Telemedicine
Telemedicine is the delivery of health care services using telecommunication technology to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care. This can include real-time (synchronous) interactions between patient and provider, asynchronous (capture, store, and forward) review of patient health information and/or remote patient monitoring.
As telecommunications, information and medical technologies advance, opportunities for patients to access health care services via non-traditional settings continue to develop, particularly allowing patients in underserved or remote locations to access medical expertise quickly, efficiently and without travel. Additionally, telemedicine has the potential to enhance doctor-patient relationships, support ongoing care and monitoring of eye health conditions, encourage office visits when needed, improve patient engagement in treatment plans for better health outcomes and reduce costs.
VSP® supports delivery of appropriate medical eye care services via telehealth channels to supplement access to quality vision care, including evaluating opportunities to further connect members and doctors and enable providers to practice to the full scope of their licensure, utilizing telehealth channels, when appropriate.
Patient Consent
Prior to rendering telemedicine service, inform the beneficiary, obtain consent (verbal or written based individual state requirements), and maintain appropriate documentation. Best practice is written consent.
Providing Telemedicine Services
Only offer telemedicine services in states where you are licensed and practice only when permissible by federal, state and local laws within your scope of licensure – you do not have to sign up with VSP for telemedicine for Billable Services outlined below. If you choose, you can designate your practice as offering telemedicine services using the Office Special Interest form on VSPOnline on eyefinity.com, which will display these services are available to members on the Find a Doctor Directory on vsp.com.
VSP reimburses providers for medical eye care services delivered via telehealth channels, including specific CPT codes covered under the Essential Medical Eye Care and Diabetic Eyecare Plus ProgramSM (only for appropriate conditions covered under the corresponding plan). Use your professional judgement to determine if a benefit or service is clinically appropriate to be provided via telehealth, subject to consent by the patient; allow or recommend alternate delivery options, when appropriate. Check with your liability insurance to verify if it covers telemedicine services, for your protection.
Billable Services
Please reference the VSP CPT codes and information in the following chart to continue providing appropriate medical eye care services to your patients via telemedicine channels. Complete CPT code details are available under the Essential Medical Eye Care and Diabetic Eyecare Plus Program detail pages.
Remember:
- All telemedicine services must have patient verbal or written consent (based on state) and documentation of their consent prior to rendering remote services.
- All images and/or videos used to make a diagnosis are required to be saved for future reference.
- Standard billing and documentation requirements must be followed for both remote and in-office services.
- Use the most appropriate CPT code that supports the service completed and appropriate modifier, when billing.
- The following services may be billed under Essential Medical Eye Care Plan and Diabetic Eyecare Plus Program when delivered remotely:
|
CPT Code Range |
Brief Summary Description |
|---|---|
|
92002, 92004 |
Ophthalmological services: medical examination and evaluation, new patient bill the CPT code with a GQ or 95 modifier, as appropriate |
|
92012, 92014 |
Ophthalmological services: medical examination and evaluation, established patient bill the CPT code with a GQ or 95 modifier, as appropriate. |
|
99202-99205 |
Office/outpatient visit, new patient evaluation and management service bill the CPT code with a GQ or 95 modifier, as appropriate. |
|
99211-99215 |
Office/outpatient visit, established patient evaluation and management service bill the CPT code with a GQ or 95 modifier, as appropriate. |
|
99421-99423 |
On-line digital evaluation and management service, for up to 7 days established patient, patient initiated only billable once per patient per seven-day period per chief complaint, cannot result in another evaluation and management service within 24 hours. |
|
99441-99443 |
Telephone evaluation and management service, for established patient, patient initiated, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. |
|
99446-99449, 99451 |
Interprofessional telephone/internet assessment, including health record assessment, by consulting provider or other qualified health care professional, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional. only billable once per patient per seven-day period, not allowed if you have seen the patient directly within past 14 days. |
|
99452 |
Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician only billable once per patient per seven-day period. |
Copays
Copays, if required, apply to exams only (92002-92014, 99202-99205, 99211-99215, 99421-99423, 99441-99443). You will receive your VSP payable fee for the service provided, less the copay.
Other Approved Services
For patients with Vision Therapy coverage, vision therapy sessions (CPT code 92065) can be billed when performed remotely. Be sure to refer to the Patient Record Report for coverage details.
|
CPT Code Range |
Brief Summary Description |
|---|---|
|
92065 |
Orthoptic and/or pleoptic training, with continuing medical direction and evaluation bill the CPT code with a GQ or 95 modifier, as appropriate. |
Eligibility & Submitting Claims
Telemedicine services may be billed under the Essential Medical Eyecare and Diabetic Eyecare Plus Program (only for appropriate conditions covered under the corresponding plan). Check the Patient Record Report to confirm if the patient has one of these plans.
- Enter the specific procedure code and related diagnosis code(s), when completing the claim online or manually on the CMS-1500 Claim Form.
- When applicable, bill the diagnosis code with the correct eye location: left, right or bilateral.
- Bill the CPT code with a modifier to indicate the modality it was rendered, 95 synchronous or GQ asynchronous, as appropriate.
Note:
VSP recognizes but does not currently support Place of Service (POS) code 02 for reporting telehealth services rendered from a distant site except when submitted on paper as a secondary for coordination of benefits. Additionally, VSP recognizes but does not currently support POS code 10 for reporting telehealth services provided in a patient’s home.
Note:
Modifiers GQ or 95 are used instead to identify telehealth services, as appropriate. Modifiers are used for information purposes only.
- Standard timely filing guidelines apply
- Patients choosing non-covered services should be informed of any out-of-pocket cost and asked to sign the Patient Responsibility Statement prior to receiving services. You can find the form under the Forms section of the Administration menu on VSPOnline on eyefinity.com.
Coordination of Benefits
Essential Medical Eye Care and Diabetic Eyecare Plus Program provide supplemental medical eye care coverage to VSP patients. These plans are secondary to other medical eye insurance coverage that may reimburse you, if you are a participating provider with the patient’s medical plan. Standard coordination of benefit guidelines apply. Please refer to Coordination of Benefits in this section for more information.
Reimbursement
Telemedicine services follow the appropriate payment guidelines of the benefit being billed, which include Essential Medical Eye Care, Diabetic Eyecare Plus Program and Vision Therapy.
Technology
Use your professional judgement when selecting the appropriate telemedicine equipment, platform and technology used, adhering to federal, state and local laws to ensure patient health, safety and privacy are protected.
- Be sure to document the technology used when performing remote care.
- Providers must use equipment and data collection techniques consistent with or exceeding the accepted standards of care for in-person eye care services. (Equipment, platforms, and technology vendors used is up to provider’s discretion, same as today for in-person equipment),
- Systems/processes must meet regulatory compliance for confidentiality, protecting patient’s right to medical information and privacy using HIPAA/HITECH-secure channels.