March 26, 2008

BC-08-07

Originating Site Telemedicine Services

Starting May 1, 2008, Blue Cross and Blue Shield of Kansas will provide reimbursement for originating site telemedicine services that meet established guidelines.  

The guidelines are:

• Applies to outpatient claims received by BCBSKS starting May 1, 2008 that have a service date on or after April 1, 2008. Claims with dates prior to these will not be reimbursed.
• Like outpatient clinic visits, the telemedicine service must involve a physician's specialty that is not otherwise available in the community.
• Telemedicine services for primary care or care by a mid-level practitioner are not covered nor should they be billed to BCBSKS.

Billing procedures:

Originating site telemedicine services meeting these guidelines should be billed to BCBSKS:

• Using the UB-04 billing format
• Type of bill 13X or 85X.  (Telemedicine services are billable only on outpatient claims.)
• With either:
• Revenue code 0780 – telemedicine general classification; or
• The revenue code center that identifies where the service was performed (i.e. 0450 = emergency room, 0510 = clinic, 0360 = operating room).
• HCPCS Q3014, telehealth originating site facility fee.  (This HCPCS must be reported regardless of what revenue code is used.)   
• Additional services provided during the telemedicine encounter (e.g. laboratory, x-rays, etc.) are separately billable.

Reimbursement:

Originating site telemedicine services will be reimbursed a maximum allowable payment (MAP) assigned to HCPCS Q3014.  The allowance for Q3014 will be the same as the MAP for outpatient clinic visits, revenue code 0510.  (See your 2008 Outpatient Maximum Allowable Payments listing for the exact amount or contact the institutional relations department.) 

If you have any questions regarding Blue Cross and Blue Shield of Kansas' coverage or reimbursement of originating site telemedicine services, contact your institutional relations provider consultant:

         Angie Martin, hospitals in southern Kansas:
                             (316) 269-1602

          Vicki Haverkamp, hospitals in northern Kansas:
                             (785) 291-8862