Quick Reference to Telemedicine Guidelines in the Georgia Workers’ Compensation Medical Fee Schedule

Effective April 1, 2020, the Georgia State Board of Workers’
Compensation (SBWC) is providing guidance for the provision of select services
via telemedicine during the COVID-19 pandemic. The national and state health
guidelines for limiting COVID-19 exposure recommend social distancing and
avoiding all but essential public contact. Therefore, telemedicine is
encouraged as a way to protect injured workers and healthcare providers from
exposure to the coronavirus during medical appointments that do not require
emergency treatment at a time when the health care system is over-extended.

The guidance regarding telemedicine is subject to change at any time at
the discretion of the SBWC. Reimbursement rates for telemedicine services prior
to April 1, 2020, should be negotiated between the parties. For negotiation
assistance, refer to the reimbursement rates in the 2019 Medical Fee Schedule
that were in effect on the date of service.

The procedure codes listed below are eligible to be provided via
telemedicine if the patient is non-emergent and when the healthcare provider
and the patient agree to the medical appointment being handled via
telemedicine. These procedure codes are designated with a  in the Georgia Medical
Fee Schedule. The maximum allowable reimbursement for telemedicine services
shall be the lesser of billed charges or the professional maximum allowable
reimbursement (PROF MAR) amount as listed in the fee schedule.

Modifier 95
should be appended when reporting services provided via telemedicine. See page
11.

95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive
Audio and Video

Telecommunications
System

Synchronous telemedicine service is defined as a real-time interaction
between a physician or other qualified health care professional and a patient
who is located at a distant site from the physician or other qualified health
care professional. The totality of the communication of information exchanged
between the physician or other qualified health care professional and the
patient during the course of the synchronous telemedicine service must be of an
amount and nature that would be sufficient to meet the key components and/or
requirements of the same service when rendered via a face-to-face interaction.
Modifier 95 may only be appended to the services listed in Appendix P of CPT
2020. Appendix P is the list of CPT codes for services that are typically performed
face-to-face, but may be rendered via a real-time (synchronous) interactive
audio and video telecommunications system.

Evaluation
and Management Services

Physical Therapy, Occupational Therapy and
Speech Therapy Services

General Medicine
Services

CPT ©
2019 American Medical Association. All Rights Reserved.