Georgia Guide to reimbursement for telehealth PDF Print E-mail

Georgia Medicaid reimburses for Telehealth

 Useful summary of GA Telehealth Law 

 Georgia Medicaid Telemedicine

 

Appendix R

TELEMEDICINE CONSULTATIONS

 

Telemedicine allows a specialist physician located at a medical center to communicate with a patient

and the attending physician in a distant community through video teleconsultation. This new

technology enables members to receive optimum care in their local community which otherwise may

not be available. For reimbursement amounts, refer to the Schedule of Maximum Allowable for

Physician, Advance Nurse Practitioner, Nurse Midwife, Oral Max, Podiatry at

www.mmis.georgia.gov.

To provide coverage for medically necessary consultations provided using this technology, the

following requirements must be met:

1. The consulting physician must be licensed and practicing medicine within the State of Georgia.

2. The consultation must be requested by the patient‘s attending physician, and request for the

consultation must be documented in the patient‘s medical record.

3. The attending physician must be requesting the opinion or advice of another physician

regarding the evaluation and/or management of a patient with a specific medical problem,

illness, or injury.

. 4. Medical personnel trained to use the GSPT Network equipment should be present to facilitate

the examination. However, based upon the telehealth provisions of the Benefits Improvement

and Protection Act of 2000 (BIPA,) a clinician is no longer required to present the patient to the

consulting provider unless it is medically necessary (as determined by the consulting provider.)

However, an enrolled attending physician, physician‘s assistant, nurse practitioner, or nurse

midwife, when present with the patient at the originating location, may bill for their services

using the most appropriate CPT Evaluation and Management code.

5. The consultant‘s findings and recommendations must be documented in writing in the format

normally used for recording consultations in medical records, and included in the patient‘s

medical record at the patient‘s location. The consultant‘s report may be faxed to the patient‘s

location. Additionally, the electronic documentation of the consultation must be available for

review by the Medical Assistance Plans Division.

6. The video teleconsultation system must, at a minimum, have the capability of allowing the

consulting physician to visually examine the patient‘s entire body including body orifices such

as the ear canals, nose and throat. Also, the consultant physician must be able to hear the

patient‘s heart tones and lung sounds clearly using a stethoscope.

Rev.04/11 7. The use of electronic conferencing for direct patient management and physician consultations

are covered for telemedicine services.

Rev. 10/04

 

APPENDIX R

TELEMEDICINE SERVICES

 

January 2012 Physician Services R-2

The CPT codes on the following table are HIPAA compliant and should be used in conjunction with modifier GT to report and bill for approved Telemedicine Services. For reimbursement amounts, refer to the Schedule of Maximum Allowable Payments for Physician, Advance Nurse Practitioner, Nurse Midwife, Oral Max, Podiatry. The Medical Assistance Plans Division periodically reviews and audits Telemedicine services billed ensuring appropriate reimbursement and medical necessity.

 

CPT Codes

Definition of Service

 

90801 Psychiatric diagnostic interview examination

99241 Office consultation for a new or established patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward medical decision making.

99251 Initial inpatient consultation for a new or established patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward medical decision making.

99242 Office consultation for a new or established patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and straightforward medical decision making.

99252 Initial inpatient consultation for a new or established patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and straightforward medical decision making.

99243 Office consultation for a new or established patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity.

99253 Initial inpatient consultation for a new or established patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity.

99244 Office consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity.

99254 Initial inpatient consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity.

99245 Office consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity.

99255 Initial inpatient consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity.

99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused interval history; a problem focused examination; medical decision making.

99213 Office or other outpatient visit for the evaluation and management of an established patient which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity.

99214 Office or other outpatient visit for the evaluation and management of an established patient which requires at least two of these three key components: a detailed history; a detailed examination; medical decision making of moderate complexity.

99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity.

 

See news regarding the new Georgia rule allowing services to be provided in Schools here.

 

Last Updated on Monday, 14 August 2017 10:23