C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-5, subsec. 144-101-I-5.07
The Department is waiving the requirement under Ch. 1, Section 4, Telehealth, Sec. 4.06-2(B), requiring advance written notice/consent prior to services.
The Department, at its discretion, may waive the requirement under Ch. 1, Section 4, Telehealth, Sec. 4.04-1(2), requiring Interactive Telehealth Services be of comparable quality to what they would be were they delivered in person.* Requests will be handed on a case-by-case basis through a clinical review by the Department to determine whether members may face imminent harm in the absence of a telehealth mode of delivery for a particular service, given the inability due to the public health emergency for that member to receive the service in-person.
*The Department shall seek and anticipates receiving approval of this change from CMS retroactive to March 18, 2020. Pending approval, these changes are effective upon adoption.
The Department will reimburse providers for telephone evaluation and management services provided to members. The restrictions set forth in the MaineCare Benefits Manual, Ch. I, Sec. 4.04-2 are waived for this purpose.
Telephonic evaluation and management services must be rendered by a qualified professional actively enrolled in MaineCare or contracted through an enrolled MaineCare provider.
Relevant CPT codes are:
CPT/HCPC Code | Short Description | Long Description | Unit | Non- Facility Rate | Facility Rate |
98966 | nonphysician telephone assessment 5-10 min | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | 5-10 minutes of medical discussion | $10.33 | $8.95 |
98967 | nonphysician telephone assessment 11-20 min | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion | 11-20 minutes of medical discussion | $20.59 | $18.29 |
98968 | nonphysician telephone assessment 21-30 min | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion | 21-30 minutes of medical discussion | $33.27 | $29.13 |
99421 | online digital e/m svc est pt<7 d 5-10 minutes | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes | 5-10 minutes | $10.33 | $8.95 |
99422 | online digital e/m svc est pt<7 d 11-20 minutes | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes | 11-20 minutes | $20.59 | $18.29 |
99423 | online digital e/m svc est pt<7 d 21+ minutes | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes | 21 or more minutes | $33.27 | $29.13 |
99441 | phys/qhp telephone evaluation 5-10 min | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | 5-10 minutes of medical discussion | $11.89 | |
99442 | phys/qhp telephone evaluation 11-20 min | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion | 11-20 minutes of medical discussion | $23.16 | |
99443 | phys/qhp telephone evaluation 21-30 min evaluation and management service; | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion | 21-30 minutes of medical discussion | $33.95 | |
G2012* | Brief check in by md/qhp, 5-10 minutes | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion | (5-10 min) | $9.90 | $8.97 |
G2010* | Remot image submit by pt | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment | $8.43 | $6.34 | |
G2061* | Qual nonmd est pt 5-10 minutes | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes | 5-10 minutes | $8.32 | |
G2062* | Qual nonmd est pt 11-20 minutes | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes | 11-20 minutes | $14.67 | |
G2063* | Qual nonmd est pt 21>minutes | Qualified nonphysician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes | 21 or more minutes | $22.99 | $22.76 |
G0071* | Comm svcs by rhc/fqhc 5 minutes | Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only | 5 minutes or more | $9.17 |
Telephone evaluation management services are not to be billed if clinical decision-making dictates a need to see the member for an office visit within 24 hours or at the next available appointment. In those circumstances, the telephone service shall be considered a part of the subsequent office visit. If the telephone call follows an office visit performed and reported within the past seven (7) days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable.
C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-5, subsec. 144-101-I-5.07