Remote Patient Monitoring RPM

Policy ID: Q-9005-06

Section: Ancillary

Effective Date: July 01, 2018

Revised Date: May 07, 2024

Revision Effective Date: May 13, 2024

Last Reviewed: May 14, 2024

Applies To: Commercial and Medicaid Expansion

Description

Remote patient monitoring, also known as remote physiologic monitoring and remote therapeutic monitoring, is the use of digital technologies to collect physiological and psychological health data from individuals in one location and electronically transmit that information securely to a health care provider in a different location for assessment and clinical management recommendations. This allows a provider to continue to track healthcare data for a patient released from the hospital to home or to a care facility, potentially reducing readmission rates. Monitoring programs collect physiological signs such as temperature, respiratory rate, heart rate, blood pressure, blood sugar, blood oxygen levels, weight, and electrocardiograms. The data is transmitted to healthcare professionals in the office setting or hospitals, or data may be transmitted to monitoring centers or off-site case management programs. Healthcare professionals monitor these patients remotely and respond to the information received as part of the treatment plan.

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

Remote Patient Monitoring is approved when the following criteria are met:

Prescribed or administered by a board-eligible or board-certified medical provider or subspecialist.
Physiologic data are electronically collected and automatically uploaded to a secure location for analysis and interpretation
Technology used has been FDA approved, cleared, or has an emergency use authorization designation

Documentation

Medical records should include the following:

Physician order; and
All online communications relevant to the ongoing medical care of the individual; and
Support for the medical necessity of continued use of remote patient monitoring; and
Results of the monitoring and how it is used for medical decision making; and
Physician interpretation of the physiological or psychological data; and
In a given 30-day period, at least 16 days of data should be available.

Ongoing benefits are dependent upon measurable clinical improvements in acute symptoms and stabilization of the individual's acute symptoms.

Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.

Procedure Codes

Remote Patient Monitoring (RPM)

99091

99453

99454

99457

99458

99473

99474

G0322

Remote Therapeutic Monitoring

98975

98976

98977

98978

98980

98981

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 1-22-2020 Annual Review - No changes;

4-24-2020 Review

Added COVID-19 disclaimer

Internal Medical Policy Committee 9-28-2022 Annual Review - no changes in criteria

Internal Medical Policy Committee 11-29-2022 Coding update - Effective January 01, 2023

Added procedure code G0322

Internal Medical Policy Committee 11-15-2023 -Annual Review - no changes in criteria

Internal Medical Policy Committee 1-16-2024 Revision - Effective March 04, 2024

Removed BCBSND case manager and replaced with provider care team

Internal Medical Policy Committee 3-19-2024 Revision - Effective May 06, 2024

Changed title (old title: Telehome Telemonitoring for Congestive Heart Failure and/or Chronic Obstructive Pulmonary Disease); and
Removed all COPD & CHF verbiage

Internal Medical Policy Committee 5-14-2024 - Revision with coding update- Effective May 06, 2024

Changed title (old title: Telehome Telemonitoring for Chronic Diseases); and
Added procedure codes 99453; 99454; 99457; 99458; 99473; 99474; 98975; 98976; 98977; 98978; 98980; 98981; and
Added Policy Application

Internal Medical Policy Committee 5-14-2024 - Revision - Effective May 13, 2024

Removed 'for one or more of the following reasons: recent hospitalization in the last 6 months, a history of failing to adhere to their treatment plan and are at risk of an acute episode, and multiple (greater than 2) emergency room visits in the last 6 months.

Links

Not Applicable

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.

Policy ID: Q-9005-05

Section: Ancillary

Effective Date: July 01, 2018

Revised Date: April 12, 2024

Revision Effective Date: May 06, 2024

Last Reviewed: May 14, 2024

Archived Date: May 12, 2024

Applies To: Commercial and Medicaid Expansion

Description

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

Remote Patient Monitoring is approved when the following criteria are met:

Prescribed or administered by a board-eligible or board-certified medical provider or subspecialist for one or more of the following reasons:
1. Recent hospitalization in the last 6 months
2. A history of failing to adhere to their treatment plan and are at risk of an acute episode
3. Multiple (greater than 2) emergency room visits in the last six months
Physiologic data are electronically collected and automatically uploaded to a secure location for analysis and interpretation
Technology used has been FDA approved, cleared, or has an emergency use authorization designation

Documentation

Medical records should include the following:

Physician order; and
All online communications relevant to the ongoing medical care of the individual; and
Support for the medical necessity of continued use of remote patient monitoring; and
Results of the monitoring and how it is used for medical decision making; and
Physician interpretation of the physiological or psychological data; and
In a given 30-day period, at least 16 days of data should be available.

Ongoing benefits are dependent upon measurable clinical improvements in acute symptoms and stabilization of the individual's acute symptoms.

Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.

Procedure Codes

Remote Patient Monitoring (RPM)

99091

99453

99454

99457

99458

99473

99474

G0322

Remote Therapeutic Monitoring

98975

98976

98977

98978

98980

98981

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 1-22-2020 Annual Review - No changes;

4-24-2020 Review

Added COVID-19 disclaimer

Internal Medical Policy Committee 9-28-2022 Annual Review - no changes in criteria

Internal Medical Policy Committee 11-29-2022 Coding update - Effective January 01, 2023

Added procedure code G0322

Internal Medical Policy Committee 11-15-2023 -Annual Review - no changes in criteria

Internal Medical Policy Committee 1-16-2024 Revision - Effective March 04, 2024

Removed BCBSND case manager and replaced with provider care team

Internal Medical Policy Committee 3-19-2024 Revision - Effective May 06, 2024

Changed title (old title: Telehome Telemonitoring for Congestive Heart Failure and/or Chronic Obstructive Pulmonary Disease); and
Removed all COPD & CHF verbiage

Internal Medical Policy Committee 5-14-2024 - Revision with coding update- Effective May 06, 2024

Changed title (old title: Telehome Telemonitoring for Chronic Diseases); and
Added procedure codes 99453; 99454; 99457; 99458; 99473; 99474; 98975; 98976; 98977; 98978; 98980; 98981; and
Added Policy Application

Medical Policies Quick Search

Remote Patient Monitoring RPM

Description

Policy Application

Criteria

Documentation

Procedure Codes

Remote Patient Monitoring (RPM)

Remote Therapeutic Monitoring

Diagnosis Codes

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer

Description

Policy Application

Criteria

Documentation

Procedure Codes

Remote Patient Monitoring (RPM)

Remote Therapeutic Monitoring

Diagnosis Codes

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer