Reimbursement
for telemedicine:
We have made some significant
progress in the state of Michigan in the area of telemedicine
reimbursement. Most recently the announcement of coverage
by Medicaid for Telemedicine Services effective May 1, 2006.
To-date 95% of telemedicine services provided in our region
is reimbursable by third-party payers.
The current status
of telemedicine reimbursement in the Upper Peninsula of Michigan:
*Medicaid Coverage for Telemedicine
Services effective May 1, 2006. The bulletin announcement
for these services can be found On-line at: http://www.michigan.gov/documents/MSA_06-22_155090_7.pdf
*Medicare has been reimbursing
for telemedicine (practitioner and facility fee) since May
2001. The full memo on billing for these services can be found
On-line at:
http://www.cms.hhs.gov/transmittals/downloads/R1026CP.pdf
*Blue Cross/Blue Shield of Michigan
(BCBSM) announced, in the August 2003 RECORD publication,
that telehealth is now a payable service for the state of
Michigan. Please refer to the RECORD publication for the billing
guidelines or contact me and I will fax a copy to you. BCBSM
will be paying practitioners and facility fees for telehealth
services.
*Upper Peninsula Health Plan
(UPHP) a Medicaid Managed Care provider now covers clinical
telemedicine. This announcement and billing guidelines are
available in the August 2004 PROVIDER NOTES, Volume 7, Issue
3. UPHP is reimbursing practitioners and originating site
fees for telemedicine services as of July 1, 2004. Claim
Notes >>
*United Healthcare announced
they would be reimbursing for telemedicine services following
Medicare’s guidelines for patients in the Upper Peninsula.
*Preferred Provider of Michigan
(PPOM) also announced they will be following Medicare’s
guidelines for telemedicine reimbursement for patients in
the Upper Peninsula.
*We continue to work with other
Commercial Insurance agencies for our region. Some choose
to reimburse on a case-by-case basis.
Medicare reviews CPT code expansion
requests yearly. Attached is the process for submitting additional
CPT code requests and the rules for Medicare CPT codes.
CMS
CPT Code Request Template
Revised
Rules for Medicare CPT Codes
Susan Makela, BSN,
MPA
Director of Telehealth,
Marquette General Health system
smakela@mgh.org
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