Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter I - Specific Policies By Service
Sec2 144-101-I-4 - Telehealth Services
Subsection 144-101-I-4.07 - REIMBURSEMENT
Universal Citation: 10 ME Code Rules ยง 144-101-I-4.07
Current through 2024-38, September 18, 2024
4.07-1 General Conditions
A. Services are to be billed in accordance
with applicable Sections of the MBM. Providers must submit claims in accordance
with Department billing instructions.
B. Telehealth Services are subject to all
conditions and restrictions described in Chapter I, Section
1, of the MBM.
C. Telehealth Services are subject to
co-payment requirements for the underlying Covered Service, if applicable, as
established in Chapter I, Section
1, of the MBM. However, there shall
be no separate co-payment for telehealth services.
4.07-2 Telehealth Services
A. Receiving (Provider) Site
1. Except as described below, only the Health
Care Provider at the Receiving (Provider) Site may receive payment for
Telehealth Services.
2. When
billing for Telehealth Services, Health Care Providers at the Receiving
(Provider) Site must bill for the underlying Covered Service using the same
claims they would if it were delivered face-to-face and must add the GT
modifier for Interactive Telehealth Services and the 93 modifier for Telephonic
Services.
3. When billing for
Telephone Evaluation and Management Services, Health Care Providers at the
Receiving (Provider) Site must use the appropriate E& M code. The GT and 93
modifier should not be used.
4. No
separate transmission fees will be paid for Telehealth Services. The only
services that may be billed by the Health Care Provider at the Receiving
(Provider) Site are the fees for the underlying Covered Service delivered with
the GT or 93 modifier.
B.
Originating (Member) Site
1. If the Health Care Provider at the
Originating (Member) Site supports the Member's access to Telehealth Services
the Health Care Provider at the Originating (Member) Site may bill MaineCare
for an Originating Facility Fee using code Q3014 for the service of supporting
access to the Telehealth Service. Supporting access to telehealth services
means providing a room and/or telecommunications equipment and/or helping a
Member use audio or video conferencing software or equipment to enable the
Member to utilize telehealth.
2.
The Health Care Provider at the Originating (Member) Site may not bill for
assisting the Health Care Provider at the Receiving (Provider) Site with an
examination.
3. No separate
transmission fees will be paid for Telehealth Services.
4. The Health Care Provider at the
Originating (Member) Site may bill for any clinical services provided on-site
on the same day that a Telehealth Service claim is made, except as specifically
excluded elsewhere in this Section.
5. Telehealth Services may be included in a
Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian
Health Center (IHC) scope of practice, as approved by the State. If approved,
these facilities may serve as the provider site and bill under the encounter
rate. When an FQHC or RHC serves as the Originating (Member) Site, the
Originating Facility Fee is paid separately from the center or clinic
all-inclusive rate.
6. In the event
an interpreter is required, the Health Care Provider at either the Originating
(Member) Site or the Receiving (Provider) site must provide and may bill for
interpreter services in accordance with the provisions of Chapter I, Section 1,
of the MBM. Members may not bill or be reimbursed by the Department for
interpreter services utilized during a telehealth encounter.
7. If the technical component of an X-ray,
ultrasound, or electrocardiogram is performed at the Originating (Member) Site
during a Telehealth Service, the technical component and the Originating
Facility Fee are billed by the Health Care Provider at the Originating (Member)
Site.
The professional component of the procedure and the appropriate visit code are billed by the Receiving (Provider) Site.
C. The Health Care
Providers at the Receiving and Originating Sites may be part of the same
organization. A Health Care Provider at the Originating (Member) Site may bill
MaineCare and receive payment for Telehealth Services if the service is
provided by a Treating Provider who is under a contractual arrangement with the
Originating (Member) Site.
4.07-3 Telemonitoring Services
A. Only the Health Care Provider at the
Receiving (Provider) Site will be reimbursed for Telemonitoring
Services.
B. No Originating
Facility Fee will be paid for Telemonitoring Services.
C. Only a Home Health Agency may receive
reimbursement for Telemonitoring Services.
D. Telemonitoring Services shall be billed
using code S9110, which provides for a flat monthly fee for services, which is
inclusive of all Telemonitoring Services, including, but not limited to:
1. equipment installation;
2. training the Member on the equipment's use
and care;
3. monitoring of
data;
4. consultations with the
primary care physician; and
5.
equipment removal when the Telemonitoring Service is no longer medically
necessary.
Except as described in this policy, no additional reimbursement beyond the flat fee is available for Telemonitoring Services.
E.
MaineCare will not reimburse separately for Telemonitoring equipment purchase,
installation, or maintenance.
F. If
in-person visits are required, these visits must be billed separately from the
Telemonitoring Service in accordance with Chapters II and III, Section
40, Home Health Services, of the
MBM.
G. If an interpreter is
required, the Home Health Agency may bill for interpreter services in
accordance with another billable service and the requirements of Chapter I,
Section 1, of the
MBM.
4.07-4 Reimbursement Rates
The rate for Telehealth Originating Facility Fee, per visit, code Q3014, is listed on the MaineCare Provider fee schedule, which is posted on the Department's website in accordance with 22 MRSA Section3173-J(7) at https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx.
Specific reimbursement rates for other telehealth services can be found in the appropriate Sections of the MBM or the MaineCare Provider fee schedules on the MaineCare Health PAS Portal.
Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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