by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
February 17th, 2016
Medical practitioners who can bill for a covered Telehealth service vary by state law, but they may include:
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physician,
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nurse practitioner,
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physician assistant,
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nurse midwife,
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clinical nurse specialist,
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clinical psychologist,
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clinical social worker, and
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registered dietician or nutrition professional
Distant or Hub site: Site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system.
Originating or Spoke site: Location of the Medicaid patient at the time the service being furnished via a telecommunications system occurs. Telepresenters may be needed to facilitate the delivery of this service.
Asynchronous or "Store and Forward": Transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or "store and forward" applications would not be considered telemedicine but may be utilized to deliver services.
Medical Codes: States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) in order to identify, track and reimburse for telemedicine services.
Telehealth (or Telemonitoring) is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.
Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a Medicaid coverable service, such as laboratory service, x-ray service or physician services (under section 1905(a) of the Social Security Act).
Benefits to remote areas of using telehealth may include:
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transmission of medical images for diagnosis and advice on disease prevention,
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health advice in emergency cases, and
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patient care and promotion of good health via patient monitoring and follow-up
Follow-up inpatient telehealth consultations furnished to beneficiaries
in hospitals or SNFs
Office or other outpatient visits
Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days
Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days
Individual and group kidney disease education services
Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training
Individual and group health and behavior assessment and intervention
Individual psychotherapy
Telehealth Pharmacologic Management
Psychiatric diagnostic interview examination
End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment
End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents (effective for services furnished on and after January 1, 2016) CPT code
90963.
End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents (effective for services furnished on and after January 1, 2016)
End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents (effective for services furnished on and after January 1, 2016)
End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 20 years of age and older (effective for services furnished on and after January 1, 2016) CPT code
90966
Individual and group medical nutrition therapy
Neurobehavioral status examination
Smoking cessation services
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services
Annual alcohol misuse screening, 15 minutes
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
CPT only copyright 2015 American Medical Association. All rights reserved.
References:
TeleMedicine Terms and Definitions and who can bill - Using Modifiers. (2016, February 17). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/telemedicine-terms-and-definations-and-who-can-bill-using-modifiers-31619.html
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