Specifications

107 VI Streamlining Administration
The EyePACS Handbook: Tools for Program Success
 Specialist at distant site
 Check with individual payers regarding specific instructions
 Standard Medi-Cal FFS guidelines
 Only ACGME trained Ophthalmologists qualify
 Reimbursable services depending on scope of service & setting
– 99241 – 99243 (Office Consultation)
– 99251 – 99253 (Inpatient Consultation)
– 99211 – 99214 (Established Patient Office Visit)
– 99231 – 99233 (Subsequent Hospital Care)
– Must add “GQ” modifier
Medicare
 Only reimburses for store-and-forward DRS services when provider is
participating in the federal telemedicine demonstration project
 Project currently only active in Alaska & Hawaii
Anthem Blue Cross
 DRS reimbursement qualifies for CalPERS plans only
 FQHC as originating site
 Originating site fee
 Claim form: UB-04
 HCPCS Code: Q3014
 Revenue Code: 780
 Bill Type: 130
 Evaluation & management (E/M) code
 May bill preparation for the service as a part of the primary care
physician’s office visit. Consider total time & scope of services
provided to determine appropriate code.
 Claim form: UB-04
 HCPCS Code: Appropriate E/M code
 Modifier: GQ
 Revenue Code: 780
 Bill Type: 13
 Specialist at distant site
 Specialists must be approved providers/locations
 Billing for distant site services
 HCPCS Code: Appropriate E/M code
 Modifier: GQ
CMSP
 CMSP program administered by Anthem Blue Cross
 Follows the same guidelines as Anthem Blue Cross for CalPERS
 Important note: FQHCs qualify for an originating site fee outside of their
standard PPS reimbursement. Originating site services reimbursement occurs
quarterly