Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesEmergency & Medical TransportationCareSource Georgia PERS Coverage Policy Update | O…
    Ask Trek AI about this page
    CurrentCareSource GeorgiaPolicy MEDICAL POLICY STATEMENT Date Effective = Date Effective 11/01/2025. Personal Emergency Response Systems-MP-MM-1425

    Personal Emergency Response Systems

    Customize your policy alerts

    Sign up for CareSource Georgia Policy MEDICAL POLICY STATEMENT Date Effective = Date Effective 11/01/2025. Personal Emergency Response Systems-MP-MM-1425 alerts

    Get alerted when Policy MEDICAL POLICY STATEMENT Date Effective = Date Effective 11/01/2025. Personal Emergency Response Systems-MP-MM-1425 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Defines medical necessity and coverage criteria for in-home Personal Emergency Response Systems for CareSource Georgia members, including eligibility, required documentation, and case management assessment.

    Policy Summary
    PayerCareSource Georgia
    PolicyPersonal Emergency Response Systems
    Policy CodePolicy MEDICAL POLICY STATEMENT Date Effective = Date Effective 11/01/2025. Personal Emergency Response Systems-MP-MM-1425
    Change TypeNo material change
    Effective DateNov 1, 2025
    Last ReviewAug 4, 2025
    Next Review DateNov 1, 20269d
    Key ActionObtain CareSource Case Management assessment and provide provider documentation of diagnoses and functional limitations showing how PERS will improve member safety and support continued residence at home.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    ALLAll criteria required
    AssessmentCase management
    RequiredProvider documentation
    ListedMarketplace applicability

    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.

    Coverage Criteria for Personal Emergency Response Systems (PERS)

    Initial PERS eligibility

    Covered when ALL of the following are met

    PERS medical necessity criteria

    • Provider documentation: Specific clinical diagnoses and/or physical-functional limitations which serve as an indication for a PERS; and how the PERS specifically will improve member safety and facilitate continued residence in the home settingALL

      Provider must supply both items

    • Telephone requirement: Member retains an appropriate mobile or landline phone system that will support the PERS deviceALL

      Phone capability required

    • Case Management assessment items: (1) frail and functionally impaired; (2) living alone or with another functionally impaired person; (3) willing to arrange for private line telephone service if one is not in place OR willing to accept a wireless cellular device as an alternative; (4) mentally and physically able to use the equipment appropriatelyALL

      All four subitems required for eligibility

    This policy excludes remote video monitoring and systems that only connect directly to emergency service personnel. Those technologies are not considered part of a Personal Emergency Response System (PERS) for the purposes of coverage under this policy and should not be billed or requested as PERS equipment or services.

    PERS is not medically necessary and will not be covered when the required provider documentation and CareSource Case Management eligibility criteria are not all met. Medical Policy Statements do not guarantee authorization or payment; the plan contract (Evidence of Coverage) is controlling if there is a conflict. Failure to provide the documented clinical diagnoses/functional limitations, the plan for how PERS will improve safety and support continued residence, confirmation of an appropriate phone system, and completed CareSource Case Management assessment items will render PERS non-covered.

    Provider Requirements and Case Management

    Prior Authorization

    Case management assessment required

    CareSource Case Management must assess the member for PERS eligibility; PERS is considered medically necessary only when provider documentation and all Case Management criteria are satisfied.

    Note

    Engage Case Management and confirm prerequisites before requesting PERS

    Ensure CareSource Case Management is engaged for eligibility assessment and that all required provider documentation and member telephone capability are in place prior to requesting coverage.

    Documentation Required

    Required provider documentation

    Background

    A Personal Emergency Response System (PERS) is a device with an integrated monitoring service that secures help during emergencies by enabling two-way, hands-free communication between the individual and a central monitoring station staffed by trained personnel. Current PERS models may include additional alarms or services depending on device sophistication. When prescribed as part of a physician’s treatment plan, PERS can provide safety, support medication adherence, and help members remain independent in the home.

    Definitions

    PERS definition — components and functions
    Telecommunications equipmentPERS includes telecommunications equipment as part of the system that transmits alerts and enables connection to responders.
    Central monitoring stationA trained, remote central monitoring station receives alarm signals and responds to the member's PERS equipment.
    Two‑way, hands‑free communicationA medium for two‑way, hands‑free communication between the individual and the central monitoring station is required to meet the PERS definition.
    ExclusionsThe PERS definition excludes remote video monitoring of the individual in the home and systems that only connect to emergency service personnel.
    Purpose/functionsPERS can secure help during emergencies, improve safety, assist in medication adherence, and support independent living when part of a physician‑prescribed plan of treatment.
    Policy Summary
    PayerCareSource Georgia
    PolicyPersonal Emergency Response Systems
    Policy CodePolicy MEDICAL POLICY STATEMENT Date Effective = Date Effective 11/01/2025. Personal Emergency Response Systems-MP-MM-1425
    Change TypeNo material change
    Effective DateNov 1, 2025
    Last ReviewAug 4, 2025
    Next Review DateNov 1, 20269d
    Key ActionObtain CareSource Case Management assessment and provide provider documentation of diagnoses and functional limitations showing how PERS will improve member safety and support continued residence at home.
    SourceLink
    On This Page
    Coverage Criteria for Personal Emergency Response Systems (PERS)Provider Requirements and Case ManagementBackgroundDefinitions

    Provider must document both (1) the specific clinical diagnoses and/or physical-functional limitations indicating need for PERS and (2) how the PERS will specifically improve member safety and facilitate continued residence in the home.

    • Document specific clinical diagnoses and/or physical-functional limitations that indicate PERS.
    • Describe how the PERS will specifically improve safety and support continued residence at home.
    Denial Risk

    Denial risk for missing required criteria

    Failure to meet ALL required criteria — provider documentation, member phone capability, and CareSource Case Management assessment items — will render PERS non-covered and may result in denial.

    • Provider documentation must include both required elements.
    • Member must retain an appropriate mobile or landline phone system (or accept wireless alternative).
    • Case Management must find all four assessment items (frail/functionally impaired; living situation; willingness to arrange phone or accept wireless device; mentally and physically able to use equipment).