January 26, 2017
Premera has benefits that support telemedicine/telehealth services (including telepsych services), complying with updated Washington State laws Senate Bill 5175 (2015 session) and Senate Bill 6519 (2016 session). This legislation addresses home as an originating site and asynchronous communications. We want to make sure our providers are aware of updates to the payment policy for telemedicine.
In follow up to the article in the December Provider News, here's some additional clarification on the telemedicine services, when covered by a member's benefits:
Synchronous/Asynchronous Communications: The originating site for these services is the clinical setting (i.e. office, clinic) where the patient and their physician or other qualified healthcare professional is physically located, either in the same room as the patient or nearby in the office or clinic vicinity.
Telephone Assessment and Management: The patient receiving these services is located in a non-clinical setting, such as but not limited to their home or office as examples.
Online/Internet Communications: The patient receiving these services is located in a non-clinical setting, such as but not limited to their home or office as examples.
These new methods of electronic exchange are allowed for members when covered by their benefit plans.
This new legislation (SB5175) doesn't cover inter-professional telephone/internet consultations (99446-99449). These consultations wouldn't meet the definition of telemedicine as defined in the RCW since the member is not present during the exchange. Based on the CPT guidelines as stated in the American Medical Association (AMA) CPT code book, these inter-professional consults are between physicians without the presence of the patient.
For more information, see the current payment policy for Telehealth/Telemedicine Services or contact Physician and Provider Relations at 877-342-5258, option 4.