Please see the COVID-19 for Providers page for more information.
Telehome telemonitoring is the use of electronic remote monitoring devices for purposes such as blood pressure checks, weight checks via a telescale as well as other remote medical intervention and assessment tools from the convenience of the patient’s place of residence.
Congestive heart failure (CHF) telemonitoring utilizes a computerized scale that is placed in the patient’s home. The scale weighs the patient and presents a series of questions to be answered. The data is scored and transmitted to the physician’s office. An exception report documents and stores the patient data. Based on the preset parameters (weight range/criteria) the clinic may be alerted to contact the patient for additional evaluation and/or intervention.
BCBSND requires members to be enrolled in Case Management services prior to receiving benefits for this program.
Benefits are available for telehome telemonitoring for patients with Congestive Heart Failure (CHF) and/or Chronic Obstructive Pulmonary Disease (COPD) who meet ALL the following criteria:
a) Requires care coordination and ongoing engagement through BCBSND Case Management
b) History of cardiac conditions including CHF and/or COPD
c) Recent hospitalization in the last 6 months with a primary diagnosis of CHF or COPD
d) A history of failing to adhere to their treatment plan and are at risk of an acute episode
e) Multiple (> 2) emergency department visits in the past 6 months for treatment of their CHF/COPD conditions
f) The medical exam of the patient must be under the control of the consulting practitioner
g) A permanent record of online communications relevant to the ongoing medical care of the patient should be maintained as part of the patient medical record.
Ongoing benefits are dependent upon measurable clinical improvements in acute symptoms and stabilization of the patient’s acute symptoms. For members receiving Home Health skilled nursing visits for CHF/COPD, it is anticipated that face-to-face skilled nursing visits will decrease due to telehome telemonitoring.
Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.
Telemonitor equipment rental
Data collection and interpretation
Submit one claim per month.
The telemonitoring equipment is eligible only as a rental item. The provider is responsible for installation, maintenance and update of the system.
Physiologic data eligible for reimbursement as part of the CHF and/or COPD telehome monitoring program are blood pressure readings, weight checks and oxygen levels. ECG monitoring and/or glucose monitoring is excluded. If provided, ECG monitoring and/or glucose monitoring will be considered included in the allowance for 99091.
Daily monitoring of the transmitted data and interaction with the patient is the responsibility of the clinical practitioner. Thirty cumulative minutes, or more, are spent per month performing the activities of blood pressure, weight and oxygen monitoring.
The provider documentation must indicate patient is utilizing the equipment and be able to provide the documentation to support this upon request.
Charges for telephone land lines, internet connections, tele-communication or cellular devices needed for operating the telemonitoring device are not covered and will be denied.
Internal Medical Policy Committee 1-22-2020 Annual Review No changes;
4-24-20 COVID-19 disclaimer added
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving and the Company reserves the right to review and update medical policy periodically.