Remote Physiologic Monitoring (RPM)

Number: 1093

Table Of Contents

Policy
Applicable CPT / HCPCS / ICD-10 Codes
Background
References

Policy

Scope of Policy

This Clinical Policy Bulletin addresses remote physiologic monitoring (RPM) services.

  1. Medical Necessity

    Aetna considers RPM services medically necessary when all of the following criteria are met:

    1. The member has one of the following conditions that requires regular monitoring and management:

      1. Heart failure
      2. Hypertension
      3. Diabetes;
    2. The member is provided with an FDA-approved/cleared device capable of automatic data transmission;
    3. The data collected is used to inform and adjust the member's treatment plan;
    4. Services are ordered and supervised by a qualified healthcare professional;
    5. Documentation of patient consent for RPM services is present in the medical record.

  2. Experimental, Investigational, or Unproven

    Aetna considers RPM experimental, investigational, or unproven for all of the following:

    1. For conditions other than those noted as medically necessary above
    2. RPM using devices that are not approved or cleared by the FDA.

  3. Policy Limitations and Exclusions

    RPM is not covered for the following:

    1. Devices not approved or cleared by the FDA
    2. Devices that do not meet FDA medical device criteria (e.g., general wellness trackers/apps used solely for lifestyle)
    3. Data collected manually by the patient and not automatically transmitted
    4. Services not ordered or supervised by a qualified provider
    5. Situations where RPM does not impact clinical management
    6. The service is solely for wellness, lifestyle, or preventive self‑tracking (non‑medical use).

    Coverage is limited to one episode of RPM per patient per condition per provider per month. 

  4. Related Policies

Table:

CPT Codes / HCPCS Codes / ICD-10 Codes

Code Code Description

CPT codes covered if selection criteria are met:
99453 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
99454      device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
99457 Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
99458      each additional 20 minutes (List separately in addition to code for primary procedure)

Other CPT codes related to the CPB:
98975 Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); initial set-up and patient education on use of equipment
98976      device(s) supply for data access or data transmissions to support monitoring of respiratory system, each 30 days
98977      device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, each 30 days
98978      device(s) supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, each 30 days
98979 Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; first 10 minutes
98984 Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 2-15 days in a 30-day period
98985      device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 2-15 days in a 30-day period
98986      device(s) supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, 2-15 days in a 30-day period
99445 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 2-15 days in a 30-day period
99470 Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring 1 real-time interactive communication with the patient/caregiver during the calendar month; first 10 minutes

ICD-10 codes covered if selection criteria are met:
E08.00 - E13.9 Diabetes mellitus
I10 Essential (primary) hypertension
I1A.0 Resistant hypertension
I15.0 - I15.9 Secondary hypertension
I50.1 - I50.9 Heart failure

Background

Remote physiologic monitoring (RPM) refers to non–face-to-face services that use a connected medical device to collect physiologic data and automatically upload it for review and treatment management by the clinician. RPM is distinguished from remote therapeutic monitoring (RTM), based on measurement of non‑physiologic measures (e.g., medication adherence, musculoskeletal/respiratory status). This policy focuses on RPM.

RPM has been primarily used for patients with chronic diseases where frequent monitoring can improve clinical outcomes or reduce healthcare utilization. The best evidence and consensus support RPM for heart failure and hypertension. There is also evidence for RPM in COPD and diabetes. 

RPM is less well established for other conditions, such as asthma, sleep apnea, specialist maternity care, and children with complex needs, where evidence for clinical benefit is limited or insufficient. RPM has also been used for elderly patients with multiple comorbidities who may benefit from closer surveillance to prevent hospitalizations or complications.

Remote patient monitoring is standard for patients with cardiac implantable electronic devices such as pacemakers and defibrillators. New technologies are being developed for monitoring heart failure status (e.g., pulmonary artery pressure sensors) and arrhythmias (e.g., atrial fibrillation). The evidence supporting particular devices is addressed in the Aetna Clinical Policy Bulletins (CPBs) specific for those technologies.

Heart Failure

For heart failure, RPM is used post-discharge to reduce readmissions and mortality, typically involving daily monitoring of weight, blood pressure, heart rate, and symptoms.

RPM for patients with heart failure is supported by substantial evidence demonstrating reductions in all-cause mortality and heart failure-related hospitalizations compared to usual care. Meta-analyses show that RPM is associated with a 15-19% reduction in heart failure hospitalizations and a 16% reduction in all-cause mortality. These benefits are most pronounced in patients with recent heart failure hospitalization or those at higher risk (Scholte, et al., 2023; Masotta, et al., 2024; Kitsiou, et al., 2015; Klersy, et al., 2019; Bashi, et al., 2017; Mhanna, et al., 2022).

Randomized controlled trials including TIM-HF2 have shown that structured RPM interventions can reduce days lost to unplanned cardiovascular hospitalizations and all-cause death, with a hazard ratio for all-cause mortality of 0.70 (95% CI 0.50-0.96) (Koehler, et al., 2018). However, not all trials have demonstrated benefit, and effectiveness depends on program design, patient engagement, and timely clinical response to transmitted data (Schwamm, et al., 2017; Masterson, et al., 2023).

RPM for heart failure is primarily indicated in selected adults with NYHA class III heart failure who have had a recent heart failure hospitalization, are on maximally tolerated guideline-directed medical therapy, and have optimal device therapy (Heidenreich, et al., 2022; Radhoe, et al., 2021; Stevenson, et al., 2023).

Modeling studies indicate that targeting RPM to higher-risk patients (e.g., NYHA class II–IV) is the most cost-effective approach. Systematic reviews confirm that RPM is generally cost-effective for heart failure, though results can vary depending on disease severity, program design, and local healthcare costs (De Guzman, et al., 2021).

The American College of Cardiology, American Heart Association, and Heart Failure Society of America note in their 2022 guideline that remote monitoring (including noninvasive telemonitoring and implantable hemodynamic sensors) may be considered in selected patients, but the value of these interventions remains uncertain due to heterogeneity in study results and patient populations (Heidenreich, et al., 2022). The AHA further emphasizes that RPM is most effective when integrated into a health maintenance strategy, rather than crisis management alone, and when multiple physiological measures are monitored (Masterson, et al., 2023).

Hypertension

For hypertension, RPM is used to track blood pressure, with the goal of improving disease control and early detection of deterioration.

The evidence for RPM for hypertension focuses on improvements in blood pressure control compared to usual care. Meta-analyses of randomized controlled trials show that RPM, including telemonitoring of home blood pressure, results in greater reductions in both systolic and diastolic blood pressure than office-based management alone. A network meta-analysis found that telemonitoring led to a mean reduction in systolic blood pressure of 3.7 mmHg and diastolic blood pressure of 1.8 mmHg compared to usual care, with similar benefits for home blood pressure monitoring (Grover, et al., 2025).

Evidence suggests that RPM for hypertension is most effective when integrated into a multidisciplinary management strategy. The benefit is most pronounced when RPM is combined with clinical support, such as pharmacist or nurse management, patient education, and medication titration (Shimbo, et al., 2020; Reboussin, et al., 2018; McManus, et al., 2018).

The impact of RPM is greater in patients with poorly controlled hypertension or high cardiovascular risk (Reboussin, et al., 2018; Shimbo, et al., 2020). RPM is recommended as a diagnostic tool for patients with suspected white-coat or masked hypertension (USPSTF, 2021). It is also used for improving the management of adults with uncontrolled office blood pressure, especially those at high cardiovascular risk, with greater benefit when integrated into structured, multidisciplinary care models (Whelton, et al., 2018; Abdalla, et al., 2023; Shimbo, et al., 2020; Omboni, et al., 2020; McGrath, et al., 2023).

There is evidence that RPM for hypertension is cost-effective compared to usual care, though intervention costs can be higher than usual care (Shimbo, et al., 2020). An analysis of cluster-randomized trials concluded that that RPM with pharmacist management may reduce cardiovascular events and generate net cost savings over five years, with a return on investment exceeding 100% (Margolis, et al., 2020).

The American College of Cardiology and American Heart Association recommend telehealth strategies as useful adjuncts for adults with hypertension, noting that telemonitoring interventions consistently achieve greater blood pressure reductions and higher rates of blood pressure control than self-monitoring without data transmission or usual care (Whelton, et al., 2018). 

The 2025 ACC/AHA hypertension guidelines recommend remote physiologic monitoring, including telemonitoring and remote BP data transfer, as part of comprehensive blood pressure management in adults (Jones, et al., 2025). The guidelines specifically endorse out-of-office blood pressure monitoring, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), and recommend the use of telemonitoring and remote BP data transfer between patients and healthcare teams to improve blood pressure control compared with standard office-based care.

Diabetes

For diabetes, RPM is used to track glucose, with the goal of improving disease control and early detection of deterioration.

The evidence for RPM in diabetes focuses on improvements in glycemic control, particularly in patients with type 2 diabetes and persistently poor control. Meta-analyses and randomized controlled trials show that RPM interventions (such as telemonitoring of blood glucose, remote medication management, and digital self-management support) lead to modest reductions in HbA1c compared to usual care, with mean differences ranging from -0.3% to -0.6% and greater effects in high-risk populations (Cai, et al., 2023; Kim, et al., 2019; Lee, et al., 2018; Michaud, et al., 2019).

RPM for diabetes is indicated for patients with uncontrolled glycemia, those requiring frequent medication adjustments, and individuals with barriers to in-person care, including rural or under-resourced populations, particularly when integrated with team-based care, counseling, and regular feedback loops from clinicians or diabetes educators (ADA, 2025, Sawyer, et al., 2025; Aleppo, et al., 2023; Park, et al., 2023; Crowley, et al., 2022).

There is evidence that RPM for diabetes can be cost-effective, but findings are mixed and context-dependent. Systematic reviews and meta-analyses indicate that while some studies demonstrate cost savings or favorable incremental cost-effectiveness ratios (ICERs) for RPM interventions, other studies report that RPM may not be cost-effective, especially when intervention costs are high or when clinical benefits are modest (De Guzman, et al., 2022; Emonena, 2022; Ben-Assuli, 2022; Warren, et al., 2018; Alfarwan, et al., 2024; Lee & Lee, 2018; Crowley, et al., 2022).

The American Diabetes Association, in its 2025 Standards of Care, states that telehealth and RPM should complement in-person visits and can enhance timely access to diabetes care, improve glycemic management, and facilitate diabetes self-management education and support, especially for those with limited access to specialty care (ADA, 2025). The American Association of Clinical Endocrinology also notes that telemedicine and RPM are well suited for diabetes management, with evidence supporting improvements in HbA1c, medication adherence, and diabetes-related distress in both type 1 and type 2 diabetes (Grunberger, et al., 2021).

Section 7, "Diabetes Technology: Standards of Care in Diabetes-2025," from the American Diabetes Association (ADA) guidelines endorse the use of digital health technologies that enable remote monitoring and data sharing as part of comprehensive diabetes care. This includes the use of CGM and other devices that transmit physiologic data to healthcare teams for review and management. The guidelines indicate that combining technology (CGM, insulin pumps, and/or diabetes apps) with online or virtual coaching can improve glycemic outcomes in individuals with diabetes or prediabetes. They also note that many programs aim to improve diabetes outcomes by remotely monitoring clinical data (e.g., wireless monitoring of glucose levels, weight, or blood pressure) and providing feedback and coaching. The guidelines also state that education and training for device use can be delivered either in person or remotely, and emphasize the importance of ongoing evaluation of technique and the ability to utilize data, including uploading or sharing data to monitor and adjust therapy.

Chronic Obstructive Pulmonary Disease (COPD)

For COPD, RPM involves telemonitoring of symptoms, spirometry and pulse oximetry.

The evidence for RPM in COPD is mixed, with modest benefits in specific domains and patient populations. Systematic reviews and meta-analyses indicate that RPM may reduce COPD-related hospital readmissions and emergency room visits, particularly in patients with a history of frequent exacerbations, but does not consistently improve health-related quality of life, dyspnea, or all-cause hospitalizations compared to usual care (Janjua, et al., 2021; Koh, et al., 2023; Nagase, et al., 2022; Lu, et al., 2018; Glyde, et al., 2024).

Some studies show that RPM combined with health coaching or multi-component interventions can improve disease-specific quality of life and self-management in the short term, but these effects are not always sustained (Koh, et al., 2023; Benzo, et al., 2022).

RPM for COPD has focused on patients at increased risk of exacerbations, those with frequent hospitalizations or emergency visits, individuals with severe disease or limited access to in-person care, and patients who may benefit from early detection of clinical deterioration or exacerbations (Kohr, et al., 2025; Contu, et al., 2023).

There is evidence that RPM for COPD can be cost-effective, but results are variable and context-dependent. Some economic analyses demonstrate affordability or cost savings, while others report higher expenditures due to increased outpatient contacts, drug prescriptions, and monitoring costs, especially early in the intervention (Ferreira, et al., 2024; De Guzman, et al., 2022; Hofer, et al., 2022).

The American Thoracic Society notes that home-based monitoring (including spirometry and pulse oximetry) is generally acceptable to patients and can help identify exacerbations, but the impact on long-term outcomes and cost-effectiveness remains uncertain (Khor, et al., 2025). The American College of Chest Physicians and Canadian Thoracic Society guideline states that telemonitoring is feasible and acceptable, but evidence for reducing hospital admissions or exacerbations is inconsistent, likely due to heterogeneity in intervention design and patient selection (Criner, et al., 2015).

The 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2025) guideline acknowledges telehealth and remote monitoring as potential adjuncts to usual care, with the caveat that current evidence does not demonstrate clear superiority over traditional management. The guideline reviews the available evidence, including a recent Cochrane review, and notes that remote monitoring (such as transferring physiologic measurements for health professional review) has not shown consistent benefits in reducing exacerbations, hospitalizations, or improving health status and mortality compared to usual care. While there is no evidence of harm, the guideline states that it remains unclear which COPD subgroups might benefit from telehealth interventions, and the long-term effects are unknown. 

RPM for Elderly Patients

RPM of elderly patients with multiple comorbidities typically entails the use of digital systems (often including wearable devices and home-based sensors) to collect and transmit health data from the patient’s home to healthcare providers for ongoing assessment and early intervention. Systematic reviews confirm that RPM for elderly patients with multiple diseases yields some patient-relevant clinical benefits, though the overall evidence base is limited and further research is needed to clarify long-term outcomes and risks (Sahin, et al., 2024; Wartenberg, et al., 2025; Kraef, et al., 2020; Felix, et al., 2023). Meta-analyses of telemedicine interventions in multimorbid populations demonstrate moderate improvements in disease control parameters (e.g., blood pressure, HbA1c, cholesterol), but little evidence for improvements in overall health status or quality of life (Kraef, et al., 2020). 

Obstructive Sleep Apnea

There is evidence that RPM in patients with sleep apnea treated with continuous positive airway pressure (CPAP) improves adherence to therapy and can reduce the need for in-person visits (Dusart, et al., 2022; Murphie, et al., 2019; Martinotti, et al., 2025; Schisano, et al., 2024). The American Academy of Sleep Medicine suggests that telemonitoring-guided interventions during the initial period of PAP therapy in adults with OSA improve adherence, with moderate-quality evidence showing clinically significant increases in nightly CPAP use compared to standard care (Patil, et al., 2019). However, telemonitoring does not consistently improve sleepiness or quality of life, and the impact on long-term clinical outcomes remains less clear.

Asthma

RPM in patients with asthma is supported by moderate-quality evidence for improving intermediary outcomes such as adherence to maintenance inhalers, inhaler technique, and asthma control, but there is limited and inconsistent evidence for reductions in asthma exacerbations, emergency department visits, or hospitalizations (Mosnaiam, et al., 2025; Kew & Cates, 2016; Fadaizadeh, et al., 2024; Mosniam, et al., 2024; Mendoza, et al., 2025). Randomized controlled trials and systematic reviews show that remote monitoring can lead to small improvements in quality of life and lung function, but the magnitude of benefit is variable and often subject to risk of bias (Kew & Cates, 2016; Fadaizadeh, et al., 2024; Nemanic, Et al., 2019; . The American Academy of Allergy, Asthma, and Immunology highlights the utility of home peak flow and spirometry monitoring as adjuncts to telemedicine, especially for longitudinal assessment and early detection of exacerbations, but notes that these do not replace in-clinic spirometry and should be interpreted with caution (Virant, et al., 2022). The American Thoracic Society finds home spirometry to be valid and acceptable for adults with asthma, though effects on disease management and adverse events are underreported (Khor, et al., 2025). The Global Initiative for Asthma (GINA, 2024) acknowledges increasing interest and potential benefit of remote monitoring, especially for patients with more severe asthma. The GINA report discusses self-monitoring of symptoms and peak expiratory flow (PEF), noting that internet or phone-based monitoring may be beneficial for patients with severe or difficult-to-control asthma, but this is based on existing studies and is not presented as a universal recommendation. The report also notes the rapid increase in the use of digital technology, telemedicine, and telehealthcare for asthma monitoring, particularly since the COVID-19 pandemic, but emphasizes that high-quality studies are still needed to evaluate their effectiveness and utility.

Hypertensive Disorders of Pregnancy

Remote blood pressure monitoring for hypertensive disorders of pregnancy is feasible and may reduce healthcare utilization, but current evidence does not show clear improvement in maternal or fetal clinical outcomes compared to standard care. Systematic reviews and meta-analyses indicate that antenatal remote blood pressure monitoring may reduce outpatient visits and hospital admissions for hypertension without increasing adverse maternal or fetal outcomes; however, there is no evidence of improved rates of preeclampsia, cesarean delivery, or other major outcomes (Rajkumar, et al., 2025; Healy, et al., 2023). Postpartum, there is evidence that remote monitoring increases compliance with guideline-recommended follow-up and may reduce readmissions, with patient satisfaction and engagement (Rajkumar, et al., 2025; Healy, et al., 2023; Lewkowitz & Hauspurg, 2024). Large randomized trials, such as BUMP 2, found that self-monitoring with telemonitoring did not improve blood pressure control or obstetric outcomes compared to usual care in women with chronic or gestational hypertension (Healy, et al., 2023; Chappell, et al., 2022). Similarly, the USPSTF found limited evidence that home blood pressure monitoring improves serious health outcomes, though it is feasible and acceptable (Barry, et al., 2023).

Guidelines from the Society for Maternal-Fetal Medicine and the American Heart Association acknowledge the potential of remote monitoring, especially for improving access and equity, but emphasize that high-quality evidence for clinical benefit is still lacking and further research is needed (Healy, et al., 2023; Garovic, et al., 2022; Rajkumar, et al., 2025). ACOG's consensus guidance on tailored prenatal care states that monitoring of routine parameters, including blood pressure, is increasingly available outside clinical settings, and self-monitoring of blood pressure is feasible and accurate. The guidance allows for individualized monitoring options, including remote self-monitoring, especially for patients with chronic hypertension or hypertensive disorders of pregnancy who may benefit from more frequent measurements (ACOG, 2025). However, ACOG does not specifically endorse remote physiologic monitoring (e.g., telemonitoring with clinician review) as a universal standard or requirement for these patients. Guidelines from the Society for Maternal-Fetal Medicine recognize the potential benefits of telemedicine and remote monitoring in hypertensive disorders of pregnancy, but also note that evidence for improved outcomes is limited and do not make a formal recommendation for routine use (SMFM, 2023). 

Other Indications

There is evidence that RPM in specialist maternity care is feasible, safe, and can be as effective as standard in-person care for selected populations (Bekker, et al., 2023; Zizzo, et al., 2022; Butler, et al., 2019; Cantor, et al., 2022; Gunes, et al., 2024). The American College of Obstetricians and Gynecologists states that telemedicine, including remote monitoring, can be offered as part of tailored prenatal care, supporting equivalent perinatal outcomes and improved patient experience when in-person services are not required (ACOG, 2025). However, the quality of evidence is variable, and most studies emphasize the need for further research in diverse populations and for rare outcomes.

The evidence for RPM in children with complex medical needs demonstrates reductions in unplanned hospitalizations, care days outside the home, and healthcare costs, with high caregiver satisfaction, but the overall evidence base remains limited and further high-quality studies are needed (Mosquera, et al., 2021; Ferro, et al., 2021; Sasangohar, et al., 2018; Denker, et al., 2023). The American Academy of Pediatrics states that remote care can be a safe alternative to in-person visits for many children with complex needs, reducing transportation and infection risk, and facilitating earlier intervention for acute illness, especially when coordinated through the medical home (Curfman, et al., 2022). However, systematic reviews of adequate methodological quality conclude that scientific evidence on patient-relevant clinical benefits is still very limited, and standardized evaluation of clinical outcomes is lacking (Wartenberg, et al., 2025).

Remote physiological monitoring for urinary tract infection (UTI) is supported by emerging evidence, particularly for early detection and risk stratification in high-risk populations, but its clinical utility is still being established. Studies have demonstrated that remote monitoring using passive devices (tracking activity, sleep, nocturnal physiology, and bathroom visits) can identify UTI risk in older adults, especially those with dementia, with moderate sensitivity (65–75%) and specificity (71–88%) (Capstick, et al,, 2024). These systems use machine learning algorithms to alert clinicians to possible UTI, potentially enabling earlier intervention. For catheter-associated UTIs, novel remote sensing technologies (e.g., sticker-type wireless sensors) can monitor urine flow and conductivity in real time, showing promise for early risk detection in hospital settings, though these are still in proof-of-concept stages (Gopalakrishnan, et al., 2024). Home-based urine collection and testing protocols have also been shown to be viable, providing prompt and reliable outpatient care with faster turnaround times compared to office collection, and supporting decentralized management of symptomatic UTIs (Korman, et al., 2023; Singh, et al, 2023). Smartphone apps and digital diaries are feasible for tracking symptom progression and supporting patient engagement, though these are primarily research tools at present (Vellinga, et al., 2023). However, current clinical guidelines from the Infectious Diseases Society of America (IDSA) do not specifically endorse remote physiological monitoring for UTI diagnosis or management, emphasizing traditional laboratory-based methods and clinical evaluation (Miller, et al., 2024). The guidelines note that no single laboratory or physiological parameter is sufficient for UTI diagnosis, and caution is advised in populations with atypical presentations.

Glossary of Terms

Table: Glossary of Terms
Term Definition
Remote Physiologic Monitoring Non–face-to-face services that use a connected medical device to collect physiologic data and automatically upload it for review and treatment management by the billing practitioner. (Self‑reported data does not meet RPM device requirements.) 
Remote Therapeutic Monitoring (RTM) A related service family based on non‑physiologic measures (e.g., medication adherence, musculoskeletal/respiratory status); some RTM data may be self‑reported. (This policy focuses on RPM.)

References

The above policy is based on the following references:

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