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    v1.0.28
    OpenPayerPolicy UpdatesTelehealth & Remote MonitoringBlue Cross Blue Shield Michigan telemonitoring Cov…
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    Currentblue cross blue shield - michiganPolicy MAPPO 1028

    Remote patient monitoring (Telemonitoring)

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    Defines coverage, eligibility, and administration of telemonitoring services offered through Blue Cross Medicare Plus Blue PPO plans for members enrolled in the Chronic Condition Management (CCM) program. Applies to Medicare Advantage members covered by Medicare Plus Blue PPO individual and group plans.

    Policy Summary
    Payerblue cross blue shield - michigan
    PolicyRemote patient monitoring (Telemonitoring)
    Policy CodePolicy MAPPO 1028
    Change TypeNo material change
    Effective DateJan 1, 2016
    Last ReviewAug 3, 2018
    Next Review Date
    Key ActionRefer eligible high-risk members (e.g., heart failure, COPD, diabetes) and enroll them in the CCM program with the contracted telemonitoring vendor before initiating services.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    heart failure, COPD, diabetesConditions identified as potential candidates
    no member cost share

    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.

    Member cost share
    single contracted vendorService delivery
    not coveredOriginal Medicare stance

    Coverage Criteria

    Telemonitoring coverage criteria

    Covered when ALL of the following are met

    Program and referral criteria: Member is referred to the telemonitoring service and enrolled in the Chronic Condition Management (CCM) program administered by Blue Cross; services are delivered by the single contracted vendor.
    Eligible conditions (examples): Member has a diagnosis such as heart failure, chronic obstructive pulmonary disease, or diabetes and is identified as high risk.
    Living situation and exclusions: Member is in an independent living situation and has no exclusionary conditions as defined by the program.
    Member agreement: Member agrees to participate in the CCM telemonitoring program and accepts the monitor and support provided.

    Original Medicare does not cover remote patient monitoring (telemonitoring). This policy describes an enhanced benefit available through Medicare Plus Blue PPO plans; coverage, reimbursement methodology, maximum allowed payments, and member cost-sharing for telemonitoring are determined by Blue Cross (for individual plans) or by the group (for group-based coverage).

    Telemonitoring under this policy is available only to members who meet program criteria and are enrolled in the Chronic Condition Management (CCM) program administered by Blue Cross; services are provided under the program contract rather than billed through standard Original Medicare channels.

    Coding and Billing

    Referenced codeHCPCS
    R0832Code listed in policy (context: August 2018)

    Provider Actions and Requirements

    Billing Rule

    Contracted vendor administration

    Telemonitoring services are delivered through a single contracted vendor under the CCM program; services and related payments are administered under the contract between Blue Cross and that vendor rather than through conventional provider billing.

    • Vendor delivers all services under contract with Blue Cross.
    • Vendor service payments are administered under contract terms; providers should not bill members for these services.
    Step Therapy

    Program enrollment prerequisite

    Members must be identified as candidates (for example, high‑risk heart failure, COPD, or diabetes) and be enrolled in the Chronic Condition Management (CCM) program before receiving telemonitoring services.

    Background

    Remote patient monitoring, also called telemonitoring, enables patients to use an internet-capable device to perform routine tests and send test data in real time to a health care professional for analysis and follow-up. The program supplies a symptom-appropriate monitor to the member’s home and the necessary support to operate it.

    Telemonitoring is intended to provide timely, actionable clinical information when a patient’s status changes so the patient’s regular health care provider can initiate an intervention as needed and support patient self-management of chronic conditions such as heart failure, chronic obstructive pulmonary disease, or diabetes.

    Definitions

    Remote patient monitoring / Telemonitoring — definition
    TermRemote patient monitoring / Telemonitoring
    DefinitionAmbulatory health care using an internet-capable device to perform a routine test and send the test data in real time to a health care professional for analysis and follow-up.
    Care settingAmbulatory (patient at home or other non‑acute setting)
    Primary purposeEnable timely clinician analysis and follow-up of patient-generated test data to support chronic condition management.
    Data flowPatient performs routine test on internet-capable device and transmits results to a health care professional in real time.
    Policy Summary
    Payerblue cross blue shield - michigan
    PolicyRemote patient monitoring (Telemonitoring)
    Policy CodePolicy MAPPO 1028
    Change TypeNo material change
    Effective DateJan 1, 2016
    Last ReviewAug 3, 2018
    Next Review Date
    Key ActionRefer eligible high-risk members (e.g., heart failure, COPD, diabetes) and enroll them in the CCM program with the contracted telemonitoring vendor before initiating services.
    SourceLink
    On This Page
    Coverage CriteriaCoding and BillingProvider Actions and RequirementsBackgroundDefinitions
  1. Eligible diagnoses noted as examples: heart failure, chronic obstructive pulmonary disease, diabetes.
  2. Enrollment in the CCM program is required prior to receiving telemonitoring.
    3. Prior Authorization

    Eligibility verification and referral

    Blue Cross verifies member program eligibility prior to referral to the contracted telemonitoring provider; providers must ensure members are referred and enrolled in the CCM program under the contracted vendor arrangement before services begin.

    • Blue Cross performs eligibility verification before referral to the contracted provider.
    • Providers should confirm the member is enrolled in CCM and referred to the contracted vendor prior to arranging telemonitoring.
    Denial Risk

    Eligibility and referral requirements

    Members must be referred, meet all program criteria, and agree to participate in the CCM telemonitoring program to be eligible; program criteria include being in an independent living situation, current enrollment, and absence of exclusionary conditions.

    • Member must be referred to the telemonitoring service.
    • Member must meet all program criteria (independent living, currently enrolled, no exclusionary conditions).
    • Member must agree to participate in the CCM program and accept the monitor/support provided.