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    v1.0.28
    OpenPayerPolicy UpdatesTelehealth & Remote MonitoringBlue Cross Blue Shield Michigan remote patient mon…
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    Retiredblue cross blue shield - michiganPolicy MAPPO 102

    Remote patient monitoring (Telemonitoring)

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    Defines coverage and operational handling of remote patient monitoring (telemonitoring) for Medicare Plus Blue PPO members, including eligibility, vendor-administered services, and member cost sharing.

    Policy Summary
    Payerblue cross blue shield - michigan
    PolicyRemote patient monitoring (Telemonitoring)
    Policy CodePolicy MAPPO 102
    Change TypeRetirementwording update
    Effective DateJan 1, 2016
    Last ReviewNov 18, 2024
    Next Review Date
    Key ActionRefer eligible members to the contracted CCM vendor; do not bill members for vendor services.
    SourceLink
    POLICY UPDATE CHANGES

    Effective 1/1/2026 the policy is retired because product confirmed policy papers will not be necessary for vendor services where no claims are generated or processed by BCBSM/BCN.

    Updated benefit language to align with the Evidence of Coverage (EOC).

    Original Medicare covers remote patient monitoring as part of a home health plan of care combined with another skilled service.

    3targeted chronic conditions listed for eligibility

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    no cost sharemember financial responsibility for vendor services
    contracted vendorvendor delivery requirement
    2026-01-01policy retirement effective date

    Coverage Criteria for Remote Patient Monitoring

    Coverage conditions for remote patient monitoring

    Covered when ALL of the following are met

    Program and contractual conditions: Member is enrolled in the Chronic Condition Management program and remote monitoring is delivered by the single contracted vendor under terms of Blue Cross; vendor payments are administered under contract and there is no provider billing to the member.

    See member cost sharing and reimbursement sections.

    Clinical targeting: Member is diagnosed with heart failure OR chronic obstructive pulmonary disease OR uncontrolled hypertension and targeted for the remote monitoring intervention.

    Policy lists these as eligible targets for outreach/enrollment.

    Original Medicare constraint: When applicable, Original Medicare covers remote patient monitoring only as part of a home health plan of care combined with another skilled service; Medicare Plus Blue may provide enhanced coverage beyond Original Medicare.

    Applies when Original Medicare rules govern benefits.

    Original Medicare limits coverage of remote patient monitoring (telemonitoring) to instances where the service is delivered as part of a home health plan of care combined with another skilled service. This Medicare constraint applies when Original Medicare rules govern benefits for the member and should be considered when determining coverage applicability under Medicare-based products.

    For Medicare beneficiaries, remote monitoring provided outside a home health plan of care combined with a skilled service is not covered by Original Medicare. Note that this policy was retired effective 1/1/2026 because vendor services that do not generate BCBSM/BCN claims no longer require policy papers; however, the Original Medicare limitation described above remains the baseline reference for Medicare-covered benefits.

    Provider Actions, Vendor Requirements, and Billing

    Billing Rule

    Vendor/Program requirement

    The telemonitoring service is provided under the administration of the Chronic Condition Management (CCM) program and must be delivered by a single contracted vendor under agreement with Blue Cross Blue Shield of Michigan. Services provided outside this CCM administration or by vendors not under contract with Blue Cross may not be covered.

    • Services must be provided under CCM administration by the single contracted vendor.
    • Services delivered outside the contracted vendor/CCM program may not be covered.
    Billing Rule

    Eligibility verification and billing

    Blue Cross verifies member eligibility for the remote telemonitoring program prior to referral to the contracted vendor. There is no member billing or cost sharing for services delivered by the contracted vendor; vendor service payments are administered under the terms of the contract with Blue Cross.

    Background

    Remote patient monitoring, also called telemonitoring, enables a patient to use an internet-capable device to perform routine physiologic tests and transmit the resulting data in real time to a health care professional for analysis and follow-up. The modality supports ongoing clinical surveillance and condition management by allowing clinicians to receive and act on vital sign and other physiologic data without requiring an in-person visit.

    Definitions

    inv-09: Remote patient monitoring (telemonitoring) — definition entry
    TermRemote patient monitoring (telemonitoring)
    DefinitionA type of ambulatory health care that allows a patient to use an internet-capable device to perform a routine test and send the test data to a health care professional in real time for analysis and follow-up.
    Alternate nameTelemonitoring
    Care settingAmbulatory (patient at home using internet-capable device)
    Primary purposeTransmit routine test data to clinicians for real-time analysis and follow-up

    Revision History & Material Changes

    Policy Summary
    Payerblue cross blue shield - michigan
    PolicyRemote patient monitoring (Telemonitoring)
    Policy CodePolicy MAPPO 102
    Change TypeRetirementwording update
    Effective DateJan 1, 2016
    Last ReviewNov 18, 2024
    Next Review Date
    Key ActionRefer eligible members to the contracted CCM vendor; do not bill members for vendor services.
    SourceLink
    On This Page
    Coverage Criteria for Remote Patient MonitoringProvider Actions, Vendor Requirements, and BillingBackgroundDefinitionsRevision History & Material Changes
  1. Blue Cross verifies member program eligibility before referral to the contracted provider.
  2. No member billing or cost sharing for services delivered by the contracted vendor; payments handled per vendor contract.