98986
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- 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
- RTM data is being regularly assessed to detect acute changes in clinical status and prompt intervention;and
- The individual is at risk of clinically significant changes in medical status which warrant enhanced monitoring based on current status and instability of the underlying clinical condition;and
- The individual is unable to access regularly scheduled outpatient clinical care or therapeutic monitoring is required between visits due to potential changes in medical status;and
1 Active Policy
ANTHEM-CG-MED-91 — CG-MED-91 Remote Therapeutic and Physiologic Monitoring Services
Related Codes
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