Remote Patient Monitoring
POLICY
“Remote patient monitoring” means the use of synchronous or asynchronous electronic information and communication technologies to collect personal health information and medical data from a patient at an originating site that is transmitted to a telehealth provider at a distant site for use in the treatment and management of medical conditions that require frequent monitoring. Such technologies may include additional interaction triggered by previous transmissions, such as interactive queries conducted through communication technologies or by telephone.
RPM included within definition of “telehealth” in statute requiring Medicaid Reimburse telehealth delivery of services.
Subject to the approval of the state director of the budget, the commissioner may authorize the payment of medical assistance funds for demonstration rates or fees established for home telehealth services provided pursuant to subdivision three-c of section thirty-six hundred fourteen of the public health law.
Subject to federal financial participation and the approval of the director of the budget, the commissioner shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth, as defined in subdivision four of section two thousand nine hundred ninety-nine-cc of the public health law.
SOURCE: Social Services Law Title 11, Article 367-u & NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Mar. 2024).
Remote patient monitoring (RPM) uses digital technologies to collect medical data and other personal health information from members in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. Monitoring programs can collect a wide range of health data from the point of care, such as vital signs, blood pressure, heart rate, weight, blood sugar, blood oxygen levels and electrocardiogram readings. RPM may include follow-up on previously transmitted data conducted through communication technologies or by telephone.
Telehealth services provided by means of RPM should be billed using CPT code “99091” [collection and interpretation of physiologic data (e.g., Electrocardiography (ECG), blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training and licensure/regulation (when applicable) requiring a minimum of 30 minutes of time].
A fee of $48.00 per month will be paid for RPM.
Providers are not to bill “99091” more than one time per member per month.
FQHCs that have opted out of Ambulatory Patient Groups (APGs) are unable to bill for RPM services at this time.
CONDITIONS
Medical conditions that may be treated/monitored by means of RPM include, but are not limited to:
- Congestive heart failure
- Diabetes
- Chronic obstructive pulmonary disease
- Wound care
- Polypharmacy
- Mental or behavioral problems
- Technology-dependent care, such as continuous oxygen, ventilator care, total parenteral nutrition, or enteral feeding.
SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. & NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 4. (Accessed Mar. 2024).
Maternal Care RPM Coverage
Effective October 1, 2022, for fee-for-service (FFS), and December 1, 2022, for Medicaid Managed Care (MMC) Plans, New York State (NYS) Medicaid is expanding coverage for remote patient monitoring (RPM) during pregnancy and up to 84 days postpartum to further improve and expand access to prenatal and postpartum care. This expansion of coverage includes an additional monthly fee to cover the cost of RPM devices/equipment. See Medicaid Update for additional billing guidance.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 38, Number 10, September 2022 (Accessed Mar. 2024)
The additional allowance that may be reimbursable for maternity RPM equipment provided by enrolled providers to pregnant and postpartum NYS Medicaid members calls for using CPT codes “99453” and “99454” with HD modifier. Please note: “99091” and “99454” are both intended to be billed once monthly but cannot be billed on the same day. This replaces the guidance for billing these codes that was included in the September 2022 issue of the Medicaid Update that stated, “CPT Code “99454” is billed along with CPT Code “99091”.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 12. (Accessed Mar. 2024).
Continuous Glucose Monitoring (CGM)
NYS Medicaid covers continous glucose monitoring for:
- Members with a diagnosis of gestational diabetes; or
- Members with a diagnosis of type 1 or type 2 diabetes, who meet all the following criteria:
- Are under the care of an endocrinologist, or an enrolled Medicaid provider with experience in diabetes treatment, who orders the device.
- Are compliant with regular visits to review CGM data with their provider.
- Are on an insulin treatment plan or an insulin pump.
- Are able, or have a caregiver who is able, to hear and view CGM alerts and respond appropriately
SOURCE: NY Dept. of Health, Provider Communication, Updated Continuous Glucose Monitoring Criteria, Oct. 2023. (Accessed Mar. 2024).
PROVIDER LIMITATIONS
Remote patient monitoring shall be ordered by a physician licensed pursuant to article one hundred thirty-one of the education law, a nurse practitioner licensed pursuant to article one hundred thirty-nine of the education law, or a midwife licensed pursuant to article one hundred forty of the education law, with which the patient has a substantial and ongoing relationship.
SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Mar. 2024)
OTHER RESTRICTIONS
No Reference Found
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