Billing & Reimbursement

Basic Definitions

The following definitions are based on CMS Medicare and Medicaid services, and also used by many private payers.

Telemedicine: South Carolina definition: “The practice of medicine using electronic communications, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening practitioner. This definition does not, on its face, explicitly require synchronous interactive audio-video communications technology. However, licensees must use technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care.” Former Governor Nikki Haley signed S.1035 into law in June 2016. One of the key features sets standard of care when establishing patients via synchronous communications (video visits).

Originating site, aka referring site: Location of the patient

  • Current covered originating sites, varies by payer:
    • Physician or practitioner offices
    • Hospitals
    • Critical access hospitals
    • Rural health clinics
    • Federally qualified health centers
    • Hospital based or CAH-based renal dialysis centers
    • Skilled nursing facilities
    • Community mental health centers

*Note: Independent renal dialysis facilities are not covered originating sites.

  • Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014. Coverage and billing varies by payer. Please check payer policies for guidance.

Distant site, aka consulting site: Location of the distant or consulting provider

  • Current covered  distant providers, varies by payer:
    • Physician
    • Nurse practitioner
    • Physician assistant
    • Nurse midwife
    • Clinical nurse specialist
    • Certified registered nurse anesthetist
    • Clinical psychologist
    • Clinical social worker
    • Registered dietitian

Billing professional fee with the GT modifier: Distant site providers must submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GT, “via interactive audio and video telecommunications systems” (for example, 99201 GT).

The GT modifier is added to the CPT code to alert the insurance company that the service was provided via telehealth. Per CMS, “by coding and billing the GT modifier with a covered telehealth procedure code, you are certifying that the beneficiary was present at an eligible originating site when you furnished the telehealth service.” CPT and HCPCS code coverage varies by payer. Please check payer policies for guidance.

Health Professional Shortage Area (HPSA), aka rural area: Applies to  Medicare coverage only. Patients must be in an HPSA for services to be covered for telemedicine service.

Scheduling Outpatient Telehealth Appointments

To be used only as a guide. Consult patient’s health insurance for specific scheduling and coverage details.

  • The most current list of MUSC in-network insurance plans is a general guide for medical services only, understanding each patient’s health plan may be different with the same health insurance company.
  • If the patient does not have health insurance, they will be eligible for a 50 percent discount on charges. This does not apply to patients who are out-of-network with MUSC or who “elect” to be self-pay.
    • If the patient has questions or concerns about a bill, they should contact the MUSC Customer Service Department at 843-792-2311 or 800-598-0624.

Scheduling Inpatient Telehealth Consultations

To be used only as a guide. Consult patient’s health insurance for specific scheduling and coverage details.

  • If emergent or urgent, standard scheduling protocol applies.
  • If not emergent or urgent, request the patient’s insurance information prior to the consult to determine eligibility.

Health Plan Telehealth Policies

**Distant or consulting providers may use this online search tool to see available coverage to deliver care using telemedicine.