Impact of UHC's 2026 Restrictions on Remote Patient Monitoring
- Angel Callaway, CPC, CPB
- 5 days ago
- 3 min read
Remote Patient Monitoring (RPM) has become a vital tool in healthcare, allowing providers to track patients’ health data outside traditional settings. However, UnitedHealthcare (UHC) announced new restrictions on RPM services starting in 2026. These changes will affect how healthcare providers deliver care and how patients access remote monitoring. Understanding these restrictions is essential for healthcare professionals preparing for the evolving landscape.
What Are the New UHC Restrictions?
UHC intends to restrict coverage for RPM services by tightening eligibility requirements and reducing the number of reimbursable codes.
The UHC RPM policy lists covered conditions as heart failure and hypertensive disorders of pregnancy.
“Remote physiologic monitoring is not deemed reasonable and necessary due to insufficient evidence of efficacy for all other indications not specified 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 stated.
This change does not align with CMS reimbursement policies, where MA plans are legally required to cover all Part A/B covered services. It seems that UHC is trying to use the lack of a National Coverage Determination to apply internal criteria to the RPM policy.
How These Changes Affect Healthcare Providers
Providers who rely on RPM services to manage patient care will face several challenges:
Financial impact: Lower reimbursement and fewer billable codes mean less revenue from RPM programs. Smaller practices may struggle to maintain these services.
Patient selection: Providers must carefully identify which patients meet the new criteria, potentially leaving out those who previously qualified.
Administrative burden: Increased documentation and reporting requirements will demand more time and resources.
Program adjustments: Some RPM programs may need redesigning to fit the new rules, which could delay care delivery.
For example, a primary care clinic that used RPM to monitor patients with hypertension and diabetes might now only be able to bill for patients with advanced heart failure or COPD. This limits the clinic’s ability to intervene early and prevent complications.
Impact on Patients and Care Outcomes
Patients who have relied on RPM for managing chronic conditions may experience reduced access or interruptions in service. This could lead to:
Delayed detection of health issues: Without continuous monitoring, early signs of deterioration might be missed.
Increased hospital visits: Lack of RPM support could result in more emergency room visits or hospital admissions.
Reduced patient engagement: RPM often encourages patients to stay involved in their care; restrictions may reduce this engagement.
Health disparities: Vulnerable populations who benefit from RPM might face greater barriers to care.
For instance, elderly patients living in rural areas who depend on RPM to avoid frequent travel to clinics could lose this convenience, impacting their overall health management.
Strategies for Providers to Adapt
Healthcare providers can take several steps to navigate UHC’s new RPM restrictions:
Focus on high-risk patients: Prioritize RPM services for patients who clearly meet the new eligibility criteria.
Enhance documentation: Develop efficient workflows to meet increased reporting demands without overwhelming staff.
Explore alternative reimbursement: Investigate other payers or value-based care models that support RPM.
Educate patients: Communicate changes clearly to patients and discuss alternative care options.
Leverage technology: Use RPM platforms that integrate data collection and reporting to reduce administrative work.
By adapting programs and workflows, providers can continue to offer RPM services where they are most needed and maintain quality care.
How can Providers support UHC patients?
If you are operating an RPM program, examine your list of enrolled patients who are UHC beneficiaries and inform them about the coverage modification.
Patients can express their concerns about the new limitations by contacting Medicare at 1-800-MEDICARE.
The Medicare open enrollment periods are from October 15 to December 7, 2025, and from January 1 to March 31, 2026. During these times, patients have the option to switch to traditional Medicare or select a different Medicare Advantage Plan.