Telehealth Standard v3.2

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UHIN Telehealth Standard is compatible with all ASC X12N HIPAA requirements as well as industry recommendations and guidance.

The purpose of UHIN Telehealth Standard is to provide a uniform standard of billing for health care claims/encounter delivered via telehealth. 

DEFINITIONS:

Connectivity methods:

  • Synchronous: "Synchronous interaction" means real-time communication through interactive technology that enables a provider at a distant site and a patient at an originating site to interact simultaneously through two-way audio and video transmission.
  • A-Synchronous: "Asynchronous store and forward transfer" means the transmission of a patient's health care information from an originating site to a provider at a distant site. Transmission of recorded health data through an electronic communication system to a practitioner (usually a specialist i.e. radiologist).
  • Store and forward telehealth – is the electronic transmission of health data and digitized images. The exchange of data and digitized images (i.e. teleradiology), and is done between the referring provider and consulting provider.
  • Remote monitoring: Patient remote monitoring where data are sent to a provider.

These connectivity methods are technology agnostic (undefined).

Delivery Exchanges: include exchanges from:

  • Patient to Provider (Direct-To-Consumer)
  • Provider to Provider     
  • Provider to more than one patient (group/peer support sessions)

The exchanges may use one or more of the connectivity methods described above for health care services

Types of Services/Care may include:

  • clinical care;
  • health education;
  • health administration;
  • home health; or facilitation of self-managed care and caregiver support; and provided by a provider to a patient through a method of communication that: uses asynchronous store and forward transfer; or (B) uses synchronous interaction

Place of Service (Originating site/Patient Location):

  • "Distant site" means the physical location of a provider delivering telemedicine services.
  • "Originating site" means the physical location of a patient receiving telemedicine services.

Billing/Reporting Requirements:

  1. The billing provider will bill using customary medical billing codes (ex. HCPCS/CPT), one of the following modifiers.
  • GT: Via interactive audio and video telecommunication systems
  • GQ: Via a-synchronous telecommunication systems
  • 95: Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System
  1. Billing for services electronically are accomplished by using the most current version of the ASC X12 HIPAA transaction for Healthcare Claim.
  2. When the billing using form CMS 1500, the following are the box requirements for the originating and distance providers:

Box 24B - Place of Service must be appropriate to where services are rendered.

For Distance Billing Provider: Place of Service code 02 must be used.

For Originating billing provider Place of Service must be the appropriate code required and allowed by the payer, without a telehealth modifier.       

X12 Professional Claim Mapping:            2400 SV105

Box 24D: Procedure, Services or Supplies require codes from the current nationally approved procedure code list, applicable to the service and allowed by the payer.

X12 Professional Claim Mapping:            2400 SV01-2 (proc code) and SV101-3 -4, -5, -6 (Modifiers)

Box 24J: Rendering Provider ID# requires the servicing provider National Provider Identifier (NPI).

X12 Professional Claim Mapping:            2420A NM108 (Qualifier) NM109 (NPI)

Box 25: Federal Tax ID is required for the billing provider.

X12 map:            2010AA REF02

Box 33 Billing Provider Info & phone requires the address of the billing provider.

X12 Professional Claim Mapping::          Name: 2010AA NM103, NM104, NM105, NM107

                                                                     Address: 2010AA/AB N301, N401, N402, N403

                                                                     Phone Number: 10AA/AB PER04

All other CMS1500 form requirements can be found in the CMS 1500 Paper Claim Form Standard.


Implementation Issues:

  1. Clearinghouses, payers and providers must make necessary modifications to use approved modifiers in their systems.
  2. Providers must be aware of any requirements regarding Originating Provider billing. Not all payers will provide benefits for originating providers.
  3. Payers that pay for Telehealth services will assist in educating the provider community about this UHIN Standard and the specific benefits covered by the payer.

 

History: (MM/DD/YY)

 

Original

A1

A2

 

 

 

ORIGINATION DATE

10/14/98

03/03

10/2016

 

 

 

APPROVAL DATE

03/16/98

08/13/03

11/1/2017

 

 

 

EFFECTIVE DATE

04/16/99

09/13/03

12/1/2017

 

 

 

* A = Amendment

 

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