Permanent Rules Adopted

Jurisdiction
Colorado
Publication
Issue 16
Volume 43
Published August 26, 2020
Rule Type
Final Rule
Issuing Body
Department of Labor and Employment
Division of Workers' Compensation

Notice Text

AGOpinion
Philip J. Weiser Ralph L. Carr
Attorney General Colorado Judicial Center
1300 Broadway, 10th floor
Natalie Hanlon Leh Denver, CO 80203
Chief Deputy Attorney General Phone 720-508-6000
Eric R. Olson Office of the Attorney General
Solicitor General STATE OF COLORADO
DEPARTMENT OF LAW
Tracking Number: 2020-00423
OPINION OF THE ATTORNEY GENERAL RENDERED IN CONNECTION WITH THE RULES ADOPTED BY THE Division of Workers; Compensation ON 07/27/2020
7 CCR 1101-3
WORKERS' COMPENSATION RULES OF PROCEDURE WITH TREATMENT GUIDELINES
The above-referenced rules were submitted to this office on 07/27/2020 as required by section 24-4-103, C.R.S. This office has reviewed them and finds no apparent constitutional or legal deficiency in their form or substance.
August 10, 2020 15:43:48 MST
Philip J. Weiser Attorney General by Eric R. Olson Solicitor General
18-3 GENERAL POLICIES (B) Place of Service Codes: Place of Service Code Description 19 Off Campus - Outpatient Hospital 21 Inpatient Hospital 22 On Campus - Outpatient Hospital 23 Emergency Room-Hospital 24 Ambulatory Surgery Center (ASC) 26 Military Treatment Facility 31 Skilled Nursing Facility 34 Hospice 41 Ambulance - Land 42 Ambulance - Air or Water 51 Inpatient Psychiatric Hospital 52 Psychiatric Facility-Partial Hospitalization 53 Community Mental Health Center 56 Psychiatric Residential Treatment Center 61 Comprehensive Inpatient Rehabilitation Facility The table below lists the place of service codes corresponding to the RBRVS facility RVUs. All other maximum fee calculations shall use the non-facility RVUs listed in the RBRVS. 18-4 PROFESSIONAL FEES AND SERVICES (I) TELEMEDICINE (1) In addition to the healthcare services listed in Appendix P of CPT®, and Division Z-codes (when appropriate), the following CPT® codes may be provided via telemedicine: G0396, G0397, G0406-G0408, G0425-G0427, G0436, G0437, G0447, G0459, G0508, G0509, 97110, 97112, 97116, 91729, 97130, 97150, 97530, 97535, 97542, 97750, 97755, 97760, 97761, and 98960-98962. Additional services may be provided via telemedicine with prior authorization. The provider shall append modifier 95 to the appropriate CPT® code(s) to indicate synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. All treatment provided through telemedicine shall comply with the applicable requirements found in the Colorado Medical Practice Act and Colorado Mental Health Practice Act, as well as the rules and policies adopted by the Colorado Medical Board and the Colorado Board of Psychologist Examiners and shall follow applicable laws, rules and regulations for informed consent. (2) HIPAA privacy and electronic security standards are required for the originating site and the rendering provider. (3) The physician-patient/psychologist-patient relationship needs to be established. This relationship is established through assessment, diagnosis, and treatment of the injured worker. Both in-person evaluation and, two-way live audio/video services are among acceptable methods to 'establish' a patient relationship. (4) Reimbursement: (a) The rendering provider may be the only provider involved in the provision of telemedicine services. The rendering provider shall bill place of service (POS) code 02. Maximum allowance is the appropriate CPT® code's non-facility relative weight from RBRVS multiplied by the appropriate CF, unless only a facility weight is established. (b) An originating site fee may only be billed when the injured worker is receiving services at an authorized originating site. The originating site is responsible for verifying injured worker and rendering provider's identities. Originating site must bill with the appropriate facility POS code. Authorized originating sites include: • A Hospital (inpatient or outpatient) • A Critical Access Hospital (CAH) • A Rural Health Clinic (RHC) • A federally qualified health center (FQHC) • A hospital based renal dialysis center (including satellites) • A Skilled Nursing Facility (SNF) • A community mental health center (CMHC) Maximum allowance for Q3014 is $35.00 per 15 minutes. (Equipment, supplies, and professional fees of supporting providers at the originating site are not separately payable.) (5) Documentation: Documentation requirements are the same as for a face-to-face encounter and shall also include the location of the rendering provider and the injured worker at the time of service, and a statement on how the treatment was rendered through telemedicine (such as secured video).