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New Policy Allows Providers to Bill Certain Telemedicine Visits

Blue Care Network has developed a new medical policy to provide coverage for certain telemedicine services, effective Jan. 1, 2016. The telemedicine policy applies to both commercial members and BCN Advantage.

Telemedicine visits include voice only or audio visual communication. However, the visit must take place at an originating site, for example, a doctor's office. An example of a telemedicine visit would be a patient using his or her PCP's office equipment to communicate with a specialist at another location.

To bill a telemedicine visit, providers should add a GT modifier to the normal code for that visit. The member copayment still applies to the visit.

Medical Policy updates

The following applies to Blue Care Network members:

  • The following are covered services.
  • The effective date is indicated for the service
  • The effective date is indicated for the service, technology or procedure.

Covered service Telemedicine

  • Revised policy
  • Effective date: Jan. 1, 2016
  • Referral required
  • Procedure codes: Various established codes within the provider's scope of practice with GT Modifier

Telemedicine is the use of an electronic media (audio, video or both) to link patients with health care professionals in different locations. The health care professional must be able to examine the patient via a real-time telecommunications system and the patient must be able to interact with the off-site health care professional at the time the services are provided. Telemedicine may substitute for a face-to-face, hands-on encounter between a patient and the health care provider when using the appropriate, secured technology.

The safety and effectiveness of telemedicine have been established. It may be considered a useful diagnostic and therapeutic option when indicated.

Telemedicine must include the following:

  • Originating site -- An originating site is the location of the member at the time the service occurs via a telecommunications system.
  • The provider must be licensed, registered or otherwise authorized to perform service in their health care profession in the state where the patient is located. The provider is not required to be located in the state of Michigan but must be contracted with Blue Care Network. Services must fall within their scope of practice.
  • Telemedicine delivered services are available to all clinicians. However, it may not be the preferred method of delivery in certain clinical scenarios, for example chronic suicidal ideation or unstable angina. A hosted visit may be necessary due to the complexity of the clinical situation.
  • Telemedicine delivered services for ongoing treatment of a condition that is chronic or is expected to take more than three to five sessions before the condition resolves or stabilizes may require a hosted visit or a face-to-face encounter during the active treatment period.
  • The service must be conducted over a secured channel.
  • Eligible providers may include MD/DO, certified nurse midwife, clinical nurse practitioner, clinical psychologist, clinical social worker, physician assistant or licensed professional counselor.

Telemedicine service is not covered for the following indications:

  • Store and forward -- asynchronous (not real-time) transmission of medical information to be reviewed at a later time by a physician or practitioner at the distant site.
  • Tele-monitoring
  • Email, telephone or text-only communication
  • Facsimile transmission
  • Request for medication refills
  • Reporting of normal test results
  • Provision of educational materials
  • Scheduling of appointments and other health care related issues
  • Registration or updating billing information
  • Reminders for health care related issues
  • Referrals to other providers
  • Any telemedicine visit resulting in an office visit, urgent care or emergency care encounter on the same day for the same condition
  • Any telemedicine visit for the same condition originating from an office visit, urgent care or emergency care encounter within the previous seven days
  • Any telemedicine visit occurring during the postoperative period

 

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