RTM Coverage Lookup: Search Your Payer

Covered Covered with criteria Not covered No policy found PRIMARY SOURCE we read the payer's own document UNVERIFIED we did not

Read this before you act on any row. This is a summary of published payer documents. It is not coverage advice and not a guarantee of payment. About 67% of covered workers are in self-funded employer plans, where the employer's plan document governs and can differ from the carrier's published policy. Cigna says so itself: "a customer's benefit plan document always supersedes the information in the Coverage Policies." The guide explains why in full, and how to verify for your own patient.

A separate criterion worth checking: does your platform have to be an FDA-authorized device? Some payers attach a technology requirement to RTM on top of the clinical criteria, and it is easy to miss because it sits below the coverage decision. Highmark requires that "all technology utilized has been authorized by the FDA, either through approval, clearance, or emergency use authorization." Blue Cross of Idaho is more pointed still: it requires data "generated by a medical device or approved digital therapeutic platform" and explicitly excludes monitoring via "phone calls, texting, or manual logs" and non-FDA-compliant software.

This cuts against the way the codes are often described. Blue Cross Blue Shield of Michigan says the opposite in its own policy: "The use of a device is not required. If a platform is able to track data from an individual (eg, software, a wearable, self-reported information), remote therapeutic monitoring is achieved." Highmark's own document defines RTM data as "typically self-reported" while still demanding FDA authorization, which is an unresolved tension inside a single policy.

What to do: if you use any RTM platform, ask your payer in writing whether it satisfies their technology criterion before you bill, and ask your vendor what its FDA status actually is. Note that "meets the FDA definition of a device" is not the same as "FDA cleared," and most RTM software is not cleared. For the record: Rehabity is not an FDA-cleared device, and we are telling you that here rather than letting you discover it in a denial.

About this data

Every row was read from the named document on the date shown. Where we could not find a policy after a good-faith search, the row says so rather than guessing. "No policy found" is a real answer and is not the same as "not covered." Nothing here is inferred from one payer to another, and nothing is filled in from secondary summaries, which we have caught being wrong in three separate directions.

You are welcome to take the data: download the raw JSON. If you have a policy document that contradicts a row, or a remittance showing a payer behaving differently from its published policy, send it to contact@rehabityhealth.com and we will update the page and credit the correction.

Rehabity builds home exercise and remote therapeutic monitoring software for outpatient physical therapy clinics. We built this because we needed the answer ourselves. Nothing on this page is gated. Join the waitlist if you want to see the product.