Bulletin: 05-208 - Telehealth Originating Site Facility Fee Payment Amount Update

This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff. Additional copies may be downloaded from our website at www.highmarkmedicareservices.com

Coming in 2006! Beginning January 1, 2006, Medicare prescription drug coverage will be available to people with Medicare. Health care professionals can find information about this new coverage at www.cms.hhs.gov/medlearn/drugcoverage.asp, on the CMS website.

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Related Change Request (CR) #: 4201
Related CR Release Date: December 16, 2005
Related CR Transmittal #: 41
Effective Date: January 1, 2006
Implementation Date: January 18, 2006

Providers Type Affected:

All providers who bill Medicare for the telehealth originating site facility fee

Providers Action Needed:

CR4201, upon which this article is based, provides the calendar year 2006 telehealth originating site facility fee payment update. Beginning on and after January 1, 2006, the telehealth originating site facility fee is $22.47.

Background:

Section 1834(m) of the Social Security Act (the Act) established the amount Medicare paid as the telehealth originating site facility fee for services provided from October 1, 2001, through December 31 2002. The amount was set at $20.

For such services provided on or after January 1 of each subsequent calendar year, the telehealth originating site facility fee was increased as of the first day of the year by the percentage increase in the Medicare Economic Index (MEI).

The 2006 MEI increase is 2.8%. Thus, for calendar year 2006, the payment amount for HCPCS code Q3014 (telehealth originating site facility fee) is 80% of the lesser of the actual charge or $22.47 (2.8% x $21.86 [the 2005 fee see below] + $21.86).

Note that the beneficiary is responsible for any unmet deductible amount or coinsurance.

For reference, the Medicare telehealth originating site facility fees and MEI increases by the applicable time period are shown in the table below:

Medicare Telehealth Originating Site Facility Fee	MEI Increase	Period
$20.00	N/A	10/01/2001-12/31/2002
$20.60	3%	01/01/2003-12/31/2003
$21.20	2.9%	01/01/2004-12/31/2004
$21.86	3.1%	01/01/2005-12/31/2005
$22.47	2.8%	01/01/2006-12/31/2006

Additional Information:

You can find more information about the telehealth originating site facility fee payment amount by going to http://www.cms.hhs.gov/transmittals/downloads/R41BP.pdf on the CMS web site.

Assistance:

If you have any questions regarding this bulletin, please contact the appropriate Customer Contact Center at:

Maryland Providers: 1-866-488-0545
Pennsylvania Providers: 1-800-560-6170

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