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Frequently Asked Telemedicine Questions |
| Last updated: Jan 21 2009. |   
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The Medicaid Agency recognizes physician consultations when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine services.
The state uses specific codes to identify telemedicine services.
The Medicaid Agency recognizes physician consultations (medical & mental health) when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for telemedicine services.
The state uses consultative CPT codes with the modifier "TM" to identify telemedicine services.
The Medicaid Agency recognizes physician consultations when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for telemedicine services.
The State uses specific local codes to identify the consultation furnished at the hub site. No special codes or modifier is used at the spoke site.
The Medicaid agency recognizes physician consultations when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional face-to face manner. Reimbursement is made at both ends (hub and spoke sites) for telemedicine services.
The state uses specific codes to identify telemedicine services.
The Medicaid Agency recognizes physician consultations when furnished using interactive video teleconferencing.
Payment is based on the State’s fee-for-service rates for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for telemedicine services.
Specific local codes are used for the add-on payment and CPT codes with the modifier "TM" is used to identify the consultations.
The Medicaid Agency recognizes home health care and mental health services already covered by the state plan when furnished using video equipment. Home health is limited to certain services.
Payment is on a fee-for-service basis for the mental health services, which is the same as the reimbursement for covered services furnished in the conventional manner. Compensation for home health care via telemedicine is made at a reduced rate. Reimbursement is made for only the service furnished at the hub site.
Local codes have been established to specifically identify home health services furnished using visual communication equipment. No special modifiers are used for mental health services.
The Medicaid agency recognizes physician consultations when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face to face manner. Reimbursement is made at both ends (hub and spoke site) for the telemedicine services. Physician Assistants are allowed to perform the service using telemedicine if they are authorized by a primary physician, which is the only one that is authorized to bill.
The State uses consultative CPT codes.
The Medicaid agency recognizes physician consultations (medical and mental health) when furnished using interactive video or store-and-forward technology. Interactive video consultations may be billed when there is no physician present in the emergency room, if the nursing staff requests a consultation from a physician in a hub site. Coverage is limited to three consultations per beneficiary per calendar week.
Payment is on a fee-for-service basis, suing the same payment rate as for covered services furnished in a conventional, face-to-face manner. Payment is made at both the hub and spoke sites. No payment is made for transmission fees.
Minnesota uses consultation CPT codes with the modifier "CT" for interactive video services and the modifier "WT" for consultations provided through store-and-forward technology. Emergency room CPT codes are used with a "GT" modifier for interactive video consultations done between emergency rooms.
The Medicaid Agency recognizes any medical or psychiatric service already covered by the state plan when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine service.
No special codes have been developed. Providers use codes from the existing CPT.
The Medicaid agency recognizes most State plan services when furnished using interactive video teleconferencing. In general, services are covered so long as a comparable service is not available to a client within a 30-mile radius of his or her home. Services specifically excluded include medical equipment and supplies; orthotics and prosthetics; personal care aide services; pharmacy services; medical transportation services; and mental health and substance abuse services and home and community-based waiver services provided by persons who do not meet practitioner standards for coverage.
Payment is on a fee-for-service basis, which is the same as reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both the hub and spoke sites. Payment for transmission costs are set at the lower of the billed charge or the state’s maximum allowable amount.
Billing and coding requirements will vary depending on who bills for the service and which claim form is used.
The Medicaid agency recognizes initial, follow-up or confirming consultations in hospitals and outpatient facilities when furnished using real-time interactive video teleconferencing. The patient must be present during the teleconsultation.
Payment is on a fee-for-service basis. The consulting practitioner at the hub site receives 75 percent of the fee schedule amount for the consultation code. The referring practitioner at the spoke site receives 25 percent of the applicable fee.
Teleconsultations are billed with modifiers to identify which portion of the teleconsult visit is billed; ie., the consulting practitioner at the hub site uses a GT modifier and the referring practioner at the spoke site uses a YS modifier.
The Medicaid Agency recognizes speciality physician consultations when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine services.
Current CPT codes for consultative services are used with a "TM" modifier to specifically identify covered services which are furnished by using audio visual communication equipment. State contact is David Zetner (701) 328-3194.
The Medicaid agency recognizes physician consultations when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face to face manner. Reimbursement is made at both ends (hub and spoke site) for the telemedicine services.
The State uses consultative CPT codes.
The Medicaid Agency recognizes physician consultations when furnished using (interactive & non-interactive) video equipment.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine services.
The state uses consultative CPT codes with a "TM" modifier to identify telemedicine services.
The Medicaid agency recognizes physician consultations (teleconsultations) when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face to face manner. Reimbursement is made at both ends (hub and spoke site) for the telemedicine services. Other health care providers, such as advanced nurse practitioners and certified nurse midwives are allowed to bill, as are Rural Health Clinics and Federally Qualified Health Centers.
The State uses consultative CPT codes with the modifier "TM" to identify telemedicine services.
The Medicaid agency recognizes the following services when furnished using interactive video teleconferencing: mental health consultations provided by psychiatrists, psychologists, social workers, psychiatric registered nurses and certified marriage or family therapists; diabetes self management training provided by qualified registered nurses or dieticians and; services provided to children with special health care needs by physician specialists, dieticians and pediatricians when those children reside in rural areas.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both the hub and spoke sites for diabetes self management training services and services provided to children with special health care needs. Reimbursement is made only to the consulting professional for mental health services. Payment is made for transmission fees.
The state uses CPT codes with GT and TR modifiers to identify telehealth services.
The Medicaid Agency recognizes, as a pilot project, medical and mental health services already covered by the state plan when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for only medical services.
The state uses specific local codes to identify telemedicine services.
The Medicaid Agency recognizes physician consultations when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine services.
The state uses consultative CPT codes with the modifier "tv" to identify telemedicine services.
201.13 Telehealth.--An HHA (home health agency) may adopt telehealth technologies that it believes promote efficiencies or improve quality of care. Telehomecare encounters do not meet the definition of a visit set forth in regulations at 42 CFR 409.48(c) and the telehealth services may not be counted as Medicare covered home health visits or used as qualifying services for home health eligibility. An HHA may not substitute telehealth services for Medicare-covered services ordered by a physician. However, if an HHA has telehealth services available to its clients, a doctor may take their availability into account when he or she prepares a plan of treatment (i.e., may write requirements for telehealth services into the POT). Medicare eligibility and payment would be determined based on the patient’s characteristics and the need for and receipt of the Medicare covered services ordered by the physician. If a physician intends that telehealth services be furnished while a patient is under a home health plan of care, the services should be recorded in the plan of care along with the Medicare covered home health services to be furnished.
(Source: Centers for Medicare & Medicaid Services (CMS). Medicare Home Health Agency Manual [HM-11]. Washington, DC: GPO: Section 201.13
Physicians would be allowed to bill for follow-up inpatient consultations delivered electronically under a proposed rule from the Centers for Medicare and Medicaid (CMS) that sets Medicare payments for 2009. The CMS is proposing to add new codes specific to the telehealth delivery of follow-up inpatient consultations. The codes are intended for use by providers who are consulted by a patient’s attending physician regarding care but are not available for a face-to-face encounter. Congressmen Mike Thompson (D-CA) and Kenny Hulshof (R-MO) introduced legislation that would increase the number of health facilities that offer telehealth services to Medicare recipients. (Source: Redwood Times, June 11, 2008)| Please contact webmaster@phrst.org for any website issues. |