We identified significant policy changes when recently reviewing several commercial payer policies on remote monitoring: reduction in diseases that qualify for remote physiological monitoring (RPM) or complete deletion of remote therapeutic monitoring (RTM).
Aetna
Aetna’s policy was updated on 2/27/26 and limits RPM) to three diseases:
- Heart failure
- Hypertension
- Diabetes
The covered CPT codes only seem to be the original ones: 99453, 99454, 99457 and 99458. The new codes released this year, 99445 and 99470, are listed as “not covered” on the bulletin, as are the Remote Therapeutic Monitoring (RTM) codes: 98975, and so forth.
The policy article also discusses non-covered but promising use cases, such as for COPD, hypertension in pregnancy, for the “elderly” and so on. The fact that the policy discusses these conditions is a great indicator that this would be a good opportunity to contact Aetna and provide data and discussions about Aetna populations prior to the restrictions to show the positive outcomes. In addition, a push for coverage of the two new codes promoting the lower day and time threshold would be good. The next policy review is in October 2026.
Check for coverage by contacting or accessing Aetna via Availity, since different contracts will cover services not set out in policy; this includes checking on Medicare Advantage plans which must cover what Medicare covers, and your regional Medicaid plans.
Aetna: Remote Physiologic Monitoring (RPM)
Cigna
- Like Aetna, Cigna has a listing of diseases that it will cover for RPM:
- Chronic Obstructive Pulmonary Disease (COPD)
- Diabetes Mellitus
- Gestational Diabetes
- Heart Failure
- Hypertensive Disorders Of Pregnancy (HDP)
Also like Aetna, Cigna has chosen to not reimburse for RTM.
Cigna: Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM)
United Health Care (UHC)
Finally, UHC has delayed that implementation of a more restrictive policy: The Medical Policy titled Remote Physiologic Monitoring (RPM) will not be effective on Jan. 1, 2026, as previously announced; implementation of the new policy has been postponed until further notice.
United Health Care: Implementation Delay: Remote Physiologic Monitoring (RPM)
Findings
These are major shifts from top national payers. It does not eliminate RPM entirely, but it signals a move toward tighter, evidence-based coverage criteria. Programs that have Aetna patients as a large part of its payor mix or use RTM-enhanced PT vendors should therefore reassess their financial exposure and patient mix.
This raises an important question: what does this mean for Medicare, Medicaid and other payers’ coverage?
At the same time, there may be alternative pathways emerging for programs focused on prevention and remote care. One example is the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model, a new federal initiative designed to address the growing burden of chronic disease in the United States.
MAHA ELEVATE model:
The MAHA ELEVATE model will provide approximately $100 million in funding through three-year cooperative agreements for up to 30 selected proposals that promote prevention and health improvement among Original Medicare beneficiaries. These projects will test evidence-based, whole-person care approaches, including lifestyle and functional medicine interventions that are not currently reimbursed under Original Medicare. Importantly, these approaches are intended to complement—not replace—traditional medical care.
Beyond funding innovative interventions, the program is designed to generate new evidence on cost, quality, and health outcomes. The goal is to determine which lifestyle-based interventions—such as those targeting nutrition, physical activity, and related behaviors—can most effectively improve health and reduce long-term healthcare spending in the Medicare population.
If successful, the findings from MAHA ELEVATE could inform future Medicare coverage decisions or new value-based care models developed by the Centers for Medicare & Medicaid Services. The agency is expected to release a Notice of Funding Opportunity (NOFO) in early 2026, with the voluntary model scheduled to launch in October 2026.
At its core, the initiative reflects a broader strategy: shifting the healthcare system toward proactive prevention and whole-person care, addressing the root causes of chronic disease rather than focusing only on treating symptoms.
MAHA ELEVATE (Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence) Model
Takeaway: As reimbursement policies evolve, programs may need to diversify their funding strategies, strengthen outcomes data, and stay attentive to both payer policy changes and emerging federal innovation opportunities.
