UPDATE: TMHP 2021 Billing Code Changes – Everything You Need to Know

What the recent TMHP 2021 billing code changes really mean, and how to keep providing telemonitoring services for your TMHP-eligible patients.

TMHP has clarified that Telemonitoring CPT Code 99091 will only be paid at the Medicare allowed rate ($55) for dual eligible patients that have Medicare as Primary Insurance.

TMHP has clarified that Telemonitoring CPT Code 99091 will be paid at the Medicaid allowed rate of ($183) for patients that have Medicaid as Primary Insurance.

As we know, the majority of patients that qualify for TMHP Telemonitoring services are MQMB and have Medicare as Primary Insurance. Therefore, effective immediately, your remote care provider should be providing monthly billing reports to submit claims to Medicare for Telemonitoring Codes 99454, 99457, and 99458.

Why 99454 / 99457 / 99458 over 99091? Higher monthly reimbursement

• 99454 ($60), 99457 ($50), and 99458 ($40-$80 - can be billed for up to two units each month) for an average monthly total reimbursement of ~$150 per patient. Versus, code 99091 which only reimburses $55.

Accuhealth provides the services incident to and under your referring providers general supervision

• 99454 / 99457 / 99458 allow time accumulation by any Qualified Health Care Professional Role, including Medical Assistants and above, and the services can be provided by Accuhealth medical staff. Code 99091 has more stringent rules and only your Clinic’s RNs, NPs, PAs, and MDs can account for the interactive time.

As a result of this, there should be absolutely no change in protocol and your remote care provider should be sending you a monthly billing report that details the new codes and dates of service to bill. With Accuhealth, the platform calculates everything so you don’t need to worry.

Accuhealth has been providing these services for some time now, so rest assured, if you work with us, we can offer you the best options for remote patient monitoring.

For more information about Accuhealth and coding changes, please feel free to book a meeting with Accuhealth’s billing team www.accuhealth.tech