Billing & Reimbursement
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. S.1035 was signed into law 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
Distant site, aka consulting site = Location of the distant/consulting provider
Telehealth service = CPT code with the GT modifier indicating telehealth
In typical FFS (fee-for-service) reimbursement, a covered originating
site + a covered provider type + covered service (CPT code) = a covered telehealth service
Use the coverage SEARCH TOOL to find out if a telehealth service is covered, and by which payer
South Carolina Telehealth Payer Policies
- Aetna (PDF)
- Blue Cross Blue Shield
- Medicaid (PDF)
- Select Health (PDF)
- Tricare (PDF)
- United Health Care (PDF)
- Medicare (PDF), 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.