Movra Payer Coverage — RTM / RPM / CCM / BHI Qualification

Snapshot 2026-05-27 · 99 policy authorities · 354 coverage rules · 3 derivation rules
AMA CPT licensing notice: CPT codes and descriptors are copyrighted by the American Medical Association. Descriptions here are Movra-paraphrased summaries, not verbatim AMA text. A CPT license is required before reproducing verbatim descriptors in any deployed product surface.

Will this patient qualify?

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Status:
Confidence:
354 / 354
AuthorityType/StateProgram/CodeProvider classDx scopeStatusPAReasonPolicyEffectiveLast verifiedConfidence
Medicare (Traditional / FFS)medicare_ffsRTMtherapy—covered—RTM billable by PT/OT/SLP under a plan of care (GP/GO/GN); CY2026 added short-cycle 98979/98984/98985/98986.CMS-1832-F (CY2026 PFS Final Rule)2026-01-012026-05-27policy-confirmed
Medicare (Traditional / FFS)medicare_ffsRTMphysician—covered—RTM treatment-management billable by MD/DO/NP/PA.CMS-1832-F (CY2026 PFS Final Rule)2026-01-012026-05-27policy-confirmed
Medicare (Traditional / FFS)medicare_ffsanyDC—excluded—Chiropractors are statutorily limited to 98940-98943 and cannot bill RTM/RPM/CCM/BHI under Medicare regardless of state scope.42 CFR 410.21 / CMS Article A562732026-01-012026-05-27policy-confirmed
Medicare (Traditional / FFS)medicare_ffsRPMphysician—covered—RPM covered; CY2026 added 99445 (2-15d device) + 99470 (10-19 min mgmt). 16-day data floor relaxed.CMS-1832-F (CY2026 PFS Final Rule)2026-01-012026-05-27policy-confirmed
Medicare (Traditional / FFS)medicare_ffsCCMphysician—covered—CCM physician personal-time + complex CCM covered.CMS-1832-F (CY2026 PFS Final Rule)2026-01-012026-05-27policy-confirmed
Medicare (Traditional / FFS)medicare_ffsCCMnursing—covered—Clinical-staff CCM time under physician general supervision (incident-to).CMS-1832-F (CY2026 PFS Final Rule)2026-01-012026-05-27policy-confirmed
Medicare (Traditional / FFS)medicare_ffsBHIphysician—covered—General BHI 99484 + CoCM 99492-99494 / G2214 covered.CMS-1832-F (CY2026 PFS Final Rule)2026-01-012026-05-27policy-confirmed
Medicare (Traditional / FFS)medicare_ffsBHIbh—covered—BH care-manager minutes performed under the treating practitioner, who bills.CMS-1832-F (CY2026 PFS Final Rule)2026-01-012026-05-27policy-confirmed
AetnacommercialRTMany—excluded—All RTM 98975-98986 non-covered for all provider types (deemed experimental/investigational/unproven).Aetna CPB 10932026-02-272026-05-27policy-confirmed
AetnacommercialRPManyHF, HTN, DMcovered—RPM covered only for heart failure, hypertension, and diabetes; HTN requires a documented multidisciplinary management strategy. All other diagnoses non-covered.Aetna CPB 10932026-02-272026-05-27policy-confirmed
Aetnacommercial99445 (RPM)any—excluded—Aetna kept legacy 16-day/20-min thresholds; CY2026 short-cycle RPM device code not covered.Aetna CPB 10932026-02-272026-05-27policy-confirmed
Aetnacommercial99470 (RPM)any—excluded—Aetna kept legacy 16-day/20-min thresholds; CY2026 short-cycle RPM management code not covered.Aetna CPB 10932026-02-272026-05-27policy-confirmed
AetnacommercialCCMany—covered—CCM covered; no CY2026 narrowing in CPB 1093 (defaults to plan documents + CMS rules).Aetna CPB 10932026-02-272026-05-27derived
AetnacommercialBHIany—covered—General BHI + CoCM covered; no standalone CPB restriction.Aetna CPB 10932026-02-272026-05-27derived
CignacommercialRTMany—excluded—All RTM codes non-covered for all indications, providers, and plans (MCP 0563).Cigna MCP 0563 / Reimbursement Policy R322026-03-152026-05-27policy-confirmed
CignacommercialRPManyCOPD, DM, GDM, HF, HDPcovered—RPM covered only for COPD, diabetes, gestational diabetes, heart failure, and hypertensive disorders of pregnancy. Essential HTN (I10) explicitly excluded — use SMBP 99473/99474.Cigna MCP 0563 / Reimbursement Policy R322026-03-152026-05-27policy-confirmed
CignacommercialCCMany—excluded—CCM/PCM bundled into "overall care of the customer" under Reimbursement Policy R32; modifiers do not unbundle.Cigna MCP 0563 / Reimbursement Policy R322026-03-152026-05-27policy-confirmed
CignacommercialBHIany—covered—General BHI 99484 + CoCM 99492-99494 explicitly removed from the R32 bundle (2020-05-16); covered.Cigna MCP 0563 / Reimbursement Policy R322026-03-152026-05-27policy-confirmed
Anthem / ElevancecommercialRTMany—covered—Cleanest commercial RTM policy; CY2026 short-cycle codes added; no prior auth. Gotcha: denied when patient is concurrently on home health.Anthem CG-MED-912026-01-012026-05-27policy-confirmed
Anthem / ElevancecommercialRPMany—covered—RPM covered incl. CY2026 99445/99470; no prior auth (CG-MED-91 covers RPM + RTM in one document).Anthem CG-MED-912026-01-012026-05-27policy-confirmed
Anthem / ElevancecommercialCCMany—covered—Recognizes CCM 99487/99489/99490 commercially.Anthem CG-MED-912026-01-012026-05-27derived
Anthem / ElevancecommercialBHIany—covered—BHI / CoCM covered commercially.Anthem CG-MED-912026-01-012026-05-27derived
UnitedHealthcarecommercialRTMany—prior_authyesRTM prior-authorization required on some plans. DC RTM unsettled (high denial risk); never bill DC RTM to UHC Medicare Advantage.UHC commercial medical policy / Optum BH carve-out2026-01-012026-05-27derived
UnitedHealthcarecommercialRPMany—verify—Coverage varies per plan; verify per-member benefits.UHC commercial medical policy / Optum BH carve-out2026-01-012026-05-27derived
UnitedHealthcarecommercialCCMany—verify—Coverage varies per plan; verify per-member benefits.UHC commercial medical policy / Optum BH carve-out2026-01-012026-05-27derived
UnitedHealthcarecommercialBHIany—covered—BH (CoCM 99492-94, BHI 99484, G2214) covered via the Optum carve-out (payer ID 87726, separate adjudication); provider must be separately Optum-credentialed.UHC commercial medical policy / Optum BH carve-out2026-01-012026-05-27derived
HumanacommercialRTMany—verify—No standalone published RTM policy located; verify per-member. MA should honor RTM short-duration codes from 2026-01-01.Humana medical coverage policy2026-01-012026-05-27derived
HumanacommercialRPMphysician—covered—RPM covered FFS, BUT check global-cap/capitation: ~332k seniors in CenterWell/Conviva plus ChenMed/Oak Street/Aledade arrangements roll RPM/CCM into PMPM caps (not paid line-item).Humana medical coverage policy2026-01-012026-05-27derived
HumanacommercialCCMany—covered—CCM covered FFS; watch capitation/global-cap arrangements that bundle CCM into a PMPM.Humana medical coverage policy2026-01-012026-05-27derived
HumanacommercialBHIany—verify—No standalone published BHI policy located; verify per-member.Humana medical coverage policy2026-01-012026-05-27derived
BlueCross BlueShield of Texas (HCSC)bcbs / TXRTMany—verify—No standalone public RTM medical policy; verify per-member via Availity.BCBS-TX CPCP033 / RP033 (telehealth payment policy)2025-01-012026-05-27unverified
BlueCross BlueShield of Texas (HCSC)bcbs / TXRPMany—verify—No standalone public RPM policy; coverage runs through CPCP033/RP033 telehealth payment policy. Verify per-member via Availity.BCBS-TX CPCP033 / RP033 (telehealth payment policy)2025-01-012026-05-27unverified
BlueCross BlueShield of Texas (HCSC)bcbs / TXCCMphysician—covered—99490 added to the E/M coding policy CPCP024 v2 (late 2025).BCBS-TX CPCP033 / RP033 (telehealth payment policy)2025-01-012026-05-27derived
BlueCross BlueShield of Texas (HCSC)bcbs / TXBHIany—verify—BHI silent in published policy; verify per-member.BCBS-TX CPCP033 / RP033 (telehealth payment policy)2025-01-012026-05-27unverified
Arizona Medicaid (AHCCCS)medicaid_ffs / AZRPMphysician—covered—RPM 99453-99458 + 99091 covered (sync + async) per AMPM 320-I.AHCCCS AMPM 320-I (Telehealth)2026-01-012026-05-27policy-confirmed
Arizona Medicaid (AHCCCS)medicaid_ffs / AZCCMany—covered—CCM covered FFS.AHCCCS AMPM 320-I (Telehealth)2026-01-012026-05-27policy-confirmed
Arizona Medicaid (AHCCCS)medicaid_ffs / AZBHIany—covered—BHI 99484 + CoCM 99492-94 covered FFS.AHCCCS AMPM 320-I (Telehealth)2026-01-012026-05-27policy-confirmed
Arizona Medicaid (AHCCCS)medicaid_ffs / AZRTMany—verify—RTM likely covered but not codified; operative source is the AHCCCS Telehealth Code Set. Modifier discipline GT (sync) / GQ (async) / FQ (audio-only) is a silent-denial source.AHCCCS AMPM 320-I (Telehealth)2026-01-012026-05-27derived
Idaho Medicaidmedicaid_ffs / IDBHIany—verify—BH Medicaid carved out to Magellan (IBHP) since 2024-07-01. 99484 likely bills under standard medical; CoCM 99492-94 needs Magellan-side confirmation.Idaho Medicaid / IBHP (Magellan)2024-07-012026-05-27unverified
Idaho Medicaidmedicaid_ffs / IDRPMany—verify—Historically synchronous-only telehealth posture; async RPM coverage unconfirmed; verify.Idaho Medicaid / IBHP (Magellan)2024-07-012026-05-27unverified
Idaho Medicaidmedicaid_ffs / IDRTMany—verify—No codified RTM coverage; verify. DCs have broad ID scope but the federal floor still excludes them — DC RTM = cash-pay only.Idaho Medicaid / IBHP (Magellan)2024-07-012026-05-27unverified
Idaho Medicaidmedicaid_ffs / IDCCMany—verify—No codified CCM coverage located; verify.Idaho Medicaid / IBHP (Magellan)2024-07-012026-05-27unverified
Washington Apple Healthmedicaid_ffs / WABHIany—prior_authyesCoCM 99492/93/94 requires HCA attestation form 13-0017 BEFORE the first claim (one-time clinic onboarding gate); silent denials otherwise.WA Apple Health (HCA) Telehealth2026-01-012026-05-27policy-confirmed
Washington Apple Healthmedicaid_ffs / WARPMphysician—covered—RPM covered; ARNPs are fully independent (RCW 18.79.250) and can bill RPM/CCM/CoCM with no physician supervision.WA Apple Health (HCA) Telehealth2026-01-012026-05-27policy-confirmed
Washington Apple Healthmedicaid_ffs / WACCMany—covered—CCM covered; ARNP independence applies.WA Apple Health (HCA) Telehealth2026-01-012026-05-27policy-confirmed
Washington Apple Healthmedicaid_ffs / WARTMany—verify—RTM coverage not confirmed; OT requires a referral for treatment (RCW 18.59.100), relevant for OT-led RTM. Verify.WA Apple Health (HCA) Telehealth2026-01-012026-05-27derived
Texas Medicaid (TMHP)medicaid_ffs / TXRPMany—excluded—Texas Medicaid does NOT cover the federal RPM CPT family (99453/99454/99457/99458). TX uses home-telemonitoring HCPCS S9110 + U-modifiers, prior-auth-gated, scoped to diabetes/HTN only.Texas Medicaid (TMHP) Telecommunication2026-01-012026-05-27policy-confirmed
Texas Medicaid (TMHP)medicaid_ffs / TXRTMany—excluded—RTM (98975-series) is not a separate Texas Medicaid benefit.Texas Medicaid (TMHP) Telecommunication2026-01-012026-05-27policy-confirmed
Texas Medicaid (TMHP)medicaid_ffs / TXCCMany—verify—G0511 retired in TX Medicaid 2026-01-01 (FQHC/RHC must use S9110+U3); standalone CCM coverage unconfirmed; verify.Texas Medicaid (TMHP) Telecommunication2026-01-012026-05-27policy-confirmed
Texas Medicaid (TMHP)medicaid_ffs / TXBHIany—verify—BHI coverage unconfirmed; verify. NP/PA need a Prescriptive Authority Agreement (1:7 supervising-physician cap).Texas Medicaid (TMHP) Telecommunication2026-01-012026-05-27policy-confirmed
North Carolina Medicaidmedicaid_ffs / NCRPMphysician—covered—RPM 99457/99458 restricted to MD/NP/PA/CNM with no incident-to pathway; OPR-NPI + PA each visit; 30-visit/yr cap (PT+OT combined) for adults 21+.NC Medicaid Clinical Coverage Policy2024-09-012026-05-27derived
North Carolina Medicaidmedicaid_ffs / NCRTMany—verify—NC Medicaid does not affirmatively cover RTM; verify. (BCBS-NC commercial DOES reimburse 98975-81 + 99453-58 since 2023-04-18.)NC Medicaid Clinical Coverage Policy2024-09-012026-05-27derived
North Carolina Medicaidmedicaid_ffs / NCCCMany—verify—CCM coverage unconfirmed; verify.NC Medicaid Clinical Coverage Policy2024-09-012026-05-27derived
North Carolina Medicaidmedicaid_ffs / NCBHIany—verify—BHI coverage unconfirmed; verify.NC Medicaid Clinical Coverage Policy2024-09-012026-05-27derived
Florida Medicaid (AHCA / SMMC)medicaid_ffs / FLCCMany—verify—No AHCA-published 99490 fee schedule; best path is Medicare-primary + Medicaid wrap for dual-eligibles. Verify.FL Medicaid (AHCA / SMMC)2026-01-012026-05-27unverified
Florida Medicaid (AHCA / SMMC)medicaid_ffs / FLBHIany—verify—No AHCA-published 99484/CoCM fee schedule; verify.FL Medicaid (AHCA / SMMC)2026-01-012026-05-27unverified
Florida Medicaid (AHCA / SMMC)medicaid_ffs / FLRPMany—verify—RPM coverage unconfirmed in FL Medicaid; verify.FL Medicaid (AHCA / SMMC)2026-01-012026-05-27unverified
Florida Medicaid (AHCA / SMMC)medicaid_ffs / FLRTMany—verify—RTM coverage unconfirmed in FL Medicaid; verify.FL Medicaid (AHCA / SMMC)2026-01-012026-05-27unverified
Centene / AmbettercommercialRTMany—verify—No published Centene/Ambetter RTM determination located as of 2026-05-27; the WNC.CP.193 telehealth policy addresses RPM, not RTM — verify per-member.Centene WNC.CP.193 (Telehealth & RPM)2025-05-012026-05-27unverified
Centene / AmbettercommercialRPMany—covered—Centene telehealth/RPM policy WNC.CP.193 lists 99453/99454/99457/99458 as billable with frequency limits and no dx restriction; derived to the Ambetter commercial line.Centene WNC.CP.193 (Telehealth & RPM)2025-05-012026-05-27derived
Centene / AmbettercommercialCCMany—verify—Ambetter names chronic care management as a covered category but no code-level Centene determination for the 99490 family was located; verify per-member.Centene WNC.CP.193 (Telehealth & RPM)2025-05-012026-05-27unverified
Centene / AmbettercommercialBHIany—verify—No published Centene/Ambetter BHI/CoCM determination located as of 2026-05-27; verify per-member.Centene WNC.CP.193 (Telehealth & RPM)2025-05-012026-05-27unverified
Molina HealthcarecommercialRTManyCOPD, DM, HF, HTN, ASTHprior_authyesMolina Clinical Policy MCP-419 governs RTM within the same RPM policy; covered when prescribed for a qualifying chronic condition by a network practitioner, with initial + 90-day continuation authorization.Molina Clinical Policy MCP-419 (Remote Patient Monitoring)2025-10-082026-05-27policy-confirmed
Molina HealthcarecommercialRPManyCOPD, DM, HF, HTN, ASTHprior_authyesMCP-419 covers RPM only with a qualifying chronic condition (asthma/COPD/diabetes/heart failure/hypertension) + active treatment plan + network practitioner; UM policy with initial + 90-day continuation authorization.Molina Clinical Policy MCP-419 (Remote Patient Monitoring)2025-10-082026-05-27policy-confirmed
Molina HealthcarecommercialCCMany—verify—MCP-419 covers only RPM/RTM; no Molina national CCM determination located; verify per-member/state plan.Molina Clinical Policy MCP-419 (Remote Patient Monitoring)2025-10-082026-05-27unverified
Molina HealthcarecommercialBHIany—verify—No Molina national BHI/CoCM determination located; verify per-member/state plan.Molina Clinical Policy MCP-419 (Remote Patient Monitoring)2025-10-082026-05-27unverified
Kaiser PermanentecommercialRTMany—verify—Kaiser is an integrated/capitated system; no published FFS reimbursement policy for RTM located — services are delivered internally, so verify per Kaiser regional contract.Kaiser Permanente — integrated/capitated (no published FFS policy)2024-01-012026-05-27unverified
Kaiser PermanentecommercialRPMany—verify—Kaiser delivers RPM internally under capitation; no published FFS coverage/billing policy located — verify per regional Kaiser contract, not assumed FFS-billable.Kaiser Permanente — integrated/capitated (no published FFS policy)2024-01-012026-05-27unverified
Kaiser PermanentecommercialCCMany—verify—Kaiser provides chronic-care coordination internally; no published FFS reimbursement policy for CCM located — verify per regional contract.Kaiser Permanente — integrated/capitated (no published FFS policy)2024-01-012026-05-27unverified
Kaiser PermanentecommercialBHIany—verify—No published Kaiser FFS determination for BHI/CoCM located; BH is delivered within the integrated/capitated model — verify per regional contract.Kaiser Permanente — integrated/capitated (no published FFS policy)2024-01-012026-05-27unverified
Blue Shield of Californiabcbs / CARTMany—verify—No RTM-specific Blue Shield of California policy located; the Telehealth Services payment policy does not enumerate RTM codes; verify per-member.Blue Shield of California — Telehealth Services payment policy2023-07-012026-05-27unverified
Blue Shield of Californiabcbs / CARPMany—covered—The Telehealth Services payment policy reimburses CMS-recognized services per CMS/NCCI/AMA standards, under which RPM is payable with no stated dx limit or prior auth.Blue Shield of California — Telehealth Services payment policy2023-07-012026-05-27derived
Blue Shield of Californiabcbs / CACCMphysician—covered—The Telehealth Services payment policy follows CMS/AMA adjudication under which CCM is recognized; no Blue Shield CA exclusion or prior auth located.Blue Shield of California — Telehealth Services payment policy2023-07-012026-05-27derived
Blue Shield of Californiabcbs / CABHIbhBHcovered—CMS/AMA adjudication standards recognize CoCM/BHI codes, which by definition require a diagnosed behavioral-health condition; no Blue Shield CA exclusion located.Blue Shield of California — Telehealth Services payment policy2023-07-012026-05-27derived
Premera Blue Cross (WA, AK)bcbs / WARTMany—verify—No Premera RTM-specific policy located; the Telehealth/Telemedicine payment policy (CP.PP.194) does not enumerate RTM codes; verify per-member.Premera CP.PP.194 — Telehealth/Telemedicine Services2025-12-092026-05-27unverified
Premera Blue Cross (WA, AK)bcbs / WARPMany—verify—No Premera RPM-specific policy located; CP.PP.194 does not list RPM codes; verify per-member.Premera CP.PP.194 — Telehealth/Telemedicine Services2025-12-092026-05-27unverified
Premera Blue Cross (WA, AK)bcbs / WACCMany—verify—No published Premera CCM policy located; verify per-member.Premera CP.PP.194 — Telehealth/Telemedicine Services2025-12-092026-05-27unverified
Premera Blue Cross (WA, AK)bcbs / WABHIany—verify—No published Premera BHI/CoCM policy located; verify per-member.Premera CP.PP.194 — Telehealth/Telemedicine Services2025-12-092026-05-27unverified
Regence (OR, ID, UT, WA)bcbs / ORRTMany—covered—Regence Virtual Care reimbursement policy (ADM 132) includes RTM as a reimbursable virtual-care category (98975-98981); no dx restriction or prior auth.Regence ADM 132 — Virtual Care (RPM + RTM)2023-05-012026-05-27policy-confirmed
Regence (OR, ID, UT, WA)bcbs / ORRPMany—covered—ADM 132 includes RPM (99453/99454/99091/99457/99458) as reimbursable; no dx limit or prior auth.Regence ADM 132 — Virtual Care (RPM + RTM)2023-05-012026-05-27policy-confirmed
Regence (OR, ID, UT, WA)bcbs / ORCCMphysician—covered—Regence Care Management Services reimbursement policy (ADM 122) defines reimbursement of CCM codes; no dx allowlist or prior auth.Regence ADM 122 — Care Management Services2023-05-012026-05-27policy-confirmed
Regence (OR, ID, UT, WA)bcbs / ORBHIbhBHcovered—Regence Collaborative Care Codes policy covers CoCM 99492-99494 + BHI 99484/G2214; inherently limited to diagnosed behavioral-health conditions.Regence — Collaborative Care Codes (reimbursement policy)2023-05-012026-05-27policy-confirmed
Blue Cross Blue Shield of Arizona (AZ Blue)bcbs / AZRTMany—verify—AZ Blue code-level medical policies are login-gated (Availity); no public RTM determination located; verify per-member.AZ Blue — PA & Medical Policies portal (login-gated)2026-01-012026-05-27unverified
Blue Cross Blue Shield of Arizona (AZ Blue)bcbs / AZRPMany—verify—AZ Blue medical policies are behind the provider portal; no public RPM determination located; verify per-member.AZ Blue — PA & Medical Policies portal (login-gated)2026-01-012026-05-27unverified
Blue Cross Blue Shield of Arizona (AZ Blue)bcbs / AZCCMany—verify—No public AZ Blue CCM determination located; verify per-member.AZ Blue — PA & Medical Policies portal (login-gated)2026-01-012026-05-27unverified
Blue Cross Blue Shield of Arizona (AZ Blue)bcbs / AZBHIany—verify—No public AZ Blue BHI/CoCM determination located; verify per-member.AZ Blue — PA & Medical Policies portal (login-gated)2026-01-012026-05-27unverified
Hawaii Medical Service Association (HMSA)bcbs / HIRTMany—verify—HMSA payment policies sit on a login/JS-gated Provider Resource Center; no public RTM determination located; verify per-member.HMSA Provider Resource Center — Telehealth payment policy2023-05-182026-05-27unverified
Hawaii Medical Service Association (HMSA)bcbs / HIRPMany—verify—HMSA public resources define RPM only descriptively; no code-level coverage determination located; verify per-member.HMSA Provider Resource Center — Telehealth payment policy2023-05-182026-05-27unverified
Hawaii Medical Service Association (HMSA)bcbs / HICCMany—verify—No public HMSA CCM determination located; verify per-member.HMSA Provider Resource Center — Telehealth payment policy2023-05-182026-05-27unverified
Hawaii Medical Service Association (HMSA)bcbs / HIBHIany—verify—No public HMSA BHI/CoCM determination located; verify per-member.HMSA Provider Resource Center — Telehealth payment policy2023-05-182026-05-27unverified
Blue Cross Blue Shield of Michiganbcbs / MIRTMany—covered—BCBSM/BCN Telemonitoring policy (eff 7/1/25) lists 98975-98981 as Established codes with no dx limitation.BCBSM/BCN — Telemonitoring (RPM + RTM)2025-07-012026-05-27policy-confirmed
Blue Cross Blue Shield of Michiganbcbs / MIRPMany—covered—Telemonitoring policy lists 99453/99454/99457/99458/99091 as Established; RPM may be an adjunct to treatment of any condition; only the device and 90-day global periods excluded.BCBSM/BCN — Telemonitoring (RPM + RTM)2025-07-012026-05-27policy-confirmed
Blue Cross Blue Shield of Michiganbcbs / MICCMphysician—verify—No published BCBS-MI CCM coverage/reimbursement policy located; verify per-member.BCBSM/BCN — Telemonitoring (RPM + RTM)2025-07-012026-05-27unverified
Blue Cross Blue Shield of Michiganbcbs / MIBHIany—verify—No published BCBS-MI BHI/CoCM policy located; verify per-member.BCBSM/BCN — Telemonitoring (RPM + RTM)2025-07-012026-05-27unverified
Blue Cross Blue Shield of Minnesotabcbs / MNRTMany—covered—Commercial Reimbursement Policy #007 names RTM as reimbursable; the only stated limit is non-reimbursement under 16 days, with setup payable once per episode.BCBS-MN Commercial Reimbursement Policy #007 — Telehealth & Virtual Care2025-01-012026-05-27policy-confirmed
Blue Cross Blue Shield of Minnesotabcbs / MNRPMany—covered—RPM reimbursable subject to the 16-day-minimum rule and once-per-episode setup; no dx restriction or prior auth specified.BCBS-MN Commercial Reimbursement Policy #007 — Telehealth & Virtual Care2025-01-012026-05-27policy-confirmed
Blue Cross Blue Shield of Minnesotabcbs / MNCCMphysician—verify—No published BCBS-MN CCM policy located; verify per-member.BCBS-MN Commercial Reimbursement Policy #007 — Telehealth & Virtual Care2025-01-012026-05-27unverified
Blue Cross Blue Shield of Minnesotabcbs / MNBHIany—verify—Secondary sources indicate BCBS-MN reimburses CoCM with no member cost-share, but no current primary policy document was located; verify per-member.BCBS-MN Commercial Reimbursement Policy #007 — Telehealth & Virtual Care2025-01-012026-05-27unverified
Wellmark Blue Cross Blue Shield (IA, SD)bcbs / IARTMany—verify—Wellmark provider medical-policy library is bot-protected; no per-program RTM determination retrievable; verify per-member.Wellmark Medical Policies portal2026-01-012026-05-27unverified
Wellmark Blue Cross Blue Shield (IA, SD)bcbs / IARPMany—verify—No published Wellmark RPM policy retrievable; verify per-member.Wellmark Medical Policies portal2026-01-012026-05-27unverified
Wellmark Blue Cross Blue Shield (IA, SD)bcbs / IACCMany—verify—No published Wellmark CCM policy retrievable; verify per-member.Wellmark Medical Policies portal2026-01-012026-05-27unverified
Wellmark Blue Cross Blue Shield (IA, SD)bcbs / IABHIany—verify—No published Wellmark BHI/CoCM policy retrievable; verify per-member.Wellmark Medical Policies portal2026-01-012026-05-27unverified
Blue Cross Blue Shield of Kansasbcbs / KSRTMany—verify—BCBSKS medical-policies portal lists no RTM determination; verify per-member.BCBS Kansas — Medical Policies portal2026-01-012026-05-27unverified
Blue Cross Blue Shield of Kansasbcbs / KSRPMany—verify—No published BCBSKS RPM determination located; verify per-member.BCBS Kansas — Medical Policies portal2026-01-012026-05-27unverified
Blue Cross Blue Shield of Kansasbcbs / KSCCMany—verify—No published BCBSKS CCM determination located; verify per-member.BCBS Kansas — Medical Policies portal2026-01-012026-05-27unverified
Blue Cross Blue Shield of Kansasbcbs / KSBHIany—verify—No published BCBSKS BHI/CoCM determination located; verify per-member.BCBS Kansas — Medical Policies portal2026-01-012026-05-27unverified
Blue Cross Blue Shield of Nebraskabcbs / NERTMany—verify—BCBSNE telehealth policy GP-X-016 omits RTM codes and no separate RTM policy was located; verify per-member.BCBS Nebraska — Telehealth GP-X-016 + Medical Policy portal2025-04-252026-05-27unverified
Blue Cross Blue Shield of Nebraskabcbs / NERPMany—verify—GP-X-016 does not list RPM codes and no separate RPM medical policy was located; verify per-member.BCBS Nebraska — Telehealth GP-X-016 + Medical Policy portal2025-04-252026-05-27unverified
Blue Cross Blue Shield of Nebraskabcbs / NECCMany—verify—No published BCBSNE CCM policy located; verify per-member.BCBS Nebraska — Telehealth GP-X-016 + Medical Policy portal2025-04-252026-05-27unverified
Blue Cross Blue Shield of Nebraskabcbs / NEBHIany—verify—No published BCBSNE BHI/CoCM policy located; verify per-member.BCBS Nebraska — Telehealth GP-X-016 + Medical Policy portal2025-04-252026-05-27unverified
Blue Cross Blue Shield of Illinois (HCSC)bcbs / ILRTMany—excluded—BCBSIL commercial Non-Covered code list classifies 98975/98976/98977/98980/98981 as Non-Covered.BCBSIL 2026 Non-Covered Procedure Code List (Commercial)2026-01-012026-05-27policy-confirmed
Blue Cross Blue Shield of Illinois (HCSC)bcbs / ILRPMany—excluded—Non-Covered list classifies 99457/99458 (and 99453/99454 per the prior list) as Non-Covered.BCBSIL 2026 Non-Covered Procedure Code List (Commercial)2026-01-012026-05-27policy-confirmed
Blue Cross Blue Shield of Illinois (HCSC)bcbs / ILCCMany—excluded—Non-Covered list classifies 99439/99487 (and 99490/99491/99489 per the prior list) as Non-Covered.BCBSIL 2026 Non-Covered Procedure Code List (Commercial)2026-01-012026-05-27policy-confirmed
Blue Cross Blue Shield of Illinois (HCSC)bcbs / ILBHIany—verify—BHI/CoCM codes are absent from the Non-Covered list and no affirmative HCSC BHI coverage policy was located; verify per-member.BCBSIL 2026 Non-Covered Procedure Code List (Commercial)2026-01-012026-05-27unverified
Highmark (PA, WV, DE)bcbs / PARTMany—covered—Highmark RP-084 reimburses RTM (98975-98981, 98984-98986) as part of remote monitoring; requires a physician/QHP order and an FDA-defined device; no prior auth.Highmark RP-084 — Remote Monitoring (RPM + RTM)2026-02-232026-05-27policy-confirmed
Highmark (PA, WV, DE)bcbs / PARPMany—covered—RP-084 reimburses RPM (99091/99453/99454/99457/99458) when ordered by a physician/QHP for up to 90 days with an established patient relationship.Highmark RP-084 — Remote Monitoring (RPM + RTM)2026-02-232026-05-27policy-confirmed
Highmark (PA, WV, DE)bcbs / PACCMany—covered—Highmark RP-043 reimburses CCM 99490/99439/99491/99437 and complex CCM 99487/99489 per CMS time-based rules with no dx allowlist or prior auth.Highmark RP-043 — Care Management Services2026-05-252026-05-27policy-confirmed
Highmark (PA, WV, DE)bcbs / PABHIphysician—covered—RP-043 reimburses psychiatric CoCM 99492-99494/G2214 (billed by the PCP) and general BHI 99484 once per calendar month; no dx allowlist stated.Highmark RP-043 — Care Management Services2026-05-252026-05-27policy-confirmed
Independence Blue Cross (SE Pennsylvania)bcbs / PARTMany—excluded—Policy MA12.010d lists RTM 98975-98986 as not eligible for separate reimbursement; only an approved acute-decompensated-HF RPM program is payable.Independence Blue Cross MA12.010d — Remote Patient Monitoring2024-01-222026-05-27policy-confirmed
Independence Blue Cross (SE Pennsylvania)bcbs / PARPMphysicianHFprior_authyesMA12.010d reimburses RPM (99453/99454/99091/99457/99458) ONLY within a Company-approved acute-decompensated-heart-failure program (ICD-10 I50.x), requiring program approval and a prescription.Independence Blue Cross MA12.010d — Remote Patient Monitoring2024-01-222026-05-27policy-confirmed
Independence Blue Cross (SE Pennsylvania)bcbs / PACCMany—verify—No published Independence CCM reimbursement/medical policy located; verify per-member.Independence Blue Cross MA12.010d — Remote Patient Monitoring2024-01-222026-05-27unverified
Independence Blue Cross (SE Pennsylvania)bcbs / PABHIany—verify—No published Independence BHI/CoCM policy located; verify per-member.Independence Blue Cross MA12.010d — Remote Patient Monitoring2024-01-222026-05-27unverified
Horizon Blue Cross Blue Shield of New Jerseybcbs / NJRTMany—verify—No published Horizon BCBSNJ RTM determination located (telemedicine policy does not address RTM codes); verify per-member.Horizon BCBSNJ — Collaborative Care Management Services2021-12-012026-05-27unverified
Horizon Blue Cross Blue Shield of New Jerseybcbs / NJRPMany—verify—No published Horizon BCBSNJ RPM code-level determination located (only a condition-specific COPD program is referenced); verify per-member.Horizon BCBSNJ — Collaborative Care Management Services2021-12-012026-05-27unverified
Horizon Blue Cross Blue Shield of New Jerseybcbs / NJCCMany—excluded—Horizon Chronic Care Management Services policy denies 99490/99491/99437/99439 as not separately reimbursable (bundled into E/M); care coordination paid via value-based arrangements.Horizon BCBSNJ — Chronic Care Management Services (reimbursement policy)2021-12-012026-05-27policy-confirmed
Horizon Blue Cross Blue Shield of New Jerseybcbs / NJBHIphysicianBHcovered—Collaborative Care Management Services policy reimburses 99492-99494/99484/G2214 billed by the PCP, but denies them without an active DSM-5 psychiatric diagnosis.Horizon BCBSNJ — Collaborative Care Management Services2021-12-012026-05-27policy-confirmed
CareFirst BlueCross BlueShield (MD, DC, N. VA)bcbs / MDRTMany—verify—No published CareFirst RTM determination located; policy 2.01.084 addresses physiologic RPM only; verify per-member.CareFirst 2.01.084 — Remote Patient Monitoring2021-02-012026-05-27unverified
CareFirst BlueCross BlueShield (MD, DC, N. VA)bcbs / MDRPMphysicianHF, HTN, COPD, CKD, COVIDcovered—Medical policy 2.01.084 covers RPM for patients discharged from inpatient/ER with heart failure, chronic hypertension, COPD, CKD, or COVID-19, ordered within 60 days.CareFirst 2.01.084 — Remote Patient Monitoring2021-02-012026-05-27policy-confirmed
CareFirst BlueCross BlueShield (MD, DC, N. VA)bcbs / MDCCMany—covered—CareFirst provides a benefit for complex chronic care coordination (99487-99490) reportable per CPT in addition to E/M (eff 2015-01-01); newer add-ons 99491/99439/99437 unconfirmed.CareFirst 2.01.084 — Remote Patient Monitoring2021-02-012026-05-27derived
CareFirst BlueCross BlueShield (MD, DC, N. VA)bcbs / MDBHIany—verify—No published CareFirst BHI/CoCM reimbursement policy located; verify per-member.CareFirst 2.01.084 — Remote Patient Monitoring2021-02-012026-05-27unverified
Excellus BlueCross BlueShield (upstate NY)bcbs / NYRTMany—verify—No published Excellus RTM determination (RTM codes absent from policy 1.01.49); verify per-member.Excellus 1.01.49 — Telemedicine and Telehealth2017-12-142026-05-27unverified
Excellus BlueCross BlueShield (upstate NY)bcbs / NYRPManyHF, DM, COPD, BHcovered—Policy 1.01.49 covers telemonitoring/RPM (99091 + physiologic data collection) for CHF, diabetes, COPD, wound care, polypharmacy, behavioral problems, and tech-dependent care.Excellus 1.01.49 — Telemedicine and Telehealth2017-12-142026-05-27derived
Excellus BlueCross BlueShield (upstate NY)bcbs / NYCCMany—covered—Policy 1.01.49 lists chronic and complex CCM 99487-99490 as recognized covered services subject to CPT rules.Excellus 1.01.49 — Telemedicine and Telehealth2017-12-142026-05-27derived
Excellus BlueCross BlueShield (upstate NY)bcbs / NYBHIany—verify—No published Excellus BHI/CoCM determination located; verify per-member.Excellus 1.01.49 — Telemedicine and Telehealth2017-12-142026-05-27unverified
Blue Cross Blue Shield of Massachusettsbcbs / MARTMany—verify—No public BCBSMA RTM payment policy located (policies behind Provider Central; public Telehealth policy omits RTM); verify per-member.BCBSMA — Mental Health Payment Information / CoCM (Provider Central)2020-07-012026-05-27unverified
Blue Cross Blue Shield of Massachusettsbcbs / MARPMany—verify—No public BCBSMA RPM payment policy located (Telehealth-Medical Services policy is audiovisual-only and omits RPM codes); verify per-member.BCBSMA — Mental Health Payment Information / CoCM (Provider Central)2020-07-012026-05-27unverified
Blue Cross Blue Shield of Massachusettsbcbs / MACCMany—verify—No public BCBSMA CCM payment policy located; verify per-member.BCBSMA — Mental Health Payment Information / CoCM (Provider Central)2020-07-012026-05-27unverified
Blue Cross Blue Shield of Massachusettsbcbs / MABHIphysician—covered—BCBSMA reimburses Psychiatric Collaborative Care (99492-99494) and general BHI with no member cost-share (Value Partnerships, eff 2020-07-01).BCBSMA — Mental Health Payment Information / CoCM (Provider Central)2020-07-012026-05-27derived
Blue Cross & Blue Shield of Rhode Islandbcbs / RIRTMany—verify—No published BCBSRI RTM policy located (only Rehabilitative Devices with Remote Monitoring exists and it omits RTM codes); verify per-member.BCBSRI — Behavioral Health Integration incl. Collaborative Care Model2025-06-012026-05-27unverified
Blue Cross & Blue Shield of Rhode Islandbcbs / RIRPMany—verify—No published BCBSRI RPM policy located (Telemedicine policy is audiovisual-only); verify per-member.BCBSRI — Behavioral Health Integration incl. Collaborative Care Model2025-06-012026-05-27unverified
Blue Cross & Blue Shield of Rhode Islandbcbs / RICCMany—verify—No published BCBSRI CCM policy located (only Care Plan Oversight, which does not cover 99490-series codes); verify per-member.BCBSRI — Behavioral Health Integration incl. Collaborative Care Model2025-06-012026-05-27unverified
Blue Cross & Blue Shield of Rhode Islandbcbs / RIBHIphysician—covered—BCBSRI BHI/CoCM payment policy covers CoCM (99492-99494/G2214) and general BHI (99484) with no prior auth; practice must maintain a CMS-style program (registry, psychiatric consultant, validated scales).BCBSRI — Behavioral Health Integration incl. Collaborative Care Model2025-06-012026-05-27policy-confirmed
Florida Blue (GuideWell)bcbs / FLRTMany—verify—Florida Blue Medical Coverage Guidelines require provider-portal access; no public RTM determination surfaced; verify per-member.Florida Blue — Medical Coverage Guidelines (MCG portal)2026-01-012026-05-27unverified
Florida Blue (GuideWell)bcbs / FLRPMany—verify—No public Florida Blue RPM determination located; verify per-member.Florida Blue — Medical Coverage Guidelines (MCG portal)2026-01-012026-05-27unverified
Florida Blue (GuideWell)bcbs / FLCCMany—verify—No public Florida Blue CCM determination located; verify per-member.Florida Blue — Medical Coverage Guidelines (MCG portal)2026-01-012026-05-27unverified
Florida Blue (GuideWell)bcbs / FLBHIany—verify—No public Florida Blue BHI/CoCM determination located (BH vendor New Directions/Lucet); verify per-member.Florida Blue — Medical Coverage Guidelines (MCG portal)2026-01-012026-05-27unverified
Blue Cross Blue Shield of Alabamabcbs / ALRTMany—verify—BCBS-AL telehealth policy covers synchronous audio/video only and does not enumerate RTM codes; no monitoring determination located; verify per-member.BCBS-AL — Telehealth and Remote Access Telemedicine2015-12-012026-05-27unverified
Blue Cross Blue Shield of Alabamabcbs / ALRPMany—verify—BCBS-AL telehealth policy addresses only real-time audio/video; RPM codes are absent; verify per-member.BCBS-AL — Telehealth and Remote Access Telemedicine2015-12-012026-05-27unverified
Blue Cross Blue Shield of Alabamabcbs / ALCCMany—verify—No published BCBS-AL CCM policy located; verify per-member.BCBS-AL — Telehealth and Remote Access Telemedicine2015-12-012026-05-27unverified
Blue Cross Blue Shield of Alabamabcbs / ALBHIany—verify—No published BCBS-AL BHI/CoCM policy located; telehealth policy covers only synchronous BH visits; verify per-member.BCBS-AL — Telehealth and Remote Access Telemedicine2015-12-012026-05-27unverified
BlueCross BlueShield of Tennesseebcbs / TNRTMany—verify—BCBST medical policy manual and telehealth guidelines are gated behind the provider portal; no public RTM determination located; verify per-member.BCBST — Medical Policy Manual / Telehealth guidelines2026-01-012026-05-27unverified
BlueCross BlueShield of Tennesseebcbs / TNRPMany—verify—No public BCBST RPM determination located; verify per-member.BCBST — Medical Policy Manual / Telehealth guidelines2026-01-012026-05-27unverified
BlueCross BlueShield of Tennesseebcbs / TNCCMany—verify—No public BCBST CCM determination located; verify per-member.BCBST — Medical Policy Manual / Telehealth guidelines2026-01-012026-05-27unverified
BlueCross BlueShield of Tennesseebcbs / TNBHIany—verify—No public BCBST BHI/CoCM determination located; verify per-member.BCBST — Medical Policy Manual / Telehealth guidelines2026-01-012026-05-27unverified
Blue Cross Blue Shield of South Carolinabcbs / SCRTMany—verify—CAM 176 (Telehealth) does not list RTM codes; no monitoring determination located; verify per-member.BCBS-SC CAM 176 — Telehealth2025-11-042026-05-27unverified
Blue Cross Blue Shield of South Carolinabcbs / SCRPMany—verify—CAM 176 covers synchronous audio/video only and excludes asynchronous; RPM codes absent; verify per-member.BCBS-SC CAM 176 — Telehealth2025-11-042026-05-27unverified
Blue Cross Blue Shield of South Carolinabcbs / SCCCMany—verify—No published BCBS-SC CCM policy located; verify per-member.BCBS-SC CAM 176 — Telehealth2025-11-042026-05-27unverified
Blue Cross Blue Shield of South Carolinabcbs / SCBHIany—verify—CAM 176 covers synchronous BH visit codes but not BHI/CoCM codes; no BHI determination located; verify per-member.BCBS-SC CAM 176 — Telehealth2025-11-042026-05-27unverified
Blue Cross Blue Shield of North Carolinabcbs / NCRTMany—covered—Blue Cross NC reimburses RTM 98975-98981 + 98984-98986 (and 98979, 99445, 99470) commercially when medically necessary and physician/QHP-ordered; no prior auth (eff 2023-04-18). Not covered concurrent with home health.Blue Cross NC — Remote Therapeutic and Physiologic Monitoring2023-04-182026-05-27policy-confirmed
Blue Cross Blue Shield of North Carolinabcbs / NCRPMany—covered—Reimburses RPM 99453/99454/99457/99458 (and 99470) commercially when medically necessary; HF/HTN/DM/CKD are clinical examples only, not an allowlist (eff 2023-04-18).Blue Cross NC — Remote Therapeutic and Physiologic Monitoring2023-04-182026-05-27policy-confirmed
Blue Cross Blue Shield of North Carolinabcbs / NCCCMany—verify—The RTM/RPM policy does not address CCM; no published CCM determination located; verify per-member.Blue Cross NC — Remote Therapeutic and Physiologic Monitoring2023-04-182026-05-27unverified
Blue Cross Blue Shield of North Carolinabcbs / NCBHIany—verify—BHI/CoCM not addressed in the RTM/RPM policy; no published BHI determination located; verify per-member.Blue Cross NC — Remote Therapeutic and Physiologic Monitoring2023-04-182026-05-27unverified
Blue Cross Blue Shield of Louisianabcbs / LARTMany—verify—BCBS-LA §5.42 reimburses physiologic RPM but does not list RTM codes; no published RTM determination located; verify per-member.BCBS-LA Provider Office Manual §5.42 — Remote Patient Management2023-01-012026-05-27unverified
Blue Cross Blue Shield of Louisianabcbs / LARPMphysician—covered—BCBS-LA reimburses RPM 99453 (once/lifetime), 99454/99457 monthly, and 99458 for established patients, ordered by MD/DO/NP/PA, using an FDA-approved device transmitting at least 16 of 30 days; no prior auth.BCBS-LA Provider Office Manual §5.42 — Remote Patient Management2023-01-012026-05-27policy-confirmed
Blue Cross Blue Shield of Louisianabcbs / LACCMany—verify—Section 5.42 addresses only remote patient management, not CCM codes; no published CCM determination located; verify per-member.BCBS-LA Provider Office Manual §5.42 — Remote Patient Management2023-01-012026-05-27unverified
Blue Cross Blue Shield of Louisianabcbs / LABHIany—verify—No published BCBS-LA BHI/CoCM policy located; verify per-member.BCBS-LA Provider Office Manual §5.42 — Remote Patient Management2023-01-012026-05-27unverified
Blue Cross Blue Shield of Mississippibcbs / MSRTMphysicianANEM, AMI, ASTH, AFIB, CKD, COPD, BH, DM, HF, HTN, STROKEprior_authyesBCBS-MS policy L.2.04.439 covers RTM 98975-98981 only for 11 CMS chronic conditions, MS-licensed physician-ordered, with prior authorization required.BCBS-MS L.2.04.439 — Telehealth: Remote Patient Monitoring Services2026-01-012026-05-27policy-confirmed
Blue Cross Blue Shield of Mississippibcbs / MSRPMphysicianANEM, AMI, ASTH, AFIB, CKD, COPD, BH, DM, HF, HTN, STROKEprior_authyesL.2.04.439 covers RPM 99453/99454/99457/99458/99091/99445 only for the 11 CMS chronic conditions, physician-ordered, prior auth required, at least 5 monitoring encounters/week, 31-day initial / 6-month cumulative max.BCBS-MS L.2.04.439 — Telehealth: Remote Patient Monitoring Services2026-01-012026-05-27policy-confirmed
Blue Cross Blue Shield of Mississippibcbs / MSCCMany—verify—L.2.04.439 covers only remote monitoring, not CCM codes; no published CCM determination located; verify per-member.BCBS-MS L.2.04.439 — Telehealth: Remote Patient Monitoring Services2026-01-012026-05-27unverified
Blue Cross Blue Shield of Mississippibcbs / MSBHIany—verify—No published BCBS-MS BHI/CoCM policy located; depression is an allowed monitoring dx but BHI codes are not addressed; verify per-member.BCBS-MS L.2.04.439 — Telehealth: Remote Patient Monitoring Services2026-01-012026-05-27unverified
Arkansas Blue Cross and Blue Shieldbcbs / ARRTMany—excluded—Arkansas BCBS Coverage Policy 2015034 (Telehealth) explicitly excludes remote monitoring and mobile health; RTM is not a covered telehealth service.Arkansas BCBS Coverage Policy 2015034 — Telehealth2026-01-012026-05-27policy-confirmed
Arkansas Blue Cross and Blue Shieldbcbs / ARRPMany—excluded—Policy 2015034 lists remote monitoring among excluded modalities; RPM codes are not covered.Arkansas BCBS Coverage Policy 2015034 — Telehealth2026-01-012026-05-27policy-confirmed
Arkansas Blue Cross and Blue Shieldbcbs / ARCCMany—verify—CCM codes are not addressed in the telehealth policy and no separate CCM determination was located; verify per-member.Arkansas BCBS Coverage Policy 2015034 — Telehealth2026-01-012026-05-27unverified
Arkansas Blue Cross and Blue Shieldbcbs / ARBHIany—verify—BHI/CoCM codes are not addressed in the telehealth policy; no published BHI determination located; verify per-member.Arkansas BCBS Coverage Policy 2015034 — Telehealth2026-01-012026-05-27unverified
California Medicaid (Medi-Cal)medicaid_ffs / CARTMany—excluded—Medi-Cal does not reimburse RTM (98975-98981); only the RPM family is listed in the E&M Manual.DHCS Medi-Cal E&M Manual — Telehealth / RPM2026-01-012026-05-27policy-confirmed
California Medicaid (Medi-Cal)medicaid_ffs / CARPMphysician—covered—Medi-Cal reimburses 99091/99445/99453/99454/99457/99458/99470 for established patients ordered/billed by a physician or QHP with documented consent; not separately payable for FQHC/RHC (PPS-bundled).DHCS Medi-Cal E&M Manual — Telehealth / RPM2026-01-012026-05-27policy-confirmed
California Medicaid (Medi-Cal)medicaid_ffs / CACCMphysician—covered—CPT 99490/99491/99437/99439 are reimbursable per the E&M Manual; no determination located for 99487/99489.DHCS Medi-Cal E&M Manual — Telehealth / RPM2026-01-012026-05-27policy-confirmed
California Medicaid (Medi-Cal)medicaid_ffs / CABHIany—verify—No published Medi-Cal FFS BHI/CoCM determination; behavioral health care management is carved out to county Mental Health Plans / MCP managed BH; verify per-member.DHCS Medi-Cal E&M Manual — Telehealth / RPM2026-01-012026-05-27unverified
New York State Medicaidmedicaid_ffs / NYRTMany—verify—No published NY Medicaid RTM policy located; verify per-member.NYS Medicaid Telehealth Policy Manual (Jan 2026)2025-01-012026-05-27unverified
New York State Medicaidmedicaid_ffs / NYRPMphysicianHF, HTN, DM, COPD, HDP, GDM, BH, CKDcovered—NYS Medicaid reimburses 99091 and (eff 2025-01-01) 99457, plus 99453/99454 with the HD modifier for maternity, limited to an eligible-condition allowlist (CHF, DM/GDM, COPD, wound care, polypharmacy, behavioral problems, tech-dependent care, pregnancy); physician/NP/midwife-ordered; once per member per 30-day period.NYS Medicaid Telehealth Policy Manual (Jan 2026)2025-01-012026-05-27policy-confirmed
New York State Medicaidmedicaid_ffs / NYCCMany—verify—No published NY Medicaid CCM (99490-family) FFS determination located; verify per-member.NYS Medicaid Telehealth Policy Manual (Jan 2026)2025-01-012026-05-27unverified
New York State Medicaidmedicaid_ffs / NYBHIany—verify—No published NY Medicaid BHI/CoCM FFS determination; behavioral health managed via MMC/HARP; verify per-member.NYS Medicaid Telehealth Policy Manual (Jan 2026)2025-01-012026-05-27unverified
Ohio Medicaidmedicaid_ffs / OHRTMany—verify—No published Ohio Medicaid RTM policy located; verify per-member.OAC 5160-1-18 — Telehealth + ODM Billing Guidelines2026-01-012026-05-27unverified
Ohio Medicaidmedicaid_ffs / OHRPMany—covered—OAC 5160-1-18 lists remote patient monitoring as a covered asynchronous telehealth activity (GT modifier); a 16-day data minimum applies to 99453/99454; no dx restriction or prior auth stated.OAC 5160-1-18 — Telehealth + ODM Billing Guidelines2026-01-012026-05-27derived
Ohio Medicaidmedicaid_ffs / OHCCMany—verify—No published Ohio Medicaid CCM FFS determination located; verify per-member.OAC 5160-1-18 — Telehealth + ODM Billing Guidelines2026-01-012026-05-27unverified
Ohio Medicaidmedicaid_ffs / OHBHIany—verify—No published Ohio Medicaid BHI/CoCM FFS determination; BH carved into MCOs / OhioRISE; verify per-member.OAC 5160-1-18 — Telehealth + ODM Billing Guidelines2026-01-012026-05-27unverified
Pennsylvania Medical Assistancemedicaid_ffs / PARTMany—verify—No published PA Medicaid RTM policy located; verify per-member.PA MA Bulletin 99-23-08 — Telehealth (CCHP summary)2023-08-022026-05-27unverified
Pennsylvania Medical Assistancemedicaid_ffs / PARPMany—excluded—PA Medical Assistance does not reimburse remote patient monitoring (CCHP "At A Glance: No"); RPM codes are not on the PA MA fee schedule.PA MA Bulletin 99-23-08 — Telehealth (CCHP summary)2023-08-022026-05-27policy-confirmed
Pennsylvania Medical Assistancemedicaid_ffs / PACCMany—verify—No published PA Medicaid CCM (99490-family) FFS determination located; verify per-member.PA MA Bulletin 99-23-08 — Telehealth (CCHP summary)2023-08-022026-05-27unverified
Pennsylvania Medical Assistancemedicaid_ffs / PABHIany—verify—No published PA Medicaid BHI/CoCM FFS determination; behavioral health fully carved out to county HealthChoices BH-MCOs; verify with the assigned BH-MCO.PA MA Bulletin 99-23-08 — Telehealth (CCHP summary)2023-08-022026-05-27unverified
Michigan Medicaidmedicaid_ffs / MIRTMany—verify—No published MI Medicaid RTM policy located; verify per-member.MDHHS Medicaid Provider Manual — Telemedicine chapter2026-04-012026-05-27unverified
Michigan Medicaidmedicaid_ffs / MIRPMany—covered—MDHHS Provider Manual Telemedicine chapter lists remote patient monitoring as a covered asynchronous service; allowable codes are on the MDHHS telemedicine fee schedules; no dx restriction or prior auth stated.MDHHS Medicaid Provider Manual — Telemedicine chapter2026-04-012026-05-27derived
Michigan Medicaidmedicaid_ffs / MICCMany—verify—No published MI Medicaid CCM FFS determination located; verify per-member.MDHHS Medicaid Provider Manual — Telemedicine chapter2026-04-012026-05-27unverified
Michigan Medicaidmedicaid_ffs / MIBHIany—verify—No published MI Medicaid BHI/CoCM FFS determination; specialty BH carved out to PIHPs; verify per-member.MDHHS Medicaid Provider Manual — Telemedicine chapter2026-04-012026-05-27unverified
Alabama Medicaidmedicaid_ffs / ALRTMany—verify—No published RTM policy located; AL Medicaid Ch. 111 addresses only physiologic RPM; verify per-member.AL Medicaid Provider Manual Ch. 111 — Remote Patient Monitoring2026-01-012026-05-27unverified
Alabama Medicaidmedicaid_ffs / ALRPMnursingHF, DM, GDM, HTN, ASTHcovered—RPM covered per Ch. 111 §111.2 only for CHF, diabetes, gestational diabetes, hypertension/maternal HTN, and pediatric asthma; restricted to enrolled RPM-provider entities with an Agency MOU and an annual ordering-provider order.AL Medicaid Provider Manual Ch. 111 — Remote Patient Monitoring2026-01-012026-05-27policy-confirmed
Alabama Medicaidmedicaid_ffs / ALCCMany—verify—No published CCM FFS policy; AL care management runs through the ACHN program, not CCM CPT codes; verify per-member.AL Medicaid Provider Manual Ch. 111 — Remote Patient Monitoring2026-01-012026-05-27unverified
Alabama Medicaidmedicaid_ffs / ALBHIbh—verify—No published BHI/CoCM determination located; verify per-member.AL Medicaid Provider Manual Ch. 111 — Remote Patient Monitoring2026-01-012026-05-27unverified
Alaska Medical Assistancemedicaid_ffs / AKRTMany—verify—No published RTM policy located; verify per-member.Alaska Medical Assistance — 7 AAC 110.620 Telehealth2026-02-012026-05-27unverified
Alaska Medical Assistancemedicaid_ffs / AKRPMany—verify—Telehealth statute permits home self-monitoring but no confirmed Medicaid RPM implementing payment policy located; verify per-member.Alaska Medical Assistance — 7 AAC 110.620 Telehealth2026-02-012026-05-27unverified
Alaska Medical Assistancemedicaid_ffs / AKCCMany—verify—No published CCM payment policy; complex case management runs via the Comagine AMCCI contract, not CCM CPT codes; verify per-member.Alaska Medical Assistance — 7 AAC 110.620 Telehealth2026-02-012026-05-27unverified
Alaska Medical Assistancemedicaid_ffs / AKBHIbh—covered—Behavioral health is covered FFS including via telehealth by licensed BH practitioners; collaborative-care CPT family not specifically enumerated, so coverage is derived from general BH telehealth coverage.Alaska Medical Assistance — 7 AAC 110.620 Telehealth2026-02-012026-05-27derived
Arkansas Medicaidmedicaid_ffs / ARRTMany—verify—No published RTM policy located; verify per-member.AR Medicaid Provider Manual Section I Rule 105.1902022-01-012026-05-27unverified
Arkansas Medicaidmedicaid_ffs / ARRPManyHTN, HDPcovered—The only confirmed RPM benefit is self-measured blood pressure monitoring for pregnant/postpartum women (Rule 105.190); broad physiologic RPM device codes are not established.AR Medicaid Provider Manual Section I Rule 105.1902022-01-012026-05-27policy-confirmed
Arkansas Medicaidmedicaid_ffs / ARCCMany—verify—No published CCM payment policy located; verify per-member.AR Medicaid Provider Manual Section I Rule 105.1902022-01-012026-05-27unverified
Arkansas Medicaidmedicaid_ffs / ARBHIbh—covered—BH screening/counseling/crisis services reimbursable via telemedicine by licensed BH practitioners; collaborative-care CPT family not enumerated. High-need BH/IDD members are administered through their PASSE.AR Medicaid Provider Manual Section I Rule 105.1902022-01-012026-05-27derived
Health First Coloradomedicaid_ffs / CORTMany—verify—No published RTM determination; SB24-168 addresses physiologic RPM, not therapeutic monitoring; verify per-member.Health First Colorado SB24-168 + HCPF Telemedicine Billing Manual2025-07-012026-05-27unverified
Health First Coloradomedicaid_ffs / CORPMany—prior_authyesRPM (99453/99454/99457/99458/99091) a covered outpatient benefit since 2025-07-01 under SB24-168 when medically necessary to prevent admission/readmission with a qualifying condition; requires an FDA-cleared device and some RPM services require prior authorization.Health First Colorado SB24-168 + HCPF Telemedicine Billing Manual2025-07-012026-05-27policy-confirmed
Health First Coloradomedicaid_ffs / COCCMany—verify—No published CCM payment determination located; verify per-member.Health First Colorado SB24-168 + HCPF Telemedicine Billing Manual2025-07-012026-05-27unverified
Health First Coloradomedicaid_ffs / COBHIbh—covered—BH (incl. telehealth) covered under the capitated benefit administered by the RAEs; authorize with the member RAE. Collaborative-care CPT family not enumerated in the state manual.Health First Colorado SB24-168 + HCPF Telemedicine Billing Manual2025-07-012026-05-27derived
Connecticut Medical Assistance (HUSKY)medicaid_ffs / CTRTMany—verify—No published RTM determination; verify against the CMAP Telehealth Table per-member.CT Medical Assistance Program — PB 2023-38 Telehealth2026-04-152026-05-27unverified
Connecticut Medical Assistance (HUSKY)medicaid_ffs / CTRPMany—excluded—CMAP does not reimburse remote patient monitoring (CCHP At-A-Glance: RPM = No); home health may not be delivered via telehealth.CT Medical Assistance Program — PB 2023-38 Telehealth2026-04-152026-05-27policy-confirmed
Connecticut Medical Assistance (HUSKY)medicaid_ffs / CTCCMany—verify—No published CCM determination; coverage depends on the CMAP Telehealth Table; verify per-member.CT Medical Assistance Program — PB 2023-38 Telehealth2026-04-152026-05-27unverified
Connecticut Medical Assistance (HUSKY)medicaid_ffs / CTBHIbh—verify—BH delivered via telehealth and administered by the Carelon CTBHP ASO, but no specific collaborative-care determination located; verify with Carelon.CT Medical Assistance Program — PB 2023-38 Telehealth2026-04-152026-05-27unverified
Delaware Medical Assistance (DMAP)medicaid_ffs / DERTMany—verify—DMAP reimburses physiologic RPM but does not enumerate the RTM family; no published RTM determination located; verify per-member.DE DMAP Practitioner Provider Manual Ch. 16 (RPM)2026-03-172026-05-27unverified
Delaware Medical Assistance (DMAP)medicaid_ffs / DERPMphysician—covered—DMAP reimburses Remote Physiologic Monitoring (device + treatment-management) for enrolled in-scope practitioners; patient must be capable of operating equipment; no dx restriction published.DE DMAP Practitioner Provider Manual Ch. 16 (RPM)2026-03-172026-05-27policy-confirmed
Delaware Medical Assistance (DMAP)medicaid_ffs / DECCMany—covered—DMAP Practitioner Manual lists CCM 99490/99491/99437/99439 (and G0506) as reimbursable when criteria met, once/month any provider.DE DMAP Practitioner Provider Manual Ch. 16 (RPM)2026-03-172026-05-27derived
Delaware Medical Assistance (DMAP)medicaid_ffs / DEBHIbh—verify—BH covered via licensed providers (often enrolled separately through DSAMH), but no published CoCM/BHI determination located; verify per-member.DE DMAP Practitioner Provider Manual Ch. 16 (RPM)2026-03-172026-05-27unverified
Georgia Medicaidmedicaid_ffs / GARTMany—verify—No published RTM policy located; verify per-member.GA DCH Telehealth Guidance (CCHP At-A-Glance)2026-01-012026-05-27unverified
Georgia Medicaidmedicaid_ffs / GARPMany—excluded—CCHP At-A-Glance and GA DCH guidance show RPM = No; only waiver-based Emergency Response Systems are covered, not physiologic RPM CPT codes.GA DCH Telehealth Guidance (CCHP At-A-Glance)2026-01-012026-05-27policy-confirmed
Georgia Medicaidmedicaid_ffs / GACCMany—verify—No published CCM reimbursement determination located; verify per-member.GA DCH Telehealth Guidance (CCHP At-A-Glance)2026-01-012026-05-27unverified
Georgia Medicaidmedicaid_ffs / GABHIbh—verify—BH delivered via synchronous audio/video and largely managed by Georgia Families CMOs/DBHDD; no published CoCM/BHI FFS determination; verify with the CMO.GA DCH Telehealth Guidance (CCHP At-A-Glance)2026-01-012026-05-27unverified
Hawaii Medicaid (Med-QUEST)medicaid_ffs / HIRTMany—verify—Telehealth statute covers remote monitoring generically but Med-QUEST does not separately enumerate the RTM family; verify per-member.HI Med-QUEST — HRS 346-59.1 + Memo QI-25272025-12-082026-05-27unverified
Hawaii Medicaid (Med-QUEST)medicaid_ffs / HIRPMany—covered—HRS 346-59.1 requires Med-QUEST to cover telehealth including remote patient monitoring; remote-monitoring codes named in the Dec 2025 implementation memo; confirm specific codes/rates on the FFS fee schedule.HI Med-QUEST — HRS 346-59.1 + Memo QI-25272025-12-082026-05-27policy-confirmed
Hawaii Medicaid (Med-QUEST)medicaid_ffs / HICCMany—verify—No published Med-QUEST CCM reimbursement determination located; verify per-member.HI Med-QUEST — HRS 346-59.1 + Memo QI-25272025-12-082026-05-27unverified
Hawaii Medicaid (Med-QUEST)medicaid_ffs / HIBHIbh—verify—BH telehealth covered but no published CoCM/BHI determination; BH largely administered by QUEST Integration plans; verify per-member.HI Med-QUEST — HRS 346-59.1 + Memo QI-25272025-12-082026-05-27unverified
Illinois Medicaid (HFS)medicaid_ffs / ILRTMany—verify—No published IL Medicaid RTM policy located; verify per-member.IL HFS — 89 IAC 140.475 + 305 ILCS 5/5-502024-07-012026-05-27unverified
Illinois Medicaid (HFS)medicaid_ffs / ILRPMphysicianDM, GDM, HDPprior_authyesHFS does not reimburse general physiologic RPM; only narrow device-monitoring is covered — continuous glucose monitoring (PA-required, insulin-using or gestational diabetes) and home uterine monitoring (HDP/preterm, prior approval).IL HFS — 89 IAC 140.475 + 305 ILCS 5/5-502024-07-012026-05-27policy-confirmed
Illinois Medicaid (HFS)medicaid_ffs / ILCCMany—verify—No published CCM reimbursement determination located in HFS handbooks; verify per-member.IL HFS — 89 IAC 140.475 + 305 ILCS 5/5-502024-07-012026-05-27unverified
Illinois Medicaid (HFS)medicaid_ffs / ILBHIbh—covered—305 ILCS 5/5-50 mandates BH telehealth reimbursement at in-person parity (modifiers GT / 93); no separate CoCM line item but live-video BH integration is covered.IL HFS — 89 IAC 140.475 + 305 ILCS 5/5-502024-07-012026-05-27derived
Indiana Health Coverage Programs (IHCP)medicaid_ffs / INRTMany—verify—IHCP covers RPM but does not address RTM separately; no published RTM determination; verify against the Telehealth Code Set.IHCP Telehealth and Virtual Services Module + BT2025202024-10-302026-05-27unverified
Indiana Health Coverage Programs (IHCP)medicaid_ffs / INRPMany—covered—IHCP covers RPM via telehealth (codes on the Telehealth and Virtual Services Code Set; HHAs have a dedicated RPM section); subject to any PA on the specific procedure code.IHCP Telehealth and Virtual Services Module + BT2025202024-10-302026-05-27policy-confirmed
Indiana Health Coverage Programs (IHCP)medicaid_ffs / INCCMany—verify—Only a telehealth chronic-care diversion pilot exists (IC 12-10-10-14); care coordination generally non-reimbursable for telemedicine; no published CCM FFS determination; verify per-member.IHCP Telehealth and Virtual Services Module + BT2025202024-10-302026-05-27unverified
Indiana Health Coverage Programs (IHCP)medicaid_ffs / INBHIbh—covered—BH integration covered chiefly via the Behavioral and Primary Healthcare Coordination (BPHC) service (BT202440, renewed through 2029); most BH requires audiovisual modality.IHCP Telehealth and Virtual Services Module + BT2025202024-10-302026-05-27derived
Iowa Medicaidmedicaid_ffs / IARTMany—covered—RTM codes 98975/98976/98977/98980/98981 appear individually on the Iowa Approved Telehealth Services list (rates added 2022-01-01) with no dx restriction.Iowa HHS Approved Telehealth Services list2026-03-272026-05-27policy-confirmed
Iowa Medicaidmedicaid_ffs / IARPMany—covered—RPM 99453/99454 (eff 2023-07-01) and 99457/99458 are on the approved telehealth code list; 99091 is not listed, so bill the 9945x family only.Iowa HHS Approved Telehealth Services list2026-03-272026-05-27policy-confirmed
Iowa Medicaidmedicaid_ffs / IACCMany—covered—Only base CCM 99490 is on the approved telehealth list; complex CCM and add-ons 99439/99491/99437/99487/99489 are absent — verify those per-claim.Iowa HHS Approved Telehealth Services list2026-03-272026-05-27derived
Iowa Medicaidmedicaid_ffs / IABHIany—covered—Only general BHI 99484 is on the approved telehealth list; CoCM codes 99492/99493/99494 and G2214 are absent.Iowa HHS Approved Telehealth Services list2026-03-272026-05-27derived
Kansas Medicaid (KanCare)medicaid_ffs / KSRTMany—verify—No published RTM policy located (KMAP fee schedule behind SSO); verify per-member.KMAP Home Health Agency Provider Manual (telemonitoring T1030/T1031)2026-03-012026-05-27unverified
Kansas Medicaid (KanCare)medicaid_ffs / KSRPMnursing—prior_authyesKS reimburses home telemonitoring only via HCPCS T1030/T1031 (+S0315-U1 install) by a home health agency/county health dept under RN/LPN delivery, real-time video, signed consent, PA-limited to 60-day spans and 2 visits/week — not the 9945x RPM CPT family.KMAP Home Health Agency Provider Manual (telemonitoring T1030/T1031)2026-03-012026-05-27policy-confirmed
Kansas Medicaid (KanCare)medicaid_ffs / KSCCMany—verify—No published CCM policy located (KMAP fee schedule inaccessible behind SSO); verify per-member.KMAP Home Health Agency Provider Manual (telemonitoring T1030/T1031)2026-03-012026-05-27unverified
Kansas Medicaid (KanCare)medicaid_ffs / KSBHIbh—verify—KS covers discrete MH services requiring face-to-face visual contact, but no published CoCM/BHI determination is locatable; verify per-member.KMAP Home Health Agency Provider Manual (telemonitoring T1030/T1031)2026-03-012026-05-27unverified
Kentucky Medicaidmedicaid_ffs / KYRTMany—covered—KY Physician Fee Schedule pays RTM 98975/98976/98977/98980/98981 with no dx restriction on the fee schedule.KY Medicaid Physician Fee Schedule + 907 KAR 3:1702025-11-032026-05-27policy-confirmed
Kentucky Medicaidmedicaid_ffs / KYRPManyHF, HTN, DM, COPD, BH, AMI, STROKE, HDPcovered—Fee schedule pays 99453/99454/99457/99458/99091; the 907 KAR 3:170 telehealth-RPM benefit limits covered conditions (CHF/HTN/diabetes/COPD/mental illness/MI/stroke/pregnancy/cancer) and, except in pregnancy, requires 2+ documented risk factors.KY Medicaid Physician Fee Schedule + 907 KAR 3:1702025-11-032026-05-27policy-confirmed
Kentucky Medicaidmedicaid_ffs / KYCCMany—covered—Fee schedule pays CCM 99490, 99491, and complex 99487 (and add-ons) with no dx allowlist beyond the CPT 2-chronic-condition definition.KY Medicaid Physician Fee Schedule + 907 KAR 3:1702025-11-032026-05-27policy-confirmed
Kentucky Medicaidmedicaid_ffs / KYBHIany—covered—Fee schedule pays BHI 99484 and CoCM 99492/99493/99494; only G2214 is absent.KY Medicaid Physician Fee Schedule + 907 KAR 3:1702025-11-032026-05-27policy-confirmed
Louisiana Medicaid (Healthy Louisiana)medicaid_ffs / LARTMany—verify—RTM codes 98975-98981 are absent from the LA Professional Services Fee Schedule; no published RTM determination; verify per-member.LA Medicaid Professional Services Fee Schedule + Community Choices Waiver2025-03-152026-05-27unverified
Louisiana Medicaid (Healthy Louisiana)medicaid_ffs / LARPManyHF, DM, ASTH, BH, HDPprior_authyesRPM CPT codes are absent from the professional fee schedule; LA covers remote monitoring only via the Community Choices Waiver/telehealth pathway (PA required), gated to chronic conditions (sickle cell, mental illness, asthma, diabetes, cancer, heart disease) or 2+ ER/hospitalizations or pregnancy/NICU history.LA Medicaid Professional Services Fee Schedule + Community Choices Waiver2025-03-152026-05-27derived
Louisiana Medicaid (Healthy Louisiana)medicaid_ffs / LACCMany—verify—CCM codes are absent from the LA Professional Services Fee Schedule; no published CCM determination; verify per-member.LA Medicaid Professional Services Fee Schedule + Community Choices Waiver2025-03-152026-05-27unverified
Louisiana Medicaid (Healthy Louisiana)medicaid_ffs / LABHIany—verify—BHI/CoCM codes are absent from the fee schedule and BH is delivered through the Healthy Louisiana MCOs; no published determination; verify per-member.LA Medicaid Professional Services Fee Schedule + Community Choices Waiver2025-03-152026-05-27unverified
Maine Medicaid (MaineCare)medicaid_ffs / MERTMany—verify—MaineCare remote-monitoring is the S9110 telemonitoring code, not the RTM CPT family; no published RTM determination; verify per-member.MaineCare Benefits Manual Ch. II Sec. 40 (S9110 telemonitoring)2023-11-062026-05-27unverified
Maine Medicaid (MaineCare)medicaid_ffs / MERPMnursing—covered—MaineCare covers home telemonitoring via HCPCS S9110 (+Q3014 facility fee) under MBM Ch. II Sec. 40, restricted to certified Home Health Agencies with RN/NP/PA/physician data review; member must be documented at risk of hospitalization/ER.MaineCare Benefits Manual Ch. II Sec. 40 (S9110 telemonitoring)2023-11-062026-05-27policy-confirmed
Maine Medicaid (MaineCare)medicaid_ffs / MECCMany—verify—Care management exists only as Health Home/Community Care Team comprehensive care management (Sec. 91), not CCM CPT codes; verify per-member.MaineCare Benefits Manual Ch. II Sec. 40 (S9110 telemonitoring)2023-11-062026-05-27unverified
Maine Medicaid (MaineCare)medicaid_ffs / MEBHIbh—verify—MaineCare covers BH services and case management (Sec. 65) but not as integrated-care CPT codes; no CoCM/BHI determination located; verify per-member.MaineCare Benefits Manual Ch. II Sec. 40 (S9110 telemonitoring)2023-11-062026-05-27unverified
Maryland Medical Assistancemedicaid_ffs / MDRTMany—verify—MD modernized RPM under PT 78-25 but did not address RTM codes; no published RTM determination; verify per-member.MD Medicaid PT 78-25 (RPM) + PT 71-24 (CoCM)2025-05-152026-05-27unverified
Maryland Medical Assistancemedicaid_ffs / MDRPMany—covered—PT 78-25 (eff 2025-05-15) replaced the legacy S9110 model with standard CPT 99453/99454/99457/99458, removed prior auth, and dropped the old COPD/CHF/diabetes dx restriction.MD Medicaid PT 78-25 (RPM) + PT 71-24 (CoCM)2025-05-152026-05-27policy-confirmed
Maryland Medical Assistancemedicaid_ffs / MDCCMany—verify—No published standalone CPT CCM FFS determination located; verify per-member.MD Medicaid PT 78-25 (RPM) + PT 71-24 (CoCM)2025-05-152026-05-27unverified
Maryland Medical Assistancemedicaid_ffs / MDBHIphysicianBHcovered—PT 71-24 (eff 2024-04-19) covers CoCM 99492/99493/99494 + G2214 for FFS and HealthChoice; primary-care-billed even though BH is otherwise carved to Carelon.MD Medicaid PT 78-25 (RPM) + PT 71-24 (CoCM)2025-05-152026-05-27policy-confirmed
Massachusetts MassHealthmedicaid_ffs / MARTMany—verify—PHY-170 added RPM codes but did not list RTM; no published RTM determination; verify per-member.MassHealth PHY-170 + Physician Bulletin 103 (BHI)2024-08-012026-05-27unverified
Massachusetts MassHealthmedicaid_ffs / MARPMphysician—prior_authyesPHY-170 (eff 2024-08-01) made 99091/99453/99454/99457/99458 payable by physician/NP/PA/CNS/CNM; prior auth required beyond 9 units of 99454/99457 per 12 months; one provider per 30-day period; 16-day data minimum; FDA-approved device.MassHealth PHY-170 + Physician Bulletin 103 (BHI)2024-08-012026-05-27policy-confirmed
Massachusetts MassHealthmedicaid_ffs / MACCMany—verify—No published standalone CPT CCM FFS determination located; verify per-member.MassHealth PHY-170 + Physician Bulletin 103 (BHI)2024-08-012026-05-27unverified
Massachusetts MassHealthmedicaid_ffs / MABHIphysicianBHcovered—Physician Bulletin 103 + 101 CMR 317.00 cover CoCM 99492/99493/99494 and general BHI 99484 (eff 2021-07-01); BHI and CoCM mutually exclusive in the same month.MassHealth PHY-170 + Physician Bulletin 103 (BHI)2024-08-012026-05-27policy-confirmed
Minnesota Health Care Programsmedicaid_ffs / MNRTMany—verify—MHCP telemonitoring manual addresses physiologic monitoring only; no published RTM determination; verify per-member.MN MHCP Telemonitoring (DHS) + MN Stat 62A.6732024-01-012026-05-27unverified
Minnesota Health Care Programsmedicaid_ffs / MNRPManyHF, COPD, DMcovered—MHCP covers telemonitoring (incl. 99454, U2 modifier) only for high-risk medically-complex members with conditions like CHF, COPD, or diabetes; one device per 5 years; documented likelihood of preventing admission required.MN MHCP Telemonitoring (DHS) + MN Stat 62A.6732024-01-012026-05-27policy-confirmed
Minnesota Health Care Programsmedicaid_ffs / MNCCMany—verify—No published standalone CPT CCM FFS determination located; verify per-member.MN MHCP Telemonitoring (DHS) + MN Stat 62A.6732024-01-012026-05-27unverified
Minnesota Health Care Programsmedicaid_ffs / MNBHIphysicianBHcovered—DHS classifies 99492/99493/99494/G2214 and 99484 as billable BHI services for primary care; FFS pays the first claim per duplicative service per calendar month.MN MHCP Telemonitoring (DHS) + MN Stat 62A.6732024-01-012026-05-27derived
Mississippi Division of Medicaidmedicaid_ffs / MSRTMany—verify—Admin Code Part 225 Ch. 2 addresses physiologic RPM only; no published RTM determination; verify per-member.MS Medicaid Admin Code Title 23 Part 225 (Telemedicine; S9110 RPM)2024-02-012026-05-27unverified
Mississippi Division of Medicaidmedicaid_ffs / MSRPMphysicianDM, HF, COPD, BH, ASTHprior_authyesTitle 23 Part 225 Ch. 2 reimburses RPM via HCPCS S9110 (per-diem; U9 modifier for medication adherence) — NOT standard CPT 99453-99458; must be physician/PA/NP-ordered for a chronic condition and prior authorized via Alliant Health Solutions.MS Medicaid Admin Code Title 23 Part 225 (Telemedicine; S9110 RPM)2024-02-012026-05-27policy-confirmed
Mississippi Division of Medicaidmedicaid_ffs / MSCCMnursing—excluded—FFS care management is delivered only through a 5-condition nurse program (Hep C, hemophilia, HIV/AIDS, postpartum, DCLH) — not billable CPT CCM to physician practices.MS Medicaid Admin Code Title 23 Part 225 (Telemedicine; S9110 RPM)2024-02-012026-05-27derived
Mississippi Division of Medicaidmedicaid_ffs / MSBHIbh—verify—No published CoCM/BHI FFS determination located; BH largely carved to MississippiCAN CCOs; verify per-member.MS Medicaid Admin Code Title 23 Part 225 (Telemedicine; S9110 RPM)2024-02-012026-05-27unverified
Missouri MO HealthNetmedicaid_ffs / MORTMany—verify—MO statute/regs address home telemonitoring only; no published RTM determination; verify per-member.MO HealthNet RSMo 208.686 + 13 CSR 70-3.190 (home telemonitoring)2024-01-012026-05-27unverified
Missouri MO HealthNetmedicaid_ffs / MORPManyHF, HTN, DM, COPD, HDP, GDM, BH, ASTH, AMI, STROKEprior_authyesRSMo 208.686 + 13 CSR 70-3.190 cover home telemonitoring (routed through a URAC-accredited health call center, not standard CPT 99453-99458); restricted to listed conditions AND requires 2+ risk factors.MO HealthNet RSMo 208.686 + 13 CSR 70-3.190 (home telemonitoring)2024-01-012026-05-27policy-confirmed
Missouri MO HealthNetmedicaid_ffs / MOCCMany—verify—No published standalone CPT CCM FFS determination located; verify per-member.MO HealthNet RSMo 208.686 + 13 CSR 70-3.190 (home telemonitoring)2024-01-012026-05-27unverified
Missouri MO HealthNetmedicaid_ffs / MOBHIbh—covered—MO HealthNet Bulletin Vol. 46 No. 54 (eff 2024-04-15) covers interprofessional consultation / behavioral health integration; requires documented participant consent and a consultant with specialized expertise.MO HealthNet RSMo 208.686 + 13 CSR 70-3.190 (home telemonitoring)2024-01-012026-05-27policy-confirmed
Montana Healthcare Programsmedicaid_ffs / MTRTMany—verify—No published RTM policy located; verify per-member.MT DPHHS Telehealth + DME manuals (CGM A4238/A4239)2025-03-062026-05-27unverified
Montana Healthcare Programsmedicaid_ffs / MTRPMany—excluded—The only physiologic RPM covered is continuous glucose monitoring via supply HCPCS A4238/A4239 for diabetes; standard RPM CPT codes 99453/99454/99457/99458/99091 are not on the fee schedule.MT DPHHS Telehealth + DME manuals (CGM A4238/A4239)2025-03-062026-05-27derived
Montana Healthcare Programsmedicaid_ffs / MTCCMany—verify—No published CCM policy located; verify per-member.MT DPHHS Telehealth + DME manuals (CGM A4238/A4239)2025-03-062026-05-27unverified
Montana Healthcare Programsmedicaid_ffs / MTBHIbh—verify—General telehealth parity covers BH outpatient services, but no published CoCM/BHI determination; verify per-member.MT DPHHS Telehealth + DME manuals (CGM A4238/A4239)2025-03-062026-05-27unverified
Nebraska Medicaid (Heritage Health)medicaid_ffs / NERTMany—verify—No published RTM policy located; verify per-member.NE Medicaid 471 NAC Ch. 47 Telehealth (telemonitoring per-diem)2024-06-182026-05-27unverified
Nebraska Medicaid (Heritage Health)medicaid_ffs / NERPManyDMcovered—Telemonitoring paid at a fixed daily per-diem (not CPT 99453/99454/99457), limited to CGM for diabetes and outpatient cardiac rehab with telemetric monitoring; per-diem bundles equipment, review, supplies, and training.NE Medicaid 471 NAC Ch. 47 Telehealth (telemonitoring per-diem)2024-06-182026-05-27policy-confirmed
Nebraska Medicaid (Heritage Health)medicaid_ffs / NECCMany—verify—No published CCM policy located; verify per-member.NE Medicaid 471 NAC Ch. 47 Telehealth (telemonitoring per-diem)2024-06-182026-05-27unverified
Nebraska Medicaid (Heritage Health)medicaid_ffs / NEBHIbh—covered—BH services reimbursable via telehealth under 471 NAC Ch. 47; audio-only limited to established patients; no separate CoCM determination, so coverage is for BH services generally.NE Medicaid 471 NAC Ch. 47 Telehealth (telemonitoring per-diem)2024-06-182026-05-27derived
Nevada Medicaid (DHCFP)medicaid_ffs / NVRTMany—verify—No published RTM policy located; verify per-member.NV Medicaid MSM Chapter 3400 — Telehealth2026-03-312026-05-27unverified
Nevada Medicaid (DHCFP)medicaid_ffs / NVRPMany—excluded—Nevada Medicaid does not reimburse remote patient monitoring; MSM Ch. 3400 covers only live video and store-and-forward (No Reference Found under the RPM section).NV Medicaid MSM Chapter 3400 — Telehealth2026-03-312026-05-27policy-confirmed
Nevada Medicaid (DHCFP)medicaid_ffs / NVCCMany—verify—No published CCM policy located; verify per-member.NV Medicaid MSM Chapter 3400 — Telehealth2026-03-312026-05-27unverified
Nevada Medicaid (DHCFP)medicaid_ffs / NVBHIbh—verify—BH care coordination may use telehealth, but no published CoCM/BHI determination; verify per-member.NV Medicaid MSM Chapter 3400 — Telehealth2026-03-312026-05-27unverified
New Hampshire Medicaidmedicaid_ffs / NHRTMany—verify—RPM codes added 2023-10 but RTM not listed; no published RTM determination; verify per-member.NH Medicaid He-C 5004 + DMS Provider Message (RSA 167:4-d)2023-10-012026-05-27unverified
New Hampshire Medicaidmedicaid_ffs / NHRPManyHF, DM, COPD, HTN, BHcovered—Covers 99453/99454/99457/99458/99091 with no service authorization, but payment is contingent on state-fiscal-year funding availability; eligible conditions include CHF, DM, COPD, HTN, wound care, polypharmacy, BH, pneumonia, and high hospitalization risk.NH Medicaid He-C 5004 + DMS Provider Message (RSA 167:4-d)2023-10-012026-05-27policy-confirmed
New Hampshire Medicaidmedicaid_ffs / NHCCMany—verify—No published CCM policy located; verify per-member.NH Medicaid He-C 5004 + DMS Provider Message (RSA 167:4-d)2023-10-012026-05-27unverified
New Hampshire Medicaidmedicaid_ffs / NHBHIbh—covered—BH services reimbursable via telehealth (He-C 5004); no separate CoCM code determination, so coverage is for BH services generally.NH Medicaid He-C 5004 + DMS Provider Message (RSA 167:4-d)2023-10-012026-05-27derived
New Jersey Medicaid (NJ FamilyCare)medicaid_ffs / NJRTMany—covered—The NJ MAPS minimum fee schedule explicitly includes remote physiologic and therapeutic monitoring codes, bringing RTM under coverage at in-person parity; confirm individual codes via the MAPS manual.NJ FamilyCare — N.J.S.A. 30:4D-6k + MAPS fee schedule2026-01-012026-05-27derived
New Jersey Medicaid (NJ FamilyCare)medicaid_ffs / NJRPMany—covered—Statute bars denial of routine telehealth monitoring reimbursable in person; the MAPS fee schedule lists remote physiologic monitoring codes at in-person parity, no dx restriction documented.NJ FamilyCare — N.J.S.A. 30:4D-6k + MAPS fee schedule2026-01-012026-05-27derived
New Jersey Medicaid (NJ FamilyCare)medicaid_ffs / NJCCMany—verify—No published CCM-specific policy located; telehealth parity may apply but verify per-member.NJ FamilyCare — N.J.S.A. 30:4D-6k + MAPS fee schedule2026-01-012026-05-27unverified
New Jersey Medicaid (NJ FamilyCare)medicaid_ffs / NJBHIbh—verify—Telepsychiatry/BH telehealth covered, but no published CoCM/BHI determination; verify per-member.NJ FamilyCare — N.J.S.A. 30:4D-6k + MAPS fee schedule2026-01-012026-05-27unverified
New Mexico Medicaid (Turquoise Care)medicaid_ffs / NMRTMany—verify—No published RTM policy located; NM Medicaid is overwhelmingly managed care; verify per-member/MCO.NM Medicaid (Turquoise Care) — MAD Telemedicine Guidance2025-02-132026-05-27unverified
New Mexico Medicaid (Turquoise Care)medicaid_ffs / NMRPMany—verify—CCHP shows No Reference Found for Medicaid RPM; remote monitoring is a contractual Turquoise Care MCO offering but no FFS RPM CPT determination is published; verify per-member/MCO.NM Medicaid (Turquoise Care) — MAD Telemedicine Guidance2025-02-132026-05-27unverified
New Mexico Medicaid (Turquoise Care)medicaid_ffs / NMCCMany—verify—No published CCM determination located in NM MAD guidance or fee schedule; verify per-member.NM Medicaid (Turquoise Care) — MAD Telemedicine Guidance2025-02-132026-05-27unverified
New Mexico Medicaid (Turquoise Care)medicaid_ffs / NMBHIbh—verify—BH is integrated/administered through Turquoise Care MCOs; no published FFS CoCM determination; verify per-MCO.NM Medicaid (Turquoise Care) — MAD Telemedicine Guidance2025-02-132026-05-27unverified
North Dakota Medicaidmedicaid_ffs / NDRTMany—verify—No published RTM policy located; verify per-member.ND Medicaid Provider Manual — Home Health Telemonitoring2025-01-012026-05-27unverified
North Dakota Medicaidmedicaid_ffs / NDRPMnursingHTN, DMprior_authyesND reimburses RPM only as Home Health Telemonitoring (capped at 40% of visits/cert period) plus self-monitored BP (99473/99474/A4670) and glucose monitoring as DME — the standard RPM CPT family is not reimbursed under a general benefit.ND Medicaid Provider Manual — Home Health Telemonitoring2025-01-012026-05-27derived
North Dakota Medicaidmedicaid_ffs / NDCCMany—verify—No published CCM determination located; verify per-member.ND Medicaid Provider Manual — Home Health Telemonitoring2025-01-012026-05-27unverified
North Dakota Medicaidmedicaid_ffs / NDBHIbh—verify—No published BHI/CoCM determination located; verify per-member.ND Medicaid Provider Manual — Home Health Telemonitoring2025-01-012026-05-27unverified
Oklahoma SoonerCaremedicaid_ffs / OKRTMany—verify—No published RTM policy located; verify per-member.OK SoonerCare — OAC 317:30-3-27 Telehealth2024-09-012026-05-27unverified
Oklahoma SoonerCaremedicaid_ffs / OKRPMany—verify—OAC 317:30-3-27 defines RPM as a telehealth modality but reimburses only services compensable by OHCA; only CGM and extended cardiac monitoring are named — the 9945x family is not itemized; verify against the OHCA fee schedule.OK SoonerCare — OAC 317:30-3-27 Telehealth2024-09-012026-05-27unverified
Oklahoma SoonerCaremedicaid_ffs / OKCCMany—verify—No published CCM determination located in the OHCA rule or fee schedule; verify per-member.OK SoonerCare — OAC 317:30-3-27 Telehealth2024-09-012026-05-27unverified
Oklahoma SoonerCaremedicaid_ffs / OKBHIbh—verify—No published BHI/CoCM determination located; verify per-member.OK SoonerCare — OAC 317:30-3-27 Telehealth2024-09-012026-05-27unverified
Oregon Health Planmedicaid_ffs / ORRTMany—verify—No published RTM determination on the OHP fee schedule; verify per-member/CCO.Oregon Health Plan — ORS 414.723 (telemedicine parity)2026-04-072026-05-27unverified
Oregon Health Planmedicaid_ffs / ORRPMany—covered—ORS 414.723 mandates equal reimbursement for services delivered via remote-monitoring data, so RPM is payable, but code-level coverage is gated by the Prioritized List and the member CCO; confirm the code is on the FFS medical fee schedule.Oregon Health Plan — ORS 414.723 (telemedicine parity)2026-04-072026-05-27derived
Oregon Health Planmedicaid_ffs / ORCCMany—verify—No published CCM determination on the OHP fee schedule / Prioritized List; verify per-member/CCO.Oregon Health Plan — ORS 414.723 (telemedicine parity)2026-04-072026-05-27unverified
Oregon Health Planmedicaid_ffs / ORBHIbh—verify—CoCM codes recognized in the integrated-care context and BH paid via the OHA Behavioral Health Fee Schedule, but no OHP-specific covered-code determination located; verify per-member/CCO.Oregon Health Plan — ORS 414.723 (telemedicine parity)2026-04-072026-05-27unverified
Rhode Island Medicaid (EOHHS)medicaid_ffs / RIRTMany—verify—No published RTM policy located; verify per-member.RI EOHHS — Telemedicine Billing Guidance2025-05-192026-05-27unverified
Rhode Island Medicaid (EOHHS)medicaid_ffs / RIRPMany—verify—CCHP shows No Reference Found for Medicaid RPM and RI store-and-forward is limited to teledentistry; no published RPM CPT determination; verify per-member.RI EOHHS — Telemedicine Billing Guidance2025-05-192026-05-27unverified
Rhode Island Medicaid (EOHHS)medicaid_ffs / RICCMany—verify—No published CCM determination located in RI EOHHS guidance; verify per-member.RI EOHHS — Telemedicine Billing Guidance2025-05-192026-05-27unverified
Rhode Island Medicaid (EOHHS)medicaid_ffs / RIBHIbh—verify—RI covers live-video BH but no published BHI/CoCM determination; verify per-member.RI EOHHS — Telemedicine Billing Guidance2025-05-192026-05-27unverified
South Carolina Healthy Connectionsmedicaid_ffs / SCRTMany—verify—No published RTM policy located; verify per-member.SC Healthy Connections — HCBS/MTCM/CMHS manuals (Bulletin 24-070)2024-12-182026-05-27unverified
South Carolina Healthy Connectionsmedicaid_ffs / SCRPMphysician—verify—SC has no standard RPM CPT FFS policy; only HCBS-waiver telemonitoring and DME/pharmacy CGM (diabetes, PA + prescriber) are published; verify per-member.SC Healthy Connections — HCBS/MTCM/CMHS manuals (Bulletin 24-070)2024-12-182026-05-27unverified
South Carolina Healthy Connectionsmedicaid_ffs / SCCCMany—verify—No standard CCM CPT policy; only Targeted Case Management (T1016) is published; verify per-member.SC Healthy Connections — HCBS/MTCM/CMHS manuals (Bulletin 24-070)2024-12-182026-05-27unverified
South Carolina Healthy Connectionsmedicaid_ffs / SCBHIbh—covered—BH (incl. collaborative care) permanently covered via telehealth with the GT modifier under SC CMHS/RBHS manuals (Bulletin 24-070); specific CoCM CPT codes not enumerated.SC Healthy Connections — HCBS/MTCM/CMHS manuals (Bulletin 24-070)2024-12-182026-05-27derived
South Dakota Medicaidmedicaid_ffs / SDRTMany—verify—SD Telemedicine manual addresses RPM only; no published RTM determination; verify per-member.SD Medicaid Telemedicine + Physician Services manual2023-10-012026-05-27unverified
South Dakota Medicaidmedicaid_ffs / SDRPMphysicianASTH, HF, HTN, COPD, DM, GDM, COVIDcovered—RPM permanently covered since 2023-10-01 (99091/99457/99458), ordered/billed only by MD/PA/NP/CNM, restricted to listed acute/chronic conditions with a newly-diagnosed-under-6-months or 2+ ED/hospitalization criterion + consent.SD Medicaid Telemedicine + Physician Services manual2023-10-012026-05-27policy-confirmed
South Dakota Medicaidmedicaid_ffs / SDCCMphysician—covered—CCM (99487-99496 range) listed as a covered care-management service via telephone/internet/EHR per the SD Physician Services manual.SD Medicaid Telemedicine + Physician Services manual2023-10-012026-05-27policy-confirmed
South Dakota Medicaidmedicaid_ffs / SDBHIphysician—covered—BHI 99484 listed as a covered care-management service per the SD Physician Services manual; CoCM 99492-99494/G2214 not separately enumerated.SD Medicaid Telemedicine + Physician Services manual2023-10-012026-05-27policy-confirmed
Tennessee TennCaremedicaid_ffs / TNRTMany—verify—No published RTM policy located; TennCare is fully managed care; verify per-member/MCO.TennCare — TN Code 56-7-1011 + MCO telehealth policies2024-12-312026-05-27unverified
Tennessee TennCaremedicaid_ffs / TNRPMany—verify—TN statute permits RPM if covered by Medicare, but TennCare is fully managed care with no FFS code-level determination or rates published; verify per MCO/member.TennCare — TN Code 56-7-1011 + MCO telehealth policies2024-12-312026-05-27unverified
Tennessee TennCaremedicaid_ffs / TNCCMany—verify—No published CCM FFS determination; TennCare coverage governed by individual MCO policies; verify per-member.TennCare — TN Code 56-7-1011 + MCO telehealth policies2024-12-312026-05-27unverified
Tennessee TennCaremedicaid_ffs / TNBHIany—verify—No published BHI/CoCM FFS code-level determination; BH delivered through TennCare MCOs; verify per-member.TennCare — TN Code 56-7-1011 + MCO telehealth policies2024-12-312026-05-27unverified
Utah Medicaidmedicaid_ffs / UTRTMany—verify—Utah manual names RPM but not RTM; no published RTM determination; verify per-member.Utah Medicaid Provider Manual Section I (async excluded)2026-01-012026-05-27unverified
Utah Medicaidmedicaid_ffs / UTRPMany—excluded—Utah Medicaid Provider Manual Section I (Jan 2026) classifies remote patient monitoring as asynchronous communication and states Medicaid does not cover asynchronous telehealth, excluding 99453/99454/99457/99458.Utah Medicaid Provider Manual Section I (async excluded)2026-01-012026-05-27policy-confirmed
Utah Medicaidmedicaid_ffs / UTCCMany—verify—Non-real-time care management would fall under the excluded asynchronous category but no code-level CCM policy is published; verify per-member.Utah Medicaid Provider Manual Section I (async excluded)2026-01-012026-05-27unverified
Utah Medicaidmedicaid_ffs / UTBHIbh—verify—Synchronous BH is covered via telehealth, but no published code-level determination for CoCM/BHI; verify per-member.Utah Medicaid Provider Manual Section I (async excluded)2026-01-012026-05-27unverified
Vermont Medicaid (Green Mountain Care)medicaid_ffs / VTRTMany—verify—No published RTM policy located; verify per-member.VT Medicaid — HCAR 13.174.003 + Home Health Supplement (33 V.S.A. 1901g)2025-11-142026-05-27unverified
Vermont Medicaid (Green Mountain Care)medicaid_ffs / VTRPMnursingHF, HTN, DMprior_authyesVT mandates home telemonitoring (99091/99453/99454, rev code 0780) via home health agencies for serious/chronic conditions, restricted to CHF/HTN/diabetes, delivered by RN/NP/CNS/LPN with physician plan of care and prior authorization.VT Medicaid — HCAR 13.174.003 + Home Health Supplement (33 V.S.A. 1901g)2025-11-142026-05-27policy-confirmed
Vermont Medicaid (Green Mountain Care)medicaid_ffs / VTCCMany—verify—VT telehealth/home-health rules address telemonitoring only; no published CCM determination; verify per-member.VT Medicaid — HCAR 13.174.003 + Home Health Supplement (33 V.S.A. 1901g)2025-11-142026-05-27unverified
Vermont Medicaid (Green Mountain Care)medicaid_ffs / VTBHIany—verify—No published BHI/CoCM code-level determination located; verify per-member.VT Medicaid — HCAR 13.174.003 + Home Health Supplement (33 V.S.A. 1901g)2025-11-142026-05-27unverified
Virginia Medicaid (Cardinal Care)medicaid_ffs / VARTMany—prior_authyesRTM codes 98975-98981 explicitly covered alongside RPM (5/1/2022 bulletin); service authorization required and limited to eligible populations (medically complex under 21, transplant, post-surgical, chronic with 2+ hospitalizations/ED in 12 months, high-risk pregnancy).VA Cardinal Care — DMAS RPM/Telehealth Services Supplement2022-05-012026-05-27policy-confirmed
Virginia Medicaid (Cardinal Care)medicaid_ffs / VARPMany—prior_authyesRPM 99453/99454/99457/99458/99091 covered with prior auth via Kepro/Atrezzo; eligibility is population-based (medically complex under 21, transplant, post-surgical, chronic with 2+ hospitalizations/ED, high-risk pregnancy), not a simple ICD allowlist.VA Cardinal Care — DMAS RPM/Telehealth Services Supplement2022-05-012026-05-27policy-confirmed
Virginia Medicaid (Cardinal Care)medicaid_ffs / VACCMany—verify—No published CCM determination located in the DMAS Telehealth Supplement; verify per-member.VA Cardinal Care — DMAS RPM/Telehealth Services Supplement2022-05-012026-05-27unverified
Virginia Medicaid (Cardinal Care)medicaid_ffs / VABHIbh—verify—BH is carved out to the DMAS BHSA and MCOs; no published CoCM/BHI FFS determination; verify per-member.VA Cardinal Care — DMAS RPM/Telehealth Services Supplement2022-05-012026-05-27unverified
West Virginia Medicaid (BMS)medicaid_ffs / WVRTMany—verify—No published RTM policy located; remote-monitoring code family is generally absent from the WV FFS fee schedule; verify per-member.WV BMS Provider Manual Ch. 519 Policy 519.17 (Telehealth)2022-01-012026-05-27unverified
West Virginia Medicaid (BMS)medicaid_ffs / WVRPMany—excluded—RPM codes do not appear on the WV Medicaid FFS fee schedule and there is no published RPM reimbursement policy under Policy 519.17.WV BMS Provider Manual Ch. 519 Policy 519.17 (Telehealth)2022-01-012026-05-27derived
West Virginia Medicaid (BMS)medicaid_ffs / WVCCMany—verify—No published CCM policy located in WV BMS Practitioner Services manuals; verify per-member.WV BMS Provider Manual Ch. 519 Policy 519.17 (Telehealth)2022-01-012026-05-27unverified
West Virginia Medicaid (BMS)medicaid_ffs / WVBHIbh—verify—BH telehealth covered via live video, but no specific CoCM/BHI FFS determination is published; verify per-member.WV BMS Provider Manual Ch. 519 Policy 519.17 (Telehealth)2022-01-012026-05-27unverified
Wisconsin Medicaid (ForwardHealth)medicaid_ffs / WIRTMany—verify—ForwardHealth publishes a Remote Physiologic Monitoring benefit (99453-99458 only); no RTM determination is published; verify per-member.WI ForwardHealth Topic #22737 — Remote Physiologic Monitoring2023-01-012026-05-27unverified
Wisconsin Medicaid (ForwardHealth)medicaid_ffs / WIRPMphysician—covered—Remote Physiologic Monitoring covered for 99453/99454/99457/99458 only (not 99091); only physicians, NPs, and PAs enrolled in Medicaid may render/bill; codes bundled elsewhere (e.g., CGM under 95250) are not separately payable.WI ForwardHealth Topic #22737 — Remote Physiologic Monitoring2023-01-012026-05-27policy-confirmed
Wisconsin Medicaid (ForwardHealth)medicaid_ffs / WICCMany—verify—No published CCM determination located in ForwardHealth policy; verify per-member.WI ForwardHealth Topic #22737 — Remote Physiologic Monitoring2023-01-012026-05-27unverified
Wisconsin Medicaid (ForwardHealth)medicaid_ffs / WIBHIbh—verify—BH delivered via standard telehealth and not carved out, but no specific CoCM/BHI FFS determination is published; verify per-member.WI ForwardHealth Topic #22737 — Remote Physiologic Monitoring2023-01-012026-05-27unverified
Wyoming Medicaidmedicaid_ffs / WYRTMany—verify—WY telehealth excludes asynchronous/store-and-forward monitoring, so RTM is unlikely but not formally addressed; verify per-member.Wyoming Medicaid — Telehealth policy (CCHP profile)2025-10-012026-05-27unverified
Wyoming Medicaidmedicaid_ffs / WYRPMany—excluded—WY Medicaid does not reimburse remote patient monitoring (CCHP: RPM = No) and defines telehealth as real-time interactive audio/video, excluding asynchronous monitoring.Wyoming Medicaid — Telehealth policy (CCHP profile)2025-10-012026-05-27derived
Wyoming Medicaidmedicaid_ffs / WYCCMany—verify—No published CCM determination located in WY Medicaid provider manuals; verify per-member.Wyoming Medicaid — Telehealth policy (CCHP profile)2025-10-012026-05-27unverified
Wyoming Medicaidmedicaid_ffs / WYBHIbh—verify—BH governed by the separate WY Behavioral Health Division manual; no specific CoCM/BHI determination located; verify per-member.Wyoming Medicaid — Telehealth policy (CCHP profile)2025-10-012026-05-27unverified
District of Columbia Medicaid (DHCF)medicaid_ffs / DCRTMany—verify—DC FFS does not reimburse remote patient monitoring, so RTM is unlikely but not separately addressed; verify per-member.DC DHCF — DCMR Title 29 Ch. 9 §910.29 + Telemedicine Guidance2023-01-012026-05-27unverified
District of Columbia Medicaid (DHCF)medicaid_ffs / DCRPMany—excluded—DCMR Title 29 §910.29 / DHCF Telemedicine Guidance: there is no reimbursement for remote patient monitoring under DC Medicaid FFS.DC DHCF — DCMR Title 29 Ch. 9 §910.29 + Telemedicine Guidance2023-01-012026-05-27policy-confirmed
District of Columbia Medicaid (DHCF)medicaid_ffs / DCCCMany—verify—No published CCM determination located in DC DHCF policy; verify per-member.DC DHCF — DCMR Title 29 Ch. 9 §910.29 + Telemedicine Guidance2023-01-012026-05-27unverified
District of Columbia Medicaid (DHCF)medicaid_ffs / DCBHIbh—verify—BH administered via DBH-certified providers (DCMR Title 22 Ch. 34); no specific CoCM/BHI FFS determination located; verify per-member.DC DHCF — DCMR Title 29 Ch. 9 §910.29 + Telemedicine Guidance2023-01-012026-05-27unverified