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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.
If the member is not physically present at the site, then the Q3014 code would not be appropriate.
For providers other than FQHCs: If a patient receives a covered service and also is connected with a distant provider via telemedicine during the visit, then Q3014 may be billed in addition to the services provided during that visit.
For FQHCs: If a patient is at an FQHC and receives a covered service and also is connected with a distant provider via telemedicine, the FQHC can only submit a claim for an encounter. All services provided during the visit are included in the encounter payment and that would include Q3014. The only way an FQHC would receive the Q3014 payment is if there is no payable encounter for the patient on that day.
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:
To receive reimbursement for telemedicine services, providers must follow the following billing practices:
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 codes may be billed using Place of Service code 02:
Health First Colorado has added temporary coverage of well-child check-ups provided via telemedicine during the public health emergency for COVID-19. Effective November 12, 2020, Health First Colorado will reimburse providers for well-child check-up visits with procedure codes 99382, 99383, 99384, 99392, 99393, 99394 via telemedicine for children between the ages of 2 and 18. Place of Service 02 must be indicated on all CMS 1500 professional claims for well-child check-ups delivered via telemedicine.
Providers are encouraged to complete the physical examination the next time the member is seen in person. Fee for service providers who perform a physical examination within 4 months of the telemedicine well-child check-up should void the previously paid claim with the Place of Service 02 and resubmit for payment of the well-child check-up using the date of service of the physical examination. Due to the nature of their billing, FQHC/RHCs and IHS/Tribal 638 providers do not need to void a previous encounter when a physical examination is performed within 4 months of the telemedicine well-child check-up. FQHC/RHC and IHS/Tribal 638 providers must indicate the well-child check-up provided through telemedicine by appending modifier GT to the UB-04 institutional claim form with the service’s usual billing codes.
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.
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.
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.
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 fee-for-service telemedicine services. Data displayed in blue represent non-telemedicine services. For each provider type grouping, telemedicine data (in orange) is displayed by:
The data is broken out into the following provider types: