The Flaw in the 43% Statistic Leading CMS’s Case Against Remote Patient Monitoring

In its Calendar Year 2027 Physician Fee Schedule Proposed Rule (CMS-1848-P), CMS proposes the most sweeping restrictions on remote patient monitoring since Medicare began paying for it in 2019: a face-to-face initiating visit before enrollment, a ban on third-party clinical staffing, steep cuts to device-supply valuation, and a potential future consolidation of seventeen RPM and RTM codes into four G-codes.

Much of the case rests on a single statistic. The HHS Office of Inspector General reported that approximately 43 percent of Medicare enrollees who received remote patient monitoring did not receive all three billable components of the service, and CMS reads that number as a warning sign of fraud and misuse.

But the 43% is, in large part, a picture of providers doing what CMS's conditions of payment require: declining to bill codes whose requirements were not met, even after paying for the device, the connectivity, the logistics, and the clinical labor behind them.

In this position paper, we explore:

• What the OIG's 43 percent statistic actually measures, and why it reflects billing restraint rather than fraud
• How the conditions of payment, from the 16-day rule to the interactive-communication minimum to the once-per-episode setup code, force compliant providers to withhold claims
• Why perfectly complete billing every month could be a fraud signature, and incomplete billing is the compliance signature
• How to share your thoughts before the September 14, 2026 comment deadline

Download the position paper to understand what the 43 percent really measures, and how to help protect Medicare beneficiaries' access to remote monitoring.