CG-MED-91 Remote Therapeutic and Physiologic Monitoring Services

Policy CG-MED-91 addresses remote therapeutic monitoring (RTM) of non-physiologic data (for example, medication/therapy adherence or respiratory/musculoskeletal status) and remote physiologic monitoring (RPM) services delivered outside a healthcare facility. RTM in a non-healthcare setting is medically necessary only when the medical record documents the rationale and all of the following: it is clinically appropriate and consistent with generally accepted standards of medical practice; RTM data are regularly assessed to detect acute changes and prompt intervention; the service is not primarily for convenience; and the individual is at risk for clinically significant status changes warranting enhanced monitoring. RTM or RPM is not medically necessary when similar services are provided concurrently (for example, home health services) or when these criteria are not met.

"Remotetherapeuticmonitoring (RTM) in a non-healthcare setting is consideredmedically necessarywhen clinical records document the rationale for monitoring includingALLof the following:"