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

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