NYSDOH Expansion of Remote Patient Monitoring (RPM) Delivered by Clinical Staff and for Prenatal/Postpartum Services
Impacted LOBs: Medicaid, HIV-SNP, and HARP
TO: All Providers
8/15/2026
Dear MetroPlusHealth Providers,
EffectiveJanuary 1, 2026 onwards, MetroPlusHealth has implemented coverage and reimbursement of claims billed for expanded RPM services to comply with the New York State Department of Health (DOH) Medicaid mandate.
Billing Codes and Criteria:
- RPM services delivered by Clinical Staff must be ordered by a physician or other qualified health care professional because Clinical Staff cannot independently bill for these services. Providers who deliver RPM must confirm that they operate within their scope of practice.
- Effective for dates of service January 1, 2026 onwards, claims are reimbursed when billed using CPT codes:
- “99470” (no modifier)
- “99445” in combination with modifier “HD”
- Billing Frequency
- CPT codes “99470” and “99445” are billable only once/per member in a 30-day period.
- RPM Delivered by Clinical Staff
- Limitations: CPT code “99470” is a companion code to “99457”. Do not report “99470” in conjunction with CPT code “99457”, in the same 30-day period.
- Prenatal and Post Partum RPM services:
- Limitation: CPT code “99445” is part of a duration-based series with CPT code “99454”. Do not report CPT code “99445” in conjunction with CPT code “99454”, in the same 30-day period.
RPM delivered by Clinical Staff must be ordered by a physician or other qualified health care professional. Providers who deliver RPM must confirm that they operate within their scope of practice.
| CPT Code | Description |
|---|---|
| 99470 | Remote physiologic monitoring treatment management services, clinical/physician/other qualified health care professional time in a calendar month requiring one real-time interactive communication with the patient/caregiver during the calendar month. This code may be billed once per calendar month, regardless of the number of parameters monitored. Providers should not report in conjunction with 99091 or 99457 |
| 99445 (prenatal and postpartum services only) | Remote monitoring of physiologic parameters(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); initial set-up and patient education on use of equipment devices(s) supply with daily recording(s) transmission, two to 15 days in a 30-day period. Providers may bill code once in a 30-day period and must be billed with the HD modifier. Providers should not report CPT code 99445 in the same 30-day period as CPT code 99454. Providers should not report CPT code 99445 in conjunction with codes for more specific physiologic parameters. |
If you have any questions regarding this notice, please contact MetroPlusHealth at 800.303.9626, or email Provider Relations at [email protected].
Thank you,
MetroPlusHealth