Oregon Reimbursement for Telemedicine PDF Print E-mail

Oregon Medicaid (fee for service) reimburses for telehealth + a separate facility fee (Q3014)

Oregon Medicaid rules are silent on the location of the originating site (where the patient is)

Law increasing use of telemedicine in Oregon Passed June 2015

Oregon managed care contractors are not required to do so unless the provision has been negotiated into their contracts.

The Oregon rule appears below.

410-130-0610 Telemedicine

(1) For the purposes of this rule, telemedicine is defined as the use of

medical information, exchanged from one site to another, via telephonic or

electronic communications, to improve a patient’s health status. 

(2) Provider Requirements:

(a) The referring and evaluating practitioner must be licensed to practice

medicine within the state of Oregon or within the contiguous area of

Oregon and must be enrolled as a Division of Medical Assistance

Programs (Division) provider.

(b) Providers billing for covered telemedicine services are responsible for

the following:

(A) Complying with HIPAA and/or DHS Confidentiality and Privacy Rules

and security protections for the patient in connection with the telemedicine

communication and related records.  Examples of applicable Department of

Human Services (Department) Confidentiality and Privacy Rules include:

OAR 407-120-0170, 410-120-1360, and 410-120-1380, and OAR 410

Division 14.  Examples of federal and state privacy and security laws that

may apply include HIPAA, if applicable and 42 CFR Part 2, if applicable

and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft

Protection Act);  

(B) Obtaining and maintaining technology used in the telemedicine

communication that is compliant with privacy and security standards in

HIPAA and/or Department Privacy and Confidentiality Rules described in

subsection (A). 

(C) Ensuring policies and procedures are in place to prevent a breach in

privacy or exposure of patient health information or records (whether oral or

recorded in any form or medium) to unauthorized persons.  

(D) Complying with the relevant Health Service Commission (HSC) practice

guideline for telephone and email consultation.

(E) Maintaining clinical and financial documentation related to telemedicine

services as required in OAR 410-120-1360.    410-130-0610  Page 2

(3) Coverage for telemedicine services:

(a) The telemedicine definition encompasses different types of programs,

services and delivery mechanisms for medically appropriate covered

services within the patient’s benefit package.  

(b) Patient consultations using telephone and online or electronic mail (Email) are covered when billed services comply with the practice guidelines

set forth by the Health Service Commission (HSC) and the applicable HSCapproved CPT code requirements, delivered consistent with the HSC

practice guideline.  

(c) Patient consultations using videoconferencing, a synchronous (live twoway interactive) video transmission resulting in real time communication

between a medical practitioner located in a distant site and the client being

evaluated and located in an originating site, is covered when billed services

comply with the Billing requirements stated in (5). 

(d) Telephonic codes may be used in lieu of videoconferencing codes, if

videoconferencing equipment is not available. 

(4) Telephone and E-mail billing requirements:  Use the E/M code

authorized in the HSC practice guideline.

(5) Videoconferencing billing requirements:

(a) Only the transmission site (where the patient is located) may bill for the

transmission:  

(A) Bill the transmission with Q3014;  

(B) The referring practitioner may bill an E/M code only if a separately

identifiable visit is performed.  The visit must meet all of the criteria of the

E/M code billed. 

(C) The referring provider is not required to be present with the client at the

originating site.

(b) The evaluating practitioner at the distant site may bill for the evaluation,

but not for the transmission (Q3014):   410-130-0610  Page 3

(A) Bill the most appropriate E/M code for the evaluation;  

(B) Add modifier GT to the E/M code to designate that the evaluation was

made by a synchronous (live and interactive) transmission. 

(6) Other forms of telecommunications, such as telephone calls, images

transmitted via facsimile machines and electronic mail are services not

covered:

(a) When those forms are not being used in lieu of videoconferencing, due

to limited videoconferencing equipment access, or 

(b) When those forms and specific services are not specifically allowed per

the Health Service Prioritized List and Practice Guideline.   

Stat. Auth.: ORS 404.110, 409.050, 414.065

Stats. Implemented: ORS 414.065

7-01-08

7-1-10 (Hk)

 

Last Updated on Thursday, 30 November 2017 14:02