Remote Patient Monitoring

POLICY

Remote physiologic monitoring (RPM) services for established patients are reimbursable when ordered by and billed by physicians or other qualified health professionals (QHP). RPM services may be delivered by auxiliary personnel including contracted employees, when under the supervision of the billing physician or qualified health professional.  See manual for codes.

Prior to or at the time RPM services are furnished, the patient must give consent to receive the services. Consent may be verbal (written consent is not required) but must be documented in the medical record, along with justification for the use of RPM services.

SOURCE: CA DHCS Evaluation and Management Manual (Sept. 2025), p. 34-35. (Accessed Jan. 2026).

Medi-Cal reimburses for 5 remote physiologic monitoring codes (99091, 99453, 99454, 99457, 99458), consistent with Medicare Communication Technology Based Services (CTBS) .

SOURCE: CA DHCS Evaluation and Management Manual (Sept. 2025), p. 35; Medi-Cal Rates Information. (Accessed Jan. 2026).

The department may authorize the use of remote patient monitoring as an allowable telehealth modality for covered health care services and provider types it deems appropriate for dates of service on or after July 1, 2021. The department may establish a fee schedule for applicable health care services delivered via remote patient monitoring.

SOURCE: Sec. 14124.12 (f)(1)(B) of the Welfare and Institutions Code. (Accessed Jan. 2026).

Continuous Glucose Monitoring

Effective for dates of service on or after May 1, 2023, CPT^® codes 95250 (ambulatory continuous glucose monitoring [CGM] of interstitial fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional [office] provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of a sensor, and printout of recording) and 95251 (ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report) are added as Medi-Cal benefits.

SOURCE: Durable Medical Equipment (DME): Billing Codes Manual, Nov. 2023, p. 52. (Accessed Jan. 2026).

CONDITIONS

Chronic care management (CCM) services are provided when medical and/or psychosocial needs of the patient require establishing, implementing, revising, or monitoring the care plan.

Principal care management (PCM) services are provided when medical and/or psychological needs manifested by a single, complex chronic condition are expected to last at least three months.

See manual for codes.

SOURCE: CA DHCS Evaluation and Management Manual (Oct. 2025), p. 27-30, 32-34. (Accessed Jan. 2026).

PROVIDER LIMITATIONS

Remote Physiologic Monitoring

Remote physiologic monitoring (RPM) services for established patients are reimbursable when ordered by and billed by physicians or other qualified health professionals (QHP). RPM services may be delivered by auxiliary personnel including contracted employees, when under the supervision of the billing physician or qualified health professional.  See manual for codes.

SOURCE: CA DHCS Evaluation and Management Manual (Sept. 2025), p. 34-35. (Accessed Jan. 2026).

OTHER RESTRICTIONS

Remote Physiologic Monitoring

Remote physiologic monitoring (RPM) services are reimbursable for established patients.

CPT code 99453 is reimbursable once per episode of care but cannot be used for monitoring fewer than 16 days during a 30-day billing period. CPT code 99454 covers the cost associated with leasing a home-use medical device or devices to and for the patient. The interactive communication required for 99457 must be real-time synchronous with two-way audio with a minimum of 20 minutes per month and the patient must have a treatment plan for chronic care management. For additional information regarding minimum duration of service and definition of episode care, refer to the CPT book.

The frequency limit for 99453, 99454 and 99091 is one per 30 days, any provider. The frequency limit for 99457 is one per calendar month, any provider. The frequency limit for 99458 is three per interactive communication session.

Prior to or at the time RPM services are furnished, the patient must give consent to receive the services. Consent may be verbal (written consent is not required) but must be documented in the medical record, along with justification for the use of RPM services.

SOURCE: CA Department of Health Care Services. Evaluation & Management Manual. Page 34-35. Sept. 2025. (Accessed Jan. 2026).

The department may establish separate fee schedules for applicable health care services delivered via remote patient monitoring or other permissible virtual communication modalities.

SOURCE: Welfare and Institutions Code 14132.725. (Accessed Jan. 2026).

CCM/PCM Services

Chronic care management (CCM) CPT codes 99490 and 99491 each have a frequency limit of once per month any provider. CPT code 99439 has a frequency limit of two per month, any provider. CPT codes 99490, 99491, 99437, 99439 and G0506 are reimbursable when they meet the criteria noted in the manual.

Principal care management (PCM) CPT codes 99424 and 99426 each have a frequency limit of once per calendar month, any provider and 99427 has a frequency limit of two per calendar month, any provider.

SOURCE: CA DHCS Evaluation and Management Manual (Oct. 2025), p. 27-30, 32-34. (Accessed Jan. 2026).

Continuous Glucose Monitoring

CPT codes 95250 and 95251 cannot be reported more than once per month per patient, any provider, regardless of the duration of professional CGM or the number of times CGM is provided in a single month. CPT 95251 cannot be reported in conjunction with CPT 99091.

Refer to the Contracted Continuous Glucose Monitoring (CGM) Systems list and Medical Supplies and Diabetic Supplies: Continuous Glucose Monitoring (CGM) Systems section of the Medi-Cal Rx Provider Manual for coverage criteria, quantity limits and additional billing information.

SOURCE: CA Department of Health Care Services. Durable Medical Equipment (DME): Billing Codes Manual, Nov. 2023, p. 52. (Accessed Jan. 2026).