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:

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:

HCPCS codes G0425G0427
Follow-up inpatient telehealth consultations furnished to beneficiaries
 
in hospitals or SNFs
HCPCS codes G0406G0408
 
Office or other outpatient visits
CPT codes 9920199215
 
Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days
CPT codes 9923199233
 
Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days
CPT codes 9930799310
 
Individual and group kidney disease education services
HCPCS codes G0420 and G0421
 
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
HCPCS codes G0108 and G0109
 
Individual and group health and behavior assessment and intervention
CPT codes 9615096154
 
Individual psychotherapy
CPT codes 9083290834 and 9083690838
 
Telehealth Pharmacologic Management
HCPCS code G0459
 
Psychiatric diagnostic interview examination
CPT codes 90791 and 90792
 
End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment
CPT codes 9095190952909549095590957,
9095890960, and 90961
 
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)
CPT code 90964
 
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)
CPT code 90965
 
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
HCPCS code G0270 and CPT codes 9780297804
 
Neurobehavioral status examination
CPT code 96116
 
Smoking cessation services
HCPCS codes G0436 and G0437 and
CPT codes 99406 and 99407
 
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services
HCPCS codes G0396 and G0397
 
Annual alcohol misuse screening, 15 minutes
HCPCS code G0442
 
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
HCPCS code G0443
 
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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