CMS Sets Telehealth Site Facility Fee Payment

The Centers for Medicare & Medicaid Services (CMS) recently announced the telehealth site facility fee payment amount. Effective Jan. 1, the fee for telehealth services is increased annually by the Medicare Economic Index (MEI). For 2010, the MEI increase is 1.2 percent.

The 2010 telehealth site facility fee payment amount for HCPCS Level II code Q3014 Telehealth originating site facility fee is 80 percent of the lesser of the actual charge or $24—up from $23.72 in 2009. Patients are responsible for any unmet deductible amount or coinsurance.

The Medicare telehealth originating site facility fee for telehealth services provided from Oct. 1, 2001 through Dec. 31, 2002 is $20. The fee is increased each subsequent year by the MEI.

Medicare Coverage of Telemedicine/Telehealth Services

Medicare reimbursement for telemedicine or telehealth services is divided into three areas:

  1. Remote patient face-to-face services seen via live video conferencing;
  2. Non face-to-face services that can be conducted either through live video conferencing or via store and forward telecommunication services; and
  3. Home telehealth services.

Claims Submission

To claim the facility payment, physicians should bill HCPCS Level II code Q3014. The service type for the telehealth originating site facility fee is 9 Other items and services. For carrier processed claims, the “office” place of service (POS) code 11 is the only payable setting for code Q3014. There is no participation payment differential for code Q3014, and it is not priced off of the Medicare Physician Fee Schedule Database (MPFSD) file. Deductible and coinsurance rules apply to Q3014. By submitting HCPCS Level II code Q3014, the biller certifies that the originating site is located in either a rural health provider shortage area (HPSA) or a non-metropolitan statistical area (MSA) county.

Physicians’ offices serving as a telehealth originating site bill their local Medicare carrier for the originating site facility fee. Physicians at the distant site should bill their local Medicare carrier for covered telehealth services. Services provided by distant site physicians or practitioners are only paid for via telehealth if such services are not included in a bundled payment to the facility that serves as an originating site.

CMS has added three codes to the list of Medicare distant site telehealth services for individual health and behavior assessment and intervention (HBAI) services (CPT® 96150-96152) and three codes for initial inpatient telehealth consultations (HCPCS Level II G0425-G0427). CMS has also expanded the definition of follow-up inpatient telehealth consultations (HCPCS Level II G0406-G0408) to include consultative visits furnished via telehealth to patients in hospitals or skilled nursing facilities (SNFs).

Physicians should submit the appropriate CPT® procedure code for covered professional telehealth services along with modifier GT Via interactive audio and video telecommunications system. By coding and billing modifier GT with a covered telehealth procedure code, the distant site physician certifies that the patient was present at an eligible originating site when the telehealth service was provided.

Note: In the case of federal telemedicine demonstration programs conducted in Alaska or Hawaii, physicians should submit the appropriate CPT® or HCPCS Level II code for the professional service along with the telehealth modifier GQ Via asynchronous telecommunications system.

Sources: Medicare Claims Processing Manual, chapter 12, section 190.3; CMS Transmittal 613, CR 6756, issued Dec. 23, 2009; CMS Transmittal 118, CR 6705, issued Dec. 18, 2009.

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8 Responses to “CMS Sets Telehealth Site Facility Fee Payment”

  1. Jean Honey says:

    Is there anywhere I could get a comprehensive listing of all states that are currently being reimbursed through code Q3014 for telemedicine- that is for Medicaid?

    I would be most grateful!!

  2. Rick says:

    It is not clear to me by the text generally available just what constitutes telehealth.

  3. leslie says:

    I am a biller for a neurologist group and am having a hard time finding any information on telehealth/telestroke, in regards to billing for the doctor that is providing the off site, via telecommunications consult, the information I am looking for is concerning the place of service on the 1500 form, since the doctor is mobile when doing this consult. What place of service is to be used ????

    thanks, leslie

  4. Kim says:

    I am billing the telehealth facility fee with cpt code Q3014 with bill type 131 – Novitas is returning for invalid revenue code of 780 – What revenue code can I bill with the bill type of 131 on a UB04?

  5. stacy says:

    How long is a “telehealth” session via videoconferencing? Can the code be billed “plus 2, 3,….etc.?”

  6. Alison Foster says:

    Can a skilled nursing facility bill for Q3014 or can only physicians bill for it?

  7. Marilyn says:

    Please clarify that we would only bill mental health visit with only Q3014 from the originating site with POS 11…. and I am understanding the distant site bills for covered service (or procedure code?) plus modifier GT?

  8. Rhonda says:

    Did you ever get a response?

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