Medical Policy Medical Policy
Policy Num: 10.001.014
Policy Name: Telemedicine
Policy ID: [10.001.014] [Ac / L / M+ / P-] [0.00.00]
Last Review: October 24, 2024
Next Review: October 20, 2025
Related Policies: None
| Popultation Reference No. | Populations | Interventions | Comparators | Outcomes |
|---|---|---|---|---|
| 1 | Individuals:
| Interventions of interest are:
| Comparators of interest are:
| Relevant outcomes include:
|
Telemedicine is defined as the exchange of medical information between the sites through electronic communication to transmit clinical information. The terms "telemedicine" and "telehealth" are used interchangeably, although "telehealth" is intended to include a wider range of services such as videoconferencing and transmission of still images. One of the advantages is increasing the participation of people who are medically or socially vulnerable or who do not have easy access to providers. Likewise, remote access helps preserve the relationship between the patient and the provider at times when the in-person consultation is not practical or feasible. Themain proposed advantage of telehealth is the ability to offer medical services to distant areas with little or no access to medical specialists.
Telehealth and Telemedicine programs assist healthcare providers in treating people who need access to their physician and cannot readily achieve an in person consultation.
Numerous states have enacted laws regarding coverage of health care services delivered through telemedicine for either private insurers, the state Medicaid plan, or both. States have defined "telemedicine" generally as the delivery of health care services such as diagnosis, consultation, or treatment through the use of interactive audio, video, or other electronic media and do not include the sole use of an audio-only telephone, a video-only system, a facsimile machine, instant messages, or electronic mail. Communication consisting of emails, sole telephone conversations and facsimile transmission do not constitute as telemedicine consultation services. Correct codes for place of services (2) must be used. Prior contracting must have been negotiated with provider.
These services may be offered to our insureds and members by phone or electronic devices from March 6, 2020 for Medicare Advantage, March 15, 2020 for Commercial and March 17, 2020 for PSG (Plan Vital), until the emergency declaration is suspended or the applicable regulator notifies otherwise.
These measures ease the requirements necessary to use technological mechanisms to make consultations and evaluations of patient management remotely to avoid physical contact between the patient and the provider during the emergency.
Physical examination – The physical examination is typically more focused and limited but includes a global visual assessment of the patient throughout the telemedicine encounter. Resources to provide instruction on conducting virtual physical examinations are available.
Limitations of telemedicine – Telemedicine is popular with many patients due to ease of use, cost savings, and decrease in travel time. However, it also has several limitations, including the inability to conduct an in-person physical examination and the diminution of many traditional "doctoring" elements, such as touch, physical presence, and emotional connection. Telemedicine visits may not be available to all patients due to limited internet access or difficulties with accessing and utilizing technology.
Telemedicine in primary and specialty care – In primary care, telemedicine encounters can be utilized for a variety of visits; in addition to urgent care visits, telemedicine can be used for chronic disease management, including diabetes, mental health, heart failure, chronic obstructive pulmonary disease (COPD), and obesity. Information from remote patient monitoring equipment (eg, glucometers, blood pressure monitors, scales, oximeters, noninvasive ventilation equipment for sleep apnea) can also be transmitted to the provider or, in some cases, uploaded to the patient's electronic medical record automatically. Telemedicine is also being used in cardiology, endocrinology, hepatology, nephrology, neurology, mental health, ophthalmology, dermatology, and surgical perioperative care management.
BlueCard/National Account Issues
Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. Benefit products or negotiated coverages may have all or some of the services discussed in this medical policy excluded from their coverage.
Telemedicine systems allow the evaluation and monitoring of the patient's condition remotely. The devices collect physiological data through physicians in the periphery (blood pressure / pulse measurements, ECG, temperature, weight, pulse oximetry, glucose determination and PT / INR devices) and transmit the information to an agency through of telephone lines or wireless computer networks. These medical services do not involve direct contact with the patient. Telehealth services are live, interactive audio and visual transmissions of a doctor-patient encounter from one place to another using telecommunications technologies. This may include real-time telecommunications transmissions or those transmitted by storage and forwarding technology. E-visits (email and / or online medical evaluations) refers to the ability of health providers to interact with patients through a secure electronic channel
Please refer to the Table of codes that includes some of the codes of procedures approved by virtue of the dipositions of the law and applicable regulations for the use of Telemedicine. Evolving telemedicine regulatory issues – Regulatory issues surrounding the delivery of telemedicine services vary regionally and by country and are rapidly evolving. Providers should ensure that their delivery platform(s), coding, billing, licensure, and prescribing practices are compliant with regulatory requirements and provide adequate security. Regulations regarding prescriptions may also vary.
Promotion of greater diversity and inclusion in clinical research of historically marginalized groups (e.g., People of Color [African-American, Asian, Black, Latino and Native American]; LGBTQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual); Women; and People with Disabilities [Physical and Invisible]) allows policy populations to be more reflective of and findings more applicable to our diverse members. While we also strive to use inclusive language related to these groups in our policies, use of gender-specific nouns (e.g., women, men, sisters, etc.) will continue when reflective of language used in publications describing study populations.
Individuals of all populations. Interventions of interest are telemidicine consultation. Comparators of interest are standard in-person consultation. Relevant outcomes include
overall quality of care, quality of life and patient satisfaction.
| Population Reference No. 1 Policy Statement | [X] MedicallyNecessary | [ ] Investigational |
N/A
N/A
N/A
| Codes | Number | Description |
| CPT
| 99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| | 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. |
| | 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
| | 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| | 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
| | 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| | 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
| | 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. |
| | 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. |
| 99441 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | |
| 99442 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion | |
| 99443 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion | |
| 99446 | Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review | |
| 99447 | Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 11-20 minutes of medical consultative discussion and review | |
| 99448 | Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 21-30 minutes of medical consultative discussion and review | |
| 99449 | Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional; 31 minutes or more of medical consultative discussion and review | |
| 99451 | Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient's treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time | |
| 99452 | Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes | |
| 90791 | Psychiatric diagnostic evaluation | |
| 90792 | Psychiatric diagnostic evaluation with medical services | |
| 90832 | Psychotherapy, 30 minutes with patient | |
| 90833 | Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90834 | Psychotherapy, 45 minutes with patient | |
| 90836 | Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90837 | Psychotherapy, 60 minutes with patient | |
| 90838 | Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| HCPCS | G0425 | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth |
| | G0426 | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth |
| | G0427 | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth |
| | G0406 | Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth |
| | G0407 | Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth |
| | G0408 | Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment | |
| G2012 | Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | |
|
| T1014 | Telehealth transmission, per minute, professional services bill separately |
| ICD-10 CM | | applies all diagnoses |
N/A
| Date | Action | Description |
|---|---|---|
| 10/24/2024 | Policy Review | Literature review current through: October 2024. No changes on statements. Reviwed by the Providers Advisory Committee. |
| 10/26/2023 | Policy Review | Reviewed by the Providers Advisory Committee. No changes in policy statement. |
| 11/09/2022 | Annual Review | Reviewed by the Providers Advisory Committee. No changes in policy statement. |
| 11/10/2021 | Annual Review | Reviewed by the Providers Advisory Committee. Policy Statement no changes |
| 11/11/2020 | Policy Reviewed | Reviewed by the Providers Advisory Committee. No changes |
| 7/03/2020 | Policy reviewd | CPT codes added. |
| 11/14/2019 | Policy reviewed | Policy reviewed by the Providers Advisory Committee. No changes. |
| 11/14/2018 | Policy reviewed. New Format. | Policy reviewed by the Providers Advisory Committee. A recommendation of using telemedicine to have a final assetment for patients with uncontrolled hypertension was given. Policy is open to any acute diagnosis, not life threathening. |
| 12/29/2017 | Policy reviewed | |
| 06/28/2016 | Policy reviewed | |
| 08/14/2014 | Policy reviewed | |
| 12/18/2013 | Policy created | New policy |