|Indiana reimbursement for telemedicine|
New 2016 Indiana Medicaid Telehealth Policy Procedure
Indiana reimburses for telepsychiatry + a separate facility fee (Q3014)
Conditions of Payment
1. The IHCP reimburses for telemedicine services only when the hub and spoke sites are greater than 20 miles apart.
2. The member must be present and able to participate in the visit.
3. For a medical professional to receive reimbursement for professional services in addition to payment for spoke services, medical necessity must be documented. If it is medically necessary for a medical professional to be with the member at the spoke site, the spoke site is permitted to bill an evaluation and management code in addition to the fee for spoke services. Adequate documentation must be maintained in the patient’s medical record to support the need for the provider’s presence at the spoke site during the visit. Documentation is subject to postpayment review.
4. The audio and visual quality of the transmission must meet the needs of the physician located at the hub site. The IATV technology must meet generally accepted standards to allow the physician at the hub site to render medical decisions.
Hub Site Services and Billing Requirements
The following Current Procedural Terminology (CPT®3) codes are reimbursable for providers that render services via telemedicine at the hub site. Modifier GT – Via interactive audio and video telecommunications system must be used to denote telemedicine services. The payment amount is equal to the current fee schedule amount for the following services:
• Consultations – 99241 – 99245 and 99251 – 99255
• Office or other outpatient visit – 99201 – 99205 and 99211 – 99215
• Individual psychotherapy – 90804 – 90809
• Psychiatric diagnostic interview – 90801
• Pharmacologic management – 90862
• End-stage renal disease (ESRD) services – 90951 – 90970
Spoke Site Services and Billing Requirements
The following Healthcare Common Procedure Coding System (HCPCS) code and revenue code are reimbursable for providers that render services via telemedicine at the spoke site. Modifier GT – Via interactive audio and video telecommunications system must be used to denote telemedicine services. The payment amount is equal to the current fee schedule amount for HCPCS code Q3014 Telehealth originating site facility fee.
1. Spoke services are reimbursed using HCPCS code Q3014 – Telehealth originating site facility fee. The GT modifier must be used to denote telemedicine services.
2. Revenue code 780 represents telemedicine services. If a different, separately reimbursable treatment room revenue code is provided on the same day as the telemedicine consultation, the appropriate treatment room revenue code should also be included on the claim. Documentation must be maintained in the patient’s record to indicate that services were provided separate from the telemedicine visit.
3. If spoke site services are provided in a physician’s office and other services are provided on the same date as the spoke service, the medical professional should bill Q3014 as a separate line item from other professional services.
1. Documentation must be maintained at the hub and spoke locations to substantiate the services provided. Documentation must indicate the services were rendered via telemedicine.
2. Documentation must clearly indicate the location of the hub and spoke sites.
3. All other IHCP documentation guidelines apply for services rendered via telemedicine, such as chart notes, and start and stop times. Documentation must be available for postpayment review.
4. Providers must have written protocols for circumstances when the member must have a hands-on visit with the consulting provider. The member should always be given the choice between a traditional clinical encounter versus a telemedicine visit. Appropriate consent from the member must be obtained by the spoke site and maintained at the hub and spoke sites.
For more information see the ATA Wiki page for Indiana here.
|Last Updated on Friday, 03 March 2017 11:16|