Telemedicine Billing

Telehealth is the Future of Medicine. It is gaining acceptance by payers, providers and patients. The added Medicare expenditure is to be expected.

What is Telemedicine Service?

Telehealth services are live, interactive audio and visual transmissions of a physician-patient encounter from one site to another using telecommunications technology. They may include transmissions of real time telecommunications or those transmitted by store-and-forward technology.

What is Asynchronous Telecommunication?

Medical Information is stored and forwarded to be reviewed at a later time by a physician or health care practitioner at a distant site. The medical information is reviewed without the patient being present. Also referred to as store and forward telehealth or non interactive telecommunication.

What is the meaning of originating site?

The location of the patient at the time the service being furnished via a telecommunications system occurs.

Interactive Audio and Video means medical information is communicated in real time with the use of interactive audio and video communications equipment. The real time communication is between the patient and a distant physician or health care specialist who is performing the service reported. The patient must be present and participating throughout the communication.

What are the modifiers used in Telemedicine?

GT, GQ, 95 and G0

**Effective January 1, 2018 CMS has decided to largely eliminate the requirement to use the GT modifier on telehealth claims. Instead of using the GT modifier, providers must mark their telehealth services claims with Place of Service (POS) 02.

What are the conditions to be met to get paid for a telehealth service billing?

Beneficiary is located in a qualifying rural area
Beneficiary is located in a qualifying originating site
Provider is an eligible telehealth provider type
An interactive audio and video device that supports real time communication is used
The procedure code is listed as a covered telehealth service

Some Originating sites are listed below:

The office of a physician or practitioner;
A hospital (inpatient or outpatient);
A critical access hospital (CAH);
A rural health clinic (RHC);
A federally qualified health center (FQHC);
A hospital-based or critical access hospital-based renal dialysis center (including satellites); NOTE: Independent renal dialysis facilities are not eligible Originating Sites
A skilled nursing facility (SNF);
A community mental health center (CMHC)
Mobile Stroke Unit
Patient home-only for monthly end stage renal, ESRD-related clinical assessment

Place of Service Code for Telehealth : 02

Telemedicine Reimbursement Rate: Similar to normal E/M visit rates

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