Telemedicine, also known as telehealth or eHealth, refers to the growing trend of healthcare providers rendering services remotely, via face-to-face, real-time video-conferencing technology. This trend originated within the context of specialized, telemedicine physician groups and special programs for extremely rural areas. However, today private-practice physicians are beginning to implement telemedicine technology within their practice and standard service offerings, particularly for the substitution of in-person patient consultations and check-up exams. The natural question for these private-practice providers follows: “Can private-practice providers bill insurance companies for telemedicine-based patient consultations and exams?” In this article, we will answer this question and discuss important items to consider when billing for telemedicine services. Also, this answer will be in the context of private practices and insurance companies based in the United States.
To answer the first question, the short answer is simply “yes.” Private-practice providers can bill insurance companies for telemedicine consultations and patient exams. In fact, many insurance companies are required by law to reimburse providers for these telemedicine services. However, there are some limitations and requirements that providers must be careful of and comply with in order to ensure insurance reimbursement.
First, it is important here to better define what is considered billable telemedicine by insurance companies. The deciding factor is typically that there is face-to-face interaction between the provider and patient. As such, telemedicine without video-conferencing technology (such as emails or phone calls) is typically not considered billable by Medicare/Medicaid or major insurance companies. One exception here is electronically rendered “store-and-forward” services such as remote radiology review. Here, there is often no face-to-face interaction between the radiologist and the patient, however, the radiologist can still receive insurance reimbursement for these telemedicine services.
Additionally, it is important to consider the necessary codes and modifiers required to note that the service was rendered remotely. Effective January 2017, the U.S. Center for Medicare and Medicaid services requires Place of Service (POS) code “POS 02” to be included in billings for telemedicine services. Importantly, this POS code can be applied to typical patient consultation and exam Current Procedural Terminology (CPT) codes, such as CPT codes 99201–99215. You can read more on specific CMS codes in the context of telemedicine directly from the CMS here.
Also, with CMS billing, it is important to note that this Place of Service code now replaces the previous “GT” or “95” modifiers, which, prior to January 2017, served the purpose of denoting that the service was rendered over telemedicine technology. However, there is some ambiguity here as a handful of private payers still prefer and require these modifiers. It is best to check directly with the particular insurance companies that your private-practice is contracted with.
In conclusion, private-practice providers can bill to and be reimbursed by the CMS and private insurance companies for telemedicine-based patient consultations and exams. As stated, it is important for these services to be completed using face-to-face video technology and for any billing to include the appropriate POS codes and modifiers.
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