|Oregon reimbursement for telemedicine|
Law increasing use of telemedicine in Oregon Passed June 2015
Oregon Medicaid (fee for service) reimburses for telepsychiatry + a separate facility fee (Q3014)
Oregon managed care contractors are not required to do so unless the provision has been negotiated into their contracts.
The Oregon rule appears below.
(1) For the purposes of this rule
(2) Provider Requirements:
(a) The referring and evaluating practitioner must be licensed to practice
medicine within the state of
Programs (Division) provider.
(b) Providers billing for covered telemedicine services are responsible for
(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:
Division 14. Examples of federal and state privacy and security laws that
may apply include HIPAA
and ORS 646A.600 to 646A.628 (
(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
(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 (
guideline for telephone and email consultation.
(E) Maintaining clinical and financial documentation related to telemedicine
services as required in
(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 (
(c) Patient consultations using videoconferencing
between a medical practitioner located in a distant site and the client being
evaluated and located in an originating site
comply with the Billing requirements stated in (5).
(d) Telephonic codes may be used in lieu of videoconferencing codes
videoconferencing equipment is not available.
(4) Telephone and E-mail billing requirements: Use the E/M code
authorized in the
(5) Videoconferencing billing requirements:
(a) Only the transmission site (where the patient is located) may bill for the
(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
(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
transmitted via facsimile machines and electronic mail are services not
(a) When those forms are not being used in lieu of videoconferencing
to limited videoconferencing equipment access
(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
Stats. Implemented: ORS 414.065
|Last Updated on Wednesday, 29 July 2015 13:38|