Remote Patient Monitoring
POLICY
Telemonitoring. The remote monitoring of a client’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage in order to make treatment recommendations. This requires the use of a device that is defined by the federal Food and Drug Administration as a medical device.
Nebraska Medicaid will reimburse for telemonitoring when all of the following requirements are met:
- The services are from the originating site;
- The client is cognitively capable to operate the equipment or has a willing and able person to assist in the transmission of electronic data;
- The originating site has space for all program equipment and full transmission capability;
- The provider must maintain a client’s medical record containing data supporting the medical necessity of the service, all transmissions and subsequent review received from the client, and how the data transmitted from the client is being utilized in the continuous development and implementation of the client’s plan of care; and
- The service is otherwise reimbursable by Nebraska Medicaid.
SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 002, (Accessed Apr. 2025).
No later than January 1, 2023, the department shall provide coverage for continuous glucose monitors under the medical assistance program for all eligible recipients who have a prescription for such device.
SOURCE: NE Revised Statute Sec. 68-911, (Accessed Apr. 2025).
Nebraska Medicaid will provide coverage for Continuous Glucose Monitoring (CGM) devices for eligible beneficiaries with diabetes beginning January 1, 2023.
SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Apr. 2025).
The continued use of CGM may be considered medically necessary for someone who is being assessed every 6 months by the prescribing healthcare practitioner for adherence to the CGM regimen and diabetes treatment plan. The initial authorization period for therapeutic CGM is 6 months and is then renewed on a yearly basis. Supplies will be provided for 30 days or up to 90 days at a time.
CONDITIONS
Outpatient cardiac rehabilitation programs consisting of individually prescribed physical exercise or conditioning and concurrent telemetric monitoring. When a program is provided by a hospital to its outpatients, the service is covered as an outpatient service.
SOURCE: NE Admin. Code Title 471 Ch. 10, Sec. 006.16(B), Hospital Services, (Accessed Apr. 2025).
Nebraska Medicaid will provide coverage for both long-term (therapeutic) and short-term (diagnostic) CGM for eligible beneficiaries who have diabetes mellitus when medically necessary. CGM devices measure interstitial glucose, which correlates well with plasma glucose.
The initial authorization period for therapeutic CGM is 6 months, while the renewal period is yearly. Supplies will be provided for 30 days or up to 90 days at a time. Beneficiaries must meet medical necessity criteria in order to be eligible for coverage. See bulletin for prior authorization requirements.
SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Apr. 2025).
Medicaid fee-for-service members must meet eligibility criteria for the coverage of a long-term CGM for therapeutic purposes. The following criteria are used to determine medical necessity:
- Is insulin-treated, or
- Has a history of problematic hypoglycemia with documentation of at least one of the following:
- Recurrent (more than one) hypoglycemic events with blood glucose <54mg/dL (3.0mmol/L) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan, or
- A history of one hypoglycemic event with blood glucose <54mg/dL (3.0mmol/L) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia.
- And is being assessed every 6 months by the prescribing healthcare practitioner for adherence to a comprehensive diabetes treatment plan.
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
Telemonitoring is paid at a daily per diem rate set by Nebraska Medicaid and includes the following:
- Provider review and interpretation of client data;
- Equipment and all supplies, accessories, and services necessary for proper functioning and effective use of the equipment;
- Medically necessary visits to the home by a provider; and
- Training on the use of equipment and completion of necessary medical records.
No additional or separate payment beyond the fixed payment is allowable.
SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 007, (Accessed Apr. 2025).
Effective February 1, 2024, Nebraska Medicaid’s preferred Continuous Glucose Monitoring (CGM) devices are as follows:
- Dexcom G6
- Dexcom G7
- Freestyle Libre 2
- Freestyle Libre 3
Nebraska Medicaid covers CGM devices for Type 1, Type 2, and gestational diabetes mellitus as medically necessary.
The following devices are covered under Medicaid:
- FreeStyle Libre 2
- Dexcom G6
The Medtronic CGM may be covered for beneficiaries who meet the medical necessity criteria for long-term CGM and are on a Medtronic insulin pump.
CGM devices that use an implantable glucose sensor such as an Eversense CGM system (CPT codes 0046T, 00447T, and 0448T) or a noninvasive glucose sensor (e.g., optical and transdermal sensors) are considered investigational and not medically necessary due to insufficient evidence of clinical efficacy and long-term health outcomes. Any related HCPC codes for implantable or noninvasive glucose sensors are also considered investigational and not medically necessary.
SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Apr. 2025).
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