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 a medical center to communicate with a patient and the attending physician in a distant community through video teleconsultation. This new technology enables members to receive optimum care in their local community which otherwise may not be available. For reimbursement amounts, refer to the Schedule of Maximum Allowable for 1 / 7
Physician, Advance Nurse Practitioner, Nurse Midwife, Oral Max, Podiatry at www.mmis.georgia.gov. To provide coverage for medically necessary consultations provided using this technology, the following requirements must be met: 1. The consulting physician must be licensed and practicing medicine within the State of Georgia. 2. The consultation must be requested by the patient s attending physician, and request for the consultation must be documented in the patient s medical record. 3. The attending physician must be requesting the opinion or advice of another physician regarding the evaluation and/or management of a patient with a specific medical problem, illness, or injury.. 4. Medical personnel trained to use the GSPT Network equipment should be present to facilitate 2 / 7
the examination. However, based upon the telehealth provisions of the Benefits Improvement and Protection Act of 2000 (BIPA,) a clinician is no longer required to present the patient to the consulting provider unless it is medically necessary (as determined by the consulting provider.) However, an enrolled attending physician, physician s assistant, nurse practitioner, or nurse midwife, when present with the patient at the originating location, may bill for their services using the most appropriate CPT Evaluation and Management code. 5. The consultant s findings and recommendations must be documented in writing in the format normally used for recording consultations in medical records, and included in the patient s medical record at the patient s location. The consultant s report may be faxed to the patient s location. Additionally, the electronic documentation of the consultation must be available for review by the Medical Assistance Plans Division. 3 / 7
6. The video teleconsultation system must, at a minimum, have the capability of allowing the consulting physician to visually examine the patient s entire body including body orifices such as the ear canals, nose and throat. Also, the consultant physician must be able to hear the patient s heart tones and lung sounds clearly using a stethoscope. Rev.04/11 7. The use of electronic conferencing for direct patient management and physician consultations are covered for telemedicine services. Rev. 10/04 APPENDIX R TELEMEDICINE SERVICES January 2012 Physician Services R-2 4 / 7
The CPT codes on the following table are HIPAA compliant and should be used in conjunction with modifier GT to report and bill for approved Telemedicine Services. For reimbursement amounts, refer to the Schedule of Maximum Allowable Payments for Physician, Advance Nurse Practitioner, Nurse Midwife, Oral Max, Podiatry. The Medical Assistance Plans Division periodically reviews and audits Telemedicine services billed ensuring appropriate reimbursement and medical necessity. CPT Codes Definition of Service 90801 Psychiatric diagnostic interview examination 99241 Office consultation for a new or established patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward medical decision making. 99251 Initial inpatient consultation for a new or established patient, which requires these three key components: a problem focused history; a problem focused examination; and straightforward medical decision making. 99242 Office consultation for a new or established patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and straightforward medical decision making. 5 / 7
99252 Initial inpatient consultation for a new or established patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; and straightforward medical decision making. 99243 Office consultation for a new or established patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity. 99253 Initial inpatient consultation for a new or established patient, which requires these three key components: a detailed history; a detailed examination; and medical decision making of low complexity. 99244 Office consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. 99254 Initial inpatient consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of moderate complexity. 99245 Office consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. 99255 Initial inpatient consultation for a new or established patient, which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision making of high complexity. 99212 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem focused interval 6 / 7
history; a problem focused examination; medical decision making. 99213 Office or other outpatient visit for the evaluation and management of an established patient which requires at least two of these three key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of low complexity. 99214 Office or other outpatient visit for the evaluation and management of an established patient which requires at least two of these three key components: a detailed history; a detailed examination; medical decision making of moderate complexity. 99215 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity. See news regarding the new Georgia rule allowing services to be provided in Schools here. 7 / 7