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Date Printed: October 23, 2017: 02:15 AM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

01-99444-01

Original Effective Date: 09/15/04

Reviewed: 09/21/09

Revised: 05/11/14

Subject: E-Medicine (i.e., online medical evaluations, online visits, e-visits, e-consultations)

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
Other References Updates  

DESCRIPTION:

Online services (i.e., e-medicine, web visits, e-consultations, e-visits) provided remotely to patients via the Internet may include the following:

POSITION STATEMENT:

Services obtained from the attending physician by means of online email communication via the Internet may be eligible for coverage for non-urgent care when ALL of the following criteria are met:

Online services are not eligible for coverage when provided for the following situations:

BILLING/CODING INFORMATION:

CPT Coding:

98969

Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network.

99444

Online evaluation and management service provided by a physician or other qualified health care professional who may report an evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network.

REIMBURSEMENT INFORMATION:

Reimbursement for online medical evaluations is limited to one per day.

The criteria that qualifies for reimbursement of online services are as follows:

AND one or more of the following:

Claims should be billed with the correct procedure and diagnosis code(s) on a CMS 1500 claim form.

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:

No National Coverage Determination (NCD) and/or Local Coverage Determination (LCD) were found at the time of the last guideline reviewed date.

DEFINITIONS:

RelayHealth®: secure online communication for healthcare.

RELATED GUIDELINES:

None applicable.

OTHER:

Other terms used to describe e-Medicine:

e-consultation
e-visit
online consultation
online medical evaluation
online visit
web consultation
web visit

REFERENCES:

  1. American Academy of Family Physicians (AAFP). e-visits (2008).
  2. American College of Physicians Medical Service Committee Policy Paper (03/03): The Changing Face of Ambulatory Medicine – Reimbursing Physicians for Computer-Based Care; ACP Analysis and Recommendations to Assure Fair Reimbursement for Physician Care Rendered Online.
  3. Centers for Medicare & Medicaid Services (CMS). E-Health General Information Overview.
  4. Relay Health® website (accessed 06/26/07).

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 09/21/09.

GUIDELINE UPDATE INFORMATION:

09/15/04

New Medical Coverage Guideline.

10/15/05

Scheduled review; no change in coverage statement.

08/15/07

Scheduled review; reformatted guideline; updated references.

01/01/08

Annual HCPCS coding update: added 99444 and 98969, deleted 0074T, re-numbered guideline.

10/15/09

Scheduled review; no change in position statement; and updated references.

01/01/13

Annual HCPCS coding update: revised descriptors of 98969 and 99444.

05/11/14

Revision: Program Exceptions section updated.

Date Printed: October 23, 2017: 02:15 AM