SPECIAL BULLETIN COVID-19 #79: Telehealth and Virtual Patient Communications Clinical Policy Modifications – Skilled Nursing Facilities
NOTE: SPECIAL BULLETIN COVID-19 #79 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #103.
Background and General Guidance
NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and Health Choice beneficiaries.
These temporary changes are retroactive to March 10, 2020 and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded.
This Bulletin clarifies that skilled nursing facilities (SNF) are eligible originating sites for telemedicine visits and enables such facilities to bill for a facility fee when a beneficiary located in a SNF receives care via telemedicine from an eligible remote provider.
NC Medicaid will continue to evaluate telemedicine policies and will release temporary flexibilities and guidance as needed throughout the state of emergency. Specific guidance related to billing and coding is detailed in the section “Temporary Modifications to Attachment A.” All claims are subject to audit.
- Telemedicine is the use of two-way real-time interactive audio and video to provide care and services when participants are in different physical locations.
Skilled Nursing Facility (SNF) Modifications
The following are policy modifications related to skilled nursing facilities:
- SNFs may bill for an originating site facility fee when their facility is the site at which a beneficiary is located when they receive care via telemedicine from an eligible provider.
- SNFs may not bill for an originating site facility fee when the SNF Medical Director or a beneficiary’s attending physician is conducting a telemedicine visit. All claims are subject to audit.
- Eligible providers, including physicians, nurse practitioners, and physician assistants, may deliver a wide range of services to beneficiaries located in SNFs; see Special Bulletin COVID-19 #34 and the NC Medicaid Telehealth Billing Code Summary for a complete list of clinical services they may deliver via telemedicine.
- Patients are not required to obtain prior authorization prior to receiving services via telemedicine.
See “Temporary Modifications to Attachment A” for additional coding and billing guidance.
Temporary Modifications to Attachment A: Claims-Related Information
Retroactive to March 10, 2020, through the conclusion of the state of emergency related to COVID-19, NC Medicaid is temporarily modifying Attachment A of its Telemedicine and Telepsychiatry Clinical Coverage Policy 1-H to better enable the delivery of remote care to Medicaid beneficiaries. Provider(s) shall comply with the “NCTracks Provider Claims and Billing Assistance Guide,” Medicaid Bulletins, fee schedules, NC Medicaid’s clinical coverage policies and any other relevant documents for specific coverage and reimbursement for Medicaid and NC Health Choice.
A. Claim Type
Professional (CMS-1500/837P transaction)
B. International Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedural Coding System (PCS)
Provider(s) shall report the ICD-10-CM and Procedural Coding System (PCS) to the highest level of specificity that supports medical necessity. Provider(s) shall use the current ICD-10 edition and any subsequent editions in effect at the time of service. Provider(s) shall refer to the applicable edition for code description, as it is no longer documented in the policy.
C.1 The following facility fee code may be billed by an SNF on the same day a beneficiary located in the facility receives care via telemedicine from a remote physician, nurse practitioner, or physician assistant.
Telehealth originating site facility fee
Note: SNFs may not bill for an originating site facility fee when the SNF Medical Director or a beneficiary’s attending physician is conducting a telemedicine visit. All claims are subject to audit.
Provider(s) shall follow applicable modifier guidelines.
- Modifier GT must be appended to the HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for services performed telephonically or through email or patient portal.
- Modifier CR (catastrophe/disaster related) must be appended to all claims for the HCPCS code listed in this policy.
E. Billing Unit
Provider(s) shall report the appropriate code(s) used which determines the billing unit(s).
F. Place of Service
Skilled nursing facilities are not required to file facility fee claims with Place of Service (POS) Code.
- For Medicaid, refer to Medicaid State Plan, Attachment 4.18-A, page 1, located at https://medicaid.ncdhhs.gov.
Provider(s) shall bill their usual and customary charges. For a schedule of rates, refer to https://medicaid.ncdhhs.gov. When the GT modifier is appended to a code billed for professional services, the service is paid at 100% of the allowed amount of the fee schedule.
- Reimbursement for these services is subject to the same restrictions as face-to-face contacts (such as place of service, allowable providers, multiple service limitations, prior authorization) unless otherwise noted in this policy.
NCTracks Contact Center: 800-688-6696