Remote Patient Monitoring

POLICY

The Indiana Health Coverage Programs (IHCP) covers select medical, dental and remote patient monitoring services delivered via telehealth.

Remote patient monitoring (RPM) is the scheduled monitoring of clinical data transmitted through technologic equipment in the member’s home. Data is transmitted from the member’s home to the provider location to be read and interpreted by a qualified practitioner. The technologic equipment enables the provider to detect minute changes in the member’s clinical status, which allows providers to intercede before the member’s condition advances and requires emergency intervention or inpatient hospitalization.

The IHCP has implemented a single RPM coverage and prior authorization policy to be used for fee-forservice (FFS) and managed care delivery systems. This coverage and PA policy applies to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.

The IHCP covers the RPM services listed in the Procedure Codes Covered for Remote Patient Monitoring table on Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers. The service must be billed with POS code 02 or 10 and with modifier 95, as described in the Billing and Reimbursement for Telehealth Services section.

Prior authorization is required for specified RPM services, as indicated in the Procedure Codes for Remote Patient Monitoring Services table, in Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.

See manual for further details.

List of eligible CPT Codes (Feb. 6. 2025).

SOURCE:  Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Oct 30, 2024), p. 1, 9.  (Accessed May 2025).

Effective for dates of service on or after July 21, 2022, procedure codes 99091, 99453, 99454, 99457 and 99458 will be covered RPM services. RPM or “remote patient monitoring technology” is listed under the definition of telehealth services per Indiana Code IC 25-1-9.5-6.

The IHCP is implementing a single RPM coverage and prior authorization (PA) policy to be used for fee-for service (FFS) and managed care delivery systems. This coverage and PA policy apply to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.

See Bulletin for more information.

SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202238 (May 17, 2022).  (Accessed May 2025).

Indiana Code requires Medicaid to reimburse providers who are licensed as a home health agency for telehealth services.

SOURCE: IN Code, 12-15-5-11(b)(5). (Accessed May 2025).

Medicaid will reimburse Home Health Agencies for telehealth services.

SOURCE: IN Admin Code Title 405, 1-4.2-3 & 5-16-2 & IHCP Home Health Services (Oct. 3, 2023), p. 2. (Accessed May 2025).

CONDITIONS

The member must meet one or more of the following criteria to receive prior authorization for an RPM service:

• Received an organ transplantation within one year following the date of surgery
• Had a surgical procedure (three-month service authorization following the date of surgery)
• Had one or more uncontrolled chronic conditions that significantly impaired the patient’s health or resulted in two or more related hospitalizations or emergency department visits in the previous 12 months
• Had been readmitted within 30 days for the same or similar diagnosis or condition
• Identified as having a high-risk pregnancy (up to three-month service authorization postpartum); see the Obstetrical and Gynecological Services provider reference module for more information about high-risk pregnancy

The duration of initial service authorization is six months, unless otherwise indicated. Reauthorizations will be permitted for select services as appropriate.

SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Oct. 30, 2024, p. 9-10.  (Accessed May 2025).

The member must be receiving services from a home health agency.  Member must initially have two or more of the following events related to one of the conditions listed below within the previous twelve months:

• Emergency room visit
• Inpatient hospital stay

An emergency room visit that results in an inpatient hospital admission does not constitute two separate events.

The two qualifying events must be for the treatment of one of the following diagnoses:

• Chronic obstructive pulmonary disease
• Congestive heart failure
• Diabetes

SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(d). (Accessed May 2025).

Personal Emergency Response System

The following activities are allowed under the PERS service:

• Device installation
• Ongoing monthly maintenance of the device
• Electronic service that is usually a portal help button; however, it can also be an electronic device that includes, but is not limited to GPS or video monitoring service (Note: Remote monitoring will not be placed in participant bedrooms or bathrooms.)

SOURCE: IHCP Office of Medicaid Policy and Planning, Home and Community Based Services: Indiana PathWays for Aging Waiver, p. 80 (Sept 9, 2024). (Accessed May 2025).

PROVIDER LIMITATIONS

Reimbursement for home health agencies under certain conditions.  A licensed registered nurse must perform the reading of transmitted health information provided from the member in accordance with the written order of the physician.

SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(d)(5),(Accessed May 2025).

OTHER RESTRICTIONS

The IHCP is implementing a single RPM coverage and prior authorization (PA) policy to be used for fee-for service (FFS) and managed care delivery systems. This coverage and PA policy apply to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.

See Bulletin for more information.

SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202238 (May 17, 2022). (Accessed May 2025).

Treating physician must certify the need for home health services and document that there was a face-to-face encounter with the individual.

SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(e) (Accessed May 2025).

Approved telehealth services are reimbursed separately from other home health services. The unit of reimbursement for telehealth services provided by an HHA is one (1) calendar day.

Reimbursement is available for telehealth services as follows:

• One-time amount per client of fourteen dollars and forty-five cents ($14.45) related to an initial face-to-face visit necessary to train the member to appropriately operate the telehealth equipment.
• One (1) payment of nine dollars and eighty-four cents ($9.84) for each day the telehealth equipment is used by a registered nurse (RN) to monitor and manage the client’s care in accordance with the written order from a physician.

Rates for telehealth services shall not be adjusted annually.

SOURCE: IN Admin Code, “Article 1” Title 405, 1-4.2-6 (Accessed May 2025).