TeleMedicine Terms and Definitions and who can bill - Using Modifiers

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:

• physician,

• nurse practitioner,

• physician assistant,

• nurse midwife,

• clinical nurse specialist,

• clinical psychologist,

• clinical social worker, and

• 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:

• transmission of medical images for diagnosis and advice on disease prevention,

• health advice in emergency cases, and

• patient care and promotion of good health via patient monitoring and follow-up

References:

• Medicaid.gov
• CMS.gov