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PAYER POLICY CHANGES

98980 Insurance Policy Changes

CPT 98980, in plain terms, covers Remote therapeutic monitoring treatment management by a physician or other qualified professional, first 20 minutes of time in a calendar month, including interactive communication with the patient or caregiver. CPT 98980 is referenced in 13 tracked payer policy changes from Independence Blue Cross, Pennsylvania Medicaid (DHS), and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 98980 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 98980 on AAPC

Watch 98980

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • Colorado Medicaid · Effective July 1, 2026

    Prior authorization required

    Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column)

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 98980?

CalViva Health lists 98980 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for 98980?

Centene lists 98980 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Colorado Medicaid require prior authorization for 98980?

Colorado Medicaid lists 98980 on Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column) for medicaid ffs plans (list dated July 1, 2026). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 98980?

Community Health Plan of Imperial Valley lists 98980 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 98980?

There are 13 tracked policy changes affecting CPT 98980, including updates from Independence Blue Cross, Pennsylvania Medicaid (DHS), Blue Cross of Idaho. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 98980?

Payers that have issued tracked updates for CPT 98980 include: Independence Blue Cross, Pennsylvania Medicaid (DHS), Blue Cross of Idaho, Medicare/CMS - Transmittals, Blue Cross & Blue Shield of Mississippi, Sentara Health Plans.

How do I get notified when CPT 98980 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 98980. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 98980?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 98980

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 98980 in one place.

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