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Telemedicine is a widely used term with varied definitions. For the purposes of this policy telemedicine, also known as telehealth, is the use of interactive telecommunications multimedia equipment that includes, at a minimum, audio and video equipment to provide services that are usually available in face-to-face contact. This technology permits two-way real-time interactive communication, for medical diagnostic, monitoring and therapeutic purposes, between an individual in one area (generally rural) and a physician or practitioner at a distant site (generally urban). This involves one clinician examining an individual patient while a clinician in another location interacts with the two by means of telecommunication. For the purposes of this policy, this definition does not include the use of telephones, facsimile machines, and electronic mail systems.

Note: Electroencephalogram (EEGs) is often considered telemedicine but does not conform to the definition of telemedicine services as described in this policy.

Telemedicine is considered investigational.

None

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

2/13/2004: Code Reference section completed

10/24/2006: Policy reviewed, no changes

10/24/2008: Policy reviewed, no changes

12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions

3/12/2010: Code Reference section updated. New HCPCS codes G0425, G0426 and G0427 added to non-covered table.

Blue Cross Blue Shield of Tennessee

 Blue Cross Blue Shield of North Carolina

 Aetna

 Centers for Medicare & Medicaid Services (CMS)

 Non-Covered Codes

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