Telemedicine or telehealth is a TRICARE benefit and is defined by the TRICARE Management Activity (TMA) as the use of communication technology to furnish medical information and services. It’s not just for behavioral health services.
According to TMA, the use of interactive audio/video technology may substitute for:
- A face-to-face, “hands on” encounter for consultation
- Office visits
- Individual psychotherapy
- Psychiatric diagnostic interview examination
- Pharmacologic management when appropriate and medically necessary
According to TRICARE Policy Manual Chapter 1, Section 28.1, the requirements, criteria, and limitations applicable to medical and psychological services also applies to services involving telehealth. Authorized providers rendering telehealth services are required to practice within the scope and jurisdiction of their license or certification.
Generally, the following two different kinds of technology are used in telemedicine:
- Two-way interactive video. This is used when a consultation involving the patient and a specialist is necessary. The videoconferencing equipment or an interactive telecommunication system at two locations permits a “real-time” or “live” service or consultation to take place. Refer to 32 CFR 199.4(g)(52) for more information.
- Store and forward technology. This is used to transfer video images from one location to another. The sending of x-rays, computed tomography scans, or magnetic resonance images are common store-and forward applications.
These services and corresponding current procedure terminology (CPT) codes are listed below:
- Consultations (99241-99275)
- Office or other outpatient visits (99201-99215)
- Individual psychotherapy (90804-90809)
- Psychiatric diagnostic interview examination (90801)
- Pharmacologic management (90862)
Conditions of Payment
Interactive audio and video telecommunications must be used to permit real-time communication between the distant site physician or practitioner and the TRICARE beneficiary. As a condition of payment, the patient must be present and participating in the telehealth visit. A telehealth service originating from a patient's home is not covered. An Originating Site is the site where an eligible TRICARE beneficiary is located when Tele-Behavioral Health Care is being furnished via a videoconferencing system.
Reimbursement
Payment for an office visit, consultation, individual psychotherapy or pharmacologic management via a telecommunications system are at the same amount as when these services are furnished without the use of a telecommunications system. For TRICARE payment to occur, the service must be within a practitioner's scope of practice under state law. The beneficiary is responsible for any applicable copay or cost sharing.
For covered telehealth services delivered via a telecommunications system furnished during a calendar year, the Originating Site fee is the lesser of the amount shown for that calendar year in Chapter 1, Section 28.1A or the actual charge. The facility fee for the Originating Site will be updated annually by the Medicare Economic Index and will be provided in Chapter 1, Section 28.1A. Outpatient cost-share rules will apply to this fee.
When submitting claims, providers should use CPT codes with a GT modifier for Distant Provider site and HCPCS code Q3014 for Originating Site to distinguish telehealth services.
For more information, please refer to TRICARE Policy Manual Chapter 1, Section 28.1, which can be found at TRICARE.mil.