Telemonitoring for heart failure patients
Billing home health care telemonitoring services for heart failure patients
Approved telemonitoring providers
Only certain home health care providers are approved to be reimbursed for providing in-home telemonitoring services to heart failure patients.
Go to the page listing telemonitoring providers.
Covered telemonitoring services
Go to the page listing covered telemonitoring services.
Reporting and documentation
Go to the page listing monthly reporting requirements and discharge documentation criteria.
Guidelines for billing
Use these guidelines to bill for the remote clinical monitoring, triage and support of Priority Health heart failure patients at high risk for admission.
- Your patient must meet the eligibility guidelines (below).
- You must have a prior authorization approved and on file. Use the Home Health Care prior authorization form (415KB PDF) to request authorization.
- Bill telehealth services and home health care visits using standard billing guidelines for UB04 Billing.
- For monthly monitoring: Revenue code 0590 and HCPCS code S9109:
- Bill 1 unit if services were provided for 1-15 days
- Bill 2 units if services were provided for 16-31 days
- Install/de-install: Revenue code 589 with no HCPCS/procedure code:
- Install/de-install will be paid at one time (total fee = $185.00) at the time of the uninstall
- For more information, go to Covered services page, which includes reporting requirements.
When services are not reimbursed
- Home Health Care agencies must be specifically contracted by Priority Health as providers of telemonitoring services for heart failure patients to request reimbursement.
View the list of contracted telemonitoring providers. - When patients do not engage in the monitoring process within the first 5 calendar days of engagement, Priority Health will not reimburse for the monthly service & monitoring charge. We will still reimburse for the installation and de-installation of the monitor.
- For the duration of any hospital admissions, Priority Health will exclude payment for home telemonitoring and update the authorization to this effect.
Patient eligibility guidelines
Patients who are eligible for telemonitoring in the home include those who have a history of heart failure (HF) and:
- Recent hospitalization(s) with a primary diagnosis of heart failure
- A history of failing to adhere to their HF treatment plan and are at risk for an acute episode
- Emergency Department visits in the recent past for treatment of HF
- Renal failure as defined as GFR<30, hepatic failure or coronary disease that puts the patient at risk for myocardial function compromise
Patients
excluded from telemonitoring include members who:
- Refuse telemonitoring services
- Are unwilling or unable to participate AND who have no caregiver able to prompt daily use
- Are enrolled in hospice services
- Receive high frequency (greater than 3 times per week) clinical interventions
