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. 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.
  6. Services not otherwise covered by Health First Colorado are not covered when delivered via telemedicine.
  7. The use of telemedicine does not change prior authorization requirements that have been established for the services being provided.
  8. 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 90833 92508 96130 97140 97167 99203 H0004
76802 90834 92521 96131 97150 97168 99204 H0006
76805 90836 92522 96132 97151 97530 99205 H0025
76811 90837 92523 96133 97153 97533 99211 H0031
76812 90838 92524 96136 97154 97535 99212 H0032
76813 90839 92526 96137 97155 97537 99213 H2000
76814 90840 92609 96138 97158 97542 99214 H2011
76815 90846 96110 96139 97161 97755 99215 H2015
76816 90847 96112 96146 97162 97760 99451 H2016
76817 90849 96113 97110 97163 97761 G0108 S9445
90791 90853 96116 97112 97164 97763 G0109 S9485
90792 90863 96121 97129 97165 99201 H0001 T1017
90832 92507 96125 97130 97166 99202 H0002 V5011
92606 99408 99409 H0049 99402 99402 99403 99404
99406 99407 G8431 G8510 G9006 H1005 92610 99441
99442 99443 98966 98967 98968      

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.