As we all know, Medicare's coverage rules are complicated, copious and constantly changing! This is especially true of TELEHEALTH MNT and DSMT.
Are any of you doing MNT or DSMT telehealth?? What do you think of it?
BELOW (RIGHT AFTER THE "DOG-PHONE" CLIP ART) is a quick guide of the Medicare rules and regs (great desk top reference!).
Individual and group MNT and DSMT (initial and follow-up) can now be provided and reimbursed as telehealth services by Medicare Part B.
Telehealth services use a real-time audio-visual telecommunication system as a substitute for an in-person encounter between the Medicare beneficiary and the provider who are at different sites.
MNT telehealth includes individual and group MNT (HCPCS code G0270 and G0271 and CPT codes 97802, 97803 and 97804).
In January, 2011, Medicare approved payment for DSME/T benefits when delivered via telehealth (HCPCS codes G0108 and G0109).
Telehealth services use a real time audio-visual telecommunication system as a substitute for an in-person encounter between the Medicare beneficiary and the provider who are at different sites. Medicare’s specific telehealth coverage guidelines for billing and payment are summarized in the Table 1 of this article.
Additional information on Medicare MNT and DSME/T telehealth is available on the ADA website at <http://www.eatright.org> and on the CMS web site at <http://www.cms.org>.
Below is more of a detailed summary of Medicare’s coverage guidelines for telehealth MNT and DSMT:
1) The beneficiary must be at an ‘originating site’ at the time the service being furnished.
2) Originating sites must be located in a rural Health Professional Shortage Area or in a county outside of a Metropolitan Statistical Area.
a. However, entities that participate in a Federal telemedicine demonstration project approved by (or receiving funding from) the Secretary of the Department of Health and Human Services as of December 31, 2000, qualify as originating sites regardless of geographic location.
3) The originating sites authorized by law are:
a. Offices of physicians or qualified non-physician practitioners
c. Critical Access Hospitals (CAHs)
d. Rural Health Clinics
e. Federally Qualified Health Centers
f. Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
g. Skilled Nursing Facilities
h. Community Mental Health Centers
4) The provider is a ‘distant site” at the time the service being furnished.
5) An interactive audio and video telecommunications system must be used that permits real-time communication between the provider at the distant site and the beneficiary at the originating site. Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system.
a. Asynchronous “store and forward” technology is permitted only in Federal telehealth demonstration programs conducted in Alaska or Hawaii
6) Claims for telehealth services are submitted using the appropriate CPT or HCPCS code along with the telehealth modifier GT, “via interactive audio and video telecommunications system” (e.g., 97802 GT). By using the GT modifier, the distant site provider certifies that the beneficiary was present at an eligible originating site when the telehealth service was furnished.
a. In the case of Federal telemedicine demonstration programs conducted in Alaska or Hawaii, providers use the telehealth modifier GQ, “via asynchronous telecommunications system” (e.g., 97802 GQ)
7) For DSMT telehealth services, a minimum of 1 hour of in-person instruction in the self-administration of injectable drugs training must be furnished in-person during the year following the initial DSMT service, if the beneficiary is prescribed this type of drug therapy. The injection training may be furnished through either individual or group DSMT services.
8) Providers at the distant site can bill either the Medicare Carrier or the Part A/Part B Medicare Administrative Contractor (MAC) for telehealth MNT and DSMT. Reimbursement rates are the same as when MNT and DSMT services are delivered face to face.
9) In addition, the originating site that owns the specialized A/V equipment can bill the Medicare Carrier or A/B MAC a facility fee as described by HCPCS code Q3014 (telehealth originating site facility fee). Facility fee is separately billable Part B payment. Providers paid according to applicable payment methodology for facility or location; usual Medicare deductible and coinsurance policies apply to this code. For the calendar year 2012, the facility fee is $24.24.
Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder
PresentDiabetes Author of MNT and DSMT Reimbursement Audio Lectures
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