(Medicare Claims Processing Manual)

To receive the originating facility site fee, the provider submits claims with HCPCS code  Q3014, telehealth originating site facility fee; short description telehealth facility fee.  The type of service for the telehealth originating site facility fee is 9, other items and services.  For A/B MAC (B) processed claims, the office place of  service (code 11) is the only payable setting for code Q3014.  There is no participation payment differential for code Q3014.  Deductible and coinsurance rules apply to Q3014.  By submitting Q3014 HCPCS code, the originating site authenticates they are lo cated in either a rural HPSA or non -MSA county.    This benefit may be billed on bill types 12X, 13X, 22X, 23X, 71X, 72X, 73X, 76X, and 85X.  Unless otherwise applicable, report the originating site facility fee under revenue code 078X and include HCPCS code Q3014, telehealth originating site facility fee .    Hospitals and critical access hospitals bill their A/B/MAC (A) for the originating site facility fee.  Telehealth bills originating in inpatient hospitals must be submitted on a 12X TOB using the date of discharge as the line item date of service.    Independent and provider -based RHCs and FQHCs bill the appropriate A/B/MAC (A) using the RHC or FQHC bill type and billing number.  HCPCS code Q3014 is the only non- RHC/FQHC service that is billed using the clinic/center bill type and provider number.  All  RHCs and FQHCs must use revenue code 078X when billing for the originating site facility fee.  For all other non -RHC/FQHC services, provider based RHCs and FQHCs must bill using the base providers bill type and billing number.  Independent RHCs and FQHCs  must bill the A/B MAC (B) for all other non -RHC/FQHC services.  If an RHC/FQHC visit occurs on the same day as a telehealth service, the RHC/FQHC serving as an originating site must bill for HCPCS code Q3014 telehealth originating site facility fee on a s eparate revenue line from the RHC/FQHC visit using revenue code 078X. Note that for patients in an intensive outpatient program, Q3014 is not considered an intensive outpatient service.    Hospital -based or CAH -based renal dialysis centers (including satellites) bill their A/B/MAC (A) for the originating site facility fee.  Telehealth bills originating in renal dialysis centers must be submitted on a 72X TOB.  All hospital -based or CAH -based  renal dialysis centers (including satellites) must use revenue code 078X when billing for the originating site facility fee.  The renal dialysis center serving as an originating site must bill for HCPCS code Q3014, telehealth originating site facility fee , on a separate revenue line from any other services provided to the beneficiary.    Skilled nursing facilities (SNFs) bill their A/B/MAC (A) for the originating site facility fee.  Telehealth bills originating in SNFs must be submitted on TOB 22X or 23X.  For SNF inpatients in a covered Part A stay, the originating site facility fee must be submitted on a 22X TOB.  All SNFs must use revenue code 078X when billing for the originating site facility fee.  The SNF serving as an originating site must bill for HCPCS code Q3014, telehealth originating site facility fee, on a separate revenue line from any other services provided to the beneficiary.    Community mental health centers (CMHCs) bill their A/B/MAC (A) for the originating site facility fee.  Telehealth bills originating in CMHCs must be submitted on a 76X TOB.  All CMHCs must use revenue code 078X when billing for the originating site facilit y fee.  The CMHC serving as an originating site must bill for HCPCS code Q3014, telehealth originating site facility fee, on a separate revenue line from any other services provided to the beneficiary.  Note that Q3014 does not count towards the number of services used to determine per diem payments for partial hospitalization or intensive outpatient  services.    The beneficiary is responsible for any unmet deductible amount and Medicare coinsurance.   190.6 - Payment Methodology for Physician/Practitioner at the Distant Site (Rev. 3586, Issued: 08- 12-16, Effective:  01 -01-17, Implementation: 01- 03-17)  1. Distant Site Defined   The term distant site means the site where the physician or practitioner, providing the professional service, is located at the time the service is provided via a telecommunications system.   2. Payment Amount (professional fee)   The payment amount for the professional service provided via a telecommunications system by the physician or practitioner at the distant site is equal to the current fee schedule amount for the service provided at the facility rate.  Payment for an office visit, consultation, individual psychotherapy or pharmacologic management via a telecommunications system should be made at the same facility amount as when these services are furnished without the use of a telecommunications system.  For Medicare payment to occur, the service must be within a practitioners scope of practice under State law.  The beneficiary is responsible for any unmet deductible amount and applicable coinsurance.   3. Medicare Practitioners Who May Receive Payment at the Distant Site (i.e., at a site other than where beneficiary is)   As a condition of Medicare Part B payment for telehealth services, the physician or practitioner at the distant site must be licensed to provide the service under state law.  When the physician or practitioner at the distant site is licensed under state la w to provide a covered telehealth service (i.e., professional consultation, office and other outpatient visits, individual psychotherapy, and pharmacologic management) then he or she may bill for and receive payment for this service when delivered via a telecommunications system.   If the physician or practitioner at the distant site is located in a CAH that has elected Method II, and the physician or practitioner has reassigned his/her benefits to the CAH, the CAH bills its regular A/B/MAC (A) for the professional services provided at the distant site via a telecommunications system, in any of the revenue codes 096x, 097x or 098x.  All requirements for billing distant site telehealth services apply.   4. Medicare Practitioners Who May Bill for Covered Telehealth Services are Listed Below (subject to State law)   Physician  Nurse practitioner  Physician assistant  Nurse -midwife  Clinical nurse specialist Clinical psychologist*  Clinical social worker*  Registered dietitian or nutrition professional  Certified registered nurse anesthetist   *Clinical psychologists and clinical social workers cannot bill for psychotherapy services that include medical evaluation and management services under Medicare.  These practitioners may not bill or receive payment for the following CPT codes: 90805, 90807, and 90809.  190.6.1 - Submission of Telehealth Claims for Distant Site Practitioners  (Rev. 3817; Issued; 07- 28-17 Effective; 01 -01-18 Implementation: 01- 02-18)  Claims for telehealth services are submitted to the contractors that process claims for the performing physician/practitioners service area. Physicians/practitioners submit the appropriate HCPCS procedure code for covered professional telehealth services with place of service code 02 (Telehealth). By billing place of service code 02 with a covered telehealth procedure code, the distant site physician/practitioner certifies that the beneficiary was present at an eligible originating site when the telehealth  service was furnished. By billing the place of service code 02 with a covered ESRD -related service telehealth code, the distant site physician/practitioner certifies that 1 visit per month was furnished face -to-face hands on to examine the vascular access site. Refer to section 190.3.4 of this chapter for the conditions of telehealth payment for ESRD -related services.   In situations where a CAH has elected payment Method II for CAH outpatients, and the practitioner has reassigned his/her benefits to the CAH, CAHs submit the appropriate HCPCS procedure code for the covered telehealth services with the GT modifier, and A/B/MACs (A) should make payment for telehealth services provided by the physician or practitioner at 80 percent of the MPFS facility amount for the distant site service. In all other cases, except for MNT services as discussed in Section 190.7- A/B MAC (B) E diting of Telehealth Claims, telehealth services provided by the physician or practitioner at the distant site are billed to the A/B/MAC (B).  Physicians and practitioners at the distant site bill their A/B/MAC (B) for covered telehealth services.  Physicians and practitioners offices serving as a telehealth originating site bill their A/B/MAC (B) for the originating site facility fee.   190.6.2 - Exception for Store and Forward (Noninteractive) Telehealth  (Rev. 1, 10- 01-03)  In the case of Federal telemedicine demonstration programs conducted in Alaska or Hawaii, store and forward technologies may be used as a substitute for an interactive telecommunications system. Covered store and forward telehealth services are billed with  the GQ modifier, via asynchronous telecommunications system. By using the GQ modifier, the distant site physician/practitioner certifies that the asynchronous medical file was collected and transmitted to them at their distant site from a Federal te lemedicine demonstration project conducted in Alaska or Hawaii.  190.7 - A/B MAC (B) Editing of Telehealth Claims  (Rev. 3817; Issued; 07- 28-17 Effective; 01 -01-18 Implementation: 01- 02-18)  Medicare telehealth services (as listed in section 190.3) are billed with POS 02. The contractor shall approve covered telehealth services if the physician or practitioner is licensed under State law to provide the service. Contractors must familiarize the mselves with licensure provisions of States for which they process claims and disallow telehealth services furnished by physicians or practitioners who are not authorized to furnish the applicable telehealth service under State law. For example, if a nurse  practitioner is not licensed to provide individual psychotherapy under State law, he or she would not be permitted to receive payment for individual psychotherapy under Medicare. The contractor shall install edits to ensure that only properly licensed physicians and practitioners are paid for covered telehealth services.  If a contractor receives claims for professional telehealth services coded with the GQ modifier (representing via asynchronous telecommunications system), it shall approve/pay for these services only if the physician or practitioner is affiliated with a Federal telemedicine demonstration conducted in Alaska or Hawaii. The contractor may require the physician or practitioner at the distant site to document his or her participation in a Federal telemedicine demonstration program conducted in Alaska or Haw aii prior to paying for telehealth services provided via asynchronous, store and forward technologies.  Contractors shall deny telehealth services if the physician or practitioner is not eligible to bill for them.  The following reflects the remittance advice messages and associated codes that will appear when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario 3.  Group Code: CO  CARC: 185  RARC: N/A  MSN: 21.18  If a service is billed with POS 02 and the procedure code is not designated as a covered telehealth service, the contractor denies the service.  The following reflects the remittance advice messages and associated codes that will appear when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario 3.  Group Code: CO  CARC: 96  RARC: N776  MSN: 9.4  The only claims from institutional facilities that FIs shall pay for telehealth services at the distant site, except for MNT services, are for physician or practitioner services when the distant site is located in a CAH that has elected Method II, and the physician or practitioner has reassigned his/her benefits to the CAH. The CAH bills its regular FI for the professional services provided at the distant site via a telecommunications syst em, in any of the revenue codes 096x, 097x or 098x. All requirements for billing distant site telehealth services apply.  Claims from hospitals or CAHs for MNT services are submitted to the hospital's or CAH's regular FI. Payment is based on the non-facility amount on the Medicare Physician Fee Schedule for the particular HCPCS codes.   200 - Allergy Testing and Immunotherapy  (Rev.  2997, Issued: 07- 25-14, Effective: Upon implementation of ICD -10; 01- 01- 2012 -  ASC X12, Implementation: 08- 25-2014 -  ASC X12; Upon Implementation of ICD- 10)  A. Allergy Testing