How Maine and New Hampshire Passed Laws Mandating Private Insurance Reimbursement for Telemedicine

Both Maine and New Hampshire in the Summer of 2009 passed laws which require insurance companies to pay for services delivered by telemedicine. For the benefit of other states who may ponder such a step, a new article on the TIE by Michael Edwards of the Northeast Telehealth Resource Center shares details about the similarities and differences in the laws and discuss some of what we know about how these laws got through the state legislatures.

New Hampshire Senate Passes Telemedicine Reimbursement Bill

Health insurers would no longer be able to require that a doctor meet a patient face-to-face in order to be reimbursed under a bill passed recently by the New Hampshire Senate. Senate Bill 138, which defines telemedicine and requires its coverage, passed the Senate on a 17-5 roll call vote. The measure now goes to the House for approval.

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Medicare to Pay for Telemedicine for Nursing Home Patients

Medicare will now pay for nursing home patients to be treated by telemedicine, reducing the number of expensive trips to the hospital. The new federal rule allows nursing homes to charge a $20 facility fee for each patient using telemedicine. The new Medicare reimbursement rule takes effect in January. The change also expands telemedicine coverage to community mental health centers and renal dialysis facilities. More information is available here.

Medicare Reimburses for Neurobehavioral Telehealth Exams

The Centers for Medicare & Medicare Services (CMS) recently announced in that the neurobehavioral status exam (Healthcare Common Procedure Coding System (HCPCS) code 96116) has been added to the list of Medicare telehealth services. Previously, CMS determined that, if the eligibility criteria, and conditions of payment are satisfied, the use of a telecommunications system may substitute for a face-to-face, "hands on" encounter for consultation, office visits, individual psychotherapy, pharmacologic management, psychiatric diagnostic interview examination, end stage renal disease related services, and individual medical nutrition therapy.

When billing this code as a Medicare telehealth service, you must append modifier GT ("telehealth service via interactive audio-video telecommunication system"), and all other criteria for telehealth reimbursement under Medicare must be met as set forth in the Medicare Benefit Policy Manual (Publication 100-02, Chapter 15, Section 270) and the Medicare Claims Processing Manual (Publication 100-04, Chapter 12, Section 190).

HCPCS code 96116, neurobehavioral status exam, involves clinical assessment of thinking, reasoning and judgment per hour of a psychologist's or physician's time.