Telehealth Billing Examples:
Example 1:
Originating Site – Encounter clinic
Bill the encounter HCPCS Code T1015 and HCPCS Code Q3014, along with any additional appropriate detail code(s). Maximum reimbursement will be the facility’s medical encounter rate.
Reimbursement will be the facility’s medical encounter rate
Distant Site – Encounter clinic
There is no billable service; the Originating Encounter clinic is responsible for payment to the Distant Encounter clinic provider
Example 2:
Originating Site – Encounter clinic
Bill the encounter HCPCS Code T1015 and HCPCS Code Q3014, along with any additional appropriate detail code(s). Maximum reimbursement will be the facility’s medical encounter rate.
Distant Site – Physician’s office/APN/Podiatrist’s Office
There is no billable service; the Originating Encounter clinic is responsible for payment to the Distant Encounter clinic provider
Example 3:
Originating Site – Physician’s office/APN/Podiatrist’s Office
Bill HCPCS Code Q3014
Distant Site – Encounter clinic
Bill the encounter HCPCS Code T1015 and any appropriate detail code(s) with modifier GT on the detail line(s); POS 02. Maximum reimbursement will be the facility’s medical encounter rate. The rendering provider’s name and NPI must also be reported on the claim.
SOURCE: IL Department of Healthcare and Family Services, All Providers Supplement (Sept. 23, 2020). Encounter Clinic Services – Appendices. (Accessed Feb. 2023).
“Facility Fee” means the reimbursement made to the following originating sites for the telehealth service: physician’s office, podiatrist’s office, local health departments, community mental health centers, licensed hospital outpatient departments as defined in 89 Ill. Adm. Code 148.25(d) and substance abuse treatment centers licensed by the Department of Human Services-Division of Alcoholism and Substance Abuse (DASA).
A facility fee shall only be paid to providers as defined above. Clinics reimbursed under the prospective payment system shall only be eligible for a medical encounter as set forth in subsection (c)(3) of this Section.
SOURCE: IL Admin. Code Title 89, 140.403 (Accessed Feb. 2023)
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