Md. Code Regs. 10.21.30.10

Current through Register Vol. 51, No. 12, June 14, 2024

Section 10.21.30.10 - Reimbursement

A. There are three categories of fees that the Department shall reimburse an approved TMH provider, as applicable:

(1) Originating site fee;

(2) Professional fee; and

(3) Telepresenter fee.

B. Originating Site Fee.

(1) The originating site facility fee is set forth by the Center for Medicare and Medicaid Services, published annually and included in the Medicare Physician Fee Schedule Final Rule, issued by November 1, prior to the start of the calendar year for which it is effective.

(2) Originating sites only may file for reimbursement and shall use the appropriate code modifier.

(3) Fees paid to the originating site may be used to:

(a) Purchase, install, and maintain video conferencing equipment;

(b) Pay for line or per minute usage charges, or both; and

(c) Any additional programmatic, administrative, clinical or contingency support at the originating site.

C. Professional Fee. Professional Fee for individual providers or OMHC providing TMH is set forth in COMAR 10.21.25.

D. Telepresenter Fee. Telepresenter Fees for assisting in TMH are set forth in 10.21.25 and subject to the following requirements prior to billing:

(1) A telepresenter fee is applicable only when, due to medical necessity, a licensed independent practitioner is required to present the individual to the distant provider to successfully complete the examination;

(2) Fees for telepresenters that are not licensed independent practitioners, and fees for telepresenters that are licensed independent practitioners, but their presence is not medically necessary, are included as part of the originating site facility fee; and

(3) The distant provider shall clearly document in the individual's medical record the rationale requiring the involvement of the licensed independent practitioner, as medically necessary, at any particular session.

Md. Code Regs. 10.21.30.10