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 for dates of service on or after March 1, 2021, telemonitoring benefits will change for Texas Medicaid.
The collection and interpretation of a client’s data (procedure code 99091) gathered through home telemonitoring may be a benefit when services are provided by a physician or other qualified healthcare provider in the office and outpatient hospital settings.
Procedure code 99091 will be limited to once per 30 days.
Reminder: Providers submitting claims for clients who have dual eligibility for Medicaid and Medicare must first submit their claims to Medicare.
Effective March 1, 2021, online evaluation and management for home telemonitoring services (procedure codes 99421, 99422, and 99423) will no longer be a benefit.
For more information, call the TMHP Contact Center at 800-925-9126.