CMS Pub. 100-04, ch. 12, § 190.5

1. Originating site defined

The term originating site means the location of an eligible Medicare

beneficiary at the time the service being furnished via a

telecommunications system occurs. For asynchronous, store and

forward telecommunications technologies, an originating site is only a

Federal telemedicine demonstration program conducted in Alaska or

Hawaii.

2. Facility fee for originating site

The originating site facility fee is a separately billable Part B payment.

The contractor pays it outside of other payment methodologies. This fee

is subject to post payment verification.

For telehealth services furnished from October 1, 2001, through

December 31, 2002, the originating site facility fee was the lesser of $20

or the actual charge. For services furnished on or after January 1 of each

subsequent year, the originating site facility fee is updated by the

Medicare Economic Index. The updated fee is included in the Medicare

Physician Fee Schedule (MPFS) Final Rule, which is published by

November 1 prior to the start of the calendar year for which it is

effective. The updated fee for each calendar year is also issued annually

in a Recurring Update Notification instruction for January of each year.

3. Payment amount:

The originating site facility fee is a separately billable Part B payment.

The payment amount to the originating site is the lesser of 80 percent of

the actual charge or 80 percent of the originating site facility fee, except

CAHs. The beneficiary is responsible for any unmet deductible amount

and Medicare coinsurance.

The originating site facility fee payment methodology for each type of

facility is clarified below.

Hospital outpatient department. When the originating site is a hospital

outpatient department, payment for the originating site facility fee must be

made as described above and not under the OPPS. Payment is not based

on the OPPS payment methodology.

Hospital inpatient. For hospital inpatients, payment for the originating

site facility fee must be made outside the diagnostic related group

(DRG) payment, since this is a Part B benefit, similar to other services

paid separately from the DRG payment, (e.g., hemophilia blood

clotting factor).

Critical access hospitals. When the originating site is a critical access

hospital, make payment separately from the cost-based reimbursement

methodology. For CAH’s, the payment amount is 80 percent of the

originating site facility fee.

Federally qualified health centers (FQHCs) and rural health clinics

(RHCs). The originating site facility fee for telehealth services is not an

FQHC or RHC service. When an FQHC or RHC serves as the

originating site, the originating site facility fee must be paid separately

from the center or clinic all-inclusive rate.

Physicians’ and practitioners’ offices. When the originating site is a

physician’s or practitioner’s office, the payment amount, in accordance

with the law, is the lesser of 80 percent of the actual charge or 80

percent of the originating site facility fee, regardless of geographic

location. The A/B MAC (B) shall not apply the geographic practice

cost index (GPCI) to the originating site facility fee. This fee is

statutorily set and is not subject to the geographic payment adjustments

authorized under the MPFS.

Hospital-based or critical access-hospital based renal dialysis center (or

their satellites). When a hospital-based or critical access hospital-based

renal dialysis center (or their satellites) serves as the originating site, the

originating site facility fee is covered in addition to any composite rate

or MCP amount.

Skilled nursing facility (SNF). The originating site facility fee is outside

the SNF prospective payment system bundle and, as such, is not subject

to SNF consolidated billing. The originating site facility fee is a

separately billable Part B payment.

Community Mental Health Center (CMHC). The originating site

facility fee is not a partial hospitalization or intensive outpatient service.

The originating site facility fee does not count towards the number of

services used to determine payment for partial hospitalization or

intensive outpatient services. The originating site facility fee is not

bundled in the per diem payment for partial hospitalization or intensive

outpatient programs. The originating site facility fee is a separately

billable Part B payment.

To receive the originating facility site fee, the provider submits claims with HCPCS code

“Q3014, telehealth originating site facility fee”; short description

“telehealth facility fee.” The type of service for the telehealth

originating site facility fee is “9, other items and services.” For A/B

MAC (B) processed claims, the “office” place of service (code 11) is

the only payable setting for code Q3014. There is no participation

payment differential for code Q3014. Deductible and coinsurance rules

apply to Q3014. By submitting Q3014 HCPCS code, the originating

site authenticates they are located in either a rural HPSA or non-MSA

county.

This benefit may be billed on bill types 12X, 13X, 22X, 23X, 71X, 72X,

73X, 76X, and 85X. Unless otherwise applicable, report the originating

site facility fee under revenue code 078X and include HCPCS code

“Q3014, telehealth originating site facility fee.”

Hospitals and critical access hospitals bill their A/B/MAC (A) for the

originating site facility fee. Telehealth bills originating in inpatient

hospitals must be submitted on a 12X TOB using the date of discharge as

the line item date of service.

Independent and provider-based RHCs and FQHCs bill the appropriate

A/B/MAC (A) using the RHC or FQHC bill type and billing number.

HCPCS code Q3014 is the only non-RHC/FQHC service that is billed

using the clinic/center bill type and provider number. All RHCs and

FQHCs must use revenue code 078X when billing for the originating

site facility fee. For all other non-RHC/FQHC services, provider based

RHCs and FQHCs must bill using the base provider’s bill type and

billing number. Independent RHCs and FQHCs must bill the A/B MAC

(B) for all other non-RHC/FQHC services. If an RHC/FQHC visit

occurs on the same day as a telehealth service, the RHC/FQHC serving

as an originating site must bill for HCPCS code Q3014 telehealth

originating site facility fee on a separate revenue line from the

RHC/FQHC visit using revenue code 078X. Note that for patients in an

intensive outpatient program, Q3014 is not considered an intensive

outpatient service.

Hospital-based or CAH-based renal dialysis centers (including

satellites) bill their A/B/MAC (A) for the originating site facility fee.

Telehealth bills originating in renal dialysis centers must be submitted

on a 72X TOB. All hospital-based or CAH-based renal dialysis centers

(including satellites) must use revenue code 078X when billing for the

originating site facility fee. The renal dialysis center serving as an

originating site must bill for HCPCS code Q3014, telehealth

originating site facility fee, on a separate revenue line from any other

services provided to the beneficiary.

Skilled nursing facilities (SNFs) bill their A/B/MAC (A) for the

originating site facility fee. Telehealth bills originating in SNFs must

be submitted on TOB 22X or 23X. For SNF inpatients in a covered

Part A stay, the originating site facility fee must be submitted on a 22X

TOB. All SNFs must use revenue code 078X when billing for the

originating site facility fee. The SNF serving as an originating site

must bill for HCPCS code Q3014, telehealth originating site facility

fee, on a separate revenue line from any other services provided to the

beneficiary.

Community mental health centers (CMHCs) bill their A/B/MAC (A)

for the originating site facility fee. Telehealth bills originating in

CMHCs must be submitted on a 76X TOB. All CMHCs must use

revenue code 078X when billing for the originating site facility fee.

The CMHC serving as an originating site must bill for HCPCS code

Q3014, telehealth originating site facility fee, on a separate revenue

line from any other services provided to the beneficiary. Note that

Q3014 does not count towards the number of services used to

determine per diem payments for partial hospitalization or intensive

outpatient services.

The beneficiary is responsible for any unmet deductible amount and

Medicare coinsurance.