TRICARE Covers Remote Physiological Monitoring
Monday, August 23, 2021
Remote physiological monitoring (RPM) services allow for providers to monitor vital statistics for patients with medical conditions without the patient having to come into the office. Through RPM, providers can monitor a patient’s weight, blood pressure, pulse oximetry, respiratory flow rate, and more. Retroactive to March 13, 2020, TRICARE covers medically necessary RPM for chronic or acute conditions. RPM services are a limited benefit and covered as ancillary services. Beneficiary copays and cost-shares apply as appropriate.
To be eligible for RPM, the beneficiary must require RPM services of at least 20 minutes in a 30-day period and have one of the following:
- A chronic condition(s) that is expected to last at least 12 months, or until death of the beneficiary; or
- An acute condition(s) that place the beneficiary at significant risk of death, acute exacerbation/decompensation, or functional decline.
Coverage of RPM services includes set up and patient/caregiver education on use of the equipment, collection and interpretation of the data, and follow up with the beneficiary. Durable medical equipment (DME) used for RPM must meet TRICARE requirements. DME such as personal computers, smart phones, tablets, smart watches, non-medical trackers, and weight scales are specifically excluded.
Providers should bill for RPM using the codes and definitions established by Medicare and the Current Procedural Terminology (CPT®)/Healthcare Common Procedure Coding System (HCPCS) manuals for RPM billing and coding.
For more information visit our RPM Services web page and TRICARE Policy Manual, Chapter 2, Section 8.1.
CPT® is a registered trademark of the American Medical Association. All rights reserved.