Telemonitoring services for patients with chronic conditions

Applies to

Group and individual commercial plans, including most self-funded plans

Priority Health Medicare Advantage plans

Medicaid and Healthy Michigan Plan

Definition

The ongoing assessment of a condition - cardiac arrhythmias and/or other objectively measurable indicators of disease (e.g., heart failure) - by sensors attached to the patient, signals from which are sent wirelessly to a central station or “node” where abnormalities can trigger a response by health care providers.

Medical policy

Telemedicine - 91604

Telemonitoring services billing

Use these guidelines to bill for the remote clinical monitoring, triage and support of Priority Health patients with chronic conditions at high risk for admission.

  • Your patient must meet the eligibility guidelines in the medical policy.
  • Bill telehealth services and home health care visits using standard billing guidelines for UB-04 billing.
  • For monthly monitoring, use revenue code 0590 and HCPCS code S9110.
    • Bill 1 unit if services were provided for 1-15 days
    • Bill 2 units if services were provided for 16-31 days
  • For install/de-install, bill revenue code 0590 with no HCPCS/procedure code. Paid one time at the time of the uninstall.

Not payable

  • Home health care agencies that are not contracted by Priority Health will not be reimbursed.
  • When patients do not engage in the monitoring process within the first 5 calendar days, Priority Health will not reimburse for the monthly service & monitoring charge. We will still reimburse for the installation and de-installation of the monitor.
  • For the duration of any hospital admissions, Priority Health will exclude payment for home telemonitoring and update the authorization to this effect.

Telemonitoring services reporting requirements

Home health care providers of telemonitoring services will provide:

  1. Clinical updates to the Priority Health outpatient care manager a) at installation, b) monthly and c) on de-installation
  2. Notification to the treating physician of significant changes in the member's clinical signs and symptoms
  3. A summary of the patient's clinical status to the primary care physician, in the interest of providing patient-centered care

Telemonitoring discharge documentation

Before discharging a patient from telemonitoring, home care, the Priority Health care manager, and the physician must all agree that the mutual goals for the patient and service have been met and that the patient should be discharged from telemonitoring.

The patient must meet the graduation criteria identified on the Telemonitoring Discharge Form. The form is not required, but it's good practice to document the graduation criteria checklist and include it in the patient's chart for future reference.

Complete a Telemonitoring Discharge Form