Telemedicine - Provider Information

Please check this page regularly as updates and changes to the telemedicine policy will be announced here.

COVID-19 State of Emergency Changes to Telemedicine Services

To facilitate the safe delivery of health care services to members throughout the COVID-19 state of emergency, the Department is authorizing three temporary changes to the existing telemedicine policy. See  Health First Colorado Announces Telemedicine Changes for more information.

  1. Federally Qualified Health Centers, Rural Health Clinics, and Indian Health Services
    For the duration of the COVID-19 state of emergency, Health First Colorado is allowing telemedicine visits to qualify as billable encounters for Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs), and Indian Health Services (IHS). Services allowed under telemedicine may be provided via telephone, live chat, or interactive audiovisual modality for these provider types.
  2. Physical Therapy, Occupational Therapy, Home Health, Hospice and Pediatric Behavioral Health Providers
    Health First Colorado has expanded the list of providers eligible to deliver telemedicine services to include physical therapists, occupational therapists, hospice, home health providers and pediatric behavioral health providers.
    1. Home Health Agency services and therapies, Hospice, and Pediatric Behavioral Treatment may be provided via telephone-only.
    2. Outpatient Physical, Occupational, and Speech Therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.
Telemedicine is covered for behavioral health providers under the capitated behavioral health benefit administered by the Regional Accountable Entities (RAEs). Behavioral health providers should contact their RAE for guidance. Visit the Accountable Care Collaborative Phase II web page for more information.

Requirements for Telemedicine Services:

It is acceptable to use telemedicine to facilitate live contact directly between a member and a provider. Services can be provided between a member and a distant provider when a member is in their home or other location of their choice. Additionally, the distant provider may participate in the telemedicine interaction from any appropriate location.

Other standard requirements for telemedicine services include:

  1. The reimbursement rate for a telemedicine service shall, as a minimum, be set at the same rate as the medical assistance program rate for a comparable in-person service. [C. R. S. 2017, 25.5-5-320(2)].
  2. Providers may only bill procedure codes which they are already eligible to bill.
  3. Any health benefits provided through telemedicine shall meet the same standard of care as in-person care.
  4. Providers must document the member’s consent, either verbal or written, to receive telemedicine services.
  5. Contact with the provider must be initiated by the member for the service rendered.
  6. The availability of services through telemedicine in no way alters the scope of practice of any health care provider; nor does it authorize the delivery of health care services in a setting or manner not otherwise authorized by law.
  7. Services not otherwise covered by Health First Colorado are not covered when delivered via telemedicine.
  8. The use of telemedicine does not change prior authorization requirements that have been established for the services being provided.
  9. Record-keeping and patient privacy standards should comply with normal Medicaid requirements and HIPAA. Office for Civil Rights (OCR) Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency

Billing Guidance:
To receive reimbursement for telemedicine services, providers must follow the following billing practices:

  • UB-04 Institutional Claims - Providers must indicate that the service(s) were provided through telemedicine by appending modifier GT to the UB-04 institutional claim form with the service's usual billing codes. This identifies the service as provided via telemedicine during the COVID-19 State of Emergency.
  • CMS 1500 Professional Claims - Place of Service code 02 must be indicated on all CMS 1500 professional claims for telemedicine. Only specific CPT/HCPCS are allowed (see below).

Place of Service 02 (telemedicine)

Place of Service 02 should be used to report services delivered via telecommunication, where the member may be in their home and the provider may be at their office. The following list of CPT/HCPCS may be billed using Place of Service code 02:

76801 76802 76805 76811 76812 76813 76814 76815
76816 76817 90791 90792 90832 90833 90834 90836
90837 90838 90839 90840 90846 90847 90849 90853
90863 92507 92508 92521 92522 92523 92524 92526
92606 92609 92610 96110 96112 96113 96116 96121
96125 96130 96131 96132 96133 96136 96137 96138
96139 96146 97110 97112 97129 97130 97140 97150
97151 97153 97154 97155 97158 97161 97162 97163
97164 97165 97166 97167 97168 97530 97533 97535
97537 97542 97755 97760 97761 97763 97802 98703
98704 98966 98967 98968 99201 99202 99203 99204
99205 99211 99212 99213 99214 99215 99402 99402
99403 99404 99406 99407 99408 99409 99441 99442
99443 G0108 G0109 G8431 G8510 G9006 H0001 H0002
H0004 H0006 H0025 H0031 H0032H0049 H1005 H2000
H2011 H2015 H2016 S9445 S9485 T1017 V5011  

What Health First Colorado services are reimbursed using telemedicine?

Any Health First Colorado covered physician services that are within the scope of a provider’s practice and training and appropriate for telemedicine may be rendered via telemedicine.

Telemedicine is the delivery of medical services and any diagnosis, consultation, treatment, transfer of medical data or education related to health care services using interactive audio or interactive video communication instead of in-person contact.

  • Physician services may be provided as telemedicine.
  • Providers may only bill procedure codes, which they are already eligible to bill.
  • Any health benefits provided through telemedicine shall meet the same standard of care as in-person care.

Services not otherwise covered by Health First Colorado are not covered when delivered via telemedicine. Additionally, the use of telemedicine does not change prior authorization requirements that have been established for the services being provided.

Telemedicine does not include consultations provided by facsimile machines, text, email or instant messaging.

Confidentiality

  • Same standard of care as in-person care. Record keeping and patient privacy standards should comply with normal Medicaid requirements and HIPAA.

How do I bill for telemedicine services?

  1. A single provider may bill a service with Place of Service 02, for professional claims, when the member is not physically present in the provider’s office and services are rendered through telemedicine. See the coding table below. Place of Service 02 (Telehealth) should be used for all telemedicine visits.
  2. When two providers are involved, one provider can be reimbursed as the "originating provider" where the member is present with the provider at the "originating site" and that originating provider is consulting with a "distant provider". Another provider can also be reimbursed as a "distant provider" for any covered Telemedicine Services. See the description at the bottom of this page.

Originating/Distant Providers and Q3014

Origination providers:

  • An originating provider that only makes a room and telecommunications equipment available and is not providing clinical services bills Q3014 (telemedicine originating site facility fee).
  • If the originating provider also provides clinical services to the member, the provider bills the appropriate procedure code in addition to Q3014.

Distant Providers:

  • All distant providers bill the appropriate procedure code and Place of Service 02 on the CMS 1500 paper claim form or as an 837P transaction.

Where can I get more information about telemedicine?

The Telemedicine Billing Manual, located on the Billing Manuals web page under the CMS 1500 dropdown,  provides information on covered services, billing, reimbursement, and confidentiality requirements.

Telemedicine Utilization Data

Overview

In compliance with SB20-212, the presentation linked below displays data on telemedicine utilization in Health First Colorado. The data is for services rendered during the period of July 1, 2019, through May 16, 2020. The services in this dashboard are limited to the services eligible for telemedicine reimbursement. Services that are not eligible for telemedicine reimbursement are not included in this data. The data is not adjusted for changes in caseload.

Data displayed in orange in the graphs represent telemedicine services. Data displayed in blue represent non-telemedicine services. For each provider type grouping, telemedicine data (in orange) is displayed by:

  • Eligibility Category: These are groups used by the Department to organize members into categories based on their eligibility type. The data are sorted by the total paid amount for telemedicine services received by members in the eligibility category. A hierarchy is used to determine which eligibility group a member is categorized into. For example, a child with disabilities would fall into the members with disabilities group rather than the children group. Members over 65 and with a disability, however, would fall into the Adults 65 and Older group. Retroactively eligible refers to members who were not yet determined eligible for Health First Colorado on the date of their service, but who later received coverage that extends back to their date of service.
  • Age Group: Member’s age group at time of service. The data are sorted by total paid amount for telemedicine services received by members in that age category.
  • Billing Provider Type: Provides a further level of detail of the provider category. Provider Type is the classification of how a provider enrolls with Health First Colorado. The data are sorted by total paid amount for telemedicine services billed by the detailed provider type.
  • Procedure Codes: These are the CPT/HCPCS codes billed by providers to Health First Colorado as being delivered via telemedicine. The data are sorted by total dollar amount billed for telemedicine services under that code.
  • Benefit Category: Displays the total paid amount paid for services delivered by telemedicine in the selected benefit category.
  • Primary Diagnosis Codes: This is the primary diagnosis code listed on the billed telemedicine claim. The data are sorted by total dollar amount billed for telemedicine services under that code.
  • Member County Map: The map displays the total paid amount for members who received a telemedicine service by county. Dark orange indicates a higher paid amount, light orange indicates lower paid amounts. This is based on the county of residence for each member.
  • Trend Over Time: The data in this bar graph are actual paid amounts for services in the time period identified. The bar graph shows what portion of telemedicine eligible services were delivered via telemedicine as opposed to in-person care. Paid amounts are in actual totals – meaning these are services that have been provided and paid for. This means they do not include services that have been provided but have not yet been paid for.

Provider Types

The data is broken out into the following provider types:

  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Indian Health Services. Please note this data is limited to the overall trend due to small sample sizes.
  • Certified Nursing Assistant/Registered Nurse Home Health
  • Physical Therapy/Occupational Therapy Home Health
  • Speech Therapy Home Health
  • Physical Therapy/Occupational Therapy
  • Speech Therapy
  • Other medical/professional providers. These are providers with professional claims billing for CPT/HCPCS that are allowed with place of service 02 (telemedicine), excluding those providers already covered in groups above. The most common provider types covered in this category are clinics, pediatric behavioral therapists, nurse practitioners, and physicians.