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TMHP to Process Payments for Some Home Telemonitoring Services Claims for the Month of January, 2019

Last updated on 2/22/2019

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

TMHP is manually processing payments for home telemonitoring services claims submitted for dates of service January 1, 2019, through January 31, 2019, by home health agencies or outpatient hospitals with procedure codes 99453, 99090, or 99090 with modifier GQ.

Affected claims will be reflected in payments to providers by March 1, 2019.

Claims submitted with the discontinued procedure code 99090 or with procedure code 99453 will be reviewed for payment of the initial setup and installation rate as procedure code S9110 with modifier U1. Procedure code S9110 with modifier U1 will be reimbursed $50.00 for the initial setup and installation of the equipment in the client’s home.

Claims submitted with the discontinued procedure code 99090 with modifier GQ will be reviewed for payment of the monthly rate as procedure code S9110 with the appropriate modifier based on the number of days of telemonitoring services per month. To qualify for the appropriate monthly rate listed below, services must have been rendered for the number of days within the calendar month of January 2019. TMHP will manually process the payments according to the number of days rendered on claims submitted.

Procedure Code and Modifier

Dates Telemonitoring Services were Rendered in January 2019

Medicaid Fee

S9110-U2

1-5 days per month

$47.25

S9110-U3

6-10 days per month

$94.50

S9110-U4

11-15 days per month

$141.75

S9110-U7

16-20 days per month

$189.00

S9110-U8

21-25 days per month

$236.25

S9110-U9

26-30 days per month

$283.50

Information regarding the following home telemonitoring services claims will be provided in a future notification:

  • Claims submitted with procedure code 99454 for dates of service on or after January 1, 2019
  • Billing and claims for telemonitoring services provided on dates of service on or after February 1, 2019
  • Additional benefit and prior authorization information for all telemonitoring services

For more information, call the TMHP Contact Center at 800-925-9126.