Getting Started with Telemedicine: FAQs for Pennsylvania Physicians and Practices

Last Updated: Sep 20, 2018

These days, telemedicine is getting a lot of attention for its potential to transform health care delivery and offer services to underserved populations.

The question physicians and health care organizations are asking the Pennsylvania Medical Society (PAMED) is: “How do we begin the process of offering telemedicine services to our patients?” They want to know how to turn telemedicine’s potential into reality.

In this guide, PAMED’s Practice Support Team answers your frequently asked questions about what telemedicine is, what to consider before implementing telemedicine, and some of the Pennsylvania-based insurers that cover these services.

1. Are “telehealth” and “telemedicine” the same thing?
   Not exactly – telehealth refers to a broad range of technologies and services to provide patient care and improve the health care delivery system as a whole. It involves a broader scope of remote health care services than telemedicine.
   
   Telemedicine is a subset of telehealth dealing with the provision of health care services and education over a distance through telecommunications technology. Uses for telemedicine technology include but are not limited to follow-up visits, chronic care management, medication management, and specialist consultations.*
   
   
2. I sometimes see the term “originating site” used in connection to telemedicine. What is an originating site? 
   An originating site Is the location of the patient at the time the service being furnished by a telemedicine system occurs. And, a “distant” or “hub” site refers to the site at which the clinician delivering the telemedicine service is located.
   
   
3. What are “synchronous” and “asynchronous” telemedicine technologies, and how do they differ? 
   Synchronous technology involves an interactive audio and video system that permits real-time communication between the distant site practitioner and the patient at the originating site.
   
   Asynchronous technology involves the transmission of medical information that the physician or practitioner at the distant site reviews later. This is also known as “store and forward” technology.
   
   
4. What points should I consider before implementing telemedicine in my health care organization?
   Build an action plan with our member-only checklist created by PAMED’s Practice Support team:
   
   Get the Checklist
   
   
5. Does Pennsylvania have laws that regulate and support the use of telemedicine?
   Not yet, but efforts are underway to make that happen. PAMED is working with stakeholders like the Hospital and Healthsystem Association of Pennsylvania (HAP) to advocate for legislation that would create a legal framework for telemedicine, establish safeguards for patients, and require that insurers reimburse for these services.  
   
   
6. Are there payers in Pennsylvania with policies for telemedicine reimbursement? 
   Yes. Keep in mind, though, that payer policies can and do change. It’s important to review policies thoroughly and check in with payers frequently to make sure you’re up to date. And, don’t forget that commercial payers (including the commercial payers highlighted below) typically have separate policies for Medicare Advantage plans. 
   
   Here are examples of some of the Pennsylvania payers who offer telemedicine reimbursement as of August 2018:
   
   Medicare Fee-for-Service
   Medicare beneficiaries are eligible for telemedicine services only if they are presented from an originating site located in a county outside of a Metropolitan Statistical Area (MSA), or a rural Health Professional Shortage Area (HPSA) located in a rural census tract. 
   
   Services must be provided with synchronous technology, and claims are submitted using CPT and HCPCS codes with a Place of Service code 02. This Centers for Medicare and Medicaid Services booklet on telehealth offers details. 
   
   Highmark
   Highmark first introduced the telemedicine benefit to patients through Amwell and Doctor on Demand, direct-to-patient models that allow patients to register with them to use services. 
   
   In 2016, Highmark began offering Virtual PCP visits for certain plans. Virtual PCP visits allow for the remote delivery of outpatient primary care through the use synchronous technology (real-time audio and video communications). An eligible patient participates in a virtual visit with a PCP from the privacy of their own home, office or any other private setting. You can use E&M codes 99201-99215 with a GT or 95 modifier. Highmark accepts POS code 02 for Virtual PCP visits. 
   
   Highmark defines a specialist virtual visit as one that occurs when the patient is located at an originating site that is either a medical site (such as a PCP office or other facility) or a non-medical site (like the patient’s home). The patient connects to a specialist at a distant site. The specialist can bill either E&M codes 99201-99215 or consultation codes with a GT or 95 modifier. Highmark accepts POS code 02 for specialist virtual visits. An originating site that is a medical office or facility may bill an access fee, HCPCS code Q3014.
   
   Highmark does not cover asynchronous evaluations, remote critical care services, unsecured technology (such as Skype or Facetime), provider-to-provider consultations, phone calls, faxes, or emails. 
   
   Practices who wish to provide telemedicine services should update their provider directory with Highmark. Also, be sure to check patient eligibility to ensure that the patient is eligible to receive telemedicine services. View the Highmark Provider Manual for details and the parameters for providing Virtual Behavioral Health services and Teledermatology.
   
   Independence Blue Cross (IBC)
   IBC’s commercial reimbursement policy recognizes telemedicine for primary care services only, and billed via CPT codes 99441-99444. IBC recognizes either the GT or 95 modifier and accepts place of service code 11. IBC requires the use of synchronous technology. 
   
   IBC does not cover asynchronous evaluations, phone consultations, technology that is not HIPAA-compliant, and services provided by a specialist other than family medicine, internal medicine, general medicine, geriatric medicine, and pediatric medicine. 
   
   Be sure to verify patient eligibility for telemedicine services. Visit IBC’s Medical Policy Portal webpage for more information. IBC has a separate policy for Medicare Advantage.
   
   
7. Where can I find more information on telemedicine and telehealth? 
   The Mid-Atlantic Telehealth Resource Center (MATRC) is one of 12 regional telehealth resource centers in the country. MATRC offers resources including technical assistance/consultation, and Pennsylvania-specific information on telehealth programs and policies. Visit www.matrc.org.
   
   For Medicare telehealth and telemedicine resources, visit www.CMS.gov/Medicare/Medicare-General-Information/Telehealth.