Service Area

Sites

Scope of Coverage

Providers

Reimbursement

• Rural Health Professional Shortage Area (HPSA)
• Counties not in a Metropolitan Statistical Area (MSA)

Distant – UTMB
The site where the physician or physician practitioner providing the professional service, is located at the time the service is provided via telemedicine.

• Consultations
• Office Visits
• Psychiatric diagnostic interview
• Individual Psychotherapy
• Pharmacological Management
• ESRD
• Individual Medical Nutrition Therapy  (G0270, 97802 & 97803)

• Physician
• Nurse Practitioner
• Physician Assistant
• Nurse Midwife
• Clinical Nurse Specialist
• Clinical Psychologist
• Clinical Social Worker
• Registered Dietician or nutrition professional

Distant – UTMB
Will be reimbursed for the professional fee at the same amount if the service was not provided via telecommunications, which is 85% of the allowed amount.

Website

HPSA-

http://www.trailblazerhealth.com/tools/hpsa/index.asp?

Reference:

Originating – the location of an eligible Medicare beneficiary at the time the service is being furnished via a telecommunication system occurs.

Authorized sites:

• The office of a physician/physician practitioner
• A hospital
• A critical access hospital
• A rural health clinic
• A federally qualified health center

Claim Requirements

Distant - GT modifier must be appended to the correct CPT code for professional services only.

Originating - code Q3014 must be used in order to be reimbursed for the facility fee.

Note:

*Clinical Psychologist & Clinical Social Workers are not able to bill for psychotherapy services that include evaluation & management services. This would include CPT codes 90805, 90807, and 90809.

*Non Physician Practitioners can only provide the services they are licensed to provide under State law.

Originating –will be reimbursed a Facility Fee 80% of the lesser of the actual charge or $22.94.

Note
For payment to occur, interactive audio & video telecommunications must be used, permitting real time communication between the distant site physician/ practitioner and the Medicare beneficiary. The patient must be present & participating in the telehealth visit.