Provider Notice Issued 03/02/2021

Date:    March 2, 2021

To:       Enrolled Hospitals:  Chief Executive Officers; Chief FinancialOfficers; and Patient Accounts Managers

Re:      Hospitals Billing as the TelehealthOriginating Site with Revenue Code 0780 and HCPCS Code Q3014

Thisnotice provides additional guidance to hospitals billing as the originatingsite for outpatient telehealth services. The billing requirements apply to claimsbilled under Medicaid fee-for-service as well as HealthChoiceIllinois managed care plans.

Asoutlined in provider notices dated June 2,2020 and June 24,2020, effective with service From Dates beginning July 1, 2020, hospitals must bill all services previously billed asprofessional (non-hospital) services as outpatient institutional services.

The June 24,2020, provider notice stated that hospitals must bill Revenue Code 0780 –Telehealth, General Classification, on the institutional claim format todesignate the telehealth originating site. Additionally, effective withclaims received on and after March 1, 2021, the Department is revising editingto require HCPCS code Q3014 – Telehealth Originating Site Facility Fee, to bebilled in conjunction with Revenue Code 0780. HCPCS code Q3014 must beidentified on the same revenue line with Revenue Code 0780. If any otherprocedure code is billed with Revenue Code 0780, the claim will be rejectedwith error code T55 – Missing/Invalid HCPCS for Revenue Code 0780.

Otherservices may be billed as necessary on the same outpatient claim with atelehealth facility fee, but the telehealth service must be identified asdescribed above. No modifier is requiredfor the telehealth service.

Questionsregarding this notice may be directed to a hospital billing consultant in theBureau of Professional and Ancillary Services at 877-782-5565 or the applicableHealthChoiceIllinois managed care plan.

KellyCunningham, Administrator

Divisionof Medical Programs

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