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Providers Must Resubmit Some Home Telemonitoring Services Claims

Last updated on 2/25/2019

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.

Providers must resubmit the following home telemonitoring services claims:

  • Claims submitted with procedure code 99454 for dates of service on or after January 1, 2019
  • Claims submitted with procedure code 99090, 99090 with modifier GQ, or 99453 for dates of service on or after February 1, 2019.

For dates of service on or after January 1, 2019, through January 31, 2019, only those claims submitted with procedure code 99454 must be resubmitted with procedure code S9110 and the appropriate modifier combination as listed in the following table.

For dates of service on or after February 1, 2019, claims submitted with procedure codes 99454 or 99090 with modifier GQ must be resubmitted with procedure code S9110 and the appropriate modifier combination as listed in the following table.

For dates of service on or after February 1, 2019, claims submitted with procedure codes 99090 or 99453 must be resubmitted with procedure code S9110 with modifier U1 for the initial setup and installation.

Telemonitoring Modifier

Description of Telemonitoring Service

U1

Setup of telemonitoring of patient in their home, including all necessary equipment: computer system, connections, and software: maintenance: patient education and support

U2

Telemonitoring of patient in their home, including all necessary equipment: computer system, connections, and software: maintenance: patient education and support (1-5 days per month)

U3

Telemonitoring of patient in their home, including all necessary equipment: computer system, connections, and software: maintenance: patient education and support (6-10 days per month)

U4

Telemonitoring of patient in their home, including all necessary equipment: computer system, connections, and software: maintenance: patient education and support (11-15 days per month)

U7

Telemonitoring of patient in their home, including all necessary equipment: computer system, connections, and software: maintenance: patient education and support (16-20 days per month)

U8

Telemonitoring of patient in their home, including all necessary equipment: computer system, connections, and software: maintenance: patient education and support (21-25 days per month)

U9

Telemonitoring of patient in their home, including all necessary equipment: computer system, connections, and software: maintenance: patient education and support (26-30 days per month)

For dates of service January 1, 2019, through January 31, 2019, claims submitted with procedure codes 99090, 99090 with modifier GQ and 99453 do not require resubmission.

Refer to:TMHP to Process Payments for Some Home Telemonitoring Services Claims for the Month of January, 2019” for additional information.

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