Does BCBS Michigan require prior authorization for 99445?

BCBS Michigan lists 99445 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does Colorado Medicaid require prior authorization for 99445?

Colorado Medicaid lists 99445 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.

What insurance policy changes affect CPT 99445?

There are 12 tracked policy changes affecting CPT 99445, including updates from Independence Blue Cross, NY Medicaid, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99445?

Payers that have issued tracked updates for CPT 99445 include: Independence Blue Cross, NY Medicaid, Aetna, Blue Cross NC, Colorado Medicaid, Blue Cross & Blue Shield of Mississippi, Indiana Medicaid (IHCP).

How do I get notified when CPT 99445 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99445. 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 99445?

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.

PAYER POLICY CHANGES

99445 Insurance Policy Changes

CPT 99445 is referenced in 12 tracked payer policy changes from Independence Blue Cross, NY Medicaid, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99445 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Nov 30, 2026High impact
MA12.010e, Remote Physiologic Monitoring and Remote Therapeutic Monitoring
Effective 11/30/2026, Independence Blue Cross Medicare Advantage is updating medical policy MA12.010e to change remote patient monitoring (RPM and RTM) coverage from a blanket covered status to medically necessary with specific criteria. Coverage is now limited to patients with heart failure, hypertension, or diabetes mellitus, with 16 CPT/HCPCS codes now eligible only when specific diagnoses and clinical criteria are met. Billing teams must update authorization logic, documentation requirements, and claim submission workflows to reflect the new diagnosis-based eligibility rules.
NY Medicaid · Effective Jul 29, 2026High impact
Update to the New York State Medicaid Telehealth Policy Manual
New York State Medicaid updated its Telehealth Policy Manual effective July 29, 2026, with multiple changes including new CPT codes (99445, 99470), updated Remote Patient Monitoring procedure codes, revised teledentistry billing grids, rate updates for CPT 99407, and clarifications on eTriage/Treatment in Place. Providers must review the updated manual and adjust billing workflows accordingly for NYS Medicaid fee-for-service and Medicaid Managed Care enrollees.
Aetna · Effective May 31, 2026High impact
Remote Physiologic Monitoring (RPM) (CPB 1093, reviewed 2026-05-31)
Aetna has clarified its Remote Physiologic Monitoring (RPM) coverage policy (CPB 1093, effective 2026-05-31) establishing strict medical necessity criteria for three conditions: heart failure, hypertension, and diabetes. RPM is now only covered when using FDA-approved devices with automatic data transmission, documented patient consent, provider ordering/supervision, and clinical impact on treatment plans. Coverage is limited to one episode per patient per condition per provider per month. Billing teams must verify all criteria are met before submitting claims and ensure documentation supports medical necessity.
Independence Blue Cross · Effective Jan 1, 2026High impact
MA00.026y, Bundled Procedure Codes
Independence Blue Cross updated MA00.026y (Bundled Procedure Codes policy) effective 01/01/2026 to reflect annual CPT/HCPCS code changes. Procedure code 77417 was added to always-bundled services; six cardiology codes (92921, 92925, 92929, 92934, 92938, 92944) were removed from bundling; 15 new codes (including physical therapy and remote patient monitoring codes) were added to non-separately-reimbursable services; two obsolete codes were removed; and G0136 narrative was revised. Billing teams must update systems to reflect these code status changes to avoid claim denials and improper billing.
Independence Blue Cross · Effective Jan 1, 2026High impact
MA12.010d, Remote Patient Monitoring
Independence Blue Cross MA12.010d updates Remote Patient Monitoring (RPM) billing codes effective 01/01/2026. Six new CPT codes (98979, 98984, 98985, 98986, 99445, 99470) have been added for reimbursement consideration, and eight existing codes have had their narratives revised. RPM coverage remains limited to Medicare Advantage members with acute decompensated heart failure in home settings and requires program pre-approval submission to UMprogramsubmission@ibx.com.
Independence Blue Cross · Effective Jan 1, 2026High impact
00.01.52z, Bundled Procedure Codes
Independence Blue Cross updated policy 00.01.52z to 00.01.52ac effective 1/01/2026, reflecting annual CPT/HCPCS code updates. The policy adds 77417 to always-bundled procedures (Attachment A), removes six cardiology codes (92921, 92925, 92929, 92934, 92938, 92944), adds 18 codes to non-separately-reimbursable services (Attachment B), removes two codes from Attachment B, removes G0071 from Attachment C, and revises narrative descriptions for six procedure codes. Billing teams must immediately update system rules to reflect these code changes to avoid claim denials.
Blue Cross NC · Effective Jan 1, 2026High impact
Medical Policy Update December 31, 2025
Blue Cross NC updated multiple medical policies effective January 1, 2026, with extensive billing code changes including new CPT codes for IMRT procedures, archived spine-related policies, updated genetic testing codes, and new skin substitute codes. Most changes involve updating billing systems with new procedure codes while removing outdated ones.
NY Medicaid · Effective Jan 1, 2026High impact
Expansion of Remote Patient Monitoring Delivered by Clinical Staff and for Prenatal/Postpartum Services
NYS Medicaid is expanding Remote Patient Monitoring (RPM) coverage effective January 1, 2026, by adding two new CPT codes (99470 and 99445) that allow billing for shorter monitoring durations. Code 99470 covers 10-19 minutes of clinical staff-delivered RPM, and code 99445 covers 2-15 days of prenatal/postpartum RPM monitoring. Medicaid Managed Care plans must implement compliance by March 1, 2026.
Colorado Medicaid · Identified Jul 31, 2026High impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600541 - 08/2026)
Health First Colorado requires Modifier U9 on all claim lines for behavioral health services delivered by pre-licensed clinicians or unlicensed professionals for dates of service beginning July 1, 2026, and requires the service provider's individual NPI in Box 19 of the CMS 1500 claim for dates of service beginning January 1, 2027. Remote patient monitoring codes 99445 and 99470 were loaded with incorrect rates, and claims for them are being reprocessed as applicable. FQHCs should not bill vaccine products or vaccine administration codes separately on the CMS 1500 claim, and LTSS claims may be denied for dates of service on or after October 1, 2026 when license dates on file with CDPHE do not match the Medicaid system. Other changes include phased weekly caregiver hour limits beginning July 1, 2026, a cap of 7 hours per week of Homemaker services from Legally Responsible Persons effective June 12, 2026, and the end of the Medicaid eConsult platform effective August 31, 2026.
Blue Cross & Blue Shield of Mississippi · Effective Jan 1, 2026Medium impact
Telehealth: Remote Patient Monitoring Services
BCBSMS policy L.2.04.439 covers remote patient monitoring services, which must be prior authorized and ordered by a Physician, and must be performed by a Mississippi-licensed Provider affiliated with a Mississippi health care facility. An initial monitoring episode is allowed for up to 31 days, further monitoring requires an updated plan of care and re-authorization, and coverage is not provided beyond a six-month period. The 01/01/2026 update added CPT 98984, 98985, 98986 and 99445 and revised the descriptions of CPT 98976, 98977, 98980, 98981, 99453, 99454, 99457 and 99458.
Indiana Medicaid (IHCP) · Effective Jan 1, 2026Medium impact
BT2025188: Coverage and billing information for the 2026 annual HCPCS code update
Effective for dates of service on or after January 1, 2026, Indiana Medicaid lists the new CPT, CDT and other HCPCS codes from the 2026 annual HCPCS update as either covered or noncovered, and shows whether each one requires prior authorization or NDC. Codes discontinued in the update are listed with alternate code considerations, and the source states that inclusion of an alternate code does not indicate IHCP coverage of that alternate code. The IHCP is awaiting the final posting of the CMS fee schedules that set pricing for these codes, and reimbursement amounts will be posted on the Professional Fee Schedule and Outpatient Fee Schedule once pricing is established.
Aetna · Identified Oct 26, 2026Medium impact
Remote Physiologic Monitoring (RPM) (CPB 1093, reviewed 2026-06-01)
Aetna Clinical Policy Bulletin 1093 on remote physiologic monitoring (RPM), reviewed 2026-06-01, considers RPM medically necessary when all listed criteria are met, including a member with heart failure, hypertension or diabetes, an FDA-approved or cleared device capable of automatic data transmission, and documentation of patient consent in the medical record. The policy considers RPM experimental, investigational or unproven for conditions other than those listed, and for RPM using devices not approved or cleared by the FDA, and it states that coverage is limited to one episode of RPM per patient per condition per provider per month.

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MA12.010e, Remote Physiologic Monitoring and Remote Therapeutic Monitoring

Update to the New York State Medicaid Telehealth Policy Manual

Remote Physiologic Monitoring (RPM) (CPB 1093, reviewed 2026-05-31)

MA00.026y, Bundled Procedure Codes

MA12.010d, Remote Patient Monitoring

00.01.52z, Bundled Procedure Codes

Medical Policy Update December 31, 2025

Expansion of Remote Patient Monitoring Delivered by Clinical Staff and for Prenatal/Postpartum Services

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2600541 - 08/2026)

Telehealth: Remote Patient Monitoring Services

BT2025188: Coverage and billing information for the 2026 annual HCPCS code update

Remote Physiologic Monitoring (RPM) (CPB 1093, reviewed 2026-06-01)

Prior authorization required

Prior authorization required in some cases