Provider Alerts

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Date:	October 22, 2020
To:	Health Plan of San Joaquin (HPSJ) All Providers & Facilities
From:	Health Plan of San Joaquin
Subject:	UPDATE – Telehealth Billing Synchronous and Asynchronous Telehealth Services
Business:	Medi-Cal Managed Care

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This Alert is to provide clarification of billing requirements for Synchronous and Asynchronous Telehealth Services.

Important Billing Guidelines

Only the provider at the originating site can bill for an originating site fee for hosting the
patient. The originating site fee is billed using HCPCS Level II code Q3014-Telehealth
originating site facility fee without any modifier. Q3014 can only be billed and
reimbursed once per day, per patient, and same pay-to-provider.

Transmission cost is billed under HCPCS Level II code T1014 can only be billed and
reimbursed per minute for maximum of 90 minutes, per patient, per day and same
provider (1 unit of service = 1 minute of transmission cost). Transmission fees are not
applicable to asynchronous store and forward or eConsult services.

Important Terminology

• Telehealth means the mode of delivering health care and public health services
  utilizing information and communication technologies to enable the diagnosis,
  consultation, treatment, education, care management and self-management of
  patient at a distance from health care providers.
• Originating site means the site where a patient is located at the time health services are provided via a telecommunications system or where the asynchronous store and forward services originates.
• Distant site means a site where a health care provider who provides health services is located while providing these services via telecommunications system.
• Synchronous interaction means a real-time interaction between a patient and health care provider located at a distant site.
• Asynchronous store and forward means the transmission of a patient’s medical
  information from an originating site to the health care provider at a distance without the presence of the patient.

Type	Description	Billing guidelines for Originating Site Providers	Billing guidelines for Distant Site Providers
Traditional Synchronous Telehealth Services	Connects the patient in a provider office with a distant provider of health services through live videoconferencing, which is a twoway audiovisual link between a patient and a care provider.	CPT code(s): Q3014; T1014 Modifier: n/a	CPT code(s): T1014; 99201 – 99215; 99241- 99255; 99221-99233; 99291 or G0508; 99292 or G0509 Modifier: 95 (modifier required for all CPTCodes except Transmission Cost codes)
Asynchronous Telehealth Services (Store and Forward	The transmission of a patient’s medical information from an originating site to the health care provider at a distant site without the presence of the patient.	CPT code(s): Q3014 Modifier: n/a	CPT code(s): 99451 Modifier: GQ (modifier required for all asynchronous, storeand-forward services billed)
Synchronous: Provider to Patient Telehealth Services	Telehealth services provided between a qualified provider and patient at a distant location through live videoconferencing. The location may be a health facility, residential home, patient’s home or other location.	CPT code(s): n/a Modifier: n/a	CPT code(s): T1014; E&M codes 99201 – 99215 Modifier: 95 (modifier required for all CPTCodes except Transmiss

Please note that a Federally Qualified Health Center (FQHC), Rural Health Center (RHC) and Indian Health Service (HIS) cannot bill for site fee or transmission charges. These charges are included in their FQHC/RHC Prospective Payment System (PPS) rate or the IHS Memorandum of Agreement (MOA) rate.

For latest updates and changes to Telehealth Services, please refer to the following DHCS sites:

• https://files.medi-cal.ca.gov/pubsdoco/Publications/mastersMTP/Part2/mednetele.pdf
• https://www.dhcs.ca.gov/provgovpart/Pages/FAQ-Telehealth-Payments.aspx

If you have questions, please contact our Customer Service Department at 209-942-6320.