Indiana Medicaid Telehealth and RPM Reimbursement Updates

2022 Telehealth Reimbursement

Telehealth medical services follow the definition listed in Indiana Code IC 25-1-9.5-6: “the delivery of health care services using interactive electronic communications and information technology, in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA).” For a provider to be reimbursed for telehealth services under the IHCP, the provider must be enrolled with the IHCP and be a licensed practitioner listed in IC 25-1-9.5-3.5. Providers rendering services in state are also encouraged to have a telehealth provider certification filed with the Indiana Professional Licensing Agency. Providers rendering services out of state are required to have a telehealth provider certification under IC 25-1-9.5-9.

See all of the details here BT202239 (indianamedicaid.com). 

RPM Changes

The Indiana Health Coverage Programs (IHCP) Office of Medicaid Policy and
Planning (OMPP) is updating its telehealth policies to meet the needs of IHCP members both during and after the coronavirus disease 2019 (COVID-19) public health emergency. As a result of these policy updates, the IHCP will be adding new coverage for remote patient monitoring (RPM) services for IHCP members. 

The IHCP is implementing a single RPM coverage and prior authorization (PA) policy to be used for fee-for service (FFS) and managed care delivery systems. Effective for dates of service on or after July 21, 2022, procedure codes 99091, 99453, 99454, 99457, and 99458 will be covered RPM services. RPM or “remote patient monitoring technology” is listed under the definition of telehealth services per Indiana Code IC 25-1-9.5-6. 

The member must meet one or more of the following criteria to receive prior authorization for an RPM service (duration of initial service authorization is six months unless otherwise indicated):

◼ Received an organ transplantation within one year following the date of surgery.

◼ Had a surgical procedure (three-month service authorization following the date of surgery).

 ◼ Had one or more uncontrolled chronic conditions that significantly impaired the patient’s health or resulted in two or more related hospitalizations or emergency department visits in the previous 12 months.

 ◼ Had been readmitted within 30 days for the same or similar diagnosis or condition.

 ◼ Identified as having a high-risk pregnancy (up to three-month service authorization postpartum). See the Obstetrical and Gynecological Services provider reference module for more information about high-risk pregnancy. Reauthorizations will be permitted for select services as appropriate.

See all of the details here http://provider.indianamedicaid.com/ihcp/Bulletins/BT202238.pdf