Allowable sites for telemedicine visits > Michigan State Medical Society

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Allowable sites for telemedicine visits

For both Blue Care Network HMO (commercial) and Blue Care Network Advantage members, telemedicine visits are eligible for reimbursement only when the originating site -- the site in which the patient is located at the time of the visit -- is one of the following:

  • Physician or practitioner office
  • Hospital
  • Critical access hospital (CAH)
  • Rural health clinic
  • Federally qualified health center
  • Hospital or CAH-based renal dialysis center including satellite
  • Skilled nursing facility
  • Community mental health center

For Blue Care Network Advantage members, coverage for telemedicine visits mirrors that for Original Medicare. This means that there are additional site restrictions for Blue Care Network Advantage members. For these members, the originating site for the visit must be located within one of the following:

  • A rural Health Professional Shortage Area (HPSA) located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract
  • A county outside of an MSA

More information on Original Medicare coverage is found in the MLN for Telehealth Services published by CMS.

The information here clarifies the article titled "New policy allows providers to bill certain telemedicine visits," published in the April-May 2016 issue of BCN Provider News.

In addition, the Claims chapter of the BCN Provider Manual outlines the requirements for billing both telemedicine visits and e-visits. Look in the section titled "Visits completed using telecommunications."

As a reminder, telemedicine visits may be used for higher-complexity conditions and e-visits may be used for lower-complexity conditions. These types of visits differ in other ways, as well, as is explained in the Claims chapter. To access the Claims chapter, do the following:

  1. Visit bcbsm.com/providers.
  2. Log in to Provider Secured Services.
  3. Click BCN Provider Publications and Resources.
  4. Click Provider Manual.
  5. Click Claims (Billing).

     

Posted in: Reimbursement Advocate Alerts, News for Practices, Insurance

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