operational excellence is the actual work

Access isn’t just “virtual visits exist.” Access is:

• patients actually onboarding,
• devices actually transmitting,
• outreach that patients answer,
• clinicians empowered with signal, not noise,
• care plans that change behavior,
• and documentation that withstands audit scrutiny.

The 2026 code structure and valuation shifts reward programs that can do that reliably.  

And that’s the Welby thesis: remote care should be clinically excellent, operationally tight, and financially aligned with outcomes.

What Welby does differently (and why “substandard RPM” will keep disappointing people)

Welby isn’t a device company. We’re a remote care operating system that makes RPM work the way it was intended:

• High-touch patient engagement that drives adherence and behavior change
• Clinically guided escalation pathways so clinicians intervene when it matters, not when a threshold blips
• Workflow integration that reduces practice burden instead of adding another inbox
• Month-over-month measurement that makes outcomes visible and improvements repeatable

If you’re a customer running a “checkbox RPM program,” 2026 is your wake-up call. CMS is building for the long term. The market is going to keep separating into two buckets:

• programs that drive outcomes and earn their economics, and
• programs that bill until someone asks hard questions.

If you want to talk about what “good virtual care” looks like in 2026, and what it takes to get to stable BP fast, Welby’s ready.

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