Remote Patient Monitoring (RPM) and eConsults SPA Update

DOH has submitted SPA 25-02 to CMS to allow FQHCs that have not opted into APGs to bill Medicaid for eConsults and Remote Patient Monitoring (RPM) services.

1. eConsults are asynchronous provider-to-provider communications, allowing primary care providers to consult specialists without requiring a separate patient visit.
2. RPM involves collecting and analyzing a patient’s physiological data (e.g., blood pressure, glucose) over time, typically from the patient’s home using connected devices.

Currently, FQHCs not enrolled in APGs cannot bill for these services. The SPA proposes allowing billing in lieu of the PPS rate. If approved, FQHCs will be able to bill for these services starting January 1, 2025.

While the fee schedule is not finalized, non-FQHCs are currently reimbursed at approximately:

• $27 for eConsults
• $41 for RPM (billable once every 30 days)

For more details:

• Medicaid Update on eConsults
• Medicaid Update on RPM
• SPA 25-02 Submitted to CMS