August 20, 2020
Here are some tips for billing telehealth services, which has become a popular way to receive care in this time of COVID-19.
The Telehealth/Telemedicine Services Payment Policy defines the originating site as where the patient is located during a telehealth/telemedicine encounter. This location can be either with the patient’s physician or other qualified healthcare professional or by the patient self-initiating the encounter with the provider.
Only the provider at the originating site can bill for an originating site fee for hosting the patient. The originating site fee is billed using Healthcare Common Procedure Coding System (HCPCS) Level II code Q3014-Telehealth originating site facility fee without any modifier.
The distant site provider who is providing healthcare services to the patient via a telecommunications system (e.g., audio/video, telephone, online digital) can’t bill for the originating site fee since they aren’t hosting the member. The submission of the originating site fee by the distant site provider will be denied, per the payment policy.
Examples
Appropriate billing of Q3014:
- Patient visits their PCP’s office in Everett and the PCP helps to initiate a telehealth appointment with a specialist located in Seattle.
- PCP’s office in Everett can submit Q3014 – Telehealth originating site facility fee for physically hosting the patient.
- The specialist in Seattle can’t bill code Q3014 since they aren’t the originating site.
Inappropriate billing of Q3014:
- Patient is in their home and initiates telehealth visit with their PCP located in Everett.
- Since the PCP in Everett is not physically hosting the patient, they can’t bill Q3014 – Telehealth originating site facility fee as the patient isn’t present at their facility.
- The PCP is acting as a “distant site provider” to the patient who is at home.
Review the details of the current payment policy.