Billing & Reimbursement

Basic Definitions

The following definitions are based on CMS Medicare & Medicaid services, and are also used by many private payers.

Telemedicine (South Carolina definition): “The practice of medicine using electronic communications, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening practitioner.  S.1035 was signed into law in June 2016. One of the key features sets the standard of care when establishing patients via synchronous communications (video visits).

Originating site (or referring site):  Location of the patient
Distant site (or consulting site): Location of the distant/consulting provider
Telehealth service:CPT code with the GT modifier indicating telehealth

In typical FFS (fee-for-service) reimbursement, a covered originating site + a covered provider type + covered service (CPT code) = a covered telehealth service

South Carolina Telehealth Payer Policies:

• Aetna (PDF)
• Blue Cross Blue Shield
• Medicaid (PDF)
• Select Health (PDF)
• Tricare (PDF)
• United Health Care (PDF)
• Medicare (PDF) – Health Professional Shortage Area (HPSA) is a defined term for rural areas, and applies to Medicare coverage only. Patients must be in an HPSA for services to be covered for telemedicine service.
  

 

Telehealth Billing Help Tool by MUSC-P

Click here to access a Telehealth Billing Help tool (PDF) created by the MUSC Physicians Compliance Office.

• This PDF tool was created to offer support with any and all coding & billing questions related to telehealth services provided here at MUSC.

Click here for a printable postcard (PDF) that features a QR code which links to the above Telehealth Billing Tool.

• Having a physical version of this postcard can be useful to print and share with providers and staff so they can quickly access the Telehealth Billing Help tool from their mobile phones.