Medicare Shifts Cardiac Care Reimbursement to Value-Based Model
Beginning in 2026, the Centers for Medicare &. Medicaid Services (CMS) is transitioning cardiac care reimbursement from a fee-for-service model to one that emphasizes value and outcomes. This shift aims to reward providers who prevent emergency room visits, reduce hospital readmissions, and improve patient recovery, rather than simply billing for the volume of services performed.
From Volume to Value: A Modern Reimbursement Framework
Historically, Medicare paid providers based on Current Procedural Terminology (CPT) codes for each service rendered, factoring in geographic location, malpractice costs, and practice expenses. The 2026 Physician Fee Schedule introduces the concept of “care managed by the practitioner,” allowing for additional payments when providers demonstrate improved patient outcomes .
This approach builds upon the existing Merit-based Incentive Payment System (MIPS), which already adjusts payments based on performance measures like blood pressure control and preventive screenings. The new rule embeds value-based criteria directly into specific cardiac monitoring codes, allowing a cardiologist using an ECG patch to demonstrate how early intervention avoided a hospital admission, or a primary care physician to document how timely follow-up kept a patient stable and out of urgent care.
Changes to Direct Supervision Requirements
A key change involves the direct supervision requirement for billing the technical component of cardiac monitoring. Previously, a physician had to be physically present in the office for billing to qualify. Now, this supervision can be provided virtually, allowing practices to manage monitoring in-house and capture both professional and technical payments. This shift challenges the traditional role of Independent Diagnostic Testing Facilities (IDTFs).
Impact on Independent Diagnostic Testing Facilities (IDTFs)
For years, IDTFs have provided the “technical component” of cardiac monitoring, handling device tracking, report compilation, and ensuring Medicare’s direct supervision requirements were met. Physicians billed for interpreting results, while IDTFs collected payment for the monitoring itself.
The new rule specifically targets CPT code 93296, which covers the technical component for remote interrogation of implanted cardiac devices like pacemakers and defibrillators. The removal of the in-person supervision requirement allows providers to manage this work internally and bill for both components. While initially limited to this single code, CMS has historically piloted policy changes in this manner, with expectations that the model will expand to other ECG and monitoring codes by 2027.
Opportunities for Providers
The rule change empowers providers to run monitoring programs in-house, oversee them virtually, and bill for both the professional and technical components. Direct access to patient data facilitates early intervention and complication prevention, aligning with Medicare’s value-based goals.
New short-duration billing codes for Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) offer further flexibility. Previously, providers needed at least 16 days of data to bill. New CPT codes allow billing for fewer than 16 days of data and less than 20 minutes of patient interaction per month.
This is particularly beneficial for primary care physicians, who often have limited time with patients. Monitoring a patient’s blood pressure for 10 days, for example, can now be billed, rather than being ineligible for reimbursement.
What Providers Should Do Now
Providers should adapt by bringing monitoring in-house, establishing workflows for remote oversight, training staff, and ensuring clinicians can document outcomes to meet CMS standards. Selecting the right technology partners is crucial, focusing on mobile apps for patients and dashboards for clinicians that integrate into daily routines.
Education is also essential. Providers must understand the distinct requirements of the new short-duration codes for RPM (capturing electronic data) and RTM (covering patient-reported outcomes like pain or symptoms) to maximize revenue under the new system.
Providers who adapt quickly will retain more reimbursement and access new value-based payments. Those who delay risk falling behind in a rapidly evolving landscape.