(1) Definitions.
- (a) For the purpose of this rule, “telehealth” means providing healthcare remotely by means of telecommunications technology, including but not limited to telemedicine and telephonic or online digital services.
- (b) For the purpose of this rule, “telemedicine” means synchronous medical services provided via a real-time interactive audio and video telecommunications system between a patient at an originating site and a provider at a distant site.
- (c) “Distant site” means the place where the provider providing medical services to a patient through telehealth is located.
- (d) “Originating site” means the place where the patient receiving medical services through telehealth is located.
(2) Scope of services.
- (a) All services must be appropriate, and the form of communication must be appropriate for the service provided.
- (b) Notwithstanding OAR 436-009-0004, medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2025 or CPT® 2026.
(3) Distant site provider billing.
(a) When billing for telemedicine services, the distant site provider must:
- (A) Use the place of service (POS) code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and
- (B) Except for services billed with CPT® codes 98000 – 98007, use modifier 95 to identify the service as a synchronous medical service rendered via a real-time interactive audio and video telecommunications system.
(b) When billing for telehealth services other than telemedicine services, the distant site provider:
- (A) Must use the POS code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and
- (B) May not use modifier 95.
(4) Originating site billing. When billing for telehealth services, the originating site may charge a facility fee using HCPCS code Q3014, if the site is:
- (a) The office of a physician or practitioner; or
- (b) A health care facility including but not limited to a hospital, rural health clinic, skilled nursing facility, or community mental health center.
(5) Payment.
- (a) Insurers must pay distant site providers at the non-facility rate or at the provider's usual fee, whichever is less.
- (b) Equipment or supplies at the distant site are not separately payable.
- (c) The payment amount for code Q3014 is $35.70 per unit or the provider’s usual fee, whichever is lower. In calculating the units of time, 15 minutes, or any portion of 15 minutes, equals one unit.
- (d) Professional fees of supporting providers at the originating site are not separately payable.
(e) Insurers are not required to pay a telehealth transmission fee (HCPCS code T1014).
[ED. NOTE: To view attachments referenced in rule text, click here for PDF copy.]
Statutory/Other Authority
ORS 656.245, ORS 656.248, ORS 656.252, ORS 656.254 & ORS 656.726(4)
Statutes/Other Implemented
ORS 656.245, ORS 656.248, ORS 656.252 & ORS 656.254
History
WCD 2-2026, amend filed 03/25/2026, effective 04/01/2026
WCD 6-2025, temporary amend filed 12/24/2025, effective 01/01/2026 through 03/31/2026
WCD 1-2025, amend filed 03/10/2025, effective 04/01/2025
WCD 27-2024, temporary amend filed 12/09/2024, effective 01/01/2025 through 06/06/2025
WCD 1-2024, amend filed 03/05/2024, effective 04/01/2024
WCD 6-2023, temporary amend filed 12/26/2023, effective 01/01/2024 through 03/31/2024
WCD 5-2023, temporary amend filed 12/26/2023, effective 01/01/2024 through 03/31/2024
WCD 1-2023, amend filed 03/09/2023, effective 04/01/2023
WCD 12-2022, temporary amend filed 12/19/2022, effective 01/01/2023 through 06/29/2023
WCD 2-2022, amend filed 03/02/2022, effective 04/01/2022
WCD 19-2021, temporary amend filed 12/14/2021, effective 01/01/2022 through 06/29/2022
WCD 2-2021, amend filed 03/03/2021, effective 04/01/2021
WCD 21-2020, temporary amend filed 12/15/2020, effective 01/01/2021 through 06/29/2021
WCD 14-2020, amend filed 08/31/2020, effective 09/21/2020
WCD 4-2020, adopt filed 03/04/2020, effective 04/01/2020