Telemedicine Provider Information
Telemedicine expanded on October 1, 2014
Effective October 1, 2014, the Maryland Medical Assistance Program ("the Program") will reimburse approved providers for services rendered to Progam participants via telemedicine statewide. The Program will implement this expanded telemedicine service for both providers and participants, regardless of geographic location. Participants may be in the fee-for-service program, a managed care organization (MCO), or a long-term services and supports waiver program. Providers must already be enrolled in the Program.
Using “Hub-and-Spoke” models, providers mutually approved by DHMH will engage in agreements to both deliver care and bill Medicaid for approved telemedicine services, using fee-for-service reimbursement practices.
Billing Codes and Modifiers
Approved telemedicine providers will submit claims in the same manner the provider uses for in-person services (i.e., paper CMS 1500 forms or 832 electronic submission).
All telemedicine providers, both originating and distant, must bill the appropriate CPT code or revenue code with a -GT modifier when rendering services via telemedicine. The -GT modifier indicates the services were provided via an interactive audio and video telecommunication system.
Billing in the Telemedicine Program: Originating sites
• Using the -GT modifier, evaluation and management (E&M) codes 99201-99205; 99211-99215 for community outpatient services or 99281-99285 and 99288 for emergency room outpatient services; and
• If the service location is a physician’s office: HCPCS code Q3014 for the telehealth originating site facility fee; or
• If the service location is a hospital: revenue code 0780 for the standard facility fee; or
• If the service location is a an out-of-state hospital: HCPCS code Q3014 for the telemedicine originating site facility fee
Billing in the Telemedicine Program: Distant sites
• E&M codes 99241-99245 99251-99255 for consultation services along with the appended –GT modifier.
Please note: distant site providers should NOT bill the Q-code or the 0780 revenue code.
For more information on Physicians’ Services billing, you may consult the 2014 Physicians’ Services
Eligible Providers and Enrollment in the Telemedicine Program
Providers interested in participating in the telemedicine program must already be enrolled as Medicaid Providers. If you are not enrolled as a Medicaid Provider, visit: dhmh.maryland.gov/providerinfo
Interested providers enrolled in the Medicaid Program must complete and submit a Telemedicine Provider Addendum. Providers are expected to outline their plan for participation using this addendum. The Telemedicine Provider Addendum is included in the “Resources” section of this provider information page, or can be referenced in Appendix E of the 2014 Telemedicine Provider Manual.
For complete information on the telemedicine service model, provider and participant eligibility, and covered services and reimbursement, please refer to the 2014 Telemedicine Provider Manual.
For questions regarding the telemedicine program, email: firstname.lastname@example.org