Colorado reimbursement for telemedicine PDF Print E-mail

Colorado Medicaid pays for telehealth

 

COLORADO MEDICAL ASSISTANCE PROGRAM TELEMEDICINE MANUAL

Colorado pays for the physician fee + a separate facility fee (Q3014).

Click the link above for the document. 

Excerpt is Below 

 

Billing Providers

 

Telemedicine services will only be reimbursed for providers who are enrolled in the Colorado Medical Assistance Program at the time service. The availability of services through telemedicine in no way alters the scope of practice of any health care provider; or authorizes the delivery of health care services in a setting or manner not otherwise authorized by law. [C. R. S. 2006, 25.5-5-414 (7)(a) & (b)].

 

Originating Site Billing

 

All telemedicine services are billed on the Colorado 1500 paper claim form or as an 837P transaction regardless of provider type.COLORADO MEDICAL ASSISTANCE PROGRAM TELEMEDICINE MANUAL Revision Date: 12/11 Page 7

The originating provider may bill for an office, outpatient or inpatient Evaluation & Management (E&M) service that precedes a telemedicine consultation and for other Medicaid-covered services. In some cases, the originating provider site will not be providing clinical services, but only providing a site and telecommunications equipment.

Originating providers bill as follows:

                      If the originating provider is making a room and telecommunications equipment available but is not providing clinical services,  the originating provider bills Q3014, the procedure code for the telemedicine originating site facility fee.

 If the originating provider also provides clinical services to the client, the provider bills the rendering provider’s appropriate procedure code and bills Q3014.

 The originating provider may also bill, as appropriate, on the UB-04 paper claim form or as an 837I transaction for any clinical services provided on-site on the same day that a telemedicine originating site claim is made. The originating provider must submit two separate claims for the client’s two separate services.

 

The following provider types may bill procedure code Q3014 (telemedicine originating site facility fee):

Physician 05

Clinic 16

Osteopath 26

Federally Qualified Health Center 32

Psychologist 37

MA Psychologist 38

Physician Assistant 39

Nurse Practitioner 41

Rural Health Clinic 45

If practitioners at both the originating site and the distant site provide the same service to the client, both providers submit claims using the same procedure code with modifier 77. (Repeat procedure by another physician.)

The originating site may not bill for assisting the distant site provider with an examination.

 

Distant Provider Billing

 

All distant site rendering providers bill the appropriate procedure code using modifier GT (interactive communication) on the Colorado 1500 paper claim form or as an 837P transaction. The previously listed provider types may bill using modifier GT. The procedure codes for billing telemedicine are listed below.

Using modifier GT adds $5.00 to the fee for the procedure code billed.

 

Rendering Providers

 

If a rendering provider’s number is required on the claim for a face-to-face visit, it is required on the claim for a telemedicine visit.

Rural Health Clinics should leave field 19D on the Colorado 1500 paper claim form blank. Federally Qualified Health Centers, Clinics and the other provider types are required to enter the rendering provider’s Colorado Medical Assistance Program provider number in field 19D.

 

When an originating site bills Q3014 (originating site facility fee), there is generally no rendering provider actually involved in the service at the originating site. COLORADO MEDICAL ASSISTANCE PROGRAM TELEMEDICINE MANUAL Revision Date: 12/11 Page 8

However, a rendering provider number is still required and must be affiliated with the billing provider. The facility may enter either the patient’s usual provider’s number; or another provider number affiliated with that site as the rendering provider.

 

When the patient sees a rendering provider at the originating site and also uses the site as the telemedicine originating site, the facility bills the rendered service procedure code and Q3014 for the use of the telemedicine facility. The same rendering provider number is entered in field 19D.

 

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

 

Last Updated on Wednesday, 01 April 2015 08:40