$7 Million to $194 Million: Medicare Turned a Phone Call Into a Billing Code

Dianne Williams lives in rural Georgia. Every day she straps a cuff to her arm and presses a button. The reading goes to her doctor and to a nurse who calls her once a month.

When her pills weren't bringing her pressure down, that nurse told her to start walking and eating better. Now she walks a local track every day. She bakes her fish instead of frying it. She lost weight. Her pressure came down.

"They just didn't just take my blood pressure and that was it," she told KFF Health News.

That's medicine. A number, a person who looks at it, and a conversation that changes what happens next.

Now Medicare may take it away. Arielle Zionts reported for KFF Health News that a proposed CMS rule would stop paying clinicians who use outside tech companies to run remote monitoring. Medicare would pay only when someone at the clinician's own facility does the work. Williams' clinic, a community health system already running "borderline understaffed," says it couldn't offer the program without a vendor. "It looks like they're cutting off everybody," Williams said, "and that's not right."

She has a point. So does Medicare.

Traditional Medicare spent just under $7 million on remote physiologic monitoring in 2019. By 2023 it was more than $194 million. Enrollment grew tenfold, and patients stayed on it longer, from 1.7 months on average to 5.2. Some vendors sell the service to clinics as a way to generate income. Caroline Pearson of the Peterson Center on Healthcare put it plainly: paying doctors to review huge numbers of readings for years on patients whose blood pressure is already controlled "doesn't feel like a clinically driven decision. That feels like a revenue decision."

Both things are true. The nurse's phone call helped Dianne Williams. And the billing code that paid for it grew into a business.

This is what happens every time we turn a relationship into a reimbursement. We needed a code for the cuff, a code for the review, a code for the call. Then a company to bill the codes. Then an inspector general report about the company. Then a rule to police the report. Now a fight over the rule, with more than 230 groups signed on against it and Humana, the Blue Cross Blue Shield Association, and Sutter Health in favor.

Nobody in that fight is asking the simplest question. Why does a doctor need a billing code to look at a patient's blood pressure?

In direct primary care, she doesn't. A patient pays a flat monthly fee. She buys a cuff at the drugstore, takes a reading, and texts the number to her own doctor. The doctor answers. If the pills aren't working, they change the pills that week. If it's time to walk the track and bake the fish, the doctor says so, and the doctor knows her well enough for it to land. No vendor. No code. No minimum number of readings to qualify for payment. No incentive to keep a controlled patient on monitoring for years, because nobody gets paid more for it.

When the pressure is controlled, the texts slow down. When it isn't, they speed up. That's what Pearson says the evidence supports: use the data to change treatment, then stop once the patient is stable. Direct care does it by default, because the doctor's time is already paid for and nobody is counting readings.

I'm not against remote monitoring. I'm against paying for it in a way that makes the reading more valuable than the patient. Rural clinics will lose real services if this rule goes through as written, and some fix is needed. But every version of the fix still runs through the same machine: Washington writes a code, someone games the code, Washington writes a rule.

The cheapest way to watch a patient's blood pressure is to give her a doctor she can text.

Dianne Williams found something that worked: a nurse who knew her and called her once a month. That shouldn't depend on a billing code. It should be part of having a doctor.

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Source: Arielle Zionts, KFF Health News, "Many Medicare Patients Could Lose Access to Remote Monitoring Devices" (Oct. 26, 2026): kffhealthnews.org/medicare/remote-patient-monitoring-cms-medicare-rule-reimbursements-access-rural-health/