Exciting changes are on the horizon for Medicaid providers in Colorado: The state is taking significant steps to expand remote patient monitoring (RPM) services, opening up new avenues for patient care and practice enhancement.
Let's dive into what you need to know about RPM and how it fits into Colorado's Medicaid program, Health First Colorado.
A significant development was the passage of Colorado Senate Bill 24-168. This legislation, approved in May 2024, officially mandated that Health First Colorado provide reimbursement for telehealth remote monitoring for outpatient services.
The key date to mark on your calendars — and one that’s coming soon — is July 1, 2025. That's when mandated reimbursement for RPM services is set to begin. SB 24-168 also specifically includes coverage for continuous glucose monitors (CGMs) and related supplies under both medical and pharmacy benefits.
With the law in place, Colorado's Department of Health Care Policy & Financing (HCPF) was tasked with bringing the mandate to life. HCPF is actively developing the specific billing structures, provider guidelines, and operational details needed for what will hopefully be a smooth rollout.
To ensure the new system works well for everyone, especially in rural and underserved areas that greatly stand to benefit from the state’s Medicaid coverage of remote patient monitoring, HCPF has been engaging with stakeholders. Meetings were held in August 2024 with providers, device manufacturers, and others to gather valuable feedback on the proposed billing structure and how RPM can best be utilized. This collaborative approach aims to create a sustainable and effective RPM program for Health First Colorado members.
As of May 2025, detailed provider guidance, specific billing manuals, and the definitive list of covered CPT codes with reimbursement rates for the broader RPM coverage are still under development. We expect these details soon given the July 1 implementation date.
While we await the final details from HCPF, we can look at common remote patient monitoring rules and practices to help gain a better understanding of where the state’s department of health is likely heading.
Covered services: RPM involves using digital technologies to collect medical and other health data from individuals in one location and electronically transmit that information securely to healthcare providers in a different location (e.g., office, clinic) for assessment and subsequent recommendations. This often includes monitoring physiologic parameters like weight, blood pressure, pulse oximetry, and blood glucose using RPM devices like blood pressure monitors, weight scales, and blood glucose meters.
CPT codes: Nationally, several CPT codes are commonly used for RPM services. These include:
Note: It's important to remember that this is a general list. HCPF will establish the official list of covered RPM codes and their specific requirements for Health First Colorado. Current Health First Colorado fee schedules (as of January 2025) do not yet reflect these codes as active for broad RPM reimbursement, which is expected soon given the July 2025 start date.
Prior authorizations and co-payments: It's likely that some RPM services may require prior authorization from Health First Colorado or the member's managed care plan. Details on co-payments for RPM services are also pending HCPF guidance. General telehealth services under Health First Colorado often have no co-pay, especially for exempt member categories, but specific RPM policies will be clarified by HCPF.
Recognizing the importance of access in rural areas, SB 24-168 also established the Telehealth Remote Monitoring Grant Program. This initiative aims to provide grants to eligible rural outpatient healthcare facilities to help with the initial costs of implementing RPM services, which will hopefully foster early adoption and help to bridge the health equity gap. The application deadline for the grants was May 1, 2025.
Health First Colorado members are enrolled with regional accountable entities (RAEs) and some may be part of managed care organizations (MCOs) like Elevate (Denver Health) Medicaid Choice or Rocky Mountain Health Plans (RMHP) Prime. These plans will play a role in how members access RPM services. While the core benefits are set by Health First Colorado, RAEs and MCOs will likely develop their own specific implementation plans, member communications, and any network requirements for RPM, consistent with the state's mandate, once HCPF finalizes the statewide guidelines.
It's worth noting that Health First Colorado already has a solid foundation in telehealth. General telemedicine services, including live audio/visual and audio-only visits, are permanently covered and reimbursed at the same rate as comparable in-person services. This existing framework for remote care delivery sets a positive precedent for the expansion of more specific RPM services.
The move towards comprehensive remote patient monitoring coverage under Health First Colorado is clearly a positive development for both patients and providers. It promises to deliver substantial benefits, including enhancing chronic disease management, improving access to care, strengthening the financial performance of Medicaid providers, and hopefully leading to better health outcomes.
As HCPF continues its work to finalize the operational details for RPM, we at Prevounce will be closely monitoring news and announcements coming out of the department. Providers interested in staying current should keep an eye on official HCPF communications, including provider bulletins, updates on the HCPF website, and revised fee schedules, especially as the July 1 effective date approaches.
For providers serving Medicaid populations in Colorado, now is the time to begin preparing for the expansion of reimbursable remote patient monitoring services. With new coverage going into effect July 1, 2025, RPM offers a powerful opportunity to enhance care delivery, support chronic disease management, and increase revenue.
Need help navigating this expansion? Prevounce is here to help you get started with RPM. Contact us to learn how and get started.