Remote Patient Monitoring
POLICY
“Remote patient monitoring” means digital technology to collect medical and other forms of health data from an individual in 1 location and electronically transmit that information via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure system to a health care provider in a different location for assessment and recommendations.
SOURCE: MI Compiled Laws Sec. 400.105g (Accessed Dec. 2024).
Remote Patient Monitoring (RPM) is a covered service under Michigan Compiled Law (MCL) 400.105g. RPM means using digital technology to collect medical and other forms of health data from an individual in one location and electronically transmit that information via a secure, HIPAA-compliant system to a provider in a different location for assessment and recommendations. RPM is covered for both acute and chronic conditions.
SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2152, Oct. 1, 2024, (Accessed Dec. 2024).
The department must provide coverage for remote patient monitoring services through the medical assistance program and Healthy Michigan program under this act.
SOURCE: MI Compiled Laws Sec. 400.105g (Accessed Sept. 2024).
Continuous Glucose Monitoring
CGMS may be non-adjunctive/therapeutic (CGMS can be used to make treatment decisions without the need to confirm test results using a blood glucose monitor [BGM]); or adjunctive/non-therapeutic (beneficiary must use a BGM to test the results displayed on the CGMS prior to making a treatment decision).
SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1237 Oct. 1, 2024, (Accessed Dec. 2024).
CONDITIONS
RPM is covered for both acute and chronic conditions.
SOURCE: Medicaid Provider Manual, p. 2126 Jul. 1, 2024, (Accessed Dec. 2024).
RPM devices include (1) non-invasive remote monitoring devices that measure or detect common physiological parameters, and (2) non-invasive monitoring devices that wirelessly transmit the beneficiary’s medical information to their health care provider or other monitoring entity. The device must be reliable and valid, and the beneficiary must be trained or sufficiently knowledgeable in the proper use/wearing of the device to ensure appropriate recording of medical information. Medical information may include, but is not limited to, blood pressure and heart rate and rhythm monitoring.
SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2152 Oct. 1, 2024, (Accessed Dec. 2024).
Continuous Glucose Monitoring
A personal use CGMS and supplies are covered for persons with diabetes when all the following are met (see manual).
SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1237 Oct. 1, 2024, (Accessed Dec. 2024).
PROVIDER LIMITATIONS
Continuous Glucose Monitoring
Personal use CGMS are covered for beneficiaries with diabetes when all the following are met:
- The beneficiary is under the care of one of the following:
- An endocrinologist; or
- A physician or non-physician practitioner (nurse practitioner, physician assistant or clinical nurse specialist) who is managing the beneficiary’s diabetes.
- The beneficiary has diabetes requiring the administering of insulin or is currently using an insulin pump.
- The beneficiary or their caregiver is educated on the use of the device and is willing and able to use the CGMS.
Note: CGMS reduce the frequency of fingerstick blood glucose testing but do not eliminate the need to fingerstick test entirely. Glucometers and testing supplies must be made available. These supplies are billed separately (following frequency rules) for adjunctive/non-therapeutic CGMS. Glucometers and testing supplies are included in the monthly supply HCPCS code for non-adjunctive/therapeutic CGMS. Refer to the Payment Rules section of this policy.
Although not required for coverage consideration, physicians/non-physician practitioners are encouraged to refer patients who are willing and able to attend a certified diabetes self-management education training program. A map identifying Medicaid enrolled diabetes self-management education and support (DSME) providers can be found on the MDHHS website. (Refer to the Directory Appendix for website information.)
SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1237 Oct. 1, 2024, (Accessed Dec. 2024).
OTHER RESTRICTIONS
All RPM devices, including mobile medical applications, must meet the U.S. Food & Drug Administration (FDA) definition of a medical device. Personal tablets, computers, cell phones, software intended for administrative support or support of healthy lifestyles/general wellness, and electronic health records are not medical devices or durable medical equipment and are not covered as part of RPM services.
Reimbursement for the device used for remote monitoring, and programming of the device, is generally included in the reimbursement of RPM services and not separately reimbursable. For items or devices separately reimbursed to a medical supplier, such as personal use continuous glucose monitoring systems (CGMs), refer to the Medical Supplier chapter of the MDHHS Medicaid Provider Manual.
SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2152 Oct. 1, 2024, (Accessed Dec. 2024).
See bulletin/manual for documentation, prior authorization and eligible CGM codes.
SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1236-1238 Oct. 1, 2024, (Accessed Dec. 2024).
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