Remote Physiologic Monitoring (RPM)

August 9, 2021

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:

  • The beneficiary requires RPM services of at least 20 minutes of clinical staff time directed by a TRICARE-authorized provider, per 30-day period; and
  • The beneficiary has a comprehensive care plan established, implemented, revised or monitored; and one of the following criteria are met:
    • The beneficiary has a chronic condition(s) that is expected to last at least 12 months, or until death of the beneficiary; or
    • The beneficiary has an acute condition(s) that place the beneficiary at significant risk of death, acute exacerbation/decompensation, or functional decline.

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:

  • Set-up and patient/caregiver education on use of equipment (Current Procedural Terminology (CPT) code 99453);
  • Device supplies with daily recordings/alert transmission, each 30 days (CPT code 99454);
  • RPM treatment management services, TRICARE-authorized provider time per calendar month requiring interactive communication with the patient/caregiver for the first 20 minutes (CPT code 99457); and
  • The collection and interpretation of physiologic data digitally stored and/or transmitted by the patient/caregiver to the TRICARE- authorized provider with a minimum of 30 minutes of collection and interpretation time each 30 days (CPT code 99091).
  • Remote assessment of recorded video and/or images submitted (e.g., store and forward), including interpretation and follow-up with the beneficiary within 24 hours (HCPCS G2250).

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.