Cigna modified MM 0563 for Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM), effective September 26, 2025. Here's what billing teams need to know.
Cigna Healthcare updated its coverage policy for RPM and RTM under policy code MM 0563, affecting 13 CPT codes (99091, 99453, 99454, 99457, 99458, 98975–98978, 98980–98981, 99473, 99474) and one HCPCS code (G0322). This policy governs remote patient monitoring billing across a broad range of chronic conditions — hypertension, diabetes, heart failure, COPD, and high-risk pregnancy. If your practice bills remote monitoring services to Cigna patients, this update is worth reviewing before the September 26, 2025 effective date.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) |
| Policy Code | MM 0563 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Primary care, cardiology, endocrinology, pulmonology, obstetrics, physical/occupational therapy |
| Key Action | Audit your RPM and RTM charge capture against Cigna's updated medical necessity criteria before September 26, 2025 |
Cigna RPM and RTM Coverage Criteria and Medical Necessity Requirements 2025
The Cigna remote physiologic monitoring coverage policy under MM 0563 covers RPM, self-measured blood pressure (SMBP), and RTM — but only when specific medical necessity criteria are met. All 14 codes in this policy share the same coverage position: medically necessary when the criteria in the applicable coverage criteria table are satisfied. That means documentation has to support the clinical need before you bill, not after a denial.
RPM covers automated digital monitoring of physiologic parameters — pulse, blood pressure, respiratory rate, blood glucose, weight, and oxygen saturation. Think CPT 99453 (setup and patient education) and 99454 (device supply with daily recordings). These are your RPM device codes. CPT 99457 and 99458 are your RPM treatment management codes, billed when a physician or clinical staff spends time reviewing data and communicating with the patient.
SMBP is a subset of RPM. It covers blood pressure data only, self-measured by the patient and reported to the provider. CPT 99473 covers patient education and training on a validated SMBP device. CPT 99474 covers separate self-measurements with provider communication of a treatment plan. If your practice monitors hypertension patients remotely, these two codes are your primary tools under this coverage policy.
RTM is distinct from RPM. It covers non-physiologic monitoring — specifically, patient adherence to a treatment plan. CPT 98975 covers RTM setup. CPT 98976 and 98977 cover device supply for respiratory and musculoskeletal monitoring, respectively. CPT 98978 covers device supply for therapy adherence. CPT 98980 and 98981 are your RTM treatment management codes. Therapy practices billing Cigna for remote monitoring of therapy adherence should pay close attention to these codes.
Cigna also covers CPT 99091 under this policy — collection and interpretation of physiologic data (ECG, blood pressure, glucose) digitally transmitted by the patient. HCPCS G0322 covers collection of physiologic data stored or transmitted to the home health agency. These two codes have narrower use cases, but if your mix includes home health or complex chronic care, confirm your documentation supports the digital transmission and interpretation requirements.
Prior authorization requirements are not explicitly detailed in this policy summary. Contact Cigna directly to confirm whether prior authorization applies to specific codes in your patient population before September 26, 2025. If you're not sure how this applies to your payer mix, talk to your compliance officer before the effective date.
Coverage Indications at a Glance
| Indication | Status | Relevant CPT/ICD-10 Codes | Notes |
|---|---|---|---|
| Diabetes mellitus (Types 1, 2, and other) | Covered when criteria met | 99453, 99454, 99457, 99458, 99091; E08.00–E13.9, O24.011–O24.93 | Includes diabetes in pregnancy and puerperium |
| Essential hypertension | Covered when criteria met | 99473, 99474, 99453, 99454; I10 | SMBP codes most directly applicable |
| Heart failure | Covered when criteria met | 99453, 99454, 99457, 99458, 99091; I50.1–I50.9 | Weight and fluid monitoring typical use case |
| COPD | Covered when criteria met | 99453, 99454, 99457, 98976; J44.0–J44.9 | Respiratory rate and oxygen saturation monitoring |
| Pre-existing hypertension complicating pregnancy | Covered when criteria met | 99473, 99474, 99453, 99454; O10.011–O10.93 | Broad range of pregnancy hypertension subtypes |
| Gestational hypertension / pre-eclampsia / eclampsia | Covered when criteria met | 99473, 99474; O11.1–O15.9, O13.1–O14.95, O16.1–O16.9 | Covers gestational HTN without proteinuria through eclampsia |
| Elevated blood pressure without HTN diagnosis | Covered when criteria met | 99473, 99474; R03.0 | Confirmed blood pressure elevation, not yet diagnosed |
| Therapy adherence monitoring (non-physiologic) | Covered when criteria met | 98975, 98976, 98977, 98978, 98980, 98981 | RTM — musculoskeletal and respiratory rehab most common |
| Remote collection of physiologic data (home health) | Covered when criteria met | G0322 | Digital storage or transmission to home health agency required |
Cigna RPM and RTM Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for all 14 codes before September 26, 2025. Review CPT 99091, 99453, 99454, 99457, 99458, 99473, 99474, 98975, 98976, 98977, 98978, 98980, 98981, and G0322. Confirm each claim maps to an ICD-10 code that appears in Cigna's approved diagnosis list under MM 0563. |
| 2 | Verify your ICD-10 codes cover the full Cigna-recognized diagnosis range. The policy lists 48 ICD-10 codes. Hypertension in pregnancy alone spans codes O10.011 through O16.9. If your OB practice bills remote monitoring for hypertensive pregnancy patients, confirm your documentation specifies the correct O-code — not just I10. |
| 3 | Separate RPM and RTM billing on your charge sheets. These are not interchangeable. RPM covers physiologic data (blood pressure, weight, glucose, oxygen saturation, respiratory rate). RTM covers non-physiologic data — therapy adherence and treatment plan compliance. Mixing them up is a fast path to claim denial. |
| 4 | Document the digital transmission method in every RPM and RTM encounter note. Cigna's policy specifies that data must be electronically transmitted to the provider for assessment. "Patient called with readings" is not the same as automated digital transmission. Your documentation should name the technology — software, mobile device, or wearable — used for each patient. |
| 5 | Confirm prior authorization requirements directly with Cigna for your specific codes and patient population. MM 0563 in Cigna's system does not publish a blanket prior auth rule here, but individual plans vary. A surprise authorization denial on a high-volume RPM program is expensive. Make the call before September 26, 2025. |
| 6 | Flag the SMBP codes (99473 and 99474) separately in your billing workflow. These codes have a narrower scope than general RPM codes — blood pressure data only, self-measured, with a validated device. If your device isn't validated for clinical accuracy, reimbursement under these codes is at risk. |
| 7 | For therapy practices billing 98975–98981, confirm the monitoring system captures adherence data specifically. Cigna's RTM policy targets monitoring of patient adherence to a treatment plan, not general outcomes tracking. Your documentation should connect the technology to adherence measurement, not just symptom tracking. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for RPM and RTM Under MM 0563
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 98975 | CPT | Remote therapeutic monitoring — initial set-up and patient education (respiratory system status, musculoskeletal system status, therapy) |
| 98976 | CPT | Remote therapeutic monitoring — device supply with scheduled recordings; respiratory system status |
| 98977 | CPT | Remote therapeutic monitoring — device supply with scheduled recordings; musculoskeletal system status |
| 98978 | CPT | Remote therapeutic monitoring — device supply with scheduled recordings; therapy adherence, therapy response |
| 98980 | CPT | Remote therapeutic monitoring treatment management services — physician or other qualified health care professional, first 20 minutes |
| 98981 | CPT | Remote therapeutic monitoring treatment management services — physician or other qualified health care professional, each additional 20 minutes |
| 99091 | CPT | Collection and interpretation of physiologic data (ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient |
| 99453 | CPT | Remote monitoring of physiologic parameter(s) — initial; set-up and patient education |
| 99454 | CPT | Remote monitoring of physiologic parameter(s) — device supply with daily recordings or programmed alerts |
| 99457 | CPT | Remote physiologic monitoring treatment management services — clinical staff/physician/other qualified health care professional, first 20 minutes |
| 99458 | CPT | Remote physiologic monitoring treatment management services — clinical staff/physician/other qualified health care professional, each additional 20 minutes |
| 99473 | CPT | Self-measured blood pressure using a device validated for clinical accuracy — patient education/training |
| 99474 | CPT | Self-measured blood pressure using a device validated for clinical accuracy — separate self-measurements with physician or qualified health care professional communication of treatment plan |
Covered HCPCS Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| G0322 | HCPCS | Collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency |
Key ICD-10-CM Diagnosis Codes Recognized Under MM 0563
| Code | Description |
|---|---|
| E08.00–E13.9 | Diabetes mellitus (all types, including drug/chemical induced, other specified, and unspecified) |
| I10 | Essential (primary) hypertension |
| I50.1–I50.9 | Heart failure |
| J44.0–J44.9 | Chronic obstructive pulmonary disease |
| O10.011–O10.019 | Pre-existing essential hypertension complicating pregnancy |
| O10.02 | Pre-existing essential hypertension complicating childbirth |
| O10.111–O10.119 | Pre-existing hypertensive heart disease complicating pregnancy |
| O10.12 | Pre-existing hypertensive heart disease complicating childbirth |
| O10.211–O10.219 | Pre-existing hypertensive chronic kidney disease complicating pregnancy |
| O10.22 | Pre-existing hypertensive chronic kidney disease complicating childbirth |
| O10.311–O10.319 | Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy |
| O10.32 | Pre-existing hypertensive heart and chronic kidney disease complicating childbirth |
| O10.411–O10.419 | Pre-existing secondary hypertension complicating pregnancy |
| O10.42 | Pre-existing secondary hypertension complicating childbirth |
| O10.911–O10.919 | Unspecified pre-existing hypertension complicating pregnancy |
| O10.92 | Unspecified pre-existing hypertension complicating childbirth |
| O10.93 | Unspecified pre-existing hypertension complicating puerperium |
| O11.1–O11.4 | Pre-existing hypertension with pre-eclampsia |
| O11.9 | Pre-existing hypertension with pre-eclampsia, unspecified trimester |
| O13.1–O13.4 | Gestational hypertension without significant proteinuria |
| O13.9 | Gestational hypertension without significant proteinuria, unspecified trimester |
| O14.00–O14.04 | Pre-eclampsia |
| O14.10–O14.14 | Severe pre-eclampsia |
| O14.20–O14.24 | HELLP syndrome |
| O14.90–O14.94 | Unspecified pre-eclampsia |
| O14.95 | Unspecified pre-eclampsia, unspecified trimester (complicating puerperium) |
| O15.00–O15.1 | Eclampsia |
| O15.9 | Eclampsia, unspecified as to time period |
| O16.1–O16.4 | Unspecified maternal hypertension |
| O16.9 | Unspecified maternal hypertension, unspecified trimester |
| O24.011–O24.93 | Diabetes mellitus in pregnancy, childbirth, and the puerperium |
| R03.0 | Elevated blood pressure reading, without diagnosis of hypertension |
The real issue with this policy is the sheer breadth of the ICD-10 code list for hypertension in pregnancy. Thirty-plus O-codes cover the spectrum from pre-existing essential hypertension complicating the first trimester all the way through eclampsia and HELLP syndrome. OB practices running RPM programs often default to I10 for simplicity. That works for non-pregnant patients. For your pregnant patients, you need the right O-code — or Cigna's system won't connect the claim to the covered indication. Review your OB coding workflows now, before September 26, 2025.
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