Washington pays for telepsychiatry, telemedicine + a separate facility fee (Q3014)

Physician-Related Services
Billing Instructions
 (See page 75)

Clink the link above for the document.

Excerpt appears below.

When does DSHS cover telehealth?

DSHS covers telehealth through the fee-for-service program when it is used to substitute for a

face-to-face, “hands on” encounter for only those services specifically listed on page B.19.

Originating Site (Location of Client)

What is an “originating site”?

An originating site is the physical location of the eligible DSHS client at the time the

professional service is provided by a physician or practitioner through telehealth. Approved

originating sites are:

• The office of a physician or practitioner;

• A hospital;

• A critical access hospital;

• A rural health clinic (RHC); and

• A federally qualified health center (FQHC).

Is the originating site paid for telehealth?

Yes. The originating site is paid a facility fee per completed transmission.

How does the originating site bill DSHS for the facility fee?

• Hospital Outpatient: When the originating site is a hospital outpatient department,

payment for the originating site facility fee will be paid according to the maximum

allowable fee schedule. To receive payment for the facility fee, outpatient hospital

providers must bill revenue code 0789 on the same line as HCPCS code Q3014.

• Hospital Inpatient: When the originating site is an inpatient hospital, there is no payment to

the originating site for the facility fee.

• Critical Access Hospitals: When the originating site is a critical access hospital outpatient

department, payment is separate from the cost-based payment methodology. To receive

payment for the facility fee, critical access hospitals must bill revenue code 0789 on the same

line as HCPCS code Q3014.

Physician-Related Services

CPT® codes and descriptions only are copyright 2008 American Medical Association.

(Rev. 06/30/2009)(Eff. 07/01/2009) - B.24 - Programs (Guidelines/Limitations)

• FQHCs and RHCs: When the originating site is an FQHC or RHC, bill for the facility fee

using HCPCS code Q3014. This is not considered an FQHC or RHC service and is not paid

as an encounter, and is not reconciled in the monthly gross adjustment process.

• Physicians’ Offices: When the originating site is a physician’s office, bill for the facility fee

using HCPCS code Q3014.

If a provider from the originating site performs a separately identifiable service for the client on the

same day as telehealth, documentation for both services must be clearly and separately identified in

the client’s medical record.

Distant Site (Location of Consultant)

What is a “distant site”?

A distant site is the physical location of the physician or practitioner providing the professional

service to an eligible DSHS client through telehealth.

Who is eligible to be paid for telehealth services at a distant site?

DSHS pays the following provider types for telehealth services provided within their scope of

practice to eligible DSHS clients:

• Physicians (including Psychiatrists); and

• Advanced Registered Nurse Practitioners (ARNPs).

What services are covered using telehealth?

Only the following services are covered using telehealth:

• Consultations (CPT codes 99241–99245 and 99251-99255);

• Office or other outpatient visits (CPT 99201-99215);

• Psychiatric intake and assessment (CPT code 90801);

• Individual psychotherapy (CPT codes 90804-90809); and

• Pharmacologic management (CPT codes 90862).

Note

and limitation on these CPT codes.

How does the distant site bill DSHS for the services delivered through telehealth?

The payment amount for the professional service provided through telehealth by the provider at

the distant site is equal to the current fee schedule amount for the service provided.

Use the appropriate CPT codes with modifier GT (via interactive audio and video

telecommunications system) when submitting claims to DSHS for payment.