Proposed Rule Language (red-lined):
18-3
(B) 	Place of Service Codes:
The table below lists the place of service codes corresponding to used with the RBRVS facility RVUs.  All other maximum fee calculations shall use the non-facility RVUs listed in the RBRVS. 
Table #1 lists the place of service codes used with the RBRVS facility RVUs.  All other maximum fee calculations shall use the non-facility RVUs listed in the RBRVS. 

 Place of Service Code 	Place of Service Code Description	
02	 Telemedicine Services	
19	 Off Campus – Outpatient Hospital	
21	 Inpatient Hospital	
22	 On Campus - Outpatient Hospital	
23	 Emergency Room-Hospital	
24	 Ambulatory Surgery Center (ASC)	
26	 Military Treatment Facility 	
31	 Skilled Nursing Facility	
34	 Hospice	
41	 Ambulance - Land	
42	 Ambulance - Air or Water	
51	 Inpatient Psychiatric Hospital	
52	 Psychiatric Facility-Partial Hospitalization	
53	 Community Mental Health Center	
56	 Psychiatric Residential Treatment Center	
61	 Comprehensive Inpatient Rehabilitation Facility	

18-4
(I)	TELEMEDICINE 
(1)	The healthcare services listed in Appendix P of CPT®, Division Z-codes (when appropriate), G0459, G0508, and G0509 and CMS’ list of Covered Telehealth Services may be provided via telemedicine.  Additional services may be provided via telemedicine with prior authorization.  The provider shall append modifier 95 to the appropriate CPT® code(s) to indicate synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.  
All healthcare services provided through telemedicine shall comply with the applicable requirements found in the Colorado Medical Practice Act and Colorado Mental Health Practice Act, as well as the rules and policies adopted by the Colorado Medical Board and the Colorado Board of Psychologist Examiners.
(2)	HIPAA privacy and electronic security standards are required for the originating site(s) and the rendering provider.(s).
	(3)	The physician-patient/psychologist-patient relationship needs to be established.
(a)	This relationship is established through assessment, diagnosis, and treatment of the patient.  Two-way live audio/video services are among acceptable methods to ‘establish' a patient relationship. 
(b)	The patient is required to provide the appropriate consent for treatment.
(4)	Payment for telemedicine services:
	(a)	The rendering provider may be the only provider involved in the provision of telemedicine services.  The rendering provider shall bill place of service (POS) code 02.  Reimbursement Maximum allowance is the appropriate CPT® code’s non-facility relative weight from RBRVS multiplied by unit value for the CPT® code times the appropriate CF, unless only a facility weight is established.. + $5.00 transmission fee per date of service when modifier 95 is appended to the appropriate CPT® code(s).
	(b)	Telemedicine services performed outside of An originating site fee may only be billed when the injured worker is receiving services at an authorized originating site. without an originating site fee.  The originating site is responsible for establishing and verifying injured worker and rendering provider identity.  Originating site must bill with the appropriate facility POS code. does not apply to the originating site billing a facility fee. Authorized originating sites include:
•	The office of a physician or practitioner
• 	A Hospital (inpatient or outpatient)
• 	A Critical Access Hospital (CAH)
• 	A Rural Health Clinic (RHC)
• 	A federally qualified health center (FQHC)
• 	A hospital based or critical access hospital based renal dialysis center (including satellites)
• 	A Skilled Nursing Facility (SNF)
• 	A community mental health center (CMHC)
	Maximum allowance for Q3014 is $35.00 per 15 minutes. (Equipment, supplies, and professional fees of supporting providers at the originating site are not separately payable.)
	 (v)	Medical providers shall bill codes G0425-G0427 for consultations, emergency department or initial inpatient visits. 
(vi)	Medical providers shall bill codes G0406-G0408 for follow up inpatient consultations.  
(5)	Documentation:
Documentation requirements are the same as for a face-to-face encounter and shall also include the location of the rendering provider and the injured worker at the time of service, and a statement on how the treatment was rendered through telemedicine (such as secured video).