Telemedicine - Provider Information
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, interactive video, or interactive data 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.
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 covered Telemedicine Services.
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.
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.
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 (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. The Place of Service (POS) code should describe where the patient is located.
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.