Properly identifying facilities that rely upon reimbursable services can also point the way for additional fees that are exclusive to telehealth. For example, “facility fees” are often reimbursable. They are the U.S. government’s way of supporting the technology infrastructure costs often related to setting up and maintaining a range of telehealth technologies. Rates are generally $22 to $70 per session, depending on the insurer’s desire to obtain specialty services (Medicaid vs private insurer such as Blue Cross/Blue Shield). For example, in New Mexico, where there is a high demand for psychiatrists, Blue Cross/Blue Shield (BCBS) pays $70 per session as a facility fee.
A useful revenue estimation tool to help calculate fees for Medicare/Medicaid by the state is found here at the 1DocWay website. (We strongly encourage you to work with this tool for a few minutes to see its power. It will almost certainly be a very useful tool for you to decide which states to consider serving and to make financial projections.) When added to Medicare or Medicaid fees, this additional telehealth fee is the single largest factor that allows telehealth programs to be financially sustainable and profitable.
To collect the facility fee, the following specifications must be met, however:
- Use this CPT code: Q3014
- In the CMS document, entitled, “Program Memorandum Intermediaries/Carriers,” published by the Department of Health and Human Services (DHHS), HEALTH CARE FINANCING ADMINISTRATION (HCFA), on May 1, 2001, the note below is made with the subject: Revision of Medicare Reimbursement for Telehealth Services
To claim the facility payment, physicians/practitioners will bill HCPCS code “Q3014, telehealth originating site facility fee”; short description “telehealth facility fee.” The type of service for the telehealth originating site facility fee is “9, other items and services.” For carrier processed claims, the “office” place of service (code 11) is the only payable setting for code Q3014. There is no participation payment differential for code Q3014 and it is not priced off of the Medicare Physician Fee Schedule Database file. Deductible and coinsurance rules apply to Q3014. By submitting HCPCS code “Q3014”, the biller certifies that the originating site is located in either a rural HPSA or a non-MSA county.
- The facility fee can only be billed by the facility where the patient is located (originating site)
- This fee is billed much like other technical fees, such as those charged for blood draws (lab draw fee) or ECG fee
- Not to be confused with the professional service charge, which is billed with other CPT codes
- The facility fee is billed on the Uniform Bill (UB-92) form or the HCFA 1500
- The primary difference between the two forms is related to the parties using them for billing. Medical facilities use the Uniform Bill (UB-92) and individual practitioners use the HCFA form (HCFA-1500). More specifically, the UB-92 medical claim form is used by medical institutions, such as hospitals, nursing facilities, and other facility providers. The HCFA-1500 medical claim form is used by non-institutional healthcare service providers or medical professionals, such as individual doctors, nurses, and therapists.
- Identify the Place of Service (POS) as code “02,” reflecting telehealth delivery as being where the PATIENT is located
- The billing organization is the organization providing the facility rather than the clinician delivering the service
Facility fees are steadily being eliminated by the CMS as they increasingly move toward unbundling CPT Codes and value-based care. Be flexible. This is a learning process and every insurer is different. You will increase your success rate as you go.
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