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					                                 Reimbursement


Commercial Insurance Companies
Commercial insurers vary widely in payment policies for telehealth and telemedicine services.
Providers and Medicare QIOs should determine an insurer’s policy regarding payment for telemedicine
services.

If an organization’s contracts do not specifically provide payment for telehealth and telemedicine services,
reimbursement may still be obtained within an existing contract. Many contracts with insurers include
provisions that apply Medicare rules whenever the contract does not mention telemedicine specifically.
Under existing Medicare regulations, reimbursement for telemedicine services is permitted in limited
circumstances. An organization may be entitled to reimbursement from an insurer in cases where the contract
incorporates Medicare rules as their coverage of services.

Below are coverage policies for telemedicine for some large commercial insurance companies. Each insurance
company is different and may change its policies and procedures on a regular basis. It will be important for
providers always to verify the most current benefits covered by the member’s policy.

CIGNA Health Care
The following information was obtained from the Cigna Health Care Coverage Position Number 0196.
The effective date of this position was October 15, 2004. The full policy is found at www.cigna.com.
Coverage Positions are intended to supplement specific standard CIGNA benefit plans. The terms of a
participant’s benefit plan document may differ significantly from the standard benefit plans on which these
positions are based.

Telemedicine is specifically excluded under some CIGNA Health Care benefit plans, and coverage of
telemedicine services may be governed by state mandates. Please refer to the applicable CIGNA Health
Care benefit plan for the terms and conditions of coverage.

Benefit Coverage
If benefit coverage is available for telemedicine services, then the following conditions apply.

CIGNA Health Care covers telemedicine when direct patient to provider interaction is not available because
the member is located in a geographically remote area AND the services provided consist of ANY of the
following.
       •    Teleradiology
       •    Electronic transmission of electrocardiograms
       •    Electronic analysis of pacemaker function


As of March 2005
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                                 Reimbursement


CIGNA HealthCare does NOT cover telemedicine services as substitutes for interactive patient to provider
encounters that are usually provided in a direct patient to provider setting. Telemedicine services have not
been demonstrated to be as effective as direct patient to provider contact.

Note: Exceptions to this policy may be considered on a case-by-case basis when members are located in
geographically remote areas and there is no access to direct patient care services. Additional documentation
supporting the need for telemedicine services must be submitted for review.

Coding and Billing Information
Note: There are few specific procedure codes for telemedicine services; however, the Centers for Medicaid
& Medicare Services (CMS) stipulate that telemedicine services may be billed as routine current procedure
technology codes for consultations, office or other outpatient visits, individual psychotherapy, or
pharmacologic management.



               CPT Code Description
               99090        Analysis of clinical data stored in computers (e.g., ECGs, blood
                            pressures, hematologic data)
               99091        Collection and interpretation of physiologic data (e.g., ECG, blood
                            pressure, glucose monitoring) digitally stored and/or transmitted by
                            the patient and/or caregiver to the physician or other qualified health
                            care professional, requiring a minimum of 30 minutes of time
               93012        Telephonic transmission of post-symptom electrocardiogram rhythm
                            strip(s), 24-hour attended monitoring, per 30-day period of time;
                            tracing only
               93014        Telephonic transmission of post-symptom electrocardiogram rhythm
                            strip(s), 24-hour attended monitoring, per 30-day period of time;
                            physician review with interpretation and report only



               HCPC Code Description
              T1014           Telehealth transmission, per minute, professional services bill
                              separately

               Q3014          Telehealth originating site facility fee




As of March 2005
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                                   Reimbursement


Aetna
Aetna currently offers medical coverage for individuals, families, and sole proprietors in select markets
including Arizona, Connecticut, Delaware, Illinois, Maryland, New Jersey, Pennsylvania, Texas, Virginia,
and Washington, D.C. Aetna continues to evaluate other markets across the country to introduce these
types of products. Aetna does have a limited policy that covers telemedicine services. The information
below was obtained from its Clinical Policy Bulletins on Telemedicine. These bulletins can be obtained
from Aetna’s Web site at www.aetna.com.

Policy
Aetna considers telemedicine services as a substitute for services usually provided through direct provider
to patient contact experimental and investigational because telemedicine services have not been demonstrated
to be as effective as direct provider to patient contact.

Note: Exceptions to this policy may be allowed on a case-by-case basis where direct patient care services
are unavailable, for example, for members located in remote regions of the country where medically necessary
direct patient care is not geographically accessible.
Note: This policy does not apply to medically necessary services that do not require direct provider to
patient contact, such as the following examples.
        •   Teleradiology
        •   Transmission over the telephone or Internet of electrocardiograms
        •   Electronic analysis of single or dual chamber pacemaker systems

Background
An evidence review of telemedicine applications, conducted for the Agency for Healthcare Research and
Quality (AHRQ), assessed telemedicine services that substitute for face-to-face medical diagnosis and
treatment. The evidence review focused primarily on three distinct telemedicine study areas — store-and-
forward, self-monitoring and self-testing, and clinician-interactive services. Store-and-forward telemedicine
services collect clinical data, store them, and then forward them to be interpreted later. Self-monitoring and
self-testing telemedicine services enable physicians and other health care providers to monitor physiologic
measurements, test results, images, and sounds usually collected in a patient’s residence or a care facility.
Clinician-interactive telemedicine services are real-time clinician to patient interactions that, in the conventional
approach, require face-to-face encounters between a patient and a physician or other health care provider.




As of March 2005
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