Wyoming reimbursement for telemedicine PDF Print E-mail

Wyoming Medicaid reimburses for patient visits using Telehealth -

"Each site will be able to bill for their own services as long as they are an enrolled Medicaid provider (this includes out-of-state Medicaid providers)"

General Provider Information CMS-1500 Physician and Nurse Practitioner Services (See telehealth section)

Click the link above for the document.

Excerpt appears below.

Covered Services

 The acceptable hub sites for EqualityCare covered telehealth are the

following:

• Physician office

• Psychologist office

• Nurse practitioner office

• Critical access hospital

• Rural health clinic

• Federal qualified health center (FQHC)

• Hospital (as defined by Medicare, including general acute care hospitals

and acute psychiatric hospitals)

• Community Mental Health or Substance Abuse Centers

 

General Provider Information CMS-1500 Physician and Nurse Practitioner Services

 

9-113

For EqualityCare payment to occur, interactive audio and video

telecommunications must be used permitting real-time communication

between the distant site physician or practitioner and the patient with

sufficient quality to assure the accuracy of the assessment, diagnosis, and

visible evaluation of symptoms and potential medication side effects. All

interactive video telecommunication must comply with HIPAA patient

privacy regulations at the site where the patient is located, the site where the

consultant is located, and in the transmission process. If distortions in the

transmission make adequate diagnosis and assessment improbable and a

presenter at the site where the patient is located is unavailable to assist, the

visit must be halted and rescheduled. It is not appropriate to bill for portions

of the evaluation unless the exam was actually performed by the billing

provider.

 

9.17.25.2 Non-Covered Services

 

Telehealth does not include a telephone conversation, electronic mail message

(email), or facsimile transmission (fax) between a healthcare practitioner and

a patient or a consultation between two healthcare practitioners. Services will

not be reimbursed when provided via a videophone or web cam.

 

9.17.25.3 Billing Requirements

 

In order to obtain EqualityCare reimbursement for services delivered through

telehealth technology, the following standards must be observed:

 

General Provider Information CMS-1500 Physician and Nurse Practitioner Services

 

9-114

• The healthcare practitioner who has ultimate authority over the care of the

primary diagnosis of the patient must obtain an Informed Consent for

Telehealth Consultations Form (Section 9.17.24.4, Informed Consent for

Telehealth Consultations Form) from the patient or the patient’s legal

representative. This should be maintained in the patient’s permanent

record.

• The services must be medically necessary and follow generally accepted

standards of care.

• The service must be a service covered by EqualityCare.

• Claims must be made according to EqualityCare billing instructions.

• The same procedure codes and rates apply as for services delivered in

person.

• Quality assurance/improvement activities relative to telehealth delivered

services need to be identified, documented, and monitored.

• Providers need to develop and document evaluation processes and patient

outcomes related to the telehealth program, visits, provider access, and

patient satisfaction.

• All service providers are required to develop and maintain written

documentation in the form of progress notes the same as is originated

during an in-person visit or consultation with the exception that the mode

of communication (i.e. teleconference) should be noted.

• EqualityCare will not reimburse for the use or upgrade of technology, for

transmission charges, for charges of an attendant who instructs a patient

on the use of the equipment or supervises/monitors a patient during the

telehealth encounter, or for consultations between professionals.

 

NOTE:

wants to stop using the technology, the service should cease

immediately and an alternative appointment set up.

Spoke Sites Billing Code(s) (site without patient)

CPT-4 and HCPCS Level II Codes Modifier Description

99241 - 99275 GT Consultations

99241 - 99255 GT Consultations

99201 – 99215 GT Office or other outpatient visits

90804 – 90809 GT Individual psychotherapy

90862 GT Pharmacologic management

90801 GT Psychiatric diagnostic interview examination

G0308, G0309, G0311, G3012, G0314, G0315,

G0317, and G0318 GT End stage renal disease related services

G0270, 97802, 97803 GT Individual medical nutrition therapy

General Provider Information CMS-1500 Physician and Nurse Practitioner Services

9

If the patient and/or legal guardian indicate at any point that he/she 

Covered Services

The acceptable hub sites for EqualityCare covered telehealth are the

following:

 

 

 

Physician office

 

 

 

 

 

Psychologist office

 

 

 

 

 

Nurse practitioner office

 

 

 

 

 

Critical access hospital

 

 

 

 

 

Rural health clinic

 

 

 

 

 

Federal qualified health center (FQHC)

 

 

 

 

 

Hospital (as defined by Medicare, including general acute care hospitals

and acute psychiatric hospitals)

 

 

 

 

 

 

Community Mental Health or Substance Abuse Centers

 

General Provider Information

CMS-1500 Physician and Nurse Practitioner Services

 

9-113

For EqualityCare payment to occur, interactive audio and video

telecommunications must be used permitting real-time communication

between the distant site physician or practitioner and the patient with

sufficient quality to assure the accuracy of the assessment, diagnosis, and

visible evaluation of symptoms and potential medication side effects. All

interactive video telecommunication must comply with HIPAA patient

privacy regulations at the site where the patient is located, the site where the

consultant is located, and in the transmission process. If distortions in the

transmission make adequate diagnosis and assessment improbable and a

presenter at the site where the patient is located is unavailable to assist, the

visit must be halted and rescheduled. It is not appropriate to bill for portions

of the evaluation unless the exam was actually performed by the billing

provider.

 

 

Last Updated on Tuesday, 15 August 2017 15:11