Retiredblue cross blue shield - michiganPolicy MAPPO 102

Remote patient monitoring (Telemonitoring)

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

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

no cost sharemember financial responsibility for vendor services

contracted vendorvendor delivery requirement

2026-01-01policy retirement effective date

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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.

Blue Cross verifies member program eligibility before referral to the contracted provider.

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

OpenPayer

Remote patient monitoring (Telemonitoring)

Coverage Criteria for Remote Patient Monitoring

Provider Actions, Vendor Requirements, and Billing

Background

Definitions

Revision History & Material Changes