*Note: Independent renal dialysis facilities are not covered originating sites.
**Distant or consulting providers may use this online search tool to see available coverage to deliver care using telemedicine.
Distant site providers must submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GT, “via interactive audio and video telecommunications systems” (for example, 99201 GT).
The GT modifier is added to the CPT code to alert the insurance company that the service was provided via telehealth. Per CMS, “by coding and billing the GT modifier with a covered telehealth procedure code, you are certifying that the beneficiary was present at an eligible originating site when you furnished the telehealth service.” CPT and HCPCS code coverage varies by payer. Please check payer policies for guidance.
Patients must be in an HPSA for services to be covered for telemedicine service.
Medicare reimburses telemedicine services at the same rate as the comparable-in-person medical service, based on the current Medicare physician fee schedule. As mentioned above, the originating site can charge an additional facility fee and must be rural, accordingto HRSA.
VisitCMS’ Medicare Telehealth for more information.
Medicaid will reimburse covered telehealth services as long as the following criteria are met:
Medicaid beneficiaries (patient) are eligible for telemedicine services only if they are presented from a referring or originating site located in the South Carolina Medical Service Area (SCMSA). The referring site presenters may be required to facilitate the delivery of this service. Referring site presenters should be provider knowledgeable in how the equipment works and can provide the clinical support if needed during a session.
Only certain CPT codes are eligible for telemedicine reimbursement.
Medicaid has specific list of CPT codes that are covered under telemedicine services. For more information, see SC Department of Health and Human Services.
**Distant or consulting providers may use this online search tool to see available coverage to deliver care using telemedicine.