Telemedicine is not a unique service, but a means of providing selected services approved by Health First Colorado (Colorado's Medicaid Program) through live interactive audio and video telecommunications equipment. Telemedicine Direct Member Services can involve up to two (2) collaborating providers. The member must be present during any Telemedicine Direct Member Services collaboration between two providers where there is an “originating provider” and a “distant provider”. The provider where the member is located is the “originating site” or “originating provider”. In most cases, the “distant provider” is a clinician who acts as a consultant to the member and originating provider. However, it is also acceptable for the distant provider to be the only provider involved in the service with the member being the only one present at the originating site. Providers must have special equipment to provide telemedicine services. Telemedicine does not mean visits by telephone or fax.
Who is eligible for services?
All Health First Colorado members can receive services through the use of telemedicine, whether they live in rural or urban areas. Only the Health First Colorado providers that have special telemedicine equipment can serve members through telemedicine.
How does telemedicine work?
Telemedicine services are provided “live” by audio-video communications between two providers. The distant provider is a consultant to the originating provider. Sometimes the distant provider may be the only provider involved in the visit, such as with mental health sessions. Providers such as doctors, nurse practitioners, and mental health providers can provide services if they have the special equipment. If no originating provider is present during a Telemedicine Direct Member Services appointment, then the location of the originating site is at the member’s discretion and can include the member’s home. However, members can be required to choose a location suitable to delivery of telemedicine services that may include adequate lighting and environmental noise levels suitable for easy conversation with a provider.
When is telemedicine a good option?
Telemedicine is best used for members who live in rural areas and are far away from a primary care provider or specialist, as well as members facing transportation difficulties. Telemedicine can also be used by a member’s medical provider to consult in real-time with another medical provider regarding the member. However, telemedicine is not to take the place of seeing a provider in person when medically necessary.
What Health First Colorado services are reimbursed using telemedicine?
A list of approved services is available to providers and can be found in the Telemedicine Billing Manual. The services include office visits for preventive and routine medical care, psychotherapy, speech therapy, and obstetrical ultrasounds.
A provider can be reimbursed as the “originating provider” where the member is present with the provider at the “originating site” and the originating provider is consulting with a “distant provider.” A provider can also be reimbursed as a “distant provider” for any Telemedicine Direct Member Services.
Services not otherwise covered by Health First Colorado are not covered when delivered via telemedicine. Health First Colorado does not pay for provider or member education when education is the only service provided via telemedicine.
Additionally, the use of telemedicine does not change prior authorization requirements that have been established for the services being provided.
Does telemedicine add new services?
No. Telemedicine allows providers to provide services that are already covered by Health First Colorado.
What provider types can bill for telemedicine services?
- Physician 05
- Clinic 16
- Osteopath 26
- Doctorate Psychologist 37
- MA Psychologist 38
- Physician Assistant 39
- Nurse Practitioner 41
Provider types not listed above may facilitate Telemedicine Direct Member services; however, they may not bill procedure code Q3014 or use the GT modifier when billing.
How do I bill for telemedicine services?
- An originating provider that only makes a room and telecommunications equipment available and is not providing clinical services bills Q3014 (the procedure code for the 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.
- All distant providers bill the appropriate procedure code using modifier GT (interactive communication) on the CMS 1500 paper claim form or as an 837P transaction.
Where can I get more information about telemedicine?
The Telemedicine Billing Manual provides information on covered services, billing, reimbursement, and confidentiality requirements.
Call or email the Health First Colorado Member Contact Center.