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December 2016 Texas Medicaid Provider Procedures Manual

Telecommunication Services Handbook : 3 Services, Benefits, Limitations, and Prior Authorization : 3.3 Telemonitoring Services

3.3
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.
Data parameters are established as ordered by a physician’s plan of care.
Data must be reviewed by a registered nurse (RN), NP, CNS, or PA, who is responsible for reporting data to the prescribing physician in the event of a measurement outside the established parameters.
Online evaluation and management for home telemonitoring services (procedure code 99444) is a benefit in the office or outpatient hospital setting when services are provided by an NP, CNS, PA, or physician provider. Procedure code 99444 is limited to once per seven days and is denied if it is submitted within the postoperative period of a previously completed procedure or within seven days of a related evaluation and management service by the same provider.
Scheduled periodic reporting of the client data to the physician is required, even when there have been no readings outside the parameters established in the physician’s orders. Telemonitoring providers must be available 24 hours a day, 7 days a week. Although transmissions are generally at scheduled times, they can occur any time of the day or any day of the week, according to the client’s plan of care.
The physician who orders home telemonitoring services has a responsibility to ensure the following:
Although Texas Medicaid supports the use of home telemonitoring, clients are not required to use this service.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.