BlueCross BlueShield of Tennessee Medical Policy Manual

Telehealth

DESCRIPTION

Telehealth (a.k.a., telemedicine) for the purposes of this policy are both defined as the use of interactive telecommunications multimedia equipment for the exchange of medical information from one site to another. This technology permits two-way real-time interactive electronic communications to improve an individual’s health and also store and forward technology. It is used 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.

An individual’s medical information may include but is not limited to video clips, still images, x rays, MRIs, EKGs, EEGs, laboratory results audio clips and text. At a minimum, the technologies included are audio and video equipment that provide healthcare services usually available in face-to-face contact. Telemedicine is sometimes associated more with direct individual clinical services and telehealth with a broader definition of remote healthcare services.

POLICY

See also:  Retinal Telescreening for Diabetic Retinopathy

MEDICAL APPROPRIATENESS

SOURCES

American Medical Association. (2006). Telemedicine. Retrieved January 24, 2013 from https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-480.968.HTM.

American Medical Association. (2006). The promotion of quality telemedicine. Retrieved January 24, 2013 from https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-160.937.HTM.

American Medical Association. (2009). Creation of AMA data bank on interstate practice of medicine. Retrieved January 24, 2013 from https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fDIR%2fD-275.996.HTM.

American Medical Association. (2009). State authority and flexibility in medical licensure for telemedicine. Retrieved January 24, 2013 from https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fDIR%2fD-480.999.HTM.

American Medical Association. (2012). Evolving Impact of telemedicine. Retrieved January 24, 2013 from https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-480.974.HTM.

American Medical Association. (2012). Security of telemedicine communication. Retrieved January 24, 2013 from https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fDIR%2fD-480.976.HTM.

American Medical Association. (2012). Teleconsultations and Medicare reimbursement. Retrieved January 24, 2013 from https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-480.961.HTM.

American Telemedicine Association. (2007, November). Core standards for telemedicine operations. Retrieved August 5, 2009 from http://www.americantelemed.org/i4a/pages/index.cfm?pageID=3311.

American Telemedicine Association. (2011, November). Expert consensus recommendations for videoconferencing-based telepresenting. Retrieved January 17, 2013 from http://www.americantelemed.org/files/public/standards/Videoconferencing-Based-Telepresenting_wCover.pdf.

Complete Guide to Medicare Coverage Issues [Computer software]. (2012, November). Telehealth services (Section 410.78, p. 7-49, 7-50). Ingenix.

Diver, A., Lewis, H., & Gordon, D. (2009). Telemedicine and trauma referrals - a plastic surgery pilot project. Ulster Medical Journal, 78 (2), 113 - 114. (Level 4 evidence)

Giansanti, D., Maccioni, G., & Morelli, S. (2008). An experience of health technology assessment in new models of care for subjects with Parkinson’s disease by means of a new wearable device. Telemedicine and E Health, 14 (5), 467 - 472. (Level 5 Industry sponsored)

Levin, Y., & Warshaw, E. (2009). Teledermatology: a review of reliability and accuracy of diagnosis and management. Dermatologic Clinics, 27 (2), 163 - 176. (Level 5 evidence)

Myer, B., Raman, R., Hemmen, T., Obler, R., Zivin J., Rao, R., et al. (2008). Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomized, blinded, prospective study. Lancet Neurology, 7 (9), 787 - 795. (Level 2 evidence)

The Joint Commission. (2011). Telemedicine requirements critical access hospital accreditation program. Retrieved January 24, 2013 from http://www.jointcommission.org/assets/1/6/Pre-Pub_20111214_Telemedicine_CAH.pdf.

The Joint Commission. (2011). Telemedicine requirements hospital accreditation program. Retrieved January 24, 2013 from http://www.jointcommission.org/assets/1/6/PrePub_20111209_Telemedicine_HAP.pdf.

Tennessee Code: Title 56 Insurance: Chapter 7 Policies and Policyholders: Part 10 Health and Accident Insurance: 56-7-1002. Telehealth services. Retrieved February 2, 2015 from https://web.lexisnexis.com/research/retrieved? m=d0b0748023f5f29d3c87ca283515caa5&c.

U. S. Food and Drug Administration. (2008. October). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K082664, Retrieved August 5, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf8/K082664.pdf.

U. S. Food and Drug Administration. (2009. January). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K083046, Retrieved August 5, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf8/K083046.pdf.

Winifred S. Hayes, Inc. Medical Technology Directory. (2011, May). Teledermatology for diagnosis and management of skin neoplasms. Retrieved October 30, 2012 from www.Hayesinc.com/subscribers (47 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  2/1/2003

MOST RECENT REVIEW DATE:  2/13/2017

ID_Product Development

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.