Telehealth. Administrative Process. Coverage. Indications that are covered

Size: px
Start display at page:

Download "Telehealth. Administrative Process. Coverage. Indications that are covered"

Transcription

1 Telehealth These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. Administrative Process Prior authorization is not required for Telehealth services. Coverage HealthPartners supports the use of Telehealth as an alternative to an office visit. Access to these services is limited to care that meets all of the conditions of this policy. HealthPartners defines covered Telehealth as: 1. Electronic visit (e-visit) - a web-based exchange of non-urgent clinical information between a provider and an established patient conducted over a secure encrypted web site. For behavioral health services, an established patient means a psychiatrist has had a previous assessment face-to-face with the patient. E-visits aren t typically considered real time visits. 2. Scheduled Visit (STV) - a telephone encounter between a provider and an established patient conducted over the phone 3. Telemedicine Telemedicine means the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site. A communication between licensed health care providers that consists solely of a telephone conversation, , or facsimile transmission does not constitute telemedicine consultation services. A communication between a licensed health care provider and a patient that consists solely of an or facsimile transmission does not constitute telemedicine consultations or services. Telemedicine may be provided by means of real-time twoway, interactive audio and visual communications, including the application of secure video conferencing to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient s health care. Practitioners eligible to provide Telehealth services are licensed and have one of the following designations: MD (medical doctor), DO (doctor of osteopathy), Podiatrist, Dentist, PA (physician s assistant), CNM (certified nurse midwife) NP (nurse practitioner), Clinical nurse specialist, CNS (certified nurse specialist), CRNA (certified registered nurse anesthetist), RD (registered dietician) or nutrition professional, or Pharmacist, Physical, Occupational or Speech Therapist, Certified genetic counselor Practitioners eligible to provide Telemedicine services are licensed and have one of the following designations: Clinical Psychologist Clinical Social Worker All applications used for the provision of Telehealth services must be Health Insurance Portability and Accountability Act (HIPAA) compliant and follow all applicable state and federal rules. Indications that are covered Covered technologies used for electronic communication may include over a secure encrypted web site with an established patient and a provider, telephone encounters between an established patient and a provider or consultation between a patient and a provider via video conference. For Behavioral Health services delivered via or phone, established patient means the psychiatrist has had a Page 1 of 8

2 previous assessment face-to-face with the patient. Video conference with a psychiatrist does not require a previous face-to-face visit. Indications that are not covered The following services would not be reimbursed as part of Telehealth: Definitions 1. Electronic connections that are not conducted over a secure encrypted web site as specified by the Health Insurance Portability & Accountability Act of 1996 Privacy & Security Rules. (e.g., Skype) 2. Initial inpatient consultation or emergency room visit 3. Asynchronous store and forward technology 4. Prescription renewals 5. Scheduling a test or appointment 6. Call to nurse line for questions or standing orders, e.g. sinusitis or conjunctivitis 7. Clarification of issues from previous visit 8. Other non-clinical communication 9. Updating patient demographic information 10. Reporting test results 11. Requesting a referral 12. Any consultation with another physician in reference to the patient 13. Phone, or interactive video visits not initiated by the member 14. Reminders 15. Providing educational materials Electronic visit (e-visit) E-visits are member initiated, online evaluation and management (E/M) services by a physician or assessment and management services when provided by a qualified non-physician. Services provided to an established patient through the internet. E-visit are used to address non-urgent, new or ongoing symptoms to which providers respond with substantive medical advice. Established patient patient who has been seen by a provider or by another provider with the same specialty in the same group practice at least once in the past three years. Scheduled Visit (STV) a telephone encounter between a provider and an established patient conducted over the phone. Telemedicine Consultation (interactive audio visual) a secure, real time consultation between a patient at a provider s office/facility (originating site provider) and a consulting provider (distant site provider) via a secure two-way interactive video connection. Originating Site (referring provider) an office/clinic, hospital or skilled nursing facility where the member is located. Distant Site (consulting provider) an office/clinic, hospital or skilled nursing facility where the consulting provider is located at the time the service is provided. Telemedicine Consultation (online video consult) a secure consultation between a patient and a provider using online video technology. This service is typically covered under the member s Office Visit benefit. Codes If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive. CPT Codes Description Service Provided By: 0188T Remote real-time interactive videoconferenced critical care, evaluation and Video management of the critically ill or critically injured patient; first minutes Psychiatric diagnostic evaluation Psychiatric diagnostic evaluation with medical services Page 2 of 8

3 90832 Psychotherapy, 30 minutes with patient and/or family member Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) Psychotherapy, 45 minutes with patient and/or family member Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) Psychotherapy, 60 minutes with patient and/or family member Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per month End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month End-stage renal disease (ESRD) related services monthly, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per month End-stage renal disease (ESRD) related services monthly, for patients years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 4 or more face-to-face visits by a physician or other qualified health care professional per month End-stage renal disease (ESRD) related services monthly, for patients years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents; with 2-3 face-to-face visits by a physician or other qualified health care professional per month End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 2-3 face-to-face visits by a physician or other qualified health care professional per month Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment Health and behavior intervention, each 15 minutes, face-to-face; individual Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients) Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present) Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes Page 3 of 8

4 98967 assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; minutes assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; minutes On-line assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-toface with the patient and/or family Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. e-visit Page 4 of 8

5 Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-toface with the patient and/or family Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 10 minutes are spent at the bedside and on the Page 5 of 8

6 patient's facility floor or unit Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient's facility floor or unit Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service) Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service) Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; minutes evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; minutes Online evaluation and management service provided by a physician or other qualified health care professional who may report an evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or e-visit Page 6 of 8

7 caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of high complexity during the service period Face-to-face visit, within 7 calendar days of discharge HCPCS Codes Description Service provided by: G0108 Diabetes outpatient self-management training services, individual, per 30 minutes G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-toface with the patient, each 15 minutes G0406 Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via Telehealth G0407 Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via Telehealth G0408 Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via Telehealth G0420 Face-to-face educational services related to the care of chronic kidney disease; G0421 individual, per session, per one hour Face-to-face educational services related to the care of chronic kidney disease; group, per session, per one hour G0425 Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via Telehealth G0426 Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via Telehealth G0427 Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via Telehealth G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 10 minutes G0438 Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit G0439 Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit G0442 Annual alcohol misuse screening, 15 minutes G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes G0444 Annual depression screening, 15 minutes G0445 Semiannual high intensity behavioral counseling to prevent STIs, individual, face-toface, includes education skills training & guidance on how to change sexual behavior G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes G0447 Face-to-face behavioral counseling for obesity, 15 minutes G0459 Inpatient telehealth pharmacologic management, including prescription, use and review of medication with no more than minimal medical psychotherapy Q3014 Telehealth originating site facility fee Video S0265 Genetic counseling, under physician supervision, each 15 minutes CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Claims for services provided through video for consultation services should be submitted using the appropriate CPT or HCPCS Code for the professional service and GT modifier via interactive audio and video telecommunications system (e.g., GT). Page 7 of 8

8 Claims for facility services provided by the referring site should be submitted using Q3014 Originating Site Facility Fee Products This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at or Approved Medical Director Committee 12/19/12; Revised 2/3/2014, 5/14/14, 11/9/15, 11/24/2017; Annual review 12/2013, 11/2014, 11/2015, 11/2016, 11/2017 Page 8 of 8

JOHNS HOPKINS HEALTHCARE

JOHNS HOPKINS HEALTHCARE Page 1 of 16 ACTION: New Policy Effective Date: 10/01/2013 Revising : Review Dates: 03/29/16, 06/29/17, Superseding 09/01/17, 12/01/17 Archiving Retiring Johns Hopkins HealthCare LLC (JHHC) provides a

More information

Account Management, Coding, Customer Service, Legal, Medical Management, Finance, Claims, Underwriting, Network Management

Account Management, Coding, Customer Service, Legal, Medical Management, Finance, Claims, Underwriting, Network Management DEPARTMENT: Coding Reimbursement APPROVED DATE: POLICY DESCRIPTION: Telemedicine/Telehealth/Telecommunications/Televideo EFFECTIVE DATE: 6-24-04 PAGE: 1 of 4 REPLACES POLICY DATED: REFERENCE NUMBER: P-30

More information

JOHNS HOPKINS HEALTHCARE

JOHNS HOPKINS HEALTHCARE Page 1 of 19 ACTION: New Policy Effective Date: 10/01/2013 Revising : Review Dates: 03/29/16, 06/29/17, Superseding 09/01/17, 12/01/17, 05/15/18 Archiving Retiring Johns Hopkins HealthCare LLC (JHHC) provides

More information

Telemedicine Guidance

Telemedicine Guidance Telemedicine Guidance GEORGIA DEPARTMENT OF COMMUNITY HEALTH DIVISION OF MEDICAID Revised: October 1, 2017 Policy Revisions Record Telemedicine Guidance 2017 REVISION DATE Oct. 1, 2017 SECTION REVISION

More information

MEDICAL POLICY No R2 TELEMEDICINE

MEDICAL POLICY No R2 TELEMEDICINE Summary of Changes Clarifications: Page 1, Section I. A 6, additional language added for clarification. Deletions: Additions Page 4, Section IV, Description, additional language added in regards to telemedicine.

More information

TELEMEDICINE POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, 2018

TELEMEDICINE POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, 2018 TELEMEDICINE POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 114.28 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES

More information

MEDICAL POLICY No R1 TELEMEDICINE

MEDICAL POLICY No R1 TELEMEDICINE Summary of Changes MEDICAL POLICY TELEMEDICINE Effective Date: March 1, 2016 Review Dates: 12/12, 12/13, 11/14, 11/15 Date Of Origin: December 12, 2012 Status: Current Clarifications: Deletions: Pg. 4,

More information

Telemedicine Policy Annual Approval Date

Telemedicine Policy Annual Approval Date Policy Number 2017R0046A Telemedicine Policy Annual Approval Date 7/13/2016 Approved By REIMBURSEMENT POLICY CMS-1500 Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You

More information

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 232.10 T0 Effective Date: March 1, 2017 Table of Contents Page INSTRUCTIONS

More information

Telemedicine Policy. Approved By 4/08/2015

Telemedicine Policy. Approved By 4/08/2015 Telemedicine Policy Policy Number 2016R0046B Annual Approval Date 4/08/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission

More information

PREVENTIVE MEDICINE AND SCREENING POLICY

PREVENTIVE MEDICINE AND SCREENING POLICY UnitedHealthcare Oxford Reimbursement Policy PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.19 T0 Effective Date: July 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE...

More information

Telemedicine Policy. 7/12/2017 Approved By

Telemedicine Policy. 7/12/2017 Approved By Telemedicine Policy Policy Number 2018R0046A Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission

More information

Telehealth and Telemedicine Policy

Telehealth and Telemedicine Policy Reimbursement Policy CMS 1500 Telehealth and Telemedicine Policy Policy Number 2018R0046B Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT

More information

Observation Care Evaluation and Management Codes Policy

Observation Care Evaluation and Management Codes Policy Policy Number Observation Care Evaluation and Management Codes Policy 2017R0115A Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible

More information

Telemedicine and Telehealth Services

Telemedicine and Telehealth Services INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Telemedicine and Telehealth Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 8 P U B L I S H E D : J A N U A R Y 1

More information

Telehealth and Telemedicine Policy

Telehealth and Telemedicine Policy Reimbursement Policy CMS 1500 Telehealth and Telemedicine Policy Policy Number 2018R0046J Annual Approval Date 7/11/2018 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT

More information

Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care

Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care P R A C T I C E R E S O U R C E A P R I L 2015 NO.2 Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care By Margaret McManus, MHS The National Alliance to Advance Adolescent

More information

Telemedicine allows a specialist physician located at a medical center to communicate with a patient

Telemedicine allows a specialist physician located at a medical center to communicate with a patient Georgia Medicaid reimburses for Telehealth Useful summary of GA Telehealth Law Georgia Medicaid Telemedicine Appendix R TELEMEDICINE CONSULTATIONS Telemedicine allows a specialist physician located at

More information

Chapter 7 Section 22.1

Chapter 7 Section 22.1 Medicine Chapter 7 Section 22.1 Issue Date: April 17, 2003 Authority: 32 CFR 199.4 and 32 CFR 199.14 Copyright: CPT only 2006 American Medical Association (or such other date of publication of CPT). All

More information

Telehealth and Telemedicine Policy

Telehealth and Telemedicine Policy Telehealth and Telemedicine Policy Policy Number Annual Approval Date 7/11/2018 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare

More information

Telehealth and Telemedicine Policy Annual Approval Date

Telehealth and Telemedicine Policy Annual Approval Date Policy Number Telehealth and Telemedicine Policy Annual Approval Date 04/12/2017 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare

More information

DIVISION OF HEALTHCARE FINANCING CMS 1500 ICD-10. October 1, 2017

DIVISION OF HEALTHCARE FINANCING CMS 1500 ICD-10. October 1, 2017 DIVISION OF HEALTHCARE FINANCING CMS 1500 ICD-10 October 1, 2017 General Information Overview Thank you for your willingness to serve clients of the Medicaid Program and other medical assistance programs

More information

Oklahoma Health Care Authority. Telemedicine

Oklahoma Health Care Authority. Telemedicine Oklahoma Health Care Authority Telemedicine Telemedicine Policy: OAC 317:30-3-27 Billing Technology 2 Telemedicine Applicability & Scope The purpose of the SoonerCare telemedicine is to improve access

More information

Primary Care Mental Health for Veterans: Integrating Care. October 25, 2017

Primary Care Mental Health for Veterans: Integrating Care. October 25, 2017 Primary Care Mental Health for Veterans: Integrating Care October 25, 2017 Integrated Care Mental Health Specialty Care Location On site, embedded in the primary care clinic A different floor,

More information

Chapter 7 Section 22.1

Chapter 7 Section 22.1 TRICARE Policy Manual 6010.57-M, February 1, 2008 Medicine Chapter 7 Section 22.1 Issue Date: April 17, 2003 Authority: 32 CFR 199.4 and 32 CFR 199.14 1.0 DESCRIPTION 1.1 refers to the use of information

More information

Note: Telemedicine is not the use of the following. (1) Telephone transmitter for transtelephonic monitoring; or

Note: Telemedicine is not the use of the following. (1) Telephone transmitter for transtelephonic monitoring; or INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 8 0 2 J A N U A R Y, 8 2 0 0 8 To: All Providers Subject: Overview Effective April 1, 2007, telemedicine services are covered

More information

Chapter 7 Section 22.1

Chapter 7 Section 22.1 Medicine Chapter 7 Section 22.1 Issue Date: April 17, 2003 Authority: 32 CFR 199.4 and 32 CFR 199.14 Copyright: CPT only 2006 American Medical Association (or such other date of publication of CPT). All

More information

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Telecommunication Services Handbook

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Telecommunication Services Handbook Texas Medicaid Provider Procedures Manual Provider Handbooks December 2017 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid

More information

Corporate Reimbursement Policy Telehealth

Corporate Reimbursement Policy Telehealth Corporate Reimbursement Policy Telehealth File Name: Origination: Last Review Next Review: telehealth 11/1997 12/2017 12/2018 Description Telehealth is a potentially useful tool that, if employed appropriately,

More information

EDITED DATE: 08/27/09, 08/26/10) CATEGORY: Miscellaneous

EDITED DATE: 08/27/09, 08/26/10) CATEGORY: Miscellaneous MEDICAL POLICY SUBJECT: TELEMEDICINE and TELEHEALTH (ARCHIVED DATE: 06/25/09-12/08/11; PAGE: 1 OF: 10 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not

More information

TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL

TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL NOVEMBER 2017 CSHCN PROVIDER PROCEDURES MANUAL NOVEMBER 2017 TELECOMMUNICATION SERVICES Table of Contents 38.1 Enrollment......................................................................

More information

Telehealth Reimbursement Policy in

Telehealth Reimbursement Policy in Telehealth Reimbursement Policy in New York State Greater New York Hospital Association Telehealth Webinar Series July 11, 2016 July 2016 2 Agenda Telehealth NY State Telehealth Parity Statutory Changes

More information

Telehealth 101. Telehealth Summit May 24, 2018

Telehealth 101. Telehealth Summit May 24, 2018 Telehealth 101 Telehealth Summit May 24, 2018 Tim Bickel Telehealth Director, University of Louisville Deborah Burton, Telehealth Program Manager, KentuckyOne Health, Lexington; Chair, Kentucky Teleheath

More information

Telemedicine and Reimbursement

Telemedicine and Reimbursement Telemedicine and Reimbursement Presented for : March 14 th 2018 About Acevedo Consulting Incorporated Acevedo Consulting Incorporated prides itself on not providing cookie-cutter programs, but a quality

More information

THE TELEMEDICINE MARKET LANDSCAPE

THE TELEMEDICINE MARKET LANDSCAPE How Telehealth is Changing the Care Provided to Patients Anne Cadwell, The Permanente Medical Group THE TELEMEDICINE MARKET LANDSCAPE Approximately 1 million virtual doctor visits in the U.S. in 2015 1

More information

Provider Handbooks. Telecommunication Services Handbook

Provider Handbooks. Telecommunication Services Handbook Provider Handbooks December 2016 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid under contract with the Texas Health

More information

The Telemedicine Opportunity. Presented By: Marybeth McCall, MD

The Telemedicine Opportunity. Presented By: Marybeth McCall, MD The Telemedicine Opportunity Presented By: Marybeth McCall, MD 1962 Episode of the The Jetsons Presentation Objectives Identify telemedicine utilization projections Describe New York s Telemedicine Mandate

More information

NEW PATIENT VISIT POLICY

NEW PATIENT VISIT POLICY NEW PATIENT VISIT POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 229.12 T0 Effective Date: November 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE

More information

Telehealth/Telemedicine Online Visit

Telehealth/Telemedicine Online Visit Telehealth/Telemedicine Online Visit Blue Cross Blue Shield and Blue Care Network 1 Telemedicine Medical Policies The Blue Cross Blue Shield of Michigan and Blue Care Network Medical Policies are attached

More information

Chronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky

Chronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky Chronic Care Management Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Agenda Chronic Care Management (CCM) History Define Requirements

More information

CMS Changes Expanding Coverage of Telehealth

CMS Changes Expanding Coverage of Telehealth CMS Changes Expanding Coverage of Telehealth WASHINGTON Saturday, Nov. 30, 2013 -- Medicare beneficiaries received good news on the eve of Thanksgiving as the Centers for Medicare and Medicaid Services

More information

u Telemedicine The Virtual Experience

u Telemedicine The Virtual Experience Telemedicine The Virtual Experience April 2017 Telemedicine vs. Telehealth Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients

More information

REVISION DATE: FEBRUARY

REVISION DATE: FEBRUARY Mary Ann Hodorowicz, MBA, RDN CDE, CEC, Owner, Mary Ann Hodorowicz Consulting LLC, Palos Heights, IL Coverage: In-Person Payable Places of Services Excluded Places for Part B Payment Excluded Places: 0

More information

LOUISIANA MEDICAID PROGRAM ISSUED: 06/09/17 REPLACED: CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION 2.2: OUTPATIENT SERVICES PAGE(S) 8

LOUISIANA MEDICAID PROGRAM ISSUED: 06/09/17 REPLACED: CHAPTER 2: BEHAVIORAL HEALTH SERVICES SECTION 2.2: OUTPATIENT SERVICES PAGE(S) 8 Licensed Practitioner Outpatient Therapy includes: Individual; Family; Group; Outpatient psychotherapy; Mental health assessment; Evaluation; Testing; Medication management; Psychiatric evaluation; Medication

More information

19 th Annual Western Regional Conference Women in Government May 21, 2016 Seattle, WA

19 th Annual Western Regional Conference Women in Government May 21, 2016 Seattle, WA TELE TODAY 19 th Annual Western Regional Conference Women in Government May 21, 2016 Seattle, WA 877 707 7172 cchpca.org Mei Wa Kwong, JD Senior Policy Associate & Project Director DISCLAIMERS Any information

More information

This policy describes the appropriate use of new patient evaluation and management (E/M) codes.

This policy describes the appropriate use of new patient evaluation and management (E/M) codes. Private Property of Florida Blue. This payment policy is Copyright 2017, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

CMS-1676-F 120. and makes a separate payment to the distant site practitioner furnishing the service.

CMS-1676-F 120. and makes a separate payment to the distant site practitioner furnishing the service. CMS-1676-F 120 C. Medicare Telehealth Services 1. Billing and Payment for Telehealth Services Several conditions must be met for Medicare to make payments for telehealth services under the PFS. The service

More information

Telehealth And Telemedicine

Telehealth And Telemedicine Manual: Policy Title: Reimbursement Policy Telehealth And Telemedicine Section: Medicine Subsection: None Date of Origin: 1/1/2010 Policy Number: RPM052 Last Updated: 3/17/2018 Last Reviewed: 3/17/2018

More information

Medicaid Program Administrator: Bureau for Medical Services, under the West Virginia Dept. of Health and Human Resources

Medicaid Program Administrator: Bureau for Medical Services, under the West Virginia Dept. of Health and Human Resources West Virginia Medicaid Program: West Virginia Medicaid Medicaid Program Administrator: Bureau for Medical Services, under the West Virginia Dept. of Health and Human Resources Regional Telehealth Resource

More information

Maryland. Center for Connected Health Policy. Medicaid Program: MD Medical Assistance Program. Program Administrator: MD Dept. of Social Services

Maryland. Center for Connected Health Policy. Medicaid Program: MD Medical Assistance Program. Program Administrator: MD Dept. of Social Services Maryland Medicaid Program: MD Medical Assistance Program Program Administrator: MD Dept. of Social Services Regional Telehealth Resource Center Mid-Atlantic Telehealth Resource Center PO Box 800711 Charlottesville,

More information

Agency telemedicine rules are revised to clarify that telemedicine networks be approved at the OHCA's discretion to ensure medical necessity.

Agency telemedicine rules are revised to clarify that telemedicine networks be approved at the OHCA's discretion to ensure medical necessity. POLICY TRANSMITTAL NO. 11-35 April 18, 2011 HEALTH POLICY OKLAHOMA HEALTH CARE AUTHORITY TO: SUBJECT: STAFF LISTED MANUAL MATERIAL CHAPTER 30. MEDICAL PROVIDERS-FEE FOR SERVICE OAC 317:30-3-27. EXPLANATION:

More information

MARYLAND MEDICAID TELEHEALTH PROGRAM Telehealth Provider Manual

MARYLAND MEDICAID TELEHEALTH PROGRAM Telehealth Provider Manual Telehealth Provider Manual Updated May 3, 2016 Table of Contents Table of Contents Scope Service Model Covered Services Program Eligibility Provider Registration Technical Requirements Reimbursement Confidentiality

More information

9/21/2017. Telemedicine vs. Telehealth. Telemedicine vs. Telehealth. Telemedicine vs. Telehealth. Time is Money. Disruptive Technology

9/21/2017. Telemedicine vs. Telehealth. Telemedicine vs. Telehealth. Telemedicine vs. Telehealth. Time is Money. Disruptive Technology Telemedicine vs. Telehealth Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients health status. Telemedicine The Virtual Experience

More information

COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE ISSUE DAT E: DRAFT

COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE ISSUE DAT E: DRAFT MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE NUMBER: DRAFT ISSUE DAT E: DRAFT EFFECTIVE DATE: DRAFT SUBJECT: Behavioral Health Services:

More information

Cheryl A Skiffington, CCO & Interim CFO Columbia County Health System

Cheryl A Skiffington, CCO & Interim CFO Columbia County Health System Cheryl A Skiffington, CCO & Interim CFO Columbia County Health System Telemedicine is A mode of delivery The service provided is basically the same as if the patient and provider were face-to-face. A modifier

More information

I. LIVE INTERACTIVE TELEDERMATOLOGY

I. LIVE INTERACTIVE TELEDERMATOLOGY Position Statement on Teledermatology (Approved by the Board of Directors: February 22, 2002; Amended by the Board of Directors: May 22, 2004; November 9, 2013; August 9, 2014; May 16, 2015; March 7, 2016)

More information

2015 MEDICARE UPDATES

2015 MEDICARE UPDATES Disclaimer 2015 MEDICARE UPDATES The information contained in these slides are current at the time of writing. However, CMS can change the information at any time. Please monitor the ISMA website and all

More information

8/1/2017. Services and Description

8/1/2017. Services and Description Index of CPT Codes for Medical Home The following index was originally published in November 2003 in Medical Home Crosswalk To Reimbursement. The information was developed by Margaret McManus, Alan Kohrt,

More information

SERVICE CODE CLARIFICATIONS

SERVICE CODE CLARIFICATIONS SERVICE CODE CLARIFICATIONS Service Description Assertive Community Treatment (ACT) Assisted Outpatient Treatment (AOT) HCPCS Code Description Explanation of Code Utilization H0039 ACT Report only face-to-face

More information

Updated Only for Logo and Branding Provider Notice

Updated Only for Logo and Branding Provider Notice Updated Only for Logo and Branding Provider Notice To: From: PerformCare Network Providers Sheryl M. Swanson, MBA, Project Manager Date: December 21, 2012 Subject: AD12 112 2013 CPT Code Update IMPLEMENTATION

More information

ATTENTION PROVIDERS. This bulletin does not supersede any provider enrollment requirements

ATTENTION PROVIDERS. This bulletin does not supersede any provider enrollment requirements EqualityCareNews MAY 2007 ATTENTION PROVIDERS This bulletin does not supersede any provider enrollment requirements CMS-1500 Bulletin 07-002 Wyoming Medicaid will pay for telehealth services that meet

More information

LEGAL CONSIDERATIONS FOR FQHCS: REIMBURSEMENT FOR TELEMEDICINE SERVICES

LEGAL CONSIDERATIONS FOR FQHCS: REIMBURSEMENT FOR TELEMEDICINE SERVICES LEGAL CONSIDERATIONS FOR FQHCS: REIMBURSEMENT FOR TELEMEDICINE SERVICES SOUTH CAROLINA PRIMARY HEALTH CARE ASSOCIATION SOUTH CAROLINA PRIMARY HEALTH CARE ASSOCIATION 2017 STATE POLICY & ISSUES FORUM Jeanne

More information

CPT Pediatric Coding Updates 2013

CPT Pediatric Coding Updates 2013 (TNAAP) CPT Pediatric Coding Updates 2013 The 2013 Current Procedural Terminology (CPT) codes are effective as of January 1, 2013. This is not an all inclusive list of the 2013 changes. TNAAP has listed

More information

Primary Care Setting Behavioral Health Billing Codes

Primary Care Setting Behavioral Health Billing Codes Primary Care Setting s Medicaid Medicare Third Eligible Documentation Assessment 90792 Psychiatric Prescribers only (MD, NP, PA, APRN) Psychiatric diagnostic evaluation with medical services. Medical though

More information

Condition: MAJOR DEPRESSION, RECURRENT; MAJOR DEPRESSION, SINGLE EPISODE, SEVERE ICD-9: , ,298.0

Condition: MAJOR DEPRESSION, RECURRENT; MAJOR DEPRESSION, SINGLE EPISODE, SEVERE ICD-9: , ,298.0 HEALTH SYSTEMS DIVISION) Oregon Medicaid - Adult Services Kate Brown, Governor Memorandum To: Oregon Supported Employment Center for Excellence (OSECE) From: Chad Scott Date: September 10, 2015 Subject:

More information

Deleted Codes. Agenda 1/31/ E/M Codes Deleted Codes New Codes Changed Codes

Deleted Codes. Agenda 1/31/ E/M Codes Deleted Codes New Codes Changed Codes February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation

More information

February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS

February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation

More information

Medical Management Program

Medical Management Program Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent Fraud, Waste and Abuse in its programs. The Molina

More information

TELEHEALTH REIMBURSEMENT

TELEHEALTH REIMBURSEMENT FACT SHEET CENTER FOR CONNECTED HEALTH POLICY The Federally Designated National Telehealth Policy Resource Center Info@cchpca.org 877-707-7172 TELEHEALTH REIMBURSEMENT Telehealth is a well-established

More information

Telehealth. Clinical Applications 6/28/2011 TELEHEALTH UPDATE: MONTANA AND BEYOND

Telehealth. Clinical Applications 6/28/2011 TELEHEALTH UPDATE: MONTANA AND BEYOND TELEHEALTH UPDATE: MONTANA AND BEYOND Telehealth Telehealth is the delivery of healthrelated services via telecommunications technologies Clinical Applications Allergy Cardiology * Dermatology Oncology

More information

FQHC Behavioral Health Billing Codes

FQHC Behavioral Health Billing Codes FQHC s Eligible Documentation Assessment 90792 Psychiatric Prescribers only (MD, NP, PA, APRN) Psychiatric diagnostic evaluation with medical services. Medical though process clearly reflected in assessment

More information

Multiple Visit Reduction

Multiple Visit Reduction Private Property of Florida Blue. This payment policy is Copyright 2017 Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

Section 7. Medical Management Program

Section 7. Medical Management Program Section 7. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.

More information

Providing and Billing Medicare for Chronic Care Management Services

Providing and Billing Medicare for Chronic Care Management Services Providing and Billing Medicare for Chronic Care Management Services (and Other Fee-For-Service Population Health Management Services) No portion of this white paper may be used or duplicated by any person

More information

EVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO

EVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO EVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO Sandy Giangreco, RHIT, CCS, CCS-P, CHC, CPC, COC, CPC-I, COBGC Agenda 2014 OIG Report CMS Documentation

More information

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant

More information

Coding Guidance for HIV Clinical Practices: Care Management Services

Coding Guidance for HIV Clinical Practices: Care Management Services Coding Guidance for HIV Clinical Practices: Care Management Services HIV medical practices and clinicians provide many services outside of a face-to-face encounter with a patient. Some of these services

More information

3/27/2017. Historical Perspective. Innovative Model of Healthcare Delivery Using Telemedicine

3/27/2017. Historical Perspective. Innovative Model of Healthcare Delivery Using Telemedicine Innovative Model of Healthcare Delivery Using Telemedicine Vinita Kamath MS RDN MHA Clinical Director, Nutrition Therapy Cincinnati Children s Hospital Medical Center CNM Conference March 20, 2017 Outline

More information

CHIA PRESENTATION HANDOUT

CHIA PRESENTATION HANDOUT 5055 E. McKinley Ave, Fresno CA 95407 Tel: (559) 251 5038 Info@ CHIA PRESENTATION HANDOUT 2018 CHIA CONVENTION & EXHIBIT SAN DIEGO, CA Transforming Health Care with Connected Health Technology: An Update

More information

KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for

KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant

More information

Payment Policy: Problem Oriented Visits Billed with Preventative Visits

Payment Policy: Problem Oriented Visits Billed with Preventative Visits Payment Policy: Problem Oriented Visits Billed with Preventative Visits Reference Number: CC.PP.052 Product Types: ALL Effective Date: 11/1/2017 Last Review Date: Coding Implications Revision Log See Important

More information

Telehealth and Nutrition Law and Regulations Holistic Nutrition Coalition

Telehealth and Nutrition Law and Regulations Holistic Nutrition Coalition 1 Telehealth and Law and Regulations Holistic Coalition Telehealth There are different definitions of telemedicine or telehealth depending on state law. Generally, telehealth or telemedicine is defined

More information

AN ACT authorizing the provision of health care services through telemedicine and telehealth, and supplementing various parts of the statutory law.

AN ACT authorizing the provision of health care services through telemedicine and telehealth, and supplementing various parts of the statutory law. Title. Subtitle. Chapter. Article. (New) Telemedicine and Telehealth - - C.:- to :- - C.0:D-k - C.:S- C.:-.w C.:-..h - Note (CORRECTED COPY) P.L.0, CHAPTER, approved July, 0 Senate Substitute for Senate

More information

Telemedicine Reimbursement. An Overview for Oregon

Telemedicine Reimbursement. An Overview for Oregon Telemedicine Reimbursement An Overview for Oregon A Brief History - Medicare In 1997 the Balanced Budget Act first authorized Medicare to reimburse for telemedicine services Since 2000 there have been

More information

Telemedicine and Health Reform. Jonathan Neufeld, PhD Clinical Director Upper Midwest Telehealth Resource Center

Telemedicine and Health Reform. Jonathan Neufeld, PhD Clinical Director Upper Midwest Telehealth Resource Center Telemedicine and Health Reform Jonathan Neufeld, PhD Clinical Director Upper Midwest Telehealth Resource Center 1 telehealthresourcecenters.org Links to all TRCs National Webinar Series Reimbursement,

More information

PerformCare Provider Network (MH Inpatient Psychiatric Providers) Scott Daubert, VP Operations

PerformCare Provider Network (MH Inpatient Psychiatric Providers) Scott Daubert, VP Operations Memorandum To: From: Date: July 1, 2013 Subject: PerformCare Provider Network (MH Inpatient Psychiatric Providers) Scott Daubert, VP Operations PC-11 Use of CRNP s for Inpatient Hospital Care Claims Payment

More information

Multi-payer G and CPT Care Management Code Summary v7

Multi-payer G and CPT Care Management Code Summary v7 Purpose This document is a guide to help care management team members quickly understand the requirements and documentation fields required for billing care management-related G and CPT codes. Please note

More information

Procedure Code Job Aid

Procedure Code Job Aid Procedure Code 99211 Job Aid Definition for 99211: Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually,

More information

Telehealth Legal and Compliance Issues. Nathaniel Lacktman, Anna Whites, Esq.

Telehealth Legal and Compliance Issues. Nathaniel Lacktman, Anna Whites, Esq. Telehealth Legal and Compliance Issues Nathaniel Lacktman, Esq. @Lacktman Anna Whites, Esq. Anna Whites Law Office Attorney Advertising Prior results do not guarantee a similar outcome Models used are

More information

Care Plan Oversight Services and Physician Services for Certification

Care Plan Oversight Services and Physician Services for Certification Education Makes the Difference Care Plan Oversight Services and Physician Services for Certification and Recertification of Medicare-Covered Home Health Services A CMS CONTRACTED INTERMEDIARY CARRIER The

More information

CONSULTATION SERVICES POLICY

CONSULTATION SERVICES POLICY CONSULTATION SERVICES POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 256.3 T0 Effective Date: October 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE

More information

Coding and Billing for Lifestyle Medicine

Coding and Billing for Lifestyle Medicine Coding and Billing for Lifestyle Medicine Presented to Tools for Healthy Change June 21, 2014 Agenda Understanding Documentation Guidelines and key components of E/M Services History, Exam, Medical Decision

More information

TELEMEDICINE LAWS AND RECENT LEGISLATION IN NEARBY STATES

TELEMEDICINE LAWS AND RECENT LEGISLATION IN NEARBY STATES kslegres@klrd.ks.gov 68-West Statehouse, 300 SW 10th Ave. Topeka, Kansas 66612-1504 (785) 296-3181 FAX (785) 296-3824 http://www.kslegislature.org/klrd October 18, 2017 TELEMEDICINE LAWS AND RECENT LEGISLATION

More information

February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS

February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation

More information

Medicare Behavioral Health Authorization List Effective 5/26/18

Medicare Behavioral Health Authorization List Effective 5/26/18 100 All inclusive room and board 101 All inclusive room and board 104 Anesthesia, ECT 114 Room and Board- private psychiatric 116 Room and Board- private room detoxification 118 Room and Board- private

More information

Cruising Through Key Legal Compliance Issues in Telemedicine

Cruising Through Key Legal Compliance Issues in Telemedicine April 12, 2018 Cruising Through Key Legal Compliance Issues in Telemedicine Presented by Cal Marshall 2018 Chambliss, Bahner & Stophel, P.C. All Rights Reserved. Chambliss, Bahner & Stophel, P.C. Liberty

More information

Medicaid Rehabilitation Option Provider Manual

Medicaid Rehabilitation Option Provider Manual H P P r o v i d e r R e l a t i o n s U n i t I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Medicaid Rehabilitation Option Provider Manual L I B R A R Y R E F E R E N C E N U M B E R : P R

More information

Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By

Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By Policy Number 2016RP505A Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date 09/30/2016 Approved By Optum Behavioral Reimbursement Committee IMPORTANT NOTE

More information

Transitional Care Management We provide these services a-la-carte...

Transitional Care Management We provide these services a-la-carte... Transitional Care Management We provide these services a-la-carte... Initial Patient Outreach* This must be done within 2 days of the patient s discharge from the hospital. During this call patient s medications

More information

Prolonged Services With Direct Face-to-Face Patient Contact Service (Codes ) (ZZZ codes)

Prolonged Services With Direct Face-to-Face Patient Contact Service (Codes ) (ZZZ codes) 30.6.15.1 - Prolonged Services With Direct Face-to-Face Patient Contact Service (s 99354-99357) (ZZZ codes) (Rev.1490, Issued: 04-11-08, Effective: 07-01-08, Implementation: 07-07-08) A. Definition Prolonged

More information