Or. Admin. Code § 436-009-0012 - [Effective 6/6/2025] Telehealth
(1)
Definitions.
(a) For the purpose
of this rule, "telehealth" means providing healthcare remotely by
means of telecommunications technology, including but not limited to
telemedicine and telephonic or online digital services.
(b) For the purpose of this rule,
"telemedicine" means synchronous medical services provided via a
real-time interactive audio and video telecommunications system between a
patient at an originating site and a provider at a distant site.
(c) "Distant site" means the
place where the provider providing medical services to a patient through
telehealth is located.
(d)
"Originating site" means the place where the patient receiving
medical services through telehealth is located.
(2)
Scope of services.
(a) All services must be appropriate, and the
form of communication must be appropriate for the service provided.
(b) Notwithstanding OAR
436-009-0004, medical services
that may be provided through telemedicine are not limited to those listed in
Appendix P of CPT® 2024.
(3)
Distant site provider
billing.
(a) When billing for
telemedicine services, the distant site provider must:
(A) Use the place of service (POS) code "02"
(Telehealth Provided Other than in Patient 's Home) or "10" (Telehealth Provided
in Patient 's Home); and
(B) Use
modifier 95 to identify the service as a synchronous medical service rendered
via a real-time interactive audio and video telecommunications
system.
(b) When billing
for telehealth services other than telemedicine services, the distant site
provider:
(A) Must use the POS code "02"
(Telehealth Provided Other than in Patient 's Home) or "10" (Telehealth Provided
in Patient 's Home); and
(B) May not
use modifier 95.
(4)
Originating site billing.
When billing for telehealth services, the originating site may charge a
facility fee using HCPCS code Q3014, if the site is:
(a) The office of a physician or
practitioner; or
(b) A health care
facility including but not limited to a hospital , rural health clinic , skilled
nursing facility, or community mental health center.
(5)
Payment.
(a) Insurers must pay distant site providers
at the non-facility rate.
(b)
Equipment or supplies at the distant site are not separately payable.
(c) The payment amount for code Q3014 is
$35.70 per unit or the provider's usual fee , whichever is lower. In calculating
the units of time, 15 minutes, or any portion of 15 minutes, equals one
unit.
(d) Professional fees of
supporting providers at the originating site are not separately
payable.
(e) Insurers are not
required to pay a telehealth transmission fee (HCPCS code T1014).
Notes
Statutory/Other Authority: ORS 656.245, ORS 656.248, ORS 656.252, ORS 656.254 & ORS 656.726(4)
Statutes/Other Implemented: ORS 656.245, ORS 656.248, ORS 656.252 & ORS 656.254
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