Remote Patient Monitoring (RPM) — Coverage Criteria
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Governs coverage and clinical criteria for remote physiologic monitoring services (collection of physiologic data using devices) for Johns Hopkins Health Plans participating lines of business.
Links and references were reviewed and updated; codes 99445 and 99470 were added to the Coding section.
Coverage and Medical Necessity
Initial Medical Necessity Criteria
Covered when ALL of the following are met:
Duration and Continuation Criteria
Continuation and duration rules:
Requests totaling more than 120 days per 365 days require medical director review
Policy criteria status
No change to existing coverage criteria
This policy addresses Remote Physiologic Monitoring (RPM) — the collection of physiologic data using a medical device — and explicitly states that Remote Therapeutic Monitoring (RTM) (non-physiological, self-reported data) is not addressed and therefore is excluded from the scope of this policy.
Within the sections reviewed, there are no additional explicit exclusions specified beyond the RTM scope exclusion; the revision history confirms the document's coverage criteria remain unchanged.
The presence or absence of CPT/HCPCS codes in the Coding section is informational only. Inclusion or exclusion of codes does not imply the service is covered; benefit coverage is determined by the member's specific benefit plan document and applicable laws, and inclusion of a code does not guarantee payment.
The revision history for this policy documents that on 04/21/2026 there were no changes to policy criteria; updates were limited to links, references, and coding additions.
Coding and Billing Information
| 99445 | Remote monitoring of physiologic parameter(s); device(s) supply with daily recording(s) or programmed alert(s) transmission, 2-15 days in a 30-day period. |
| 99453 | Remote monitoring of physiologic parameter(s), initial; set-up and patient education on use of equipment. |
| 99454 | Remote monitoring of physiologic parameter(s), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. |
| 99457 | Remote physiologic monitoring treatment management services; clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver; first 20 minutes. |
| 99458 | Remote physiologic monitoring treatment management services; each additional 20 minutes. |
| 99470 | Remote physiologic monitoring treatment management services requiring 1 real-time interactive communication; first 10 minutes. |
| 99091 | Collection and interpretation of physiologic data digitally stored and/or transmitted requiring a minimum of 30 minutes of time, each 30 days. |
| J44 | Other Chronic Obstructive Pulmonary Disease |
| E10 | Type 1 Diabetes Mellitus |
| E11 | Type 2 Diabetes Mellitus |
| I50 | Heart Failure |
| I10 | Essential (primary) hypertension |
Provider Responsibilities and Authorization
Prior authorization and duration
Preauthorization is required for all inpatient admissions; initial RPM requests may be approved for up to 60 days. For continuing RPM, include required documentation and a dated, signed order every 60 days; requests totaling more than 120 days per 365 days require medical director review.
- Initial approvals may be up to 60 days.
- Continuing requests require written documentation of continued medical necessity, an updated plan of care, and a dated and signed order every 60 days.
- Continuing requests >120 days per 365 require medical director review.
Program readiness and device requirements
Ensure RPM programs are supported by an appropriate treatment plan, patient consent and education, a monitoring plan, and that devices automatically collect and securely transmit physiologic data to the ordering provider or qualified team member.
- Treatment plan elements: goals/endpoints, patient consent, patient capacity/education, internet/connectivity and supplies, and willingness to meet monitoring frequency.
- Device requirements: cleared/authorized for intended use, automatically collect data, and securely transmit data for analysis and interpretation.
- Minimum data collection: at least 16 days of data within each 30-day period.
No additional provider actions specified
No additional provider action is specified in this section beyond those documented elsewhere in the policy.
Required documentation for initial and continuing RPM
For initial requests, submit documentation from the prior six months demonstrating the member's condition is poorly controlled (one of the specified options). For continuation, provide written documentation of continued medical necessity and an updated plan of care plus a dated and signed order every 60 days.
- Documentation options in the last 6 months: (a) ≥2 hospital admissions with the same qualifying condition as the primary diagnosis; or (b) ≥2 ER visits with the same qualifying condition as the primary diagnosis; or (c) ≥1 hospital admission AND ≥1 separate ER visit with the same qualifying condition as the primary diagnosis.
- Continuation requests must include written documentation of continued medical necessity and an updated plan of care, and a dated and signed order every 60 days.
Documentation of clinical rationale
Retain clinical documentation supporting the medical rationale for RPM consistent with the references reviewed by the Medical Policy Team and provide that documentation if requested.
- The Medical Policy Team reviewed cited scientific and clinical references used to develop this policy.
- Providers should retain documentation that aligns with the evidence and guidance cited in the policy and supply it when requested.
Inpatient preauthorization required
All inpatient admissions require preauthorization.
Authorization triggers/denials
This section lists no explicit authorization denial triggers.
- No explicit authorization denial triggers are specified in this portion of the document.
Definitions and Common Conditions
Background and Scope
Remote Physiologic Monitoring (RPM) uses medical devices to capture physiologic data outside traditional care settings to support management of acute and chronic conditions. Devices commonly include scales, blood pressure monitors, pulse oximeters, glucose monitors, and spirometers; evidence cited in the policy supports potential reductions in utilization and improved clinical control for conditions such as heart failure, diabetes, and COPD.
Revision History and Policy Changes
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