Medically necessary RPM services of physiologic parameter(s) including, but not limited to, weight, blood pressure, pulse oximetry and respiratory flow rate are covered when:
Monitoring devices and equipment must be US Food and Drug Administration (FDA) approved and meet the definition of Durable Equipment (DE) and/or Durable Medical Equipment (DME). Examples of devices and equipment that do not meet TRICARE’s definition of DE/DME include personal computers, smartphones, tablets, smart watches, non-medical trackers and weight scales.
Covered services include:
CPT procedure codes 99091, 99453, 99454, 99457, 99458 / HCPCS code G2250
RPM is considered an ancillary service as defined in TRICARE Reimbursement Manual (TRM), Chapter 2, Section 2, paragraph 2.7.4. Ancillary service cost-shares and copayments will apply.