DESCRIPTION
Telemedicine and telehealth 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. 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. 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.
For the purposes of this policy, this definition does not include the use of telephones, facsimile machines, electronic mail systems and digital imaging (i.e., digital photos).
POLICY
Telemedicine/ Telehealth are considered investigational.
See also:
Telemedicine Transmission of Electroencephalograms (EEGs)
ADDITIONAL INFORMATION
The four policies listed above are often considered telemedicine but they do not all conform to the definition of telemedicine and telehealth services as described in this policy.
There is a lack of evidence in the published literature to validate the use of telemedicine and telehealth in the diagnosis and treatment of individuals. Published studies have not demonstrated a significant impact by telemedicine and telehealth on improving an individual’s treatment choices and healthcare outcomes as compared to those of conventional medical healthcare services.
SOURCES
111th Congress: 1st Session: H.R. 2068: (2009, April). To improve the provision of telehealth services under the Medicare Program, to provide grants for the development of telehealth networks, and for other purposes. Retrieved August 5, 2009 from http://thomas.loc.gov.
Agency for Healthcare Research and Quality. (2006). Telemedicine for the medicare population: Update. Evidence Report/Technology Assessment Number 131. Retrieved August 5, 2009 from http://www.ahrq.gov/downloads/pub/evidence/pdf/telemedup/telemedup.pdf.
American Academy of Dermatology and AAD Association. (2004, May). Position Statement on telemedicine. Retrieved August 5, 2009 from http://www.aad.org/forms/policies/ps.aspx.
American Medical Association. (2008). H-160.937 The promotion of quality telemedicine. Retrieved August 5, 2009 from http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf. .
American Medical Association. (2008). H-225.962 Medical staff membership category for physicians providing telemedicine. Retrieved August 5, 2009 from http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf. .
American Medical Association. (2008). H-480.969 The promotion of quality telemedicine. Retrieved August 5, 2009 from http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf.
American Medical Association. (2008). H-480.974 Evolving impact of telemedicine. Retrieved August 5, 2009 from http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf.
American Telemedicine Association. (2002, October). Home telehealth clinical guidelines. Retrieved August 5, 2009 from http://www.americantelemed.org/files/public/standards/Home%20Telehealth%20Clinical%20Guidelines(1).pdf.
American Telemedicine Association. (2007, December). Practice Guidelines for Teledermatology. Retrieved August 5, 2009 from http://www.americantelemed.org/i4a/pages/index.cfm?pageID=3311.
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. (2008, December). Medicare payment of Telemedicine and Telehealth services. Retrieved August 5, 2009 from http://www.americantelemed.org/files/public/policy/Medicare_Payment_Of_Services.pdf.
Bashshur, R., Shannon, G., & Sapci, Hasan. (2005). Telemedicine evaluation. Telemedicine and e-Health, 11 (3), 296 - 316. (Level 5 Evidence)
BlueCross BlueShield Association. (2009). Healthcare trends in America: a reference guide from BCBSA 2009 edition. Retrieved August 5, 2009 from http://www.bcbs.com/blueresources/healthcare-trends-report/pdfs/2009-healthcare-trends-in-america.pdf.
BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2004). Electroencephalograms (EEGs) [2.01.14]. Retrieved August 5, 2009 from BlueWeb.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2005). Digital Imaging Systems for the Detection and Evaluation of Diabetic Retinopathy (9.03.13). Retrieved August 5, 2009 from BlueWeb.
Center for Telehealth and E-Health Law. (2005). Remote patient monitoring or telehomecare. Retrieved August 5, 2009 from http://www.ctel.org/RemotePatientMonitoring.html.
Centers for Medicare and Medicaid Services. (2009, April). Telemedicine. Retrieved August 5, 2009 from http://www.cms.hhs.gov/Telemedicine/.
Cohen, M., Rumreich, L., Garriot, K., & Jennings, S. (2005). Planning for PACS: a comprehensive guide to nontechnical considerations. Journal of the American College of Radiology, 2 (4), 327 - 337. (Level 5 Evidence)
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, July). Use of telehealth in delivery of home health services (NCD 110, p. 4-80). The Ingenix Complete Guide to Medicare Coverage Issues.
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, July). Telehealth services (NCD 270, pp. 4-268 - 4-271). The Ingenix Complete Guide to Medicare Coverage Issues.
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, July). Use of telehealth in delivery of home health services (Section 410.78, pp. 7-51 - 7-52). The Ingenix Complete Guide to Medicare Coverage Issues.
Cummings, C., Flint, P. Haughey, B., Robbins, K., Thomas, J., & Harker, L. (Eds.). (2005). Cummings: Otolaryngology: Head & Neck Surgery (4th ed., pp. 504 - 508). Philadelphia: Elsevier Mosby.
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)
National Guideline Clearinghouse. Society of American Gastrointestinal Endoscopic Surgeons (SAGES). (2007, May). Guidelines for the surgical practice of telemedicine. Retrieved August 5, 2009 from http://www.guideline.gov/summary/summary.aspx?doc_id=9857&nbr=005281&string=telemedicine.
Richter, G., Sun, G., Lee, T., Chan, R., Flynn, J., Starren, J., et al. (2009). Speed of telemedicine vs. ophthalmoscopy for retinopathy of prematurely diagnosis. American Journal of Ophthalmology, 148 (1), 136 - 142. (Level 4 Evidence)
Tennessee Code: Title 63 Professions of the Healing Arts: Chapter 6 Medicine and Surgery: Part 2 General Provisions, Issue of licenses: TENN CODE ANN. § 63-6-209 (b).Retrieved August 5, 2009 from http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=tncode.
Tennessee Code: Title 63 Professions of the Healing Arts: Chapter 10 Pharmacy: Part 6 Federally Qualified Health Center, Definitions requirements legislative intent: TENN CODE ANN. § 63-10-601 (a-2, e). Retrieved August 5, 2009 from http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=tncode.
U. S. Food and Drug Administration. (1997. December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K973873, Retrieved August 5, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf/K973873.pdf.
U. S. Food and Drug Administration. (2006. November). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K062662, Retrieved August 5, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf6/K062662.pdf.
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.
ORIGINAL EFFECTIVE DATE: 2/1/2003
MOST RECENT REVIEW DATE: 10/8/2009
ID_BT
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.