Remote Patient Monitoring
POLICY
“Remote patient monitoring” means the use of digital technologies to collect medical and other forms of health data (e.g., vital signs, weight, blood pressure, blood sugar) from individuals in one (1) location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations.
Health care services delivered by telehealth such as Remote Patient Monitoring, Store and Forward, or any other telehealth technology, must be compensable by OHCA in order to be reimbursed.
Services provided by telehealth must be billed with the appropriate modifier.
If the technical component of an X-ray, ultrasound or electrocardiogram is performed during a telehealth transmission, the technical component can be billed by the provider that provided that service. The professional component of the procedure and the appropriate visit code should be billed by the provider that rendered that service.
The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.
SOURCE: OK Admin. Code Sec. 317:30-3-27(a) & (e). (Accessed Jun. 2025).
Continuous glucose monitoring (CGM)
CGM means a minimally invasive system that measures glucose levels in subcutaneous or interstitial fluid. CGM provides blood glucose levels and can help members make more informed management decisions throughout the day.
CGM must be determined by a provider to be medically necessary and documented in the member’s plan of care as medically necessary and used for medical purposes. A request by a qualified provider for CGM in and of itself shall not constitute medical necessity. The Oklahoma Health Care Authority (OHCA) shall serve as the final authority pertaining to all determinations of medical necessity. Refer to Oklahoma Administrative Code (OAC) 317:30-5-211.2 and 317:30-3-1(f) for policy on medical necessity. CGM devices must be approved by the U.S. Food and Drug Administration (FDA) as non-adjunctive and must be used for therapeutic purposes. Devices may only be used for members within the age range for which the devices have been FDA approved.
In-person or telehealth visit [within the last six (6) months] between the treating provider, member and/or family to evaluate their diabetes control.
SOURCE: OK Admin. Code Sec. 317:30-5-211.25. (Accessed Jun. 2025).
CONDITIONS
Continuous glucose monitoring (CGM)
Member must have a diagnosis that correlates to the use of CGM.
SOURCE: OK Admin. Code Sec. 317:30-5-211.25. (Accessed Jun. 2025).
Extended Ambulatory Cardiac Monitoring
Effective Nov. 1, 2023, OHCA has added coverage for extended ambulatory cardiac monitoring codes 93241-93244 and 93245-93248. Coverage is intended to evaluate syncope and lightheadedness, to document arrhythmia in members with a non-diagnostic Holter monitor or 48-hour telemetry, or in persons whose symptoms occur infrequently such that the arrhythmia is unlikely to be diagnosed by Holter monitoring.
PROVIDER LIMITATIONS
Continuous glucose monitoring (CGM)
Prescription must be made by a qualified provider.
SOURCE: OK Admin. Code Sec. 317:30-5-211.25. (Accessed Mar. 2025).
Extended Ambulatory Cardiac Monitoring
Providers: 08, 09, 10, 31, and 52
OTHER RESTRICTIONS
No Reference Found
< BACK TO RESOURCES