Colorado Telemedicine & Telehealth Reimbursement Overview

Provider Reimbursement Eligibility
Consent for Telemedicine Live Video Reimbursement Store & Forward Reimbursement Originating Site & Transmission Fees Eligible Practitioners
State Law

First-time Patients require a written consent with specific statements they must agree to.

See Colorado Revised Statutes 25.5-5-320

A health benefit plan that is not allowed to restrict or deny coverage solely because the services are being provided by means of telemedicine.

See CO Revised Statutes 10-16-123

 

Store & forward is included in Colorado’s definition of telemedicine. Therefore, it is reimbursed at an equal rate.
See CO Revised Statutes 10-16-123

Colorado statutes only define the originating site as a site a patient is located at the time health care services are provided to him or her by means of telehealth.  The statutes further explain eligibility for originating site fees, but excludes the home from being reimbursable for “transmission costs”.

See CO Revised Statutes 10-16-123

No Reference Found

Medicaid

Health First Colorado typically requires face-to-face contact prior to telemedicine services, however, this requirement can be waived.
See Pg. 3 of the Health First Colorado Telemedicine Billing Manual

CO Medicaid will cover telemedicine direct member services which can involve up to two collaborating providers and the member. It is also acceptable for an originating provider not to be present, as long as the telecommunication equipment facilitates live contact between a member and a distant provider.

See Pg. 3 of the Health First Colorado Telemedicine Billing Manual

 

In-person contact between a health care or mental health care provider and a patient shall not be required under the state’s medical assistance program for health care or mental health care services delivered through telemedicine that are otherwise eligible for reimbursement under the program.

CO Revised Statutes 25.5-5-320

The Health First Colorado Telemedicine Program is intentionally vague on its definition of telemedicine.  Due to wording, Store-and-Forward is supported between two collaborating providers; however, the member must be present in order for Health First Colorado to reimburse Store & Forward.

See Pg. 1 of the Health First Colorado Telemedicine Billing Manual

If no originating provider is present during a Telemedicine Direct Member Services appointment, then the location of the originating site is at the member’s discretion and can include the member’s home.
See Page 2 of Health First Colorado Telemedicine Program Overview

The originating site is eligible for a facility fee subject to the provider being eligible as well. A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.
See Pg. 5 of the Health First Colorado Telemedicine Billing Manual 

The following providers are eligible:
-Physician
-Clinic
-Osteopath
-Doctorate
-Psychologist
-MA Psychologist
-Physician Assistant
-Nurse Practitioner

(Telemedicine Program Overview)

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Provider Reimbursement Eligibility
Consent for Telemedicine
State Law

First-time Patients require a written consent with specific statements they must agree to.

See Colorado Revised Statutes 25.5-5-320

Medicaid

Health First Colorado typically requires face-to-face contact prior to telemedicine services, however, this requirement can be waived.
See Pg. 3 of the Health First Colorado Telemedicine Billing Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

A health benefit plan that is not allowed to restrict or deny coverage solely because the services are being provided by means of telemedicine.

See CO Revised Statutes 10-16-123

 

Medicaid

CO Medicaid will cover telemedicine direct member services which can involve up to two collaborating providers and the member. It is also acceptable for an originating provider not to be present, as long as the telecommunication equipment facilitates live contact between a member and a distant provider.

See Pg. 3 of the Health First Colorado Telemedicine Billing Manual

 

In-person contact between a health care or mental health care provider and a patient shall not be required under the state’s medical assistance program for health care or mental health care services delivered through telemedicine that are otherwise eligible for reimbursement under the program.

CO Revised Statutes 25.5-5-320

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store & forward is included in Colorado’s definition of telemedicine. Therefore, it is reimbursed at an equal rate.
See CO Revised Statutes 10-16-123

Medicaid

The Health First Colorado Telemedicine Program is intentionally vague on its definition of telemedicine.  Due to wording, Store-and-Forward is supported between two collaborating providers; however, the member must be present in order for Health First Colorado to reimburse Store & Forward.

See Pg. 1 of the Health First Colorado Telemedicine Billing Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Colorado statutes only define the originating site as a site a patient is located at the time health care services are provided to him or her by means of telehealth.  The statutes further explain eligibility for originating site fees, but excludes the home from being reimbursable for “transmission costs”.

See CO Revised Statutes 10-16-123

Medicaid

If no originating provider is present during a Telemedicine Direct Member Services appointment, then the location of the originating site is at the member’s discretion and can include the member’s home.
See Page 2 of Health First Colorado Telemedicine Program Overview

The originating site is eligible for a facility fee subject to the provider being eligible as well. A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.
See Pg. 5 of the Health First Colorado Telemedicine Billing Manual 

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No Reference Found

Medicaid

The following providers are eligible:
-Physician
-Clinic
-Osteopath
-Doctorate
-Psychologist
-MA Psychologist
-Physician Assistant
-Nurse Practitioner

(Telemedicine Program Overview)

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Telemedicine CPT Codes

Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.

  • For interactive audio and video sessions, place a GT modifier in front of the CPT codes you typically use for in person services.
  • For services provided via an asynchronous telecommunication system, simply add a GQ modifier in front of the CPT codes you typically use for in person services.

Telehealth Parity

(b) (I) Subject to all terms and conditions of the health benefit plan, a carrier shall reimburse the treating participating provider or the consulting participating provider for the diagnosis, consultation, or treatment of the covered person delivered through telehealth on the same basis that the carrier is responsible for reimbursing that provider for the provision of the same service through in-person consultation or contact by that provider.

(d) A carrier may offer a health coverage plan containing a deductible, copayment, or coinsurance requirement for a health care service provided through telehealth, but the deductible, copayment, or coinsurance amount must not exceed the deductible, copayment, or coinsurance applicable if the same health care services are provided through in-person diagnosis, consultation, or treatment.

See CO Revised Statutes 10-16-123

Definitions

Telehealth Parity

Telehealth services are equal to in person services and reimbursed at the same rate.

Asynchronous Communication

The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.

Distant or Hub Site

The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.

Originating Site

The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.

Additional Telemedicine Resources

Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites: