A Small Investment In Audio Visual Equipment = Big $ Potential With TeleMedicine

January 19th, 2016

CMS loves technology and a provider who is an early adopter of technologies can pump up their bottom line!  Most providers were familiar with dollars available with meaningful use and the adoption of EHR.

Less well known and with the potential for even more dollars is TeleMedicine.

By making a small investment in audio visual equipment where you can observe and ask questions of a patient as another provider serves as your “hands”,  both you at the “distance site” and the other provider as the “originating site” can be reimbursed by Medicare.  Such a scenario would work well both for specialists and primary care providers providing services  remotely to rural areas.

An added benefit for providing  these service is, as the patient needs to travel to the “big city” for services, the distance provider will oftenbe the first choice to render additional services to the patient.

Per the Medicare Learning Network’s publication , many services will be paid to providers at both the originating and distant site when you “use an interactive audio and video telecommunications system that permits real-time communication between you, at the distant site, and the beneficiary, at the originating site.”  Real time interactive audio and video is NOT just using a smart phone and/or home computer.  This must be professional grade equipment that allows you to remotely participate in patient care.

To be eligible for Telehealth service, the Medicare beneficiary must be located in

  • 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 a MSA.


So what exactly does that mean?  You can cut through the verbiage and enter the address at http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx to determine if your originating site is eligible. 

Originating sites (the sites where the patient is located) can include:

  • The offices of physicians or practitioners;
  • Hospitals;
  • Critical Access Hospitals (CAH);
  • Rural Health Clinics;
  • Federally Qualified Health Centers;
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites);
  • Skilled Nursing Facilities (SNF); and
  • Community Mental Health Centers (CMHC).

 An independent renal dialysis facility cannot be an eligible originating site but beginning in 2016, a patient's home may be.

 The distant site providers that may provide Telehealth services include

  • Physicians;
  • Nurse practitioners (NP);
  • Physician assistants (PA);
  • Nurse-midwives;
  • Clinical nurse specialists (CNS);
  • Certified registered nurse anesthetists;
  • Clinical psychologists (CP) and clinical social workers (CSW). CPs and CSWs cannot bill for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services under Medicare. These practitioners may not bill or receive payment for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838; and
  • Registered dietitians or nutrition professionals


Providers should submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GT, “via interactive audio and video telecommunications systems” (for example, 99201 GT). Using the GT modifier with a covered telehealth procedure code, certifies that the beneficiary was present at an eligible originating site when you furnished the telehealth service. By coding and billing the GT modifier with a covered ESRD-related service telehealth code, you are certifying that you furnished one “hands on” visit per month to examine the vascular access site.

The originating facility should bill HCPCS code Q3014 to the MAC as a part B charge.  The provider may also bill services rendered at the originating site.

Codes listed in the Medlearn publication plus billing codes and national allowed amounts can be accessed here.  Of course, providers must be qualified to provide the services!

Several new codes are available for 2016:  ESRD home services 90963-90966 which allows of 240.05 through 549.60 and Inpatient Prolonged Service Codes 99356 and 99357 which adds 92.44 for the first hour of prolonged service to the underlying evaluation and management code.

According to the Centers for telehealth, thirty-nine states also offer some sort of reimbursement for telehealth services through Medicaid.

Many private insurors also offer telehealth payments.  But as with all things new in healthcare, it’s best to check the rules first!

Tags: Telehealth


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