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.