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99470

PAYER POLICY CHANGES

99470 Insurance Policy Changes

CPT 99470, in plain terms, covers Remote physiologic monitoring treatment management by clinical staff or a clinician, first 10 minutes in a calendar month. CPT 99470 is referenced in 17 tracked payer policy changes from Independence Blue Cross, Anthem BCBS, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 99470 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 99470 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.
Anthem BCBS · Effective Jan 1, 2027High impact
[Virginia] Payment discontinued for select procedure codes effective
Effective January 1, 2027, HealthKeepers, Inc. (Anthem HealthKeepers Plus Medicaid in Virginia) will discontinue reimbursement for 44 specific procedure codes to align with the Virginia Department of Medical Assistance Services (DMAS) fee schedule. The practice must stop billing these codes for dates of service on or after that date, as claims for discontinued codes will be denied or subject to adjustment and recovery.
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.
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).
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.
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.
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.
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.

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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

Colorado Medicaid · Effective July 1, 2026
Prior authorization required
Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column)
BCBS Michigan · Effective January 1, 2026
Prior authorization required in some cases
BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does BCBS Michigan require prior authorization for 99470?

BCBS Michigan lists 99470 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 99470?

Colorado Medicaid lists 99470 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 99470?

There are 17 tracked policy changes affecting CPT 99470, including updates from Independence Blue Cross, Anthem BCBS, NY Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 99470?

Payers that have issued tracked updates for CPT 99470 include: Independence Blue Cross, Anthem BCBS, NY Medicaid, Aetna, Blue Cross NC, Blue Cross of Idaho, Colorado Medicaid, Nebraska Medicaid, Indiana Medicaid (IHCP).

How do I get notified when CPT 99470 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 99470. 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 99470?

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 99470 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

[Virginia] Payment discontinued for select procedure codes effective

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

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

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

Coverage for Remote Physiologic Monitoring

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

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

Prior authorization required

Prior authorization required in some cases