What is Telemedicine? Telemedicine is the use of medical information about a patient that is exchanged from one eligible referring provider ("Referring Physician") site to another eligible consulting provider site ("Consulting Physician") via two-way, real-time, interactive, secured and HIPAA compliant, electronic audio and video telecommunications systems to provide medical care to a patient in circumstances in which in-person, face-to-face contact with the Consulting Physician is not necessary.
Is telemedicine the same as telehealth? What’s the difference? Although the terms have been used interchangeably, telemedicine is generally considered the clinical application of technology. Telehealth encompasses a broader definition – it’s a collection of means or methods, not a specific clinical service, to enhance care delivery and education.
Do all BlueCross BlueShield of South Carolina and BlueChoice® plans cover both telemedicine and telehealth? BlueCross and BlueChoice cover consultations between referring and consulting physicians via telemedicine. Blue CareOnDemand – a telehealth service that allows members to see a doctor by video visit via computer or mobile device – is not included in all BlueCross and BlueChoice health plans.
What providers are eligible for Telemedicine? Providers who meet the BlueCross or Home Plan contracting requirements and are currently contracted are eligible to submit claims for telemedicine and telepsychiatry when the service is within the scope of their practice. The Eligible Referring Physician is the practitioner who has evaluated the member/beneficiary, determined the need for a consultation, and has arranged the services of the Eligible Consulting Physician for the purpose of consultation, diagnosis, and/or treatment. The Eligible Consulting Physician is the practitioner who evaluates the beneficiary via the telemedicine mode of delivery upon the recommendation of the Referring Physician. Eligible Consulting Physicians at the consulting/distant site who may furnish and receive payment of covered telemedicine services are limited to allopathic and osteopathic physicians.
What are some examples of eligible telemedicine services?
- Consultation for high-risk pregnancy
- Consultation for acute stroke treatment
- Pharmacologic management, and psychiatric diagnostic interview examinations and testing
- Emergency Room-to-Emergency Room consultations
- Specialty consultations provided to hospitalized inpatients
What are unacceptable types of telecommunication for telemedicine?
- Telephone conversations
- Email messages
- Video cell phone interactions
- Facsimile transmissions
- Services provided by allied health professionals that are neither allopathic or osteopathic physicians
- Internet-based audio-video communication that is not secure and HIPAA compliant (e.g., Skype)
What is the Medical Policy associated with telemedicine? CAM Policy 032 gives complete information about our telemedicine program.
How are telemedicine claims processed? Reimbursement to the Consulting Physician delivering the medical service is the same as the current fee schedule amount for the service provided. Consulting Physicians will submit claims for telemedicine or telepsychiatry services using the appropriate CPT code for the professional service along with the telemedicine modifier GT, via interactive audio and video telecommunications systems (e.g., 99243 GT). By coding and billing the "GT" modifier with a covered telemedicine procedure code, the Consulting Physician is certifying that the member/beneficiary was present at the Referring Physician site when the telemedicine service was furnished. Telemedicine services are subject to any co-insurance or co-payment requirements.
What is a Referring Site? A referring site is the location of an eligible Referring Physician site in which a BlueCross beneficiary/member is personally presented by the Referring Physician to a Consulting Physician at the time the service is being furnished as defined above. BlueCross members/beneficiaries are eligible for telemedicine services only if the member/beneficiary access to appropriate specialty care is difficult, inaccessible or unavailable by the member or in an urgent situation such that access to the specialty care is needed immediately without requiring the patient to travel. Referring Physician sites are required to facilitate the delivery of this service. Referring site presenters should be a physician or other clinician provider knowledgeable in how the equipment works and that can provide the clinical support needed during a session.
What is a Consultant Site? A consultant site means the site or location at which the specialty Consulting Physician providing the medical care is located at the time the service is provided via telemedicine. The Consulting Physician providing the medical care must be currently and appropriately licensed as required by the appropriate state’s Board of Medical Examiners.
How do I become approved to provide telemedicine services?
- Providers who are interested in offering telemedicine services should do the following:
- Complete the virtual care application found on our website.
- Email the completed application to VIRTUALCARE@bcbssc.com.
- The provider certification area will contact Provider Relations once the application has been received. Provider Relations will arrange a time to visit your office and take pictures of the equipment you will use to conduct telemedicine services.
- Provider Relations will submit the pictures to the provider certification area to accompany your application.
- Your office will be notified once the location and physicians have been approved.