Or. Admin. R. 436-009-0012
Current through Register Vol. 63, No. 6, June 1, 2024
Section 436-009-0012 - Telehealth(1)Definitions.(a) For the purpose of this rule, "telehealth" means providing healthcare remotely by means of telecommunications technology, including but not limited to telemedicine and telephonic or online digital services.(b) For the purpose of this rule, "telemedicine" means synchronous medical services provided via a real-time interactive audio and video telecommunications system between a patient at an originating site and a provider at a distant site.(c) "Distant site" means the place where the provider providing medical services to a patient through telehealth is located.(d) "Originating site" means the place where the patient receiving medical services through telehealth is located.(2)Scope of services.(a) All services must be appropriate, and the form of communication must be appropriate for the service provided.(b) Notwithstanding OAR 436-009-0004, medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2024.(3)Distant site provider billing.(a) When billing for telemedicine services, the distant site provider must: (A) Use the place of service (POS) code "02" (Telehealth Provided Other than in Patient's Home) or "10" (Telehealth Provided in Patient's Home); and(B) Use modifier 95 to identify the service as a synchronous medical service rendered via a real-time interactive audio and video telecommunications system.(b) When billing for telehealth services other than telemedicine services, the distant site provider:(A) Must use the POS code "02" (Telehealth Provided Other than in Patient's Home) or "10" (Telehealth Provided in Patient's Home); and(B) May not use modifier 95.(4)Originating site billing. When billing for telehealth services, the originating site may charge a facility fee using HCPCS code Q3014, if the site is: (a) The office of a physician or practitioner; or(b) A health care facility including but not limited to a hospital, rural health clinic, skilled nursing facility, or community mental health center.(5)Payment.(a) Insurers must pay distant site providers at the non-facility rate.(b) Equipment or supplies at the distant site are not separately payable.(c) The payment amount for code Q3014 is $35.70 per unit or the provider's usual fee, whichever is lower. In calculating the units of time, 15 minutes, or any portion of 15 minutes, equals one unit.(d) Professional fees of supporting providers at the originating site are not separately payable.(e) Insurers are not required to pay a telehealth transmission fee (HCPCS code T1014).Or. Admin. R. 436-009-0012
WCD 4-2020, adopt filed 03/04/2020, effective 4/1/2020; WCD 14-2020, amend filed 08/31/2020, effective 9/21/2020; WCD 21-2020, temporary amend filed 12/15/2020, effective 1/1/2021 through 6/29/2021; WCD 2-2021, amend filed 03/03/2021, effective 4/1/2021; WCD 19-2021, temporary amend filed 12/14/2021, effective 1/1/2022 through 6/29/2022; WCD 2-2022, amend filed 03/02/2022, effective 4/1/2022; WCD 12-2022, temporary amend filed 12/19/2022, effective 1/1/2023 through 6/29/2023; WCD 1-2023, amend filed 03/09/2023, effective 4/1/2023; WCD 5-2023, temporary amend filed 12/26/2023, effective 1/1/2024 through 3/31/2024; WCD 6-2023, temporary amend filed 12/26/2023, effective 1/1/2024 through 3/31/2024; WCD 1-2024, amend filed 03/05/2024, effective 4/1/2024Statutory/Other Authority: ORS 656.245, ORS 656.248, ORS 656.252, ORS 656.254 & ORS 656.726(4)
Statutes/Other Implemented: ORS 656.245, ORS 656.248, ORS 656.252 & ORS 656.254