Basic Technical Requirements of a Telemedicine Consult:
- Synchronous telemedicine visits should utilize a high-resolution video camera coupled with broadband technologies.
- Connection speed of at least 384 kbps in both the downlink and uplink directions is recommended.
- Videoconferencing systems must use HIPAA-compliant encryption software. HIPAA requires 128-bit encryption and password-level authentication.
Payment for Telemedicine:
Medicare: The Centers for Medicare & Medicaid (CMS) reimburses for a limited set of services that may subsequently be reported as telehealth services. When a telehealth service is provided and has been designated by CMS as payable under Part B of the Medicare program, Place of Service (POS) code 02 should be used instead of Medicare modifier GT. POS code 02 indicates to the claims processors that the service provided meets Medicare telehealth requirements.
In addition to the use of POS 02 on the claim, there are other requirements for the provision and subsequent reimbursement for telehealth services under the Medicare program. The telehealth service must be provided to the beneficiary located at a Medicare approved, originating site. An originating site is the location of the beneficiary at the time the telehealth service is rendered and for Medicare reimbursement purposes must be in a rural location as defined by the following two geographical conditions:
- A rural Health Professional Shortage Area (HPSA) located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract; or
- A county outside of an MSA.
The originating site (location of the beneficiary) must then be in a medical facility such as:
- Physician or other practitioner office
- Critical Access Hospital (CAH)
- Rural Health Clinic
- Federally Qualified Health Center
- Hospital-based or CAH-based Renal Dialysis Center (including satellites
- Skilled Nursing Facility
- Community Mental Health Center
- The beneficiary’s home is not an approved originating site for the provision of telehealth services.
Medicare Telehealth Approved Codes of Interest to Infectious Disease Physicians,
- Office or other outpatient visits: CPT codes 99201-99215
- Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days: CPT codes 99231-99233
- Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days: CPT codes 99307-99310
- Telehealth Pharmacologic Management: HCPCS code G0459
- Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour: CPT code 99354
- Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes: CPT code 99355
- Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient evaluation and management service): CPT code 99356
- Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service): CPT code 99357
The Medicare List of Telehealth Services 2018 is posted on the CMS website. Approvedtelehealth services may be found on the CMS website: Medicare List of Telehealth Services 2018
While there are restrictions on reimbursement for telehealth services under the Medicare program, many states provide reimbursement for telehealth services under state Medicaid programs. States have discretion as to how telehealth services will be reimbursed and therefore many states currently provide separate payment for telehealth services under state Medicaid programs. Presently, 49 states and the District of Columbia provide some coverage for telehealth services, while nine states including Alaska, Arizona, California, Illinois, Minnesota, New Mexico, Oklahoma and Virginia reimburse providers for the provision of store and forward services. In addition, there are 17 states that have some form of reimbursement for remote patient monitoring. Providers should check with their state Medicaid agencies to understand the requirements and restrictions of Medicaid payments in their respective state.
Commercial insurance companies set their own policies regarding coverage and reimbursement for telehealth services, however there are some states that mandate coverage for telehealth services in order to do business within that state. Now, there are 32 states and the District of Columbia that have telehealth private payer laws. Providers should check with each insurance carrier to determine what types of telehealth services are covered.