Updated 02/22/2023 Telehealth Billing Instructions
pv11/18/2020 1 / 2
Telehealth Billing Instructions
Telehealth
Telehealth is the use of a telecommunications system instead of an in-person recipient encounter for professional
consultations, office visits, office psychiatry services and a limited number of other medical services. Telehealth may be
used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice to provide services that
can be appropriately provided via telehealth. Please review Medicaid Services Manual (MSM) Chapter 3400 (Telehealth
Services) for complete policy, covered services, non-covered services and coverage requirements.
The telecommunications system used must be appropriate for the service being provided. Facsimile machines, electronic
mail, and text messages do not meet this criteria.
Distant Site
The distant site is the site where the provider delivering services is located at the time the service is provided via a
telecommunications system. The provider at the distant site must use the appropriate Place of Service (POS) code in
addition to the appropriate modifier when billing for services provided via telehealth. Note that for distant site services
billed under Critical Access Hospital (CAH) method II on institutional claims and billed by outpatient providers on
institutional claims, the GT modifier (telehealth service rendered via interactive audio and video telecommunications
system) is required.
Note: The distant site may not also be the originating site.
Originating Site
The originating site is the location where an eligible Medicaid/Nevada Check Up recipient is at the time the service is
provided via a telecommunications system.
Code
Description
Q3014
Telehealth originating site facility fee.
In order to bill the Q3014 facility fee, an originating site must be enrolled as a Nevada Medicaid provider. Eligible sites
include:
• Office of provider
• Critical Access Hospital (CAH)
• Rural Health Clinic (RHC)
• Federally Qualified Health Center (FQHC)
• Hospital
• End Stage Renal Disease (ESRD) Facility
• Skilled Nursing Facility (SNF)
• Community Mental Health Centers (CMHC)
• Indian Health Services/Tribal Organization/Urban Indian Organization
• School-Based Health Centers
• Schools
• Family Planning Clinics
• Public Health Clinics
• Comprehensive Outpatient Rehabilitation Facilities
• Community Health Clinics (State Health Division)
Updated 02/22/2023 Telehealth Billing Instructions
pv11/18/2020 2 / 2
Telehealth Billing Instructions
• Special Children’s Clinics
• Human Immunodeficiency Virus (HIV) Clinics
• Therapy offices
• Chiropractic offices
• Emergency Medical Services (EMS) performing Community Paramedicine Services
• Recipient smart phones
• Recipient home computers
• Recipient’s home
Per Diem/Encounter-based Providers
Providers that bill per diem or encounter rates may bill an encounter rate in lieu of the originating site fee. Per diem or
encounter-based providers would not bill HCPCS code Q3014 and an encounter code, as the facility fee is already included
in the per diem/encounter rates. If the telecommunication system used is a recipient's smart phone or home computer,
the facility fee may not be billed.
Billing Requirements
Place of Service Codes
Description
02
Telehealth provided in a location other than in a recipient’s home
10
Telehealth provided in a recipient’s home
Modifiers
Description
93
Synchronous audio only
95
Synchronous telehealth service rendered via a real-time interactive audio and visual
telecommunications system
G0
Telehealth service for diagnosis, evaluation or treatment of symptoms of an acute stroke
GQ
Telehealth service rendered via an asynchronous telecommunications system (store and
forward)
GT
Interactive audio and video telecommunication systems (Institutional claims - Critical Access
Hospital only)
