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UPDATED KMAP BULLETIN: Telemedicine Updates in Response to COVID-19 Emergency

Date: 08/07/20

UPDATED KMAP GENERAL BULLETIN 20046 (PDF)

Effective with dates of service on or after March 12, 2020 the following codes will be allowed for payment when provided by telemedicine/telephone. Most of these codes are currently covered for both face-to-face and telemedicine. These updates do not change or modify the current coverage but allow for an additional delivery method. Allowed provider types and specialties will remain unchanged. Reimbursement will be the same as a face-to-face visit. Existing National Correct Coding Initiative (NCCI) edits/limitations will remain in place and are not waived with this policy.

Providers will be allowed to be reimbursed for the following codes when the originating Telemedicine site is place of service “home” (POS code 12). No payment for the Q3014 code will be made for POS 12 without the physical presence of a Provider. Telemedicine services (including telephonic contact) can be made when there is verbal consent received from the patient (to be followed up by written approval) in the medical record. Tele-video communication can only be utilized if that contact is HIPAA compliant.

Services provided by telemedicine/telephone will need to be billed with POS code 02.

Reminder on Q3014 when appropriately billed as the distant site: The place of service code 02 should NOT be used. The place of service code should reflect where the beneficiary is actually located. An example of this would be if a beneficiary is being seen in an office, the place of service for the Q3014 code would be that of an 11.

Mental Health Codes –

  • 90832
  • 90833
  • 90834
  • 90836
  • 90837
  • 90838
  • 90839
  • 90840
  • 90847
  • 90863
  • H0036*
  • H0038
  • H0038 HQ
  • 90792

*(with all current modifiers for this code continuing for coverage in this expansion)

SUD Codes -

  • H0001
  • H0004
  • H0005 U5
  • H0006 U5
  • H0015 U5
  • H0038
  • H0038 HQ

For more information regarding additional coverage for Mental Health and SUD codes, please reference General Bulletin 20065.

SBIRT Codes –

  • H0049
  • H0050
  • 99408
  • 99409

Autism Codes

  • 97155
  • 97156

Evaluation and Management Codes –

  • 99201
  • 99202
  • 99203
  • 99204
  • 99211
  • 99212
  • 99213
  • 99214

As applicable to the Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC)/Indian Health Clinic (IHC), these entities will receive an encounter rate when serving as the distant site.

Effective with dates of service on and after March 12, 2020, nursing facilities will be allowed as an originating site for the provision of tele-medicine services utilizing the telemedicine originating site billing code of Q3014. The conditions/payment for billing this service, as outlined in KMAP general bulletin 18224, continue to be in effect.

Effective with dates of service on and after March 12, 2020, nursing facilities will be allowed as an originating site for the provision of telemedicine services: however, there will be no reimbursement provided for this location as an originating site.

When a member is seen in the same physical location where the service is being billed as a telemedicine distant site, no reimbursement will be provided for the originating site code of Q3014.

At this time code, the G2012 “virtual check in” is not being allowed for coverage since some designated E&M codes are being allowed to be provided over the telephone.

Out-of-state physicians may provide telemedicine when treating patients in Kansas without a Kansas license provided the physician holds an unrestricted license in the state in which the physician practices. This does not extend to any other licensed provider.

Exceptions granted in this policy shall be in place until rescinded.

Note: The effective date of the policy is March 12, 2020. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associate.