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Ask a Rev Cycle Expert: Q3014 vs. E/M for Telehealth Visits?

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Question:

My facility is a Rural Health Center (RHC). My providers have been doing a combination of telehealth and face-to-face visits with their patients. Do we need to bill the Q3014 instead of an E/M for our telehealth visits?

Answer:

For RHCs, HCPCS code G2025, Payment for a telehealth distant site service provided by a rural health clinic (RHC) or federally qualified health center (FQHC) only, was created on January 27, 2020 and would be used in place of HCPCS code Q3014, Telehealth originating site facility fee. Modifier CG, Policy criteria applied, should be appended. Modifier 95, Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System, may be appended, but is not required. Any other applicable modifiers, such as CR or CS, should also be appended. Additionally, CMS recommends a revenue code within range 052X, Freestanding Clinic.

Claims will be paid at the RHC's all-inclusive rate (AIR) of $92/03. This rare was not in the claims processing systems until after July 1, 2020, so any claims submitted between January 27 and June 20, 2020 will be reprocessed beginning on July 1, 2020.

You may wish to review MLN Matters(R) article SE20016 'New and Expanded Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) During the COVID-19 Public Health Emergency (PHE)' to review additional flexibilities that are specific to RHC providers.

Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).