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Dear Members, 

As a follow-up to Sarah's post from last week on this issue, I'd like to remind you to continue billing for these services as directed in the Claims Filing Section of the Texas Medicaid Provider Procedures Manual. 

As background, Section 6.3.3.1. of the manual gives a good explanation of the HCPCS updates process that resulted in the deletion of code 99090 for telemonitoring, and describes the resulting state rate hearings that are supposed to be associated with deletions of this kind. It is important to note these instructions, taken directly from this section of the TMPPM:

Claims for services that are provided before the rates are adopted through the rate hearing process are
denied as pending a rate hearing (EOB 02008) until the applicable reimbursement rate is adopted. The
client cannot be billed for these services.

Providers are responsible for meeting the initial 95-day filing deadline. Providers must submit the
procedure codes that are most appropriate for the services provided, even if the procedure codes have
not yet completed the rate hearing process and are denied by Texas Medicaid as pending a rate hearing.

Once the reimbursement rates are established in the rate hearing and applied, TMHP automatically
reprocesses affected claims. Providers are not required to appeal the claims unless they are denied for
other reasons after the claims reprocessing is complete.

While TAHC&H continues to work with the state to resolve this issue, please keep in mind that you must continue to file your claims timely for these services using the procedure codes the state has suggested will replace 99090, as appropriate.

We will provide additional updates to you as we have them. Please do not hesitate to contact us if you have additional questions.

Thank you,