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Payment for Telehealth Care

Should pediatricians be paid for health services provided via the telephone? Yes, and for other non-face-to-face methods such as email and telemedicine as well. Payment for telehealth care is a topic of primary importance to AAP members.

The AAP Department of Practice recently conducted a survey on state Medicaid payment policies. The survey asked about payment policies and rates for several specific CPT codes, including telephone and online evaluation and management codes. The results will be available by Fall 2011.

Here's what the Section on Telehealth Care has done to help pediatricians get paid appropriately for these services.

1. Set policy
In 2006, the AAP published, "Payment for Telephone Care". This policy reviewed the role of telephone care in pediatric practice, the current reimbursement environment, and examined the evidence supporting the notion that telephone care improves the quality and cost of pediatric service delivery. Ethical considerations and barriers surrounding telephone fees were discussed. The policy also gave recommendations on how to introduce charging for telephone care to patients and third party payers.

2. Fixed CPT codes for Telehealth Care
The SOTC has worked with many other stakeholder groups to create new codes for Non-Face-to-Face Care that include codes for telephone encounters and online visits.
Click here to access the RVUs for these codes on the Academy's RBRVS brochure.

3. Showed pediatricians how to do it. (Member Center login required)
To help pediatricians understand and implement the policy on payment for telephone care the SOTC has revised its step-by-step tool kit. It includes sample patient communication, phone call documentation, billing procedures and suggestions for communicating with third party payers.
Click here for Toolkit.

None of this happened by chance or wishful thinking. It took the organization of the Section to study the problem, research alternatives, propose solutions, and advocate, advocate, advocate. That Section is the Section on Telehealth Care (SOTC).

Get connected to the latest information on payment for telephone care by joining the Section on
Telehealth Care. (View SOTC Membership).