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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.
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.
POLICY HISTORY3/2003: Approved by Medical Policy Advisory Committee (MPAC)
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
Centers for Medicare & Medicaid Services (CMS)
CODE REFERENCEThis is not intended to be a comprehensive list of codes. Some codes may be variable, and coverage will be based on the clinical indication for the service.