In February 2023, the majority of the MACs, led by Novitas Solutions, met in a Multi-Jurisdictional Contractor Advisory Committee (CAC) to jointly consider a new local coverage determination (LCD) for RPM and RTM for Non-Implantable Devices. Neither of these services have a National Coverage Decision (NCD) by CMS but CMS has included these services in Medicare Physician Fee Schedules since its creation in 2018. In the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare contractors based on a local coverage determination (LCD).

The MAC meeting resulted from concerns that the RPM codes were being used more broadly than originally intended, and that utilization was rising faster than expected (RPM grew six times since the creation of the codes). There were concerns from the RPM stakeholder community about potential payment cuts to RPM and the LCD process, which didn’t offer enough specificity for stakeholders to understand the implications of a potential LCD.

The Alliance was a leader in the process. The Alliance led a call for data and convened stakeholders advocating for continued RPM/RTM coverage. Due to these efforts and pressure from CMS, the MACs determined not to move forward with an LCD.

During the MAC meeting, the majority of the medical specialty societies present expressed strong support for RPM. Particularly notable were cardiologists and primary care doctors from at least a dozen leading academic medical centers testifying about how their RPM programs were crucial to improving patient outcomes.

Learn more about our RPM priorities.