Telemedicine is an excellent advancement for the healthcare system at large, since it helps underserved communities get the medical attention they deserve even when a local physician is unavailable. But despite the growing prominence of “telehealth” across the landscape of care, medical billing for it is still tricky business.
Medicare, Medicaid, and commercial payers all have different rules when it comes to billing for telemedicine, many providers who offer tele-services rely on a cash-pay-only approach. As such, there’s no set of one-size-fits-all advice for providers looking to grow their telehealth services list – but the following tips may help you navigate the evolving reimbursement environment without incurring issues.
Get Friendly with the GT Modifier
Medicare covers telemedicine services and reimburses it on the standard fee schedule. Use the appropriate CPT code with a “GT” modifier to indicate the “interactive telemedicine” component. (Don’t let the similar GQ modifier, for “asynchronous communications,” trip you up – that one’s only intended for providers in demonstration projects in Hawaii and Alaska.)
Similar for Medicaid… But also Different
To identify, track, and reimburse for telehealth services, providers can select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD), but billing and coding guidelines depend on their states’ rules. At present, 48 states and the District of Columbia now provide some form of Medicaid reimbursement for telehealth services.
For Private Payers, it’s a State-by-State Basis
States have had to create their own requirements when it comes to telehealth, and at last count 32 states and the District of Columbia have some kind of private payer policy. Research whether your state is one of 29 with a “telemedicine parity law,” which mandates commercial coverage of telehealth services the same as in-person ones. But as always, read the fine print – some states have restrictions.
The Big Five Have You Covered
Aetna, Humana, Blue Cross Blue Shield, Cigna, and United all offer some degree of coverage for telemedicine, but it’s policy-dependent (meaning many exclusions on lower-tier plans) and varies state-by-state. If you or your patient need specifics prior to the tele-encounter, be sure to verify carefully.
When in Doubt, Check
That advice to verify carefully is even more important when it comes to smaller commercial payers. Go beyond a basic eligibility check to asking an actual representative about the telemedicine CPT code in question. If the rep says it’s covered, get him or her on record (with a reference number or other form of documentation) to dodge any potential billing disputes down the road.
Telemedicine is growing in popularity for more than just underserved populations. Thanks to advances in technology and the changing expectations of patients, telemedicine is increasingly being utilized by providers and accountable care organizations to bolster primary care delivery and keep consumer costs down. Watch for pilot programs in your area and stay engaged with the evolving laws; more positive telehealth program results will ultimately lead to stronger coverage and better reimbursement rates across the board.
...and if you need help from a medical billing company...