SPECIAL BULLETIN COVID-19 #103: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Nursing Facility Care

Thursday, June 25, 2020

This bulletin replaces SPECIAL BULLETIN COVID-19 #79 in its entirety. 

NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid 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the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy modification is rescinded. 

NC Medicaid temporarily enables eligible providers to deliver evaluation and management services via telemedicine to residents of skilled nursing facilities. Additionally, this bulletin clarifies that skilled nursing facilities (SNF) are eligible originating sites for telemedicine visits and can bill for a facility fee when a beneficiary located in a SNF receives care via telemedicine from an eligible 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.

For more telehealth policy information, including definitions, see SPECIAL BULLETIN #34: Telehealth Clinical Policy Modifications – Definitions, Eligible Providers, Services and Codes.

Skilled Nursing Facility Modifications

The following are policy modifications: 

  • Eligible providers include physicians, nurse practitioners, and physician assistants may provide select nursing facility evaluation and management services (listed in Attachment A below) to beneficiaries located in skilled nursing facilities via telemedicine. 
  • In addition to the services listed in this policy bulletin, eligible providers 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.
  • SNFs may bill for an originating site facility fee (see Attachment A, C.2) 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. 
  • 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.

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. Code(s)
C.1 The following evaluation and management codes may be billed by physicians, nurse practitioners, and physician assistants when the services are provided via telemedicine to beneficiaries located in skilled nursing facilities:

Codes

Description (See 2020 CPT Code Book for Complete Details)

99307

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • A problem focused interval history;
  • A problem focused examination;
  • Straightforward medical decision making

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.  Usually, the patient is stable, recovering, or improving. Typically, 10 minutes are spent at the bedside and on the patient’s floor or unit.

99308

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • An expanded problem focused interval history;
  • An expanded problem focused examination;
  • Medical decision making of low complexity

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.  Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient’s floor or unit.

99309

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • A detailed interval history;
  • A detailed examination;
  • Medical decision making of moderate complexity

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.  Usually, the patient has developed a significant complication or a significant new problem. Typically, 15 minutes are spent at the bedside and on the patient’s floor or unit.

99310

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 components:

  • A comprehensive interval history;
  • A comprehensive examination;
  • Medical decision making of high complexity

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.  The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient’s floor or unit.

C.2 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.

Codes

Description (See 2020 CPT Code Book for Complete Details)

Q3014

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.

D. Modifiers

Provider(s) shall follow applicable modifier guidelines.

  • Modifier GT must be appended to the CPT or 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 CPT codes 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

Telemedicine claims should be filed with the provider’s usual place of service code.

Skilled nursing facilities are not required to file facility fee claims with Place of Service (POS) Code.

G. Copayments

For Medicaid, refer to Medicaid State Plan, Attachment 4.18-A, page 1, located at https://medicaid.ncdhhs.gov/.

H. Reimbursement

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.

Additional Resources

•    NC Medicaid Telehealth Billing Code Summary Chart  
•    NC Medicaid Telehealth Resources website 
•    NC Medicaid COVID-19 Resources website 

Contact

NCTracks Contact Center: 800-688-6696