If you're like most in the field, staying on top of CMS telehealth policies feels like a full-time job all by itself. With telehealth becoming a staple for everything from initial consults to post-op check-ins, you need to know what's changing—especially when it impacts how you deliver care for things like joint replacements, fracture management, or chronic pain issues. 

In July 2025, CMS dropped the proposed rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS), and it includes some notable tweaks to telehealth that could affect your orthopedic practice. Let's break it down in a straightforward way, focusing on what's relevant for orthopedics without getting bogged down in jargon.

What's New in the CY 2026 PFS Proposed Rule?

Released on July 14, 2025, the proposed rule lays out updates to Medicare payments and policies, including telehealth expansions that aim to make virtual care more accessible and sustainable. While it's still in the proposal stage—comments were due by September 12, 2025—these changes could kick in starting January 1, 2026, if finalized. CMS is pushing for more streamlined processes, which is good news for busy ortho clinics juggling in-person and remote visits.

Key highlights include efforts to simplify adding services to the Medicare Telehealth Services List. This means it could get easier to get new codes approved for virtual orthopedic services down the line. They're also proposing to add specific services like multiple-family group psychotherapy, group behavioral counseling for obesity, an infectious disease add-on, and auditory osseointegrated sound processor codes. While these aren't exclusively orthopedic, they could overlap with multidisciplinary care for patients dealing with mobility issues or post-surgical complications.

Telehealth Flexibilities Extended and Made Permanent

One of the biggest wins here is the push to make some pandemic-era flexibilities stick around longer—or even permanent. For instance, CMS wants to permanently allow direct supervision via real-time audio and video (not just audio-only) for certain services. This is huge for orthopedics, where supervising residents or mid-level providers during virtual assessments of gait, range of motion, or wound healing can happen without everyone being in the same room. It keeps things efficient while maintaining oversight.

They're also proposing to extend other waivers through 2026, like letting providers report their enrolled practice address instead of home addresses for services done remotely, and allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to keep billing for telehealth. For rural orthopedic practices, this could mean continued access to virtual follow-ups for patients who can't easily travel for routine checks on arthritis management or ortho rehab.

On the flip side, virtual presence for teaching physicians in resident-involved services won't extend beyond December 31, 2025, reverting to pre-pandemic rules that generally require physical presence (with rural exceptions). If your practice relies on teaching programs, it would be smart to plan accordingly to avoid disruptions in training or billing.

Nursing home telehealth codes are set to become permanent, which matters for orthopedics since many post-ortho surgery patients end up in skilled nursing facilities for recovery. This supports virtual consults for things like hip fracture rehab or prosthetic fittings without the hassle of temporary status.

How These Updates Impact Orthopedic Practices

Orthopedics has been a prime area for telehealth growth, especially for non-emergent care like pre-op planning, chronic condition monitoring, or low back pain evaluations. The proposed rule ties into this by introducing the Ambulatory Specialty Model (ASM), a new mandatory payment model focusing on episodes like heart failure and low back pain. Low back pain is a common orthopedic issue, and while the model isn't exclusively telehealth-focused, it could incorporate virtual elements for ongoing management, potentially improving reimbursement for bundled care.

For durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)—think braces, walkers, or custom orthotics—telehealth encounters can still support orders as long as they meet standard requirements. CMS updated the DMEPOS jurisdiction list in July 2025, which might affect how you handle claims for orthopedic devices prescribed via telehealth.

These changes could help orthopedic groups reduce no-shows, expand reach to underserved areas, and simplify operations. But remember, nothing's final yet—keep an eye on the final rule expected later this year.

Staying Compliant and Maximizing Reimbursement

Navigating these updates isn't always easy, but tools like remote patient monitoring and billing software can make a big difference. At Athelas, we help practices like yours adapt to CMS shifts with seamless tech that handles telehealth billing, compliance tracking, and more. If you're looking to optimize your orthopedic telehealth setup, reach out—we're here to help.