Despite increasing momentum for remote patient monitoring (RPM) of chronic conditions, a new policy from UnitedHealthcare says it is medically necessary only to treat chronic heart failure and hypertension during pregnancy. It no longer will cover remote monitoring for Type 2 diabetes or hypertension.
RPM devices help manage chronic conditions by sending a patient’s weight, blood pressure or blood glucose levels to providers, who can adjust care based on the new data. RPM has been shown to be helpful in preventing future health problems, and Medicare has covered these services since 2019. The Department of Health and Human Services has expanded RPM and incentivized upstream advanced primary care, which often includes remote monitoring of chronic conditions.
UnitedHealthcare defended its decision to limit the use of RPM in an email to Fierce Healthcare.
“Starting Jan. 1, 2026, we will cover remote physiologic monitoring only for members diagnosed with heart failure or hypertensive disorders during pregnancy, based on the latest clinical evidence,” it said. “We’ll continue to cover home monitoring devices according to members’ benefit plans and encourage providers to work with their patients to manage their health with proven, effective care.”
In a report issued last spring, the Peterson Center on Healthcare was critical of the growing number of Medicare, Medicaid and Medicare Advantage patients who have been prescribed RPM and the increasing amount of time their providers require them to continue to use the technology. The costs of Medicare RPM have grown significantly in the years since the codes became available to providers, from $6.8 million in 2019 to $194.5 million in 2023, it said.
The Remote Monitoring Leadership Council, however, said RPM actually saves money.
“One of our members recently completed a cost and utilization analysis, which included 5,872 patients enrolled in an RPM program compared against 11,449 patients in a propensity-score matched control group, demonstrating annual total savings of $1,308 per patient across three chronic disease programs (heart failure, hypertension and type 2 diabetes),” it wrote in a letter to Dr. Mehmet Oz, director of the Centers for Medicare & Medicaid Services. “Cost savings were primarily driven by a 27% reduction in hospital admissions – specifically, reductions in hospitalizations for heart failure and stroke.”
The new UnitedHealthcare policy could have a widespread impact, T.J. Ferrante, a partner at the Foley & Lardner law firm, told Fierce Healthcare.
“These patients are getting remote monitoring because the doctors deem it appropriate,” Ferrante said. “That's why the doctors are ordering it. So, yeah, it would be very harmful to, I think, tens of thousands of patients, probably.”
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