Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) - (0563)

Cigna covers RPM for COPD, diabetes (including gestational), heart failure, and hypertensive disorders of pregnancy and covers SMBP (CPT 99473/99474) for hypertension/HDP, but RTM is not covered and RPM/SMBP for other indications (including isolated elevated BP R03.0) will be denied. Coverage requires prescription/admin by a qualified provider (physician/NP/PA), electronic automatic data collection and upload (policy cites CMS parameters that devices be FDA-cleared and able to auto-transmit), monitoring over at least 16 days/30-day period, use of specified CPT/HCPCS and ICD-10 codes, required documentation (device setup/education, measurement frequency—e.g., 99474: two readings one minute apart twice daily for ≥12 readings/30 days—and communication of a treatment plan), and billing limits (one device-based service per patient per 30 days).

"Remote Physiologic Monitoring (RPM) is considered medically necessary for ANY of the following indications: Chronic Obstructive Pulmonary Disease (COPD); Diabetes Mellitus; Gestational Diabetes; He..."