Home Telemonitoring Reimbursement
and CPT Code Quick Reference Guide

Understanding Home Telemonitoring CPT Codes, requirements, and reimbursement.

Prior Authorization

Create and track each patients required care plan. Set goals and interventions and track progress

Care Plan Creation and Tracking

Authenticated users leverage Telos documentation tool to stay compliant when responding to out of parameter readings and missed reading instances.

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Billing & Revenue Tracking

Create and track each patients required care plan. Set goals and interventions and track progress

Compliance and Documentation

Authenticated users leverage Telos documentation tool to stay compliant when responding to out of parameter readings and missed reading instances.

Cellular Embedded FDA Class II Equipment

Create and track each patients required care plan. Set goals and interventions and track progress

Texas Medicaid Home Telemonitoring Program started in 2014. Home telemonitoring is a health service that requires scheduled remote monitoring of data related to a client’s health, and transmission of the data from the client’s home to a licensed home health agency or a hospital. The data transmission must comply with standards set by HIPAA. The provision and maintenance of home telemonitoring equipment is the responsibility of the home health agency or the hospital.
CPT coding for Home Health Agencies.
Physicians and qualified healthcare professionals use current procedural terminology (CPT) codes for billing services and procedures.
TMHP Fee Schedule payment amount
CPT Code Modifier Description # of days with Transmission Non/Facility Price
S9110 U1 Initial setup and installation of equipment N/A Show Price$50.00
S9110 U2 Monthly home monitoring (1 to 5 days per rolling month) 1-5 Show Price$47.25
S9110 U3 Monthly home monitoring (6 to 10 days per rolling month) 6-10 Show Price$94.50
S9110 U4 Monthly home monitoring (11 to 15 days per rolling month) 11-15 Show Price$141.75
S9110 U7 Monthly home monitoring (16 to 20 days per rolling month) 16-20 Show Price$189.00
S9110 U8 Monthly home monitoring (21 to 25 days per rolling month) 21-25 Show Price$236.25
S9110 U9 Monthly home monitoring (26 to 30 days per rolling month) 26-30 Show Price$283.50
CPT Coding for Physicians and Other Qualified Healthcare Professionals.
Physician and qualified healthcare professionals use procedural terminology (CPT) codes for billing services and procedures.
TMHP & Medicare Fee Schedule Payment Amount
CPT Code Description Time Spent Medicare Price Texas Medicaid Price
99091 Collection and interpretation of physiological data (e.g. blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days 30 Minutes Show Price$59.00 Show Price$183.09
Contact us with Additional Questions

Home Telemonitoring FAQs

A: TMHP began reimbursing physicians for Home Telemonitoring services in 2014.
A: We utilize FDA Class II approved cellular connected technology.  Our devices securely transport the vital sign readings to a HIPAA Compliant Software Platform.
A: Patients who have Traditional Medicaid or MQMB Star Plus are eligible to receive Home Telemonitoring.
A: No, there are no home bound requirements for Home Telemonitoring. Patients must meet the eligibility requirements outlined in the TMHP Home Telemonitoring Handbook.

A: No, any qualified staff member may perform the set-up and installation.

A: Prior Authorizations are approved for up to 6 months at a time.

A: Home Health Agencies can bill for Home Telemonitoring once every 30 days
A: Yes, they are following the same fee schedule as TMHP.  Be sure to reach out to your provider representative to assure your contract allows you to render Home Telemonitoring.
A: MDs, NPs, PA, and OQHP are also reimbursed on their own fee schedule using CPT Code 99091.
References

Texas Medicaid Provider Procedures Manual – Telecommunications Services Handbook August 2020
http://www.tmhp.com/Manuals_PDF/TMPPM/TMPPM_Living_Manual_Current/2_Telecommunication_Srvs.pdf

Overview of Telemonitoring Benefit Changes for Texas Medicaid
Benefits Changes/News Item/TMHP

Texas Medicaid Provider Procedures Manual – Provider Handbook
http://www.tmhp.com/Manuals_PDF/TMPPM/TMPPM_Living_Manual_Current/2_Med_Specs_and_Phys_Srvs.pdf

The reimbursement information is being provided on an “as is” basis with no express or implied warranty of any kind and should be used solely for your internal informational purposes only. The information does not constitute professional or legal advice on reimbursement and should be used at your sole liability and discretion. All coding, coverage policies and reimbursement information are subject to change without notice. Telos Health Solutions does not represent or warrant that any of the information being provided is true or correct and you agree to hold Telos Health Solutions harmless in the event of any loss, damage, liabilities or claims arising from the use of the reimbursement information provided to you. Before filing any claims, it is the provider’s sole responsibility to verify current requirements and coverage policies with the applicable payer

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