Email, Phone & Fax
“Audio-only visits” means the use of telephone and other audio-only technologies to deliver services.
“eConsults” means the asynchronous or synchronous, consultative, provider-to-provider assessment and management services conducted through telephone, internet, or electronic health records.
“Virtual Check-in” means a brief communication via a secure, technology-based service initiated by the patient or patient’s guardian/caregiver, e.g., virtual check-in by a physician or other qualified healthcare professional.
Payment for telehealth services shall be made in accordance with section 538.3 of this Part only if the provision of such services appropriately reduces the need for on-site or in-office visits and the following standards are met:
- An “audio-only visit” is reimbursable when the service can be effectively delivered without a visual or in-person component; and it is the only available modality or is the patient’s preferred method of service delivery; and the patient consents to an audio-only visit; and it is determined clinically appropriate by the ordering or furnishing provider; and the provider meets billing requirements, as determined and specified by the commissioner in administrative guidance. Services provided via audio-only visits shall contain all elements of the billable procedures or rate codes and must meet all documentation requirements as if provided in person or via an audio-visual visit.
- “eConsults” are intended to improve access to specialty expertise through consultations between consulting providers and treating providers. eConsults are reimbursable when the providers meet minimum time and billing requirements, as determined and specified by the commissioner in administrative guidance.
- “Virtual Check-in” visits are intended to be used for brief medical discussions or electronic communications between a provider and a new or established patient, at the patient’s request. Virtual check-ins are reimbursable when the provider meets certain billing requirements, as determined and specified by the commissioner in administrative guidance.
As required by Social Services Law § 367-u and, except for services paid by State only funds, contingent upon federal financial participation, reimbursement shall be made in accordance with fees determined by the commissioner based on and benchmarked to in-person fees for equivalent or similar services.
SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538.1-3, as proposed by Final rule per Notice Of Adoption. (Accessed Apr. 2025).
Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication, except that with respect to the medical assistance program shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner.
SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Apr. 2025).
The commissioner may specify in regulation additional acceptable modalities for the delivery of health care services via telehealth, including but not limited to audio-only or video-only telephone communications, online portals and survey applications, and may specify additional categories of originating sites at which a patient may be located at the time health care services are delivered to the extent such additional modalities and originating sites are deemed appropriate for the populations served.
SOURCE: NY Public Health Law Article 29 – G Section 2999-ee. (Accessed Apr. 2025).
Legislation Effective until April 1, 2026 – Health care services delivered by means of telehealth shall be entitled to reimbursement on the same basis, at the same rate, and to the same extent the equivalent services, as may be defined in regulations promulgated by the commissioner, are reimbursed when delivered in person; provided, however, that health care services delivered by means of telehealth shall not require reimbursement to a telehealth provider for certain costs, including but not limited to facility fees or costs reimbursed through ambulatory patient groups or other clinic reimbursement methodologies, if such costs were not incurred in the provision of telehealth services due to neither the originating site nor the distant site occurring within a facility or other clinic setting. For services licensed, certified or otherwise authorized, such services provided by telehealth, as deemed appropriate by the relevant commissioner, shall be reimbursed at the applicable in person rates or fees established by law, or otherwise established or certified by the office for people with developmental disabilities, office of mental health, or the office of addiction services and supports.
Both temporary and permanent statute state that while services delivered by means of telehealth shall be entitled to reimbursement, reimbursement for additional modalities, provider categories, originating sites and audio-only telephone communication defined in regulations shall be contingent upon federal financial participation.
SOURCE: NY Public Health Law Article 29 – G Section 2999-dd, as amended by A 9007 (2022 Session) and extended by S 8307 (2024 Session). (Accessed Apr. 2025).
Reimbursement policy applies to fee-for-service and Medicaid Managed Care plans.
NYS Medicaid covered services provided via telehealth include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a NYS Medicaid member. This definition includes audio-only services when audio-visual is unavailable, or a member chooses audio-only.
Under NYS Law Chapter 45 Article 29-G §2999-DD, healthcare services delivered by means of telehealth are entitled to reimbursement on the same basis, at the same rate, and to the same extent the equivalent services, as may be defined in regulations promulgated by the commissioner, are reimbursed when delivered in person. Exceptions from payment parity exist for some facility types, including Article 28 licensed facilities. Such exceptions exclude certain costs, including facility fees when such costs were not incurred to deliver telehealth services because neither the patient nor the provider were located at the facility or clinic setting when the service was delivered. This law is effective until April 1, 2026.
See manual for modifiers and place of service codes to be used when billing for telehealth modalities, as well as billing instructions for telehealth by site and location.
SOURCE: NY Dept. of Health Medicaid Telehealth Policy Manual (Dec. 2024), p. 5-6, 12-15. (Accessed Apr. 2025).
Telephonic service uses two-way electronic audio-only communications to deliver services to a patient at an originating site by a telehealth provider. For complete billing instructions for telephonic services, providers can refer to the “Billing Rules for Telehealth Services”, “Telephonic (Audio-only) Reimbursement Overview” section of the Medicaid Telehealth Provider Manual.
NYS Medicaid expanded coverage of remote services to include audio-only visits, to increase access to services, eliminate barriers, supplement oversight of chronic conditions, and improve outcomes. Decisions on what type of visit the NYS Medicaid member receives should be based on their choice and best interest. Provider preference or convenience are not relevant. Providers must use professional judgment to determine whether audio-only services meet patient needs and whether a visit is eligible for audio-only based on criteria below. The Department anticipates limited occasions when audio-only visits are appropriate for medical visits (non-behavioral health (BH) or community health worker (CHW) services). For example, during weather emergencies when the patient is unable to use audio-visual technologies or when the visit could not occur unless provided via audio-only telehealth. NYS DOH will monitor audio-only billing and take steps to limit overuse and prevent misuse of audio-only services.
NYS Medicaid covers audio-only visits for NYS Medicaid members when all the following conditions are met:
- audio-visual telehealth is not available to the patient due to lack of patient equipment or connectivity or audio-only is the preference of the patient;
- the provider must make either audio-visual or in-person appointments available at the request of the patient;
- the service can be effectively delivered without a visual or in-person component, unless otherwise stated in guidance issued by the NYS DOH (this is a clinical decision made by the provider); and
- the service provided via audio-only visits contains all elements of the billable procedures or rate codes and meets all documentation requirements as if provided in person or via an audio-visual visit.
Additional programmatic guidance may be published that specifically allows or prohibits the use of audio-only telehealth by type of service. Additional agency-issued guidance outlines the appropriateness of audio-only visits for their specific populations. See billing rules in Section 9.6 “Telephonic (Audio-Only) Reimbursement Review.”
When audio-only telehealth is used in accordance with the policy outlined in “Telehealth Definitions”, “Telephonic (Audio-only),” providers may bill NYS Medicaid as they would for an in-person or audio-visual telehealth visit (using the appropriate procedure or rate code) with the addition of a telehealth modifier to indicate delivery by audio-only. The American Medical Association deleted the telephonic (audio-only) E/M procedure codes “99441” through “99443” effective January 1, 2025.
Services provided via audio-only visits shall contain all elements of the billable procedures or rate codes and must meet all documentation requirements as if provided in person or via an audiovisual visit.
The telephonic rate codes “7961” through “7968” were retired effective November 1, 2023. FQHCs can bill the Prospective Payment System (PPS) rate code “4012” or “4013”, depending on on-site presence as outlined in “Billing Rules for Telehealth Services”, “FFS Billing for Telehealth by Site and Location.” Wrap payments are available for any telehealth services, including telephonic services reimbursed by an MMC Plan, under qualifying PPS and off-site rate codes.
All audio-only claims and encounters must include the “93” or “FQ” modifier unless modifiers are not allowable (e.g., teledentistry). The “UA” modifier should no longer be used to indicate the service as delivered via audio-only.
When a POS is allowable on a claim or encounter, providers should report POS “02” for telehealth provided other than in patient’s home, “10” for telehealth provided in the home of the patient, except in cases where POS “11” is typically submitted (private practice or office setting); POS “11” providers should continue to report POS “11” and use telehealth modifiers on the claim or encounter to identify it as telehealth.
NYS Medicaid does not prescribe a list of services deemed appropriate or prohibited for audio-only telehealth, but other payors, programs, or agencies may issue additional guidance that supplements or supersedes this policy (see “Restrictions for Specific Services or Populations”). For example, CMS publishes a List of Telehealth Services which includes services allowable via audio-only for Medicare claims. MMC Plans may have separate detailed billing guidance that supplements the billing guidance outlined in this issue, but must cover all services appropriate to deliver through telehealth, including audio-only telehealth. Further detail on FFS code coverage is provided in specialized guidance for mental health, substance use, and NYS OPWDD services.
Virtual Check-Ins
Virtual check-ins are brief medical interactions between a physician or other qualified health care professional and a patient. Virtual check-ins may be especially helpful for patients with ongoing chronic conditions that would benefit from recurring check-ins with their provider. A virtual check-in can be conducted via several technology-based modalities, including communication by telephone or by secure text-based messaging, such as electronic interactions via patient portal, secure email, or secure text messaging.
Communication must be Health Insurance Portability and Accountability Act (HIPAA)-compliant and don’t relate to an Evaluation and Management (E&M) visit the patient had within the past seven days, nor lead to a related E&M visit within 24 hours (see “Billing Rules for Telehealth Services” for specific information on code and modifiers).
Virtual check-ins must be patient-initiated and allow patients to communicate with their provider in order to avoid an unnecessary visit; however, practitioners may need to inform and educate beneficiaries on the availability of the service prior to patient initiation. A parent or caregiver may initiate a virtual check-in on behalf of a patient. The patient must consent to receive virtual checkin services and the provider must document the consent of the patient in their chart at least once annually while the patient receives virtual check-in services.
Expanding on previous policy, NYS Medicaid-enrolled providers (physician or other qualified health care professional who report E&M services) can bill CPT codes “G2012”* or “G2252” for reimbursement for virtual check-ins. The virtual check-in must be reported on the claim with the appropriate telehealth modifier (“93”, “95”, “FQ”, “GT”, and “GQ”). Communications reported with a virtual check-in CPT code must meet the criteria outlined in the Medicaid Telehealth Provider Manual.
*The American Medical Association replaced HCPCS code “G2012” with CPT code “98016” effective January 1, 2025.
Additional agency-issued guidance may be available for specific populations. NYS OPWDD, OASAS, and OMH providers should review their respective guidance to ensure compliance.
SOURCE: NY Dept. of Health Medicaid Telehealth Policy Manual (Dec. 2024), p. 7-8, 17-18, 21-22. (Accessed Apr. 2025).
Telemental Health
Audio-only or audio-video communication is an acceptable option only when determined appropriate by the provider of service, in accordance with guidelines established by the Office, and with informed consent from the recipient. Where the recipient is a minor, consent shall also be provided by the parent/guardian or other person who has legal authority to consent to health care on behalf of the minor.
Audio-only or audio-video communication is covered by Medicaid and the Child Health Insurance Plan to the extent consistent with regulations promulgated by the New York State Commissioner of Health pursuant to Section 2999-cc of the Public Health Law.
Telehealth services do not include an electronic mail message, text message, or facsimile transmission between a provider and a recipient, services provided where the originating and distant sites are the same location, or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support teleealth services.
SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.1(d)(e) & 596.4(r), as amended by Final Rule and Notice Of Adoption. (Accessed Apr. 2025).
Telehealth Services means the use of Telehealth Technologies by Telehealth Practitioners to provide mental health services at a distance. Such services do not currently include an electronic mail message, text message, or facsimile transmission between a practitioner and an individual receiving services, services provided where the originating and distant sites are the same location, or a consultation between two (2) physicians or nurse practitioners, or other staff, although these activities may support Telehealth Services. Telehealth Services must be synchronous. Where program regulations or guidance define an individual’s service provider as a collateral, a discussion or consultation between the Telehealth Practitioner and the individual’s other provider is considered a collateral contact, therefore is considered a Telehealth Service.
OMH’s position is that in-person and Audio-visual telehealth are the preferred methods for service delivery, while recognizing that Audio-only service delivery, where appropriate, has an important role to play in increasing access to care. OMH expects providers to use their judgment and respect individual and, as applicable, family preference in deciding which services and in which circumstances to utilize the appropriate telehealth modality to best meet the individual’s needs.
Telehealth Services must include all elements of the billable procedure code or rate codes and all required documentation, and the provider must decide that services can be effective using Telehealth Technologies and without an in-person component. Additionally, for Audio-only Telehealth Services, pursuant to Department of Health (DOH) regulation 18 NYCRR § 538.2, providers must decide that services can be effectively delivered without a visual or in-person component.
For individuals without the developmental capacity to participate meaningfully telephonically, the Audio-only modality is not recommended.
- Children 0-5 do not have the developmental capacity to participate meaningfully telephonically. Audio-only telehealth is not permissible for individual sessions with children 0-5 or dyadic sessions with a child 0-5 and parent. Audio-only telehealth is permissible for collateral sessions with parent/guardian of a child 0-5.
For all Telehealth Services including children/youth, Audio-visual is strongly encouraged.
- All services for children/youth (up to age 18 or 21, based on regulation and program guidance) must include visualization of the individual (using Audio-visual Telehealth Services or in-person) in the initial assessment period and every 12 months thereafter at minimum. When this does not occur, reasons should be documented.
- Audio-visual options should be fully explored with parents/guardians prior to considering Audio-only services.
For Audio-only Telehealth Services, DOH Medicaid guidance requires that providers document why Audio-only services were used for each encounter, i.e., Audio-only Telehealth Services are the individual’s preference or Audio-visual Telehealth Services are not available due to lack of equipment or connectivity.
See OMH Guidance for additional OMH program-specific audio-only considerations.
When clinically appropriate, prescribers may provide medication treatment services using Audio-only telehealth.
SOURCE: NY State Office of Mental Health Telehealth Services Guidance for OMH Providers (April 2023), p. 4-6, 8, 12. (Accessed Apr. 2025).
Crisis Services for Individuals with Intellectual and/or Developmental Disabilities (CSIDD)
Effective May 12, 2023, with the end of the Public Health Emergency (PHE), the State of New York will continue to allow the remote delivery of CSIDD through telephonic or other technology in accordance with State, Federal, and Health Insurance Portability and Accountability Act (HIPAA) requirements. Other technology means any two-way, real-time communication technology that meets HIPAA requirements. See Telehealth Allowance Attachment which will serve as an addendum to CSIDD ADM #2021-04R and outlines the allowance of the remote delivery of Crisis Services for Individuals with Intellectual and/or Developmental Disabilities (CSIDD).
SOURCE: OPWDD ADM#2021-04R Telehealth Allowance Attachment, Jul. 2024. (Accessed Apr. 2025).
Office for People with Developmental Disabilities (OPWDD) Article 16 Clinics – Individuals with Intellectual/Developmental Disabilities (I/DD)
Various procedure codes are approved by OPWDD for use in Article 16 clinics via telehealth, designated as allowed for either or both live video and audio-only. See Article 16 APG Crosswalk for codes.
SOURCE: OPWDD A16 APG Crosswalk 2024. (Accessed Apr. 2025).
Teledentistry
Telephonic (audio only) dental encounters are intended to increase access to services when audio-visual telehealth is not available to the patient or audio-only is the preference of the patient. This service is billable utilizing Current Dental Terminology (CDT) code “D9991”. Providers must use professional judgment to determine whether audio-only services meet patient needs and whether an audio-only visit meets criteria for eligibility. NYS DOH anticipates only rare occasions when audio-only visits are appropriate for dental encounters.
Dental telehealth services shall adhere to the standards of appropriate patient care required in other dental health care settings, including but not limited to appropriate patient examination and review of the medical and dental history of the patient. For additional information, providers can refer to NYS Law Chapter 45 Article 29-G §2999-DD.
Teledentistry may be employed during encounters delivered under a collaborative practice arrangement, as determined by the dentist or dental hygienist.
SOURCE: NY Dept. of Health Medicaid Telehealth Policy Manual (Dec. 2024), p. 14-15. (Accessed Apr. 2025).
Physicians
Medicaid payment is based upon the direct provision of a personal and identifiable service to the enrollee. Payment is not appropriate for appointments for medical care, which are not kept, or for services rendered by a physician to a patient over the telephone.
SOURCE: NY State Medicaid Program, Policy Guidelines: Physicians Manual, Feb. 2025, (Accessed Apr. 2025).
Nurse Practitioners
Reimbursement will not be made for appointments for medical care which are not kept, or for services rendered to a client over the telephone.
SOURCE: NY State Medicaid Program, Policy Guidelines: Nurse Practitioner Manual, Version 2022-1, pg. 25. (Accessed Apr. 2025).