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99458

PAYER POLICY CHANGES

99458 Insurance Policy Changes

CPT 99458, in plain terms, covers Add-on for every further 20 minutes of remote physiologic monitoring treatment management in the same calendar month, billed with the first 20 minutes of management time. CPT 99458 is referenced in 19 tracked payer policy changes from Independence Blue Cross, Arkansas Medicaid, and 8 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99458 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 99458 on AAPC

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.
Arkansas Medicaid · Effective Sep 1, 2026High impact
Coverage Added for Remote Patient Monitoring
Effective September 1, 2026, Arkansas Department of Human Services has expanded Medicaid coverage to include Remote Patient Monitoring services for CNMs, Nurse Practitioners, and Physicians serving female patients in diagnosis group 2011. Five new CPT codes (99091, 99453, 99454, 99457, 99458) are now reimbursable across three contract types (CNMW, MEDSV, NURSP).
Aetna · Effective Jul 1, 2026High impact
OfficeLink Updates - July 2026 notices and reminders (PDF)
Aetna's National Precertification List changes take effect in stages: on July 1, 2026, precertification was removed for Tegsedi and the iui case rate and added for several biosimilars, specialty drugs and hypoglossal nerve neurostimulator procedures, with further changes on August 1, 2026 and October 1, 2026. Effective October 1, 2026, Florida Dual-Eligible Special Needs Plans require precertification for certain home health aide, certified nurse assistant and personal care services. Beginning in 2027, maternity care will be reported as separate services for each phase of care instead of a single global service, and the transition period for remote physiological monitoring members runs through December 31, 2026.
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
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.
CareFirst BlueCross BlueShield · Effective Aug 1, 2025High impact
Maryland Medicaid enhanced reimbursement rates for eligible primary care providers, effective August 1, 2025
Maryland Medicaid has implemented enhanced reimbursement rates for eligible primary care providers effective August 1, 2025. The higher rates apply to evaluation and management codes 99202-99499 and G2211, with Managed Care Organizations required to pay these minimum rates to in-network PCPs.
Blue Cross of Idaho · Identified Sep 29, 2026High impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCS) - Added FQHC Billing Guidelines document
Blue Cross of Idaho provider administrative policy MAP111 sets billing requirements for federally qualified health centers (FQHCs) submitting claims for qualifying visits under the CMS Prospective Payment System, for Medicare Advantage members. Qualifying FQHC claims must use type of bill 77X and include revenue code(s) 0519, 0521, 0522, 0524, 0525, 0527, 0528, and/or 0900, and listed qualifying services for Medicare Advantage patients must include the corresponding CMS PPS payment code (HCPC).
Aetna · Identified Jun 19, 2026High impact
OfficeLink Updates - April 2026 notices and reminders (PDF)
This April 2026 notice covers several changes that have all passed their stated dates. Effective March 1, 2026, Remote Physiologic Monitoring (CPT 99453-99458) is covered only for heart failure, hypertension or diabetes, with an FDA-approved or FDA-cleared device that transmits data automatically, data used to adjust treatment, and documented member consent. Effective April 1, 2026, laminectomy codes performed as part of the access for spinal osteotomy codes 22212 and 22214 are not reimbursed separately on the same date of service. Effective July 1, 2026, reconstructive codes 15733-15738 and 14000-14302 are denied as incidental when billed on the same date of service as breast surgery (19300-19396) or digestive system surgery (40490-49999) codes by different providers. Commercial drug lists and the Combined Benefit Management drug list were updated on July 1, 2026, and several drugs were added to precertification lists with dates from March 1, 2026 through July 1, 2026.
Humana · Effective Aug 3, 2026Medium impact
Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage (Revised)
This is a revised Medicare Advantage policy for Cardioverter Defibrillators and Cardiac Resynchronization Therapy devices, effective August 3, 2026. The policy clarifies coverage for implantable devices (TV-ICD, S-ICD, EV-ICD), CRT devices, and external wearable defibrillators, and references specific CMS National Coverage Determinations and Local Coverage Determinations by geographic MAC jurisdiction. Billing teams must ensure claims align with the appropriate MAC's LCD based on patient location and device type.
Nebraska Medicaid · Effective Jul 1, 2026Medium impact
Coverage for Remote Physiologic Monitoring
Nebraska Medicaid will begin covering Remote Physiologic Monitoring (RPM) services effective July 1, 2026, for patients with heart failure or hypertensive disorders of pregnancy. Six new billing codes (99453, 99454, 99455, 99457, 99458, 99470) are now available with specific documentation and eligibility requirements.
Humana · Effective May 1, 2026Medium impact
Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage (Revised)
This is a revised Medicare Advantage policy for cardioverter defibrillators and cardiac resynchronization therapy devices, effective May 1, 2026. The policy provides updated coverage criteria and coding information for various cardiac device implantation, monitoring, and removal procedures.
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.
Maryland Medicaid · Effective May 15, 2025Medium impact
Update to Reimbursement for Remote Patient Monitoring Services: Self-Measured Blood Pressure Codes
Maryland Medicaid has updated Remote Patient Monitoring (RPM) and Self-Measured Blood Pressure (SMBP) coverage, eliminating prior authorization requirements for RPM and adding new billable SMBP codes 99473 and 99474. Code S9110 is no longer covered for RPM services.
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.
Blue Cross of Idaho · Identified Oct 6, 2026Medium impact
MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Added language about preventive exams and revised billing instructions for care coordination, VCS, CoCM, telehealth, and vaccines per CMS coding updates.
Blue Cross of Idaho revised its Medicare Advantage billing policy for Rural Health Clinics in September 2026 to add preventive exam language and update how care coordination, virtual communication services, psychiatric collaborative care, telehealth and vaccines are billed, following CMS coding changes. The policy gives no single effective date for the September 2026 revision, but it lists code-specific dates of January 1, 2026 and October 1, 2026, both now passed. The entry for G0511 reads 'Oct. 1, 25', which is unclear, so confirm that date with Blue Cross of Idaho.
Blue Cross of Idaho · Identified Oct 6, 2026Medium impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added language about preventive exams
Blue Cross of Idaho's FQHC billing policy for Medicare Advantage claims, with the September 2026 revision that added language on preventive exams. Preventive exams (CPT 99381 through 99387) are billed separately on a CMS-1500 claim, and FQHC qualifying visits need the right type of bill, revenue code and CMS payment HCPCS code, because claims missing any of these are denied and returned for correction. The policy text states no effective date of its own, so confirm the current rules on the payer's site.
Blue Cross of Idaho · Identified Sep 29, 2026Medium impact
MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added telehealth clarification
Blue Cross of Idaho's billing policy for federally qualified health centers (FQHCs) on Medicare Advantage claims, last revised September 2026 to add preventive exam language. FQHC qualifying visits must carry the right type of bill, revenue code and CMS payment HCPCS code, and claims missing any of these are denied and returned for correction, so the FQHC billing team needs to confirm its claim setup against the current list.
Aetna · Identified Aug 15, 2026Medium impact
Chronic Pain Rehabilitation Programs (CPB 0237, reviewed 2026-04-23)
Aetna's Clinical Policy Bulletin 0237 sets medical necessity criteria for chronic pain rehabilitation programs. Outpatient programs are medically necessary when the member has had chronic pain for more than 3 months, has documented failure or inadequate response to standard single-modality treatment, has persistent limitations in daily or social or vocational functioning, and has a physician referral and a pre-program psychological and behavioral health evaluation. Inpatient programs for up to 21 days require refractory pain plus two or more listed intractable pain criteria, and several conditions, including prior failure of an adequate multidisciplinary program, aggressive or violent behavior, and imminent suicidal tendencies, are considered not medically necessary.
BCBS Arizona · Identified Jun 16, 2026Medium impact
Telehealth Services
BCBSAZ covers telehealth only as the member's benefit plan provides. Under the BlueCare Anywhere benefit, telehealth is covered when the Telehealth Services Administrator provides the service and determines the condition is appropriate, for a medical, therapy or psychiatry consultation. Under the in-network telehealth benefit, a service is covered when it would be covered in person and can be provided effectively by telehealth, through audio-visual services or limited audio-only services, and out-of-network non-emergency telehealth is not covered. The most recent review, dated 07/29/26, made no revisions.

Watch 99458

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REFERENCE DATA

Payers with rules3

Payers requiring prior auth3

Anthem BCBS · Effective February 11, 2026
Prior authorization required
List of items and services that require prior authorization (Elevance CMS-0057-F list)
CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for 99458?

Anthem BCBS lists 99458 on List of items and services that require prior authorization (Elevance CMS-0057-F list) for medicaid managed plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 99458?

CalViva Health lists 99458 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 Community Health Plan of Imperial Valley require prior authorization for 99458?

Community Health Plan of Imperial Valley lists 99458 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 99458?

There are 19 tracked policy changes affecting CPT 99458, including updates from Independence Blue Cross, Arkansas Medicaid, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99458?

Payers that have issued tracked updates for CPT 99458 include: Independence Blue Cross, Arkansas Medicaid, Aetna, CareFirst BlueCross BlueShield, Blue Cross of Idaho, Humana, Nebraska Medicaid, Blue Cross & Blue Shield of Mississippi, Maryland Medicaid, BCBS Arizona.

How do I get notified when CPT 99458 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99458. 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 99458?

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.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 99458 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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

Coverage Added for Remote Patient Monitoring

OfficeLink Updates - July 2026 notices and reminders (PDF)

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

MA12.010d, Remote Patient Monitoring

Maryland Medicaid enhanced reimbursement rates for eligible primary care providers, effective August 1, 2025

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCS) - Added FQHC Billing Guidelines document

OfficeLink Updates - April 2026 notices and reminders (PDF)

Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage (Revised)

Coverage for Remote Physiologic Monitoring

Cardioverter Defibrillators/Cardiac Resynchronization Therapy - Medicare Advantage (Revised)

Telehealth: Remote Patient Monitoring Services

Update to Reimbursement for Remote Patient Monitoring Services: Self-Measured Blood Pressure Codes

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

MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Added language about preventive exams and revised billing instructions for care coordination, VCS, CoCM, telehealth, and vaccines per CMS coding updates.

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added language about preventive exams

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Added telehealth clarification

Chronic Pain Rehabilitation Programs (CPB 0237, reviewed 2026-04-23)

Telehealth Services

Prior authorization required

Prior authorization required

Prior authorization required

Does Anthem BCBS require prior authorization for 99458?

Does CalViva Health require prior authorization for 99458?

Does Community Health Plan of Imperial Valley require prior authorization for 99458?

What insurance policy changes affect CPT 99458?

Which payers have updated policy for CPT 99458?

How do I get notified when CPT 99458 policy changes?

Why do payers change policies for CPT 99458?