The data presented by Dr McCambridge et al1 indicate that there would be very few of these services billed per site per shift (one to two). If approved, a tele-ICU code likely would receive a small relative value unit value. The use of a very small number of low-value codes for this service is unlikely to make a significant financial impact on either the physician working in the virtual ICU or the health system offering the service to the patients. Although the service may be low volume for any given site, Dr McCambridge et al1 estimate ∼134,000 annual tele-ICU billable encounters nationwide at a cost to the Centers for Medicare & Medicaid Services of $30 million at current tele-ICU usage rates. This estimate works out to ∼$223 per encounter (presumably valuing a 30-min tele-ICU service similarly to a 30-min face-to-face service). Although I believe it is unlikely that a tele-ICU code would be valued at the same rate as the face-to-face service, it seems likely that the volume across the country will continue to grow. As the volume grows, the cost to the Centers for Medicare & Medicaid Services will increase, and the reimbursement for tele-ICU monitoring services has great potential to devalue actual face-to-face service. At the same time, the professional fee reimbursement per site is unlikely to increase significantly and would likely remain insufficient to cover the physician cost of the tele-ICU service. Finally, Dr McCambridge et al1 note, “Tele-ICU services should not be thought of as a surrogate for in-person care but rather as an enhanced level of care that augments in-person care, increases quality, enhances patient safety, and saves lives.” Unfortunately, this is a complicated service to integrate with current and ongoing services and potentially offers a disincentive to actual face-to-face services, which could turn tele-ICU care into a surrogate for in-person care.