98978
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- RPM/SMBP must meet ALL of the following criteria (policy text): 'Prescribed and administered by a board-eligible or board-certified medical provider or subspecialist (e.g., cardiologist, pulmonologist, endocrinologist), nurse practitioner (NP) or physician assistant (PA)).'
- RPM/SMBP must meet ALL of the following criteria (policy text): 'physiologic data are electronically collected and automatically uploaded for analysis and interpretation.'
- RPM/SMBP must meet ALL of the following criteria (policy text): 'intended for the purpose of displaying or analyzing the physiological parameter(s) measured by the device'.
- RPM/SMBP must meet ALL of the following criteria (policy text): 'used for remote communication, counseling and monitoring of acute or chronic health conditions.'
Key Coverage Criteria
- Remote Physiologic Monitoring (RPM) is considered medically necessary for ANY of the following indications: Chronic Obstructive Pulmonary Disease (COPD); Diabetes Mellitus; Gestational Diabetes; Heart Failure; Hypertensive Disorders Of Pregnancy (HDP).
- Self-Measured Blood Pressure (SMBP) monitoring (CPT codes 99473, 99474) is considered medically necessary for the following indications: Hypertension; Hypertensive Disorders Of Pregnancy (HDP).
- RPM CPT/HCPCS/ICD-10 mappings in the policy indicate coverage when billed with relevant diagnoses including diabetes (E08.00-E13.9), heart failure (I50.1-I50.9), COPD (J44.0-J44.9), and multiple pregnancy-related hypertension/diabetes codes (examples: O10.*, O11.*, O13.*, O14.*, O15.*, O16.*, O24.*) when criteria are met.
- RTM is not primarily for the convenience of the individual, physician, caregiver, or other health care provider;and
- Remotetherapeuticmonitoring (RTM) in a non-healthcare setting is consideredmedically necessarywhen clinical records document the rationale for monitoring includingALLof the following:
- RTM is clinically appropriate, in terms of type, quantity, frequency, extent, site and duration and is considered effective for the individualâs illness, injury or disease and in accordance with generally accepted standards of medical practice*;and
6 Active Policies
CIGNA-RPM — Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) - (0563)
ANTHEM-CG-MED-91 — CG-MED-91 Remote Therapeutic and Physiologic Monitoring Services
REGENCE-MED175 — Digital Therapeutic Products
REGENCE-MED175.01 — Digital Therapeutic Products for Attention Deficit Hyperactivity Disorder
REGENCE-MED175.03 — Digital Therapeutic Products for Chronic Low Back Pain
Related Codes
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