South Carolina reimbursement for telemedicine PDF Print E-mail

Summary of SC reimbursement for telehealth

New South Carolina law regarding telemedicine signed June 2016.  For a summary, click here

Physicians Provider Manual Manual Updated 03/13/15 (See page 53)

South Carolina pays for telepsychiatry + a separate facility fee ($14.96/session)

Excerpt appears below.


Services that are eligible for reimbursement include consultation, office

visits, individual psychotherapy, pharmacologic management, and

psychiatric diagnostic interview examinations and testing, delivered via a

telecommunication system. A licensed physician and/or nurse

practitioner are the only providers of telepsychiatry services. As a

condition of reimbursement, an audio and video telecommunication

system that is HIPAA compliant must be used that permits interactive

communication between the physician or practitioner at the consultant

site and the beneficiary at the referring site.

Office and outpatient visits that are conducted via telemedicine are

counted towards the applicable benefit limits for these services.

Medicaid covers telemedicine when the service is medically necessary

and under the following circumstance:

• The medical care is individualized, specific, and consistent with

symptoms or confirmed diagnosis of the illness or injury under

treatment, and not in excess of the beneficiary’s need; and

• The medical care can be safely furnished, and no equally effective

and more conservative or less costly treatment is available



Physicians Provider Manual




Covered Services


The list of Medicaid telemedicine services includes:

• Office or other outpatient visits (CPT codes 99201 – 99215)

• Inpatient consultation (CPT codes 99251-99255)

• Individual psychotherapy (CPT codes 90804 – 90809)

• Pharmacologic management (CPT code 90862)

• Psychiatric diagnostic interview examination (CPT code 90801);

• Neurobehavioral status examination (CPT code 96116);

• Electrocardiogram interpretation and report only (CPT code


• Echocardiography (CPT code 93307, 93308, 93320, 93321, and


Non-Covered Services

telepsychiatry services and will not be reimbursed:

• Telephone conversations

• E-mail messages

• Video cell phone interactions

• Facsimile transmissions

• Services provided by allied health professionals

Coverage Guidelines

1. The beneficiary must be present and participating in the

telemedicine visit.

2. The referring provider must provide pertinent medical

information and/or records to the consulting provider via a secure


3. Interactive audio and video telecommunication must be used;

permitting encrypted communication between the distant site

physician or practitioner and the Medicaid beneficiary. The

telecommunication service must be secure and adequate to protect

the confidentiality and integrity of the Telemedicine information


4. The telemedicine equipment and transmission speed and image

resolution must be technically sufficient to support the service

billed. Staff involved in the telemedicine visit must be trained in

the use of the telemedicine equipment and competent in its


Manual Updated 01/01/12 Physicians Provider Manual


Coverage Guidelines


referring site is required to present (patient site presenter) the

beneficiary to the physician or practitioner at the consulting site

and remain available as clinically appropriate.

6. If the beneficiary is a minor child, a parent and/or guardian must

present the minor child for telemedicine service unless otherwise

exempted by State or Federal law. The parent and/or guardian

need not attend the telemedicine session unless attendance is

therapeutically appropriate.

7. The beneficiary retains the right to withdraw at any time.

8. All telemedicine activities must comply with the requirements of

the Health Insurance Portability and Accountability Act of 1996:

Standards for Privacy of individually identifiable Health

Information and all other applicable state and federal laws and


9. The beneficiary has access to all transmitted medical information,

with the exception of live interactive video, as there is often no

stored data in such encounters.

10. There will be no dissemination of any beneficiary’s images or

information to other entities without written consent from the


11. The provider at the distant site must obtain prior approval for

service when services require prior approval, based on service

type or diagnosis.

Reimbursement for

Professional Services

Reimbursement to the health professional delivering the medical service

is the same as the current fee schedule amount for the service provided.

Consulting site physicians and practitioners submit claims for

telemedicine or telepsychiatry services using the appropriate CPT code

for the professional service along with the telemedicine modifier GT, “via

interactive audio and video telecommunications system” (e.g., 99243

GT). By coding and billing the “GT” modifier with a covered

telemedicine procedure code, the consulting site physician and/or

practitioner certifies that the beneficiary was present at originating site

when the telemedicine service was furnished. Telemedicine services are

subject to copayment requirements. 




Reimbursement for the

Originating Site Facility


The referring site is only eligible to receive a facility fee for

telemedicine services. Claims must be submitted with HCPCS code

Q3014 (Telemedicine originating site facility fee).The reimbursement is

$14.96 per encounter.




Last Updated on Thursday, 11 August 2016 09:31