Telemedicine is allowed in Montana, and coverage for telemedicine is described in our statutes here: https://leg.mt.gov/bills/mca/title_0330/chapter_0220/part_0010/section_0380/0330-0220-0010-0380.html:
. “33-22-138. Coverage for telemedicine services. (1) Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider or health care facility by means of telemedicine if the services are otherwise covered by the policy, certificate, contract, or agreement."
PTs are listed as a health care provider in the definitions.
Like any other service, it is important to refer to the policy and the contract for each case.
Before You Begin Practicing Via Telehealth
The use of telehealth is one approach that can help protect the patient and provider during this time of crisis. Investigate and consider the issues within the following areas as you make decisions on whether or not to use telehealth in your practice. In addition, become familiar with some of the commonly used terms in telehealth.
Telehealth: Billing and Coding Considerations
Billing physical therapy services that have been provided through telehealth is an emerging challenge. Due to the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, the Centers for Medicare and Medicaid Services (CMS) is expanding access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their providers without having to travel to a healthcare facility. For the first time, PTs will be allowed to bill Medicare for telehealth visits under codes associated with online assessment and management services (HCPCS codes G2061: Qualified non-physician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes; G2062: Qualified non-physician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes; G2063: Qualified non-physician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes). Providers must use place-of-service code “02” and “GT” modifier. The payment rates are significantly lower than the traditional payment for an in-person visit under the CPT 97000 code series. To determine the reimbursement rates for G2061-G2063, visit the CMS Physician Fee Schedule lookup tool. Medicare coinsurance and deductible apply to the services.
To qualify as an e-visit, three basic qualifications must be met:
Although the patient must initiate the service, CMS allows "practitioners to educate beneficiaries on the availability of the telehealth service prior to patient initiation." For example, if a patient cancels treatment because they can’t come to the clinic or are concerned about leaving home, then the PT may advise the patient that she or her can “virtually” contact the therapists as needed
- The billing practice must have an established relationship with the patient, meaning the provider must have an existing provider-patient relationship;
- The patient must initiate the inquiry for an e-visit and verbally consent to check-in services;
- The communications must be limited to a seven-day period through an "online patient portal."
Payment for telehealth depends on your contract with your payer. There is no list of third-party payers that pay for telerehab. Also confirm with each payer whether the originating site can be a private home or office, if services must be real-time or can be asynchronous, and any other limitations to your use of telehealth.
For third-party billing, there are "telehealth" CPT codes. But before reporting CPT codes you traditionally use for clinical visits or billing for telephone services (98966-98969), check with your payer. Many of the physical medicine and rehabilitation codes (97000 series) specify "direct 1-on-1 patient contact," which by strict definition would exclude telehealth unless you and your payer have agreed to include these services. A payer also may require an addendum attached to the bill that identifies the service as being provided via telehealth, along with an explanation of the charges, so be prepared to outline the reasoning for using telehealth.
You also should check with your payer about using place-of-service code "02" when billing for telehealth services to specify the entity where service(s) were rendered. Regardless of the payer or policy, if you provide and bill for services using telehealth, make sure that you are practicing legally and ethically, and are adhering to state and federal practice guidelines and payer contract agreements.
Montana volunteers will have more about codes next week.
Two commercial telehealth platforms are eVisit and VisuWell. If you use them, it's a good idea to check their information against the primary sources of state law.
Read more about Telehealth from APTA: