Oregon Telehealth Basics

Do You Know the Rule?

Telehealth has been going strong in workers' compensation for years and became a go-to during the COVID-19 pandemic. As Simply Research subscribers know, there are some basics about telehealth in workers' compensation, and we highlight them here.

Definitions

"Telehealth" means providing healthcare remotely by means of telecommunications technology, including but not limited to telemedicine and telephonic or online digital services.

"telemedicine" means synchronous medical services provided via a real-time interactive audio and video telecommunications system between a patient at an originating site and a provider at a distant site.

"Distant site" means the place where the provider providing medical services to a patient through telehealth is located.

"Originating site" means the place where the patient receiving medical services through telehealth is located.

Scope of Services

All services must be appropriate, and the form of communication must be appropriate for the service provided.

Medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2025.

Distant Site Provider Billing

When billing for telemedicine services, the distant site provider must:

+ Use the place of service (POS) code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and

+ Except for services billed with CPT® codes 98000 – 98007, use modifier 95 to identify the service as a synchronous medical service rendered via a real-time interactive audio and video telecommunications system.

When billing for telehealth services other than telemedicine services, the distant site provider:

+ Must use the POS code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and

+ May not use modifier 95.

Originating Site Billing

When billing for telehealth services, the originating site may charge a facility fee using HCPCS code Q3014, if the site is:

+ The office of a physician or practitioner; or

+ A health care facility including but not limited to a hospital, rural health clinic, skilled nursing facility, or community mental health center.

Payment

Insurers must pay distant site providers at the non-facility rate or at the provider’s usual fee, whichever is less.

Equipment or supplies at the distant site are not separately payable.

The payment amount for code Q3014 is $35.70 per unit or the provider’s usual fee, whichever is lower. In calculating the units of time, 15 minutes, or any portion of 15 minutes, equals one unit.

Professional fees of supporting providers at the originating site are not separately payable.

Insurers are not required to pay a telehealth transmission fee (HCPCS code T1014).

Share This Article: