On January 1, 2025, New York State Medicaid expanded its coverage to include remote patient monitoring services provided by clinical staff. With this significant change comes a huge benefit for New York citizens.NYS Medicaid will reimburse for RPM services under Current Procedural Terminology code 99457. This code pertains to remote physiologic monitoring treatment management services, which involve clinical staff, physicians or other qualified healthcare professionals spending time in a calendar month engaging in interactive communication with the patient or caregiver. The reimbursement rate for CPT code 99457 is set at $41.80 per 30-day period.Clinical staff, including individuals such as pharmacists and registered dietitians who operate under the direction of a physician or qualified healthcare professional and do not independently bill for professional services, now are authorized to deliver RPM services. However, these services must be ordered by a physician or other qualified healthcare professional.Recognizing the value of RPMAlexandria Foley, RN, is vice president of nursing and care delivery at Brook Health, a healthcare organization that delivers RPM services. She said this expansion of Medicaid coverage for RPM demonstrates that New York State recognizes the value of RPM services and that this is another step in meeting the needs of New York residents – where they live and work – by adopting the latest in healthcare information technology."The Medicaid population includes people who tend to show up for emergency care when they have an exacerbation of a chronic medical condition, just as any population, and monitoring with remote technology is one strategy to identify and intervene earlier when a patient's condition starts to worsen," she explained. "The data and monitoring of that data allows patients access to the team monitoring during timeframes that the patient may be trending in the wrong direction."This earlier identification of negative trends allows for education, communication and intervention to happen in a more efficient way," she continued. "This also allows for better educational opportunities to help the patients recognize symptoms and what to do when they notice small changes in their symptoms to decrease the likelihood of needing urgent or emergent services."Brook Health is working in the trenches of remote patient care with an offering that blends remote clinical teams with AI to deliver comprehensive care between visits."Brook augments traditional healthcare by combining intelligent data collection and analysis with compassionate support from skilled health specialists – shifting the paradigm from reactive, intermittent check-ups to proactive, ever-present, habitual care," Foley explained. "For patients, this means getting better, faster care, with instant access to care teams from the comfort of home."Providers can extend their care into patients' homes without increasing clinician workloads," she continued. "And payers can help members improve long-term health, slow disease progression and reduce costly admissions. Brook AI is trained on more than 5 million messages and more than five years of patient conversations. It serves as a personalized health assistant – providing timely nudges, insights and recommendations."Taking care of chronic conditionsBrook monitors people living with heart failure, diabetes, hypertension and other chronic conditions who need monitoring in their homes.The organization's AI-powered platform analyzes the collected health data to provide timely insights and personalized recommendations, enhancing patient engagement and adherence to care plans. The Brook Health Companion App collects health data from devices, such as glucose meters and internet-enabled blood pressure cuffs and scales to record health metrics while at home.These devices automatically transmit data to the app and care portal so it gets shared directly with the patient's care team. The app also offers features such as medication reminders and personalized health coaching.The care team is composed of registered nurses, licensed practical nurses, registered dieticians and health coaches. The care team works as an extension of the provider's office to monitor and provide symptom checks, education and ongoing clinical oversight while communicating incoming data through real-time dashboards so the team can proactively identify any health issues and escalate to the patient's medical provider to intervene when necessary.Moving toward early intervention"When this happens, the care team contacts patients to explain and manage changes in their health metrics and update care plans as appropriate," Foley explained. "This system fosters early intervention and provides ongoing patient support."It's too early to share data on the impact the new Medicaid/RPM reimbursement is having on RPM services in New York. However, Foley and her team are collecting outcomes over time and hope to demonstrate improvements in patient management, as well as less use of emergency services and more early, less costly interventions thanks to expansion of remote patient monitoring services in the state."Examples of improved outcomes we are seeing generally with a New York-based provider include earlier recognition of an exacerbation in congestive heart failure symptoms and better control of diabetes that is impacting overall health as well as additional risk factors and complications," she reported. "We have also noticed that hypertension is able to be managed more effectively by optimizing medications based on the individual's needs rather than a single blood pressure at a visit, leading to better control."In one example, this practice, that has heart failure and hypertension patients being monitored remotely by Brook, had a patient that started to experience heart failure symptoms, including shortness of breath and difficulty breathing on exertion in March 2025," she continued. "The care team contacted the patient's provider with the objective data – patient physiologic data readings – and subjective data – patient's symptom check results – and their cardiologist increased the patient's diuretic."The patient's condition improved without significant changes to blood pressure readings. This intervention spared the patient a trip to the emergency department.The value of RPM dataPrior to New York State's expansion of reimbursement for these services, many providers spent time interactively communicating with Medicaid patients in a remote setting without being reimbursed for their time. Despite this lack of payment, many providers still monitored their at-risk patients remotely using the technology because they recognized the value of this information."The added reimbursement will make a difference for RPM because it not only pays providers for time spent performing these services but it's yet another third-party recognition of the value of RPM technology and patient monitoring," Foley said. "That's not to say there won't be any challenges in the near term, such as costs, reaching patients at the right time, and limitations on the number of days patients with certain diagnoses can use remote care services."If these challenges are addressed, the expansion of RPM services in the state will increase patient engagement and enable qualified clinical staff to offer more comprehensive care," she concluded.Follow Bill's HIT coverage on LinkedIn: Bill SiwickiEmail him:
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