UnitedHealthcare bucks Medicare, ends reimbursement for most RPM services

Big changes are coming to UnitedHealthcare’s Medicare Advantage plans, according to a notice the company posted online—and it’s not clear how many providers and patients are aware it’s coming.

Sometime in the last several weeks, the insurer quietly revealed that it will not reimburse physicians for remote patient monitoring (RPM), except in limited circumstances. 

Currently, Medicare Advantage plans run by UnitedHealthcare will pay clinicians for reviewing and gathering data on a variety of chronic illnesses, including diabetes and hypertension, regardless of what medical coverage the patient has.

Starting in 2026, that will no longer be the case. 

“Remote physiologic monitoring is not reasonable and necessary due to insufficient evidence of efficacy for all other indications not listed as reasonable and necessary, including but not limited to: anxiety, bipolar disorder, chronic obstructive pulmonary disease, depression, diabetes mellitus, gestational diabetes, hypertension—other than hypertensive disorders of pregnancy—obstructive sleep apnea, [and] schizoaffective disorder,” the company explained. 

In the payer group’s mind, RPM is only necessary in two circumstances: when a patient has been diagnosed with heart failure, and when a woman is pregnant and experiencing hypertension. 

The shift in policy—impacting commercial plans offered by the insurer, alongside its Medicare Part C ones—stands in contrast to traditional Medicare reimbursement, raising the question of how the insurer can legally choose to opt out. 

Medicare tends to pay physicians for patient monitoring services that are coded properly and deemed medically necessary, casting a comparably wide net that UnitedHealthcare is narrowing for itself. 

However, in its notice, the company pushes back on that criticism in advance, emphasizing that the Centers for Medicare & Medicaid Services (CMS) hasn’t issued a nationwide coverage rule for remote physiologic monitoring—so there is some wiggle room. 

“Medicare does not have a national coverage determination for remote physiologic monitoring,” the insurer added.

The healthcare payer also said the change was approved internally on September 10, 2025, meaning the notice could have been posted anytime after then. In its statement, UnitedHealthcare included all billing codes applicable to RPM under the new rules, and provided a detailed argument for why only heart failure and maternal hypertension will be subject to reimbursement when data collected through wearables and apps.