Clinic Reimbursement
A) An encounter clinic serving as the originating site shall be reimbursed for its medical encounter as defined in Section 140.462. The clinic is responsible for reimbursement to the distant site provider.
B) An encounter clinic serving as the distant site shall be reimbursed as follows:
- If the originating site is another encounter clinic, the distant site encounter clinic shall receive no reimbursement from the Department. The originating site encounter clinic is responsible for reimbursement to the distant site encounter clinic; and
- If the originating site is not an encounter clinic, the distant site encounter clinic shall be reimbursed for its medical encounter. The originating site provider will receive a facility fee as defined in subsection (a)(4) of this Section.
SOURCE: IL Admin. Code Title 89, 140.403(c)(3) (Accessed Feb. 2023).
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 Jun. 2023).
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