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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 : 3.3.1 Facility Services

3.3.1
The provision and maintenance of home telemonitoring equipment is the responsibility of the home health agency or the hospital. The initial setup and installation (procedure code 99090) of the equipment in the client’s home is a benefit when services are provided by a home health agency or an outpatient hospital. Hospital providers must submit revenue code 780 or 789 with procedure code 99090.
Procedure code 99090 is limited to once per episode of care even if monitoring parameters are added after initial setup and installation. A claim for a subsequent set up and installation is not reimbursed unless there is a documented new episode of care or unless the provider submits documentation of extenuating circumstances that require another installation of telemonitoring equipment.
Daily home monitoring (procedure code 99090 with modifier GQ) is a benefit when services are provided by a home health agency or an outpatient hospital. The home health agency or hospital may submit a claim for the daily rate each day the telemonitoring equipment is used to monitor and manage the client’s care. Hospital providers must submit revenue code 780 or 789 with the procedure code for daily home monitoring.
Procedure code 99090 with modifier GQ is limited to once per day, regardless of the number of transmissions, for the length of the prior authorization period.

Texas Medicaid & Healthcare Partnership
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