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S9110

PAYER POLICY CHANGES

S9110 Insurance Policy Changes

HCPCS S9110 is officially defined as "Telemonitoring of patient in their home, including all necessary equipment; computer system, connections, and software; maintenance; patient education and support; per month." HCPCS S9110 is referenced in 10 tracked payer policy changes from Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS S9110 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.
Independence Blue Cross · Effective Dec 2, 2026Medium impact
12.00.04, Remote Physiologic Monitoring and Remote Therapeutic Monitoring
Effective 12/02/2026, Independence Blue Cross establishes a new medical policy covering remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) for commercial members with specific chronic and acute conditions (CHF, hypertension, diabetes) when medically necessary criteria are met. The policy defines covered CPT and HCPCS codes, requires FDA-approved devices, patient consent documentation, provider supervision, and limits initial coverage to specific monitoring periods with documented clinical justification for extensions beyond 60 days.
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.
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.
Texas Medicaid · Effective Jan 1, 2026Medium impact
FQHC and RHC Home Telemonitoring Providers Must Use Procedure Code S9110 With Modifier U3
Starting January 1, 2026, FQHCs and RHCs providing home telemonitoring services must use procedure code S9110 with modifier U3 instead of the discontinued code G0511 when billing Texas Medicaid. TMHP will automatically reprocess affected claims and has waived filing and appeal deadlines.
Sentara Health Plans · Effective Oct 1, 2025Medium impact
Authorization Updates - Effective October 1, 2025
Sentara Health Plans' authorization updates effective October 1, 2025 archived several policies, including Deep Brain Stimulation (Surgical 74), Electric Bone Growth Stimulation (DME 09), Near-infrared Spectroscopy (Medical 330) and Home Spirometry (DME 23), with the stimulation policies moved into the new Electrical Stimulation policy (Medical 349). On October 1, 2025, prior authorization became required (Y) for 44 listed procedure codes and for codes including 0420U, 0421U, 0435U, 0212U, 0213U, 81500, 81503, 81528, 88230 and 89420, with some codes directed to OncoHealth or Avalon, and 97161 and 97162 require authorization with benefit limits. Earlier updates effective July 1 and August 1, 2025 removed authorization for codes including 98975, 98976, 98977, 98978, 98980 and 98981, and required authorization for Medicaid codes 0253U, 0254U and 0255U.
Sentara Health Plans · Effective Aug 1, 2025Medium impact
Authorization Updates - Effective August 1, 2025
Sentara Health Plans' authorization updates took effect August 1, 2025, and on that date several Commercial and Medicaid policies were archived, including brachytherapy and proton beam radiation therapy. Prior authorization was removed for codes 61781, 61782 and 61783 (Commercial and Medicaid), 84112, 98975, 98976, 98977, 98978, 98980 and 98981 (Commercial, Medicaid and Medicare), 99473 and 99474 (Medicare), 0091U, 86152 and 86153 (Commercial, Medicaid and Medicare), and S9110 (Medicaid). Separate authorization updates took effect January 1, 2025 and July 1, 2025, and authorization is required with hour limits for a group of psychological and neuropsychological testing codes for Commercial plans as of August 1, 2025.
Sentara Health Plans · Effective Jul 1, 2025Medium impact
Summer 2025 Authorization Updates
Sentara Health Plans notified providers of summer 2025 authorization updates with go-live dates of July 1, 2025, August 1, 2025 and October 1, 2025. Many policies had criteria updated for Commercial and Medicaid, while Medicare continued to use the LCD and NCD policies listed for each service. Several policies were archived, and prior authorization was removed for codes including 61781, 61782 and 61783 for Commercial and Medicaid.
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.
Colorado Medicaid · Identified Jun 20, 2026Medium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200472 - 01/2022)
The January 2022 Health First Colorado provider bulletin (B2200472) announces prior authorization for 24 physician-administered drug HCPCS codes effective January 18, 2022, with Kepro as the utilization management vendor. It also notes that claims billed with 2022 procedure codes may suspend starting January 1, 2022, adds a remote supports benefit to five HCBS waivers on January 1, 2022, and removes three procedure codes from the list of ASC-covered procedures effective January 1, 2022.

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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 (Medicare)
Ambetter · Effective December 31, 2025
Prior authorization required
Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements
Arizona Complete Health · Effective December 31, 2025
Prior authorization required
Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for S9110?

Ambetter lists S9110 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for S9110?

Anthem BCBS lists S9110 on List of items and services that require prior authorization (Medicare) for medicare advantage plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for S9110?

Arizona Complete Health lists S9110 on Arizona Complete Health 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 HCPCS S9110?

There are 10 tracked policy changes affecting HCPCS S9110, including updates from Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, Texas Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS S9110?

Payers that have issued tracked updates for HCPCS S9110 include: Independence Blue Cross, Blue Cross & Blue Shield of Mississippi, Texas Medicaid, Sentara Health Plans, Maryland Medicaid, Colorado Medicaid.

How do I get notified when HCPCS S9110 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS S9110. 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 HCPCS S9110?

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 S9110

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for S9110 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

12.00.04, Remote Physiologic Monitoring and Remote Therapeutic Monitoring

MA12.010d, Remote Patient Monitoring

Telehealth: Remote Patient Monitoring Services

FQHC and RHC Home Telemonitoring Providers Must Use Procedure Code S9110 With Modifier U3

Authorization Updates - Effective October 1, 2025

Authorization Updates - Effective August 1, 2025

Summer 2025 Authorization Updates

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

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200472 - 01/2022)

Prior authorization required

Prior authorization required

Prior authorization required

Does Ambetter require prior authorization for S9110?

Does Anthem BCBS require prior authorization for S9110?

Does Arizona Complete Health require prior authorization for S9110?

What insurance policy changes affect HCPCS S9110?

Which payers have updated policy for HCPCS S9110?

How do I get notified when HCPCS S9110 policy changes?

Why do payers change policies for HCPCS S9110?