Short answer for Blue Cross NC
Yes, with criteria.
Covered when medical necessity criteria are met.
What the document says
Verbatim: 'BCBSNC will provide coverage for Remote Therapeutic and Physiologic Monitoring when it is determined to be medically necessary because the medical criteria and guidelines shown below are met.' The 2026 codes (98979, 98984, 98985, 98986) were added effective 2026-01-01. Criteria mirror the Anthem pattern including 'unable to access regularly scheduled outpatient care'. Does NOT specifically name physical therapists; refers to 'physician or other qualified healthcare professional'. BCBSNC may request medical records to determine medical necessity. Note its own caution: 'Inclusion of a code in this section does not guarantee that it will be reimbursed.'
RTM codes the document addresses:
- 98975
- 98976
- 98977
- 98978
- 98979
- 98980
- 98981
- 98984
- 98985
- 98986
Check the plan, not just the carrier
About 67% of covered workers are in self-funded employer plans. The employer carries the risk, the carrier only administers it, and the employer's plan document governs. It can differ from the carrier's published policy. Cigna says so in its own instructions for use:
"In the event of a conflict, a customer's benefit plan document always supersedes the information in the Coverage Policies."
So a carrier policy narrows the question. It does not answer it for one patient. Call, name the codes, and write the answer down.
Other payers
How to use this page
This is a summary of a published payer document. It is not coverage advice and it cannot tell you whether one patient's claim will pay. The line of business, the employer's plan document and the patient's eligibility all sit between a policy and a payment. Our coverage guide walks through how to verify for a specific patient, and how to bill RTM covers the rest of the claim.
Policies change, usually in January. If you have a newer document or a remittance that contradicts this page, send it to contact@rehabityhealth.com and we will update the page.
Rehabity builds home exercise and remote therapeutic monitoring software for outpatient physical therapy clinics. We researched payer policy because we needed the answer ourselves. If you want to see what we build, read about the therapist side or join the waitlist.