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Telemonitoring Prior Authorization Form Clarification for Procedure Code and Frequency

Last updated on 1/4/2021

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.

Effective October 1, 2020, the Home Telemonitoring Services Prior Authorization Request form and Home Telemonitoring Services Prior Authorization Request Form Instructions were updated. The updated form includes a new section for providers to enter the appropriate procedure code and frequency.

Beginning March 1, 2021, Home Telemonitoring Services Prior Authorization Request forms that do not have the procedure code and frequency entered in the required fields will be rejected.

To prevent rejection:

  • Providers must enter procedure code S9110 in the Procedure code(s) field of Section C: Authorization period (completed by home health agency or outpatient hospital). The optional Comments section can be used to provide any additional information for the request that does not have an appropriate field.
  • Providers must enter the physician-ordered frequency of clinical data transmission in the Physician-ordered frequency of clinical data transmission. This information is communicating the number of days in a month (30-day period) data will be transmitted from the client’s home to the home health agency or the hospital. This is not the duration (quantity) for telemonitoring services. The number of days per month must be consistent with the U modifier submitted later in the claim with code S9110.

Providers do not need to submit the duration (quantity) for telemonitoring services. TMHP calculates the duration (quantity) based on the dates of service requested.

EXAMPLE 1: If the clinical data is being transmitted 1 time per week, acceptable frequencies are as follows:

1x/wk Once weekly
Weekly 4x/month

Section C Example 1

EXAMPLE 2: Another example that is acceptable for the procedure code and frequency

Section C Example 2

For information about the form update, and other home telemonitoring updates, providers can refer to the article titled “Telemonitoring Benefits to Change for Texas Medicaid October 1, 2020," which was published on this website on August 14, 2020. Providers can find the current form and form instructions in the Prior Authorization section of the TMHP Forms webpage.

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