UnitedHealthcare has announced plans to significantly narrow coverage for remote patient monitoring services across both its Medicare Advantage and commercial plans, effective Jan. 1, 2026.
Under the revised policy, remote patient monitoring will be considered reasonable and necessary only for patients with heart failure or hypertensive disorders of pregnancy. All other uses — including for obstructive sleep apnea, diabetes, hypertension (other than hypertensive disorders of pregnancy), COPD, anxiety, and depression — will be classified as not reasonable and necessary due to what UnitedHealthcare cites as insufficient evidence of clinical efficacy. This decision is expected to affect millions of members and diverges from Medicare’s fee-for-service policy, which continues to cover remote patient monitoring services more broadly.
Although remote patient monitoring codes (CPT 99453, 99454, 99457, and 99458) are most frequently reported by primary care and internal medicine physicians, they are also widely used by specialists, including those in sleep medicine. Restricting coverage for conditions such as obstructive sleep apnea could limit patients’ access to technology-enabled monitoring, which improves treatment adherence and outcomes. AASM will advocate against the implementation of this policy and will continue to encourage coverage that aligns with the evidence-based use of remote monitoring across specialties.
Please feel free to contact coding@aasm.org with any questions regarding the revised remote patient monitoring policy.
