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12.00.04, Remote Physiologic Monitoring and Remote Therapeutic Monitoring
Effective date
Dec 2, 2026
Identified
Nov 3, 2026
Summary
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.
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What to do
Action · 7 steps
01Billing team: Update charge entry templates to include CPT codes 98975, 98976, 98977 and HCPCS code S9110 with corresponding ICD-10 diagnosis codes from Attachment A (CHF, hypertension, diabetes).
02Billing team: Establish a prior authorization workflow for RPM services—get prior auth before claims are submitted for these codes.
03Billing team: Create internal documentation checklist requiring verification that claims include: FDA-approved device confirmation, patient consent documentation in medical record, ordering provider credentials, approved medical condition (CHF per specific criteria, hypertension including HDP, or diabetes), and monitoring frequency (minimum 16 days per 30-day period for physiologic; minimum 2 days per 30-day period for therapeutic).
04Billing team: For services exceeding 60 days (more than two 30-day periods), ensure medical record reflects hospitalization or ER visit risk using a recognized risk calculator (e.g., Yale 30-day Readmission Risk Calculator) before submitting claims.
05Tell providers and front desk staff that RPM is now a covered benefit under IBC Commercial effective 12/02/2026 for qualifying members with CHF, hypertension, or diabetes, and that orders must include patient consent and use FDA-approved devices on HIPAA-compliant platforms.
06Billing team: Watch for claim denials if prior auth was not obtained—resubmit with completed prior auth authorization number.
07Billing team: Flag and appeal any denials citing medical necessity if the claim included all required documentation and met the coverage criteria.
Codes mentioned
989759897698977S9110
Original notice
12.00.04, Remote Physiologic Monitoring and Remote Therapeutic Monitoring
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA12.010e, Remote Physiologic Monitoring and Remote Therapeutic MonitoringHighEffective Nov 30, 2026 · Medical PolicyMA12.010c, Remote Patient MonitoringHighEffective Jan 1, 2025 · Medical PolicyMA12.010c, Remote Patient MonitoringHighEffective Jan 1, 2025 · Medical PolicyMA12.010d, Remote Patient MonitoringHighEffective Jan 1, 2026 · Medical PolicyBrowse every Independence Blue Cross change in the policy list