CurrentPartners Insurance Company dba Jefferson Health PlansPolicy RB.026.A

Remote Patient Monitoring

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This policy governs when remote patient monitoring services, devices, and related CPT-coded services are covered and eligible for reimbursement for providers serving Jefferson Health Plans members across lines of business, subject to applicable benefit documents and limits.

Policy Summary

PayerPartners Insurance Company dba Jefferson Health Plans

PolicyRemote Patient Monitoring

Policy CodePolicy RB.026.A

Change TypeCodes added

Effective DateN/A

Last ReviewFeb 2, 2026

Next Review DateN/A

Key ActionUse an FDA-approved medical device that automatically and digitally uploads physiologic data; patient self-recorded or self-reported data does not satisfy the RPM device requirement.

SourceLink

POLICY UPDATE CHANGES

Codes were added to the remote patient monitoring policy.

4Core reimbursement criteria

16–30 days99454 monitoring period

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CurrentPartners Insurance Company dba Jefferson Health PlansPolicy RB.026.A

Remote Patient Monitoring

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Sign up for partners_insurance_company_dba_jefferson_health_plans Policy RB.026.A alerts

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Policy Summary

PayerPartners Insurance Company dba Jefferson Health Plans

PolicyRemote Patient Monitoring

Policy CodePolicy RB.026.A

Change TypeCodes added

Effective DateN/A

Last ReviewFeb 2, 2026

Next Review DateN/A

Key ActionUse an FDA-approved medical device that automatically and digitally uploads physiologic data; patient self-recorded or self-reported data does not satisfy the RPM device requirement.

SourceLink

POLICY UPDATE CHANGES

Codes were added to the remote patient monitoring policy.

4Core reimbursement criteria

16–30 days99454 monitoring period

2–15 days99445 monitoring period

30 minutes99091 monitoring time

20 minutes99457 initial time

Not approvedPersonal devices

Remote Patient Monitoring Coverage Criteria

RPM Coverage and Reimbursement Criteria

RPM is covered and eligible for reimbursement only when all of the following criteria are met.

ALL of the following

RPM devices and equipment are supplied by the provider.
The device is FDA-approved and meets the FDA definition of a medical device.
The device automatically and digitally uploads the patient's physiologic data; data cannot be self-recorded or self-reported by the patient.
The device transmits the patient's physiologic data through a secure, HIPAA-compliant connection established by the prescribing provider.
The service is referred by a physician or qualified licensed healthcare provider, including an inpatient or emergency department discharging provider or the patient's primary or specialty care provider.
The provider makes RPM data available upon request.
RPM services conform to professional standards of care, scope-of-practice requirements, ethical requirements, and applicable federal, state, institutional, Practice Act, and licensing board requirements.

Excluded Personal Devices

The following device type is not approved for RPM.

ALL of the following

Personal devices such as Apple Watch or Fitbit are not approved for Remote Patient Monitoring.

Covered Codes and Billing Thresholds

Remote physiologic monitoring device, setup, and management codesCPT

99445	Remote monitoring of physiologic parameter(s), including device supply with daily recordings or programmed alert transmission, for 2-15 days in a 30-day period.
99453	Initial setup of the remote monitoring device and patient education on use of equipment.
99454	Remote monitoring device supply with daily recordings and programmed alert transmission for 16-30 days in a 30-day period; excludes fewer than 16 days.
99457	First 20 minutes of remote physiologic monitoring treatment management in a calendar month, including interactive communication with the patient or caregiver.
99458	Each additional 20 minutes of remote physiologic monitoring treatment management in a calendar month, including interactive communication with the patient or caregiver.

Additional monitoring and treatment management codesCPT

99470	First 10 minutes of monitoring and treatment management in a calendar month, including interactive communication with the patient or caregiver.
99091	Collection and interpretation of digitally stored or transmitted physiologic data requiring a minimum of 30 minutes every 30 days and not requiring interactive communication.

Related remote assessment and self-measured blood pressure codesmixed

99473	Self-measured blood pressure using a clinically validated device, including patient education, training, and device calibration.
99474	Self-measured blood pressure with two readings one minute apart twice daily over a 30-day period, with at least 12 readings, data collection, reporting of average systolic and diastolic pressures, and communication of a treatment plan.
G2250	Remote assessment of recorded video or images submitted by an established patient, including interpretation and follow-up within 24 business hours, subject to the stated related-service timing limitations.

Diagnosis codesICD-10

ICD-10 Codes N/A

No ICD-10 codes are listed.

99445 Monitoring Period

Code99445

Monitoring period2-15 days in a 30-day period

Billing frequencyBilled each 30 days for less than 16 days of monitoring

99453 Frequency

Code99453

FrequencyBilled 1X per patient

99454 reading limitation

Provider Requirements and Billing Responsibilities

Documentation Required

Provider-Supplied Equipment

Providers must supply the remote patient monitoring devices and equipment used for the program.

Billing Rule

Eligible Device and Electronic Transmission

Use an FDA-approved device that meets the FDA definition of a medical device and automatically uploads the patient’s physiologic data electronically. Patient self-recorded or self-reported data does not satisfy the RPM device requirement.

The device must support digital, automatic transmission of physiologic data.
Self-recorded or self-reported patient data is excluded.

Policy Summary

PayerPartners Insurance Company dba Jefferson Health Plans

PolicyRemote Patient Monitoring

Policy CodePolicy RB.026.A

Change TypeCodes added

Effective DateN/A

Last ReviewFeb 2, 2026

Next Review DateN/A

Key ActionUse an FDA-approved medical device that automatically and digitally uploads physiologic data; patient self-recorded or self-reported data does not satisfy the RPM device requirement.

SourceLink

On This Page

Only the first month of reading for 99454

99454 Monitoring Period

Code99454

Monitoring period16-30 days in a 30-day period

Minimum monitoringMinimum of 16 days of monitoring

99457 Time Threshold

Code99457

Initial time thresholdFirst 20 minutes of monitoring and treatment management

Time periodDuring the calendar month

99458 Time Threshold

Code99458

Additional time thresholdEach additional 20 minutes of monitoring and treatment management

Time periodDuring the calendar month; billed each calendar month

99470 Time Threshold

Code99470

Initial time thresholdFirst 10 minutes of monitoring and treatment management

Time periodDuring the calendar month

99091 Time Threshold

Code99091

Minimum time thresholdMinimum of 30 minutes

Time periodEvery 30 days

99474 Blood Pressure Readings

Code99474

Reading frequencyTwo readings one minute apart, twice daily

Monitoring periodOver a 30-day period

Minimum readingsMinimum of 12 readings

Documentation Required

Secure Data Transmission

The device must transmit the patient’s physiologic data through a secure, HIPAA-compliant connection established by the prescribing provider.

Documentation Required

Qualified Provider Referral

RPM services must be referred by a physician or qualified licensed healthcare provider. Eligible referring providers include the discharging inpatient or emergency department provider and the patient’s personal primary care or specialty care provider.

Documentation Required

Data Available Upon Request

Providers approved for RPM programs must make RPM data available to the plan upon request.

Note

Professional and Regulatory Compliance

RPM services must conform to professional standards of care, ethical practice, applicable scope-of-practice requirements, and relevant federal, state, and institutional policies and requirements.

Comply with applicable Practice Act and Licensing Board rules.
Provide services consistent with the licensed healthcare provider’s scope of practice and services appropriately delivered through RPM.

Documentation Required

Qualified Monitoring Personnel

Monitoring and evaluation of physiologic data received remotely must be performed by qualified healthcare professionals who possess the necessary clinical training.

Only appropriately trained qualified healthcare professionals may participate in monitoring and evaluating remotely received physiologic data.

Denial Risk

Personal Device Exclusion

Personal devices such as Apple Watch® or Fitbit® are not approved devices for RPM.

Do not use a patient’s personal Apple Watch® or Fitbit® as the approved RPM device.

Billing Rule

Code-Specific Billing Requirements

Bill applicable RPM codes according to their required monitoring days, time, communication, billing provider, and billing-period rules. Device data must be collected and transmitted electronically; patient self-reported data cannot be used to bill these codes.

99445: Device supply with daily recordings or programmed-alert transmission; 2–15 monitoring days in a 30-day period; practice-expense-only code and does not require clinical staff; billed every 30 days.
99453: Initial device setup; practice-expense-only code and does not require clinical staff; billed once per patient, only in the first month of reading for 99454.
99454: Device supply with daily recordings and programmed-alert transmission; minimum 16 and up to 30 monitoring days in a 30-day period; practice-expense-only code and does not require clinical staff; billed every 30 days.
99457: First 20 minutes of monitoring and treatment management, including interactive communication with the patient or caregiver during the calendar month; performed by a physician, other qualified healthcare professional (QHCP), or clinical staff; billed per calendar month.
99458: Each additional 20 minutes of monitoring; performed by a physician or other qualified healthcare professional; billed each calendar month.
99470: First 10 minutes of monitoring and treatment management, including interactive communication with the patient or caregiver during the calendar month; performed by a physician, other qualified healthcare professional (QHCP), or clinical staff; billed each calendar month.
99091: 30 minutes of monitoring every 30 days without interactive communication; performed by a physician, other qualified healthcare professional (QHCP), or clinical staff; billed every 30 days.