Upper Peninsula Telehealth Network of Michigan

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:

*Medicare Coverage for Telemedicine Services went into effect May 2001.

Links to reimbursement for professional services

Link for reimbursement for remote or distant site

*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
susan.makela@mghs.org