Q3014 billing guidelines

telemind

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  • As a telemedicine clinic is Q3014 a billable code with commercial insurances?
  • If so, are we able to back bill for this code?
  • Are we in need of a specific modifier to be used at the time of billing the commercial insurance?
 

erjones147

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  • As a telemedicine clinic is Q3014 a billable code with commercial insurances?
  • If so, are we able to back bill for this code?
  • Are we in need of a specific modifier to be used at the time of billing the commercial insurance?
1. Yes, unless your payer specifically dictates use of another code
2. Yes, back to whatever timely filing restrictions the payer has
3. No modifier (unless you are a CAH), but don't forget to change POS to 02
 

telemind

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All commercial insurances have been denying our Q3014 codes, when billed with 99204/99214 with place of service code 02, are we doing something wrong ?
But perhaps the problem is that the Q3014 is not on their list of codes that they provided to us as a behavioral health provider? And if so, is that something that can be added? Any insight from anyone in the forum would be helpful
 

thomas7331

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telemind

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The same provider should not bill both Q3014 and the E&M service. Q3014 is the fee for the originating site and is billed only by the facility where the patient is located, and the E&M or other CPT/HCPCS code is billed by the provider in the remote location based on the service that was provided. Here is a good publication that summarizes all of this:
Thanks for the replies guys. So, does these CMS guidelines apply to commercial insurers, United, Anthem, Cigna, Humana? Medicaid and medicare are paying for the code. It is the commercials that are not paying.

Also we will bill them together as I don’t understand the separation. We have a group contract with the insurers. Provider is at remote site and patient is at originating site at the clinic. All billing goes through the same npi and ein of the group. Right now it is just one provider for the group. Are you suggesting for the commercials insurers to submit two different claims?
 

mitchellde

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Thanks for the replies guys. So, does these CMS guidelines apply to commercial insurers, United, Anthem, Cigna, Humana? Medicaid and medicare are paying for the code. It is the commercials that are not paying.

Also we will bill them together as I don’t understand the separation. We have a group contract with the insurers. Provider is at remote site and patient is at originating site at the clinic. All billing goes through the same npi and ein of the group. Right now it is just one provider for the group. Are you suggesting for the commercials insurers to submit two different claims?
It probably has to do with how you are billing the location. If you are using the same address for the distant provider as you do for the originating site, since it is all the same NPI and such, then the appearance is that you have not met the requirements for telemedicine. It is probably based on zip codes, you must use the address for the service provided as the address of where the provider is located, and the originating site as the address where the originating site is located. So in short these should be two separate claims. Your distant site provider should be located at the address of where they are located, and the same with the originating site. It would be unwise to try and submit both services on the same claim.
 
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