Minnesota reimbursement for telemedicine PDF Print E-mail

Minnesota Health Care Programs Provider Manual (See telemedicine section)

Minnesota Medicaid pays for telehealth See Details here

Excerpt appears below.

Telemedicine

Distant site: The site where the physician or practitioner, providing the professional service, is located at the time the service is provided via a telecommunications system.
Telemedicine: The use of telecommunications to furnish medical information and services. Telemedicine consultations must be made via two-way, interactive video or store-and-forward technology.
Two-way Interactive Video: A type of technology that permits a "real time" consultation to take place. This is used when a consultation involving the patient, the primary caregiver, and a specialist is medically necessary. Video-conferencing equipment at two different locations permits a live non-face-to-face consultation to take place.
Hub Site: A medical facility telemedicine site where the medical specialist is located.
Spoke Site: A remote site where the referring health professional and patient are located.
Consultation: A type of service provided by a physician whose opinion or advice is requested by another provider.
Asynchronous telecommunication systems in single media format does not include telephone calls, images transmitted via facsimile machines, and test messages without visualization of the recipients (electronic mail). Photographs must be specific to the recipient’s condition and adequate for rendering or confirming a diagnosis or treatment plan.
Eligible Providers
The "spoke," or referring provider, may be any enrolled MHCP provider including a physician, nurse practitioner, clinical nurse specialist, physician assistant, certified nurse midwife, podiatrist or mental health professional.
The "hub," or consulting provider, is limited to a specialty physician or an oral surgeon.
Eligible Recipients
Telemedicine coverage applies to MHCP recipients in fee-for-service programs. Prepaid health plans may or may not choose to pay for services delivered in this manner.
Covered Services
Coverage for telemedicine includes payment for physician consultations that are performed via two-way interactive video, or via store and forward technology.
General
• Telemedicine coverage applies to MHCP recipients in fee-for-service programs. Prepaid health plans may or may not choose to pay for services delivered in this manner
• Telemedicine consultation coverage is limited to physician services (this includes psychiatrists but does not include PAs, APRNs or other physician ancillaries)
• A consultation (as defined by CPT) must take place
• A request for a consultation and the need for a consultation must be documented in the patient's medical record. The consultation opinion must be documented in the patient's medical record and communicated to the requesting provider
• Out-of-state coverage policy applies to services provided via telemedicine. Consultations performed by providers who are not located in Minnesota and contiguous counties, require authorization prior to the service being provided
• Consultations must be billed with the appropriate modifier indicating services were performed via telemedicine
Two-Way Interactive Video Consultations in an Office, Outpatient, or Inpatient Setting
• Payment is made to both the consulting physician and the referring physician if the referring physician is present during the consultation
• The referring provider bills an office or outpatient E/M code
• The consulting physician bills an office, outpatient, or inpatient E/M consultation code with the GT modifier, indicating the service was performed via two-way interactive video
Two-Way Interactive Video Consultation in an Emergency Room (ER)
Two-way interactive video consultation may be billed when there is no physician in the ER and the nursing staff is caring for the patient at the "spoke" site. The ER physician at the "hub" site bills the ER CPT codes with the GT modifier. Nursing services at the "spoke" site would be included in the ER facility code.
If the ER physician requests the opinion or advice of a specialty physician at a "hub" site, the ER physician bills the ER CPT codes without the GT modifier. The consulting physician bills the consultation E/M code with the GT modifier.
"Store and Forward" Telemedicine
• CPT definition of a consultation must be met as above
• Consultation E/M codes are billed by the consulting physician with the GQ modifier, used to indicate that the consult was done via store and forward technology
Coverage Limitations
• Payment for telemedicine consultation services is limited to three per week per recipient
• Payment will be made for only one reading or interpretation of diagnostic tests such as x-rays, lab tests, and diagnostic assessments
• Payment is not available to providers for sending materials

 

Advanced Practice Registered Nurse (APRN) Services

 

Advanced Practice Registered Nurse (APRN): An individual licensed as a registered nurse by the Minnesota Board of Nursing and certified by a national nurse certification organization acceptable to the Minnesota Board of Nursing to practice as a clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner. The practice of advanced practice registered nursing also includes accepting referrals from, consulting with, cooperating with, or referring to all other types of health care providers, including but not limited to physicians, chiropractors, podiatrists, and dentists, provided that the advanced practice registered nurse and the other provider are practicing within their scopes of practice as defined in state law. The advanced practice registered nurse must practice within a health care system that provides for consultation, collaborative management, and referral as indicated by the health status of the patient.

 

Registered nurse anesthetist practice: The provision of anesthesia care and related services within the context of collaborative management, including selecting, obtaining, and administering drugs and therapeutic devices to facilitate diagnostic, therapeutic, and surgical procedures upon request, assignment, or referral by a patient's physician, dentist, or podiatrist.

 

Clinical Nurse Specialist Practice (CNS): The provision of patient care in a particular specialty or subspecialty of advanced practice registered nursing within the context of collaborative management, and includes: (1) diagnosing illness and disease; (2) providing nonpharmacologic treatment, including psychotherapy; (3) promoting wellness; and (4) preventing illness and disease. The certified clinical nurse specialist is certified for advanced practice registered nursing in a specific field of clinical nurse specialist practice.

 

Nurse practitioner practice: Practice within the context of collaborative management: (1) diagnosing, directly managing, and preventing acute and chronic illness and disease; and (2) promoting wellness, including providing nonpharmacologic treatment. The certified nurse practitioner is certified for advanced registered nurse practice in a specific field of nurse practitioner practice.

 

Nurse-midwife practice: The management of women's primary health care, focusing on pregnancy, childbirth, the postpartum period, care of the newborn, and the family planning and gynecological needs of women and includes diagnosing and providing nonpharmacologic treatment within a system that provides for consultation, collaborative management, and referral as indicated by the health status of patients.

 

 

For more information see the ATA Wiki page for Minnesota here.

Last Updated on Wednesday, 08 February 2017 10:42