Virtual monitoring services for patients with chronic conditions

Applies to

Group and individual commercial plans, including most self-funded plans

Priority Health Medicare Advantage plans

Medicaid and Healthy Michigan Plan 

Medical policy

Telemedicine and virtual services - 91604

Virtual monitoring services billing

Use these guidelines to bill for the remote clinical monitoring, triage and support of Priority Health patients with chronic conditions at high risk for hospital admission.

• Your patient must meet the eligibility guidelines in the medical policy.
• Bill virtual services using standard billing guidelines for UB-04 billing.
• For monthly monitoring, use revenue code 0590 and HCPCS code S9110.
  • Bill 1 unit if services were provided for 1-15 days
  • Bill 2 units if services were provided for 16-31 days
• For install/de-install, bill revenue code 0590 with no HCPCS/procedure code. Paid one time at the time of the uninstall.

Not payable

• Home health care agencies that aren't contracted by Priority Health won't be reimbursed.
• When patients don't engage in the monitoring process within the first five calendar days, Priority Health won't reimburse for the monthly service and monitoring charge. We'll 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 virtual monitoring.