Provider Notice Issued 03/30/2020

Date:    March 30, 2020
 
To:       All Medical Assistance Program Providers
 
Re:      Telehealth Expansion Billing Instructions
 
 
This notice provides additional guidance for telehealth, virtual check-in, and online patient portal/E-visit billing based upon the policy identified in the provider notice dated March 20, 2020.  These temporary policy changes related to the current COVID-19 health emergency apply to claims billed for participants covered under fee-for-service as well as a HealthChoice Illinois managed care plan.
 
Telehealth - Originating Site $25.00 Facility Fee
 
Sites approved as valid originating facility sites were expanded. The March 20, 2020 notice contained a list of sites that included “providers who receive reimbursement for a patient’s room and board, including nursing facilities and Intermediate Care Facilities for the Developmentally Disabled.” For further clarification, this category would also include Family Support Program residential providers, Medically Complex Facilities for Persons with Developmental Disabilities, and Specialized Mental Health Rehabilitation Facilities.
 
·         Facility Fee Billing Instructions for Hospice Agencies:
 
In situations where a hospice patient in a long term care facility is in need of a telehealth service, the hospice may submit charges for the facility fee as an originating telehealth site.
 
Ø  Use Revenue Code 0657 in conjunction with HCPCS code Q3014 and identify the number of Service Units (telehealth occurrences) provided in the billing period.
 
Ø  The telehealth facility fee service cannot be billed separately and must be included on a claim containing the hospice’s usual charges.
 
·         Facility Fee Billing Instructions for Hospitals:
 
Hospitals are already able to bill as a non-institutional provider originating site, as stated in the Handbook for Practitioner Services, topic 202.1.4 – Allowable Fee-for-Service Charges by Hospitals.
 
·         All Other Originating Facility Sites – The Department is currently working to implement a facility fee payment system for these sites and additional information will be forthcoming.
 

Telehealth - Distant Site Modifier GT and Place of Service 02
 
Valid distant site providers were expanded and identified in the March 20, 2020 notice. All distant site providers billing for telehealth services must use modifier GT and Place of Service 02 on their claims, with the following exceptions:
 
·       Community Mental Health Centers and Behavioral Health Clinics that have staff working remotely from home or another location during this health emergency should use their usual place of service (onsite/office). Services that are already allowed by telephone per the delivery modes identified by code in the Handbook for Community Based Behavioral Services, topic 208, should not be billed as telehealth.
 
·        Independent Practitioners (Psychiatrists, Licensed Clinical Social Workers and Licensed Clinical Psychologists) billing the Group A services from the Fee Schedule for Providers of Community-Based Behavioral Services.
 
Telehealth – Distant Site Dental Services
 
The dental provider does not need to have a current relationship with the patient in order to perform teledentistry. Claims for teledentistry should be billed with the following Current Dental Terminology codes for their telehealth service, in accordance with the code definitions, in conjunction with D0140 – Limited Oral Evaluation. These services must be billed with Place of Service 02. Reimbursement for these codes will be at the lesser of the provider charge amount or the State maximum as identified in the Department’s COVID-19 Fee Schedule on the Coronavirus (COVID-19) Updates webpage.
 
CDT Code
Description
D9995
Teledentistry, synchronous; real-time encounter
D9996
Teledentistry asynchronous; information stored and forwarded to dentist for subsequent review
 
Telehealth Distant Site - Additional Procedure Codes Opened
 
For physicians providing remote consultation to inpatients, the following consultation codes have been opened for distant site providers effective with dates of service on or after March 9, 2020. These services must be billed with modifier GT and Place of Service 02, as they are specifically defined as telehealth. The Department will reimburse the lesser of the provider charge amount or the State maximum rate for these codes as indicated in the Department’s COVID-19 Fee Schedule on the Coronavirus (COVID-19) Updates webpage.
 
HCPCS Code
Description
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
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Encounter Clinics
 
The Department will allow medical/dental/behavioral health encounters with new or existing patients using audio only telephonic equipment to be reimbursed at the medical/dental/behavioral health encounter rate, as long as the encounter is of an amount and nature that would be sufficient to meet the key components of a face-to-face encounter.
 
For medical encounters the claim must include the GT modifier on all detail code service lines. For behavioral health encounters, the claim must include the GT modifier on all service lines, including the encounter service line. In order for behavioral health encounters to price correctly, the behavioral health modifier must be the first modifier appended to the encounter “T” code.
 
If an audio only telephonic interaction cannot meet key components of a face-to-face encounter, the provider may instead seek reimbursement for virtual check-in services or e-visit/online portal services. The FQHC/RHC/ERC encounter provider will be reimbursed at the lesser of the provider charge amount or the State maximum rate established on the Department’s COVID-19 Fee Schedule (not their encounter rate) for virtual check-ins and e-visits.
 
 
The March 20, 2020 notice stated CPT codes 99441, 99442, and 99443 had been opened to bill virtual check-in services. However, to better align billing processes with Medicare, the Department will instead close these codes and open the following “G” HCPCS codes:
HCPCS Code
Description
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
 
These claims must include modifier GT and Place of Service 02. The Department will reimburse for CPT codes G2010 and G2012 at the lesser of the provider charge amount or the State maximum rate established on the Department’s COVID-19 Fee Schedule on the Coronavirus (COVID-19) Updates webpage. Allowable providers are physicians; advanced practice nurses; physician assistants; Federally qualified Health Centers; Rural Health Clinics, Encounter Rate Clinics; School Based Health Centers; and Local Health Departments.
 
Online Patient Portal/E-visit
 
The Department will reimburse for the following online/patient portal activities. These activities must be patient-initiated (established patients only), provided through a secure patient-portal and can be billed once for the cumulative time provided in a seven-day period.
 
 
HCPCS Code
Description
G2061
Qualified non-physician healthcare professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days, 5-10 minutes
G2062
Qualified non-physician healthcare professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days, 11-20 minutes
G2063
Qualified non-physician healthcare professional online assessment, for an established patient, for up to 7 days, cumulative time during the 7 days, 21 or more minutes
99421
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days, 5-10 minutes
99422
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days, 11-20 minutes
99423
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days, 21 or more minutes
 
These claims must include modifier GT and Place of Service 02. The Department will reimburse these codes at the lesser of the provider charge amount or the State maximum rate established on the Department’s COVID-19 Fee Schedule on the Coronavirus (COVID-19) Updates webpage. Allowable providers are physicians; advanced practice nurses; physician assistants; Federally qualified Health Centers; Rural Health Clinics, Encounter Rate Clinics; School Based Health Centers; and Local Health Departments.  
 
FAQ Document and Contacts
 
An FAQ document has been posted to the Department’s Coronavirus (COVID-19) Updates webpage to further assist providers. Questions regarding this notice may be directed to the appropriate bureau:
 
Bureau of Professional and Ancillary Services – 877-782-5565
Bureau of Hospital and Provider Services – 877-782-5565
Bureau of Long Term Care – 844-528-8444
Bureau of Behavioral Health - 217-557-1000 or via email at HFS.BBH@illinois.gov
 
 
 
Kelly Cunningham
Interim Medicaid Administrator

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