Georgia Guide to reimbursement for telehealth PDF Print E-mail

Georgia Medicaid reimburses for Telehealth and adds the facility fee.  Contact us for information about how people are using Telehealth in Georgia and how they are getting paid for it.  

Georgia Medicaid Telemedicine Information from the Georgia Department of Community Health

 

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

 

 

 

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

 

Last Updated on Friday, 12 October 2018 13:31