Email, Phone & Fax
Telehealth encompasses telemedicine as well as a broader umbrella of services that includes the use of such technologies as telephones, interactive and secure medical tablets, remote patient monitoring devices, and store-and-forward devices. Telehealth includes services delivered in the dental health setting (i.e., teledentistry), and telehealth policies for dentistry are covered in the dental manuals.
Telemedicine: This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine does not include an audio-only telephone.
Audio only: The use of real-time telephonic communication that does not include use of video.
Attachment A lists covered services that may be reimbursed when provided via telehealth. Specifically: …
- Table 7 and Table 8 lists audio-only telehealth services
Telemedicine and Audio-Only Telehealth
- Services delivered via telemedicine or audio-only telehealth must be provided with the same standard of care as services provided in person.
- Telemedicine or audio-only telehealth must not be used when in-person services are medically and/or clinically necessary. The distant Provider is responsible for determining that the service meets all requirements and standards of care. Certain types of services that would not be expected to be appropriately delivered via telemedicine include, but are not limited to, those that: are performed in an operating room or while the patient is under anesthesia; require direct visualization or instrumentation of bodily structures; involve sampling of tissue or insertion/removal of medical devices; and/or otherwise require the in-person presence of the patient for any reason.
- If, after initiating a telemedicine or audio-only telehealth visit, the telemedicine or audio-only telehealth modality is found to be medically and/or clinically inappropriate, or otherwise can no longer meet the requirements stipulated in the “Reimbursable Telehealth Services” section, the Provider shall provide or arrange, in a timely manner, an alternative to meet the needs of the member. In this circumstance, the Provider shall be reimbursed only for services successfully delivered.
Distant site Providers must include:
- the modifier GT on claims for services delivered via telemedicine
- the modifier 93 on claims for services delivered via audio-only telehealth.
CPT codes for activities that are not considered to be essentially in-person services per the CPT Manual do not require telehealth modifiers. Examples include codes used exclusively for audio-only delivery of services (see Table 7 in this supplement below).
SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) & Updates to Telehealth Services Supplement Memo, May 13, 2024, (Accessed Apr. 2025).
Opioid Treatment Services
Intensive outpatient service providers shall meet the ASAM Level 2.1 service components. The following service components shall be assessed and monitored weekly and shall be provided in accordance to the ASAM Criteria, as directed by the member’s ISP and based on the member’s treatment needs identified in the multidimensional assessment. The provider must demonstrate the following service components in the member’s ISP as medically necessary, through provision of services or through referral: …
- Requests for a psychiatric or a medical consultation shall be available within 24 hours of the requested consult by telephone and preferably within 72 hours of the requested consult in person or via telemedicine. Referrals to external resources are allowed in this setting;
Partial hospitalization (ASAM Level 2.5) service components shall include the following provided at least once weekly or as directed by the ISP and based on the member’s treatment needs identified in the multidimensional assessment: …
- Psychiatric and medical formal agreements to provide medical consult within 8 hours of the requested consult by telephone, or within 48 hours in person or via telemedicine. Referrals to external resources are allowed in this setting;
In addition to the above, Partial Hospitalization Services (ASAM Level 2.5) co-occurring enhanced programs shall offer the following: …
- Psychiatric services as appropriate to meet the member’s mental health condition. Services may be available by telephone and on site, or closely coordinated off site, or via telemedicine.
- Clinical leadership and oversight and, at a minimum, capacity to consult with an addiction psychiatrist via telephone, telemedicine, or in person.
In addition to the Level 3.1 service components listed in this section, Clinically Managed Low Intensity Residential:
- Programs for members who have both unstable substance use and psychiatric disorders including appropriate psychiatric services, medication evaluation and laboratory services. Such services are provided either on-site, via telemedicine, or closely coordinated with an off-site provider, as appropriate to the severity and urgency of the member’s mental health condition
Clinically managed population-specific high intensity residential services (ASAM Level 3.3) as defined in 12VAC30-130-5120 and 12VAC35-105-1590 to 1620, must have all the following service components through service provision or through referral:
- Access to consulting physician or physician extender and emergency services 24 hours a day and seven days a week via telephone and in person.
Clinically managed high-intensity residential services (adult) and clinically managed medium-intensity residential services (adolescent) (ASAM Level 3.5) as defined in 12VAC30-130-5130 and 12VAC35-105-1530 to 1570, are residential treatment services which shall include through service provision or through referral:
- Telephone or in-person consultation with a physician or physician-extender who shall be available to perform required physician services. Emergency services shall be available 24 hours per day and seven days per week.
Clinically managed high-intensity residential services (adult) and clinically managed medium-intensity residential services (adolescent) (ASAM Level 3.5) co-occurring enhanced programs shall include the services listed in this section in addition to psychiatric services (psychiatric evaluation and/or therapy individual, group, family), medication evaluation, and laboratory services which shall be available by telephone within eight hours of requested service and on-site or via telemedicine, or closely coordinated with an off-site provider within 24 hours of requested service, as appropriate to the severity and urgency of the member’s mental and physical condition. Level 3.5 cooccurring enhanced programs offer planned clinical activities designed to stabilize the member’s mental health problems and psychiatric symptoms, and to maintain such stabilization. Planned clinical activities shall be required and shall be designed to stabilize and maintain the member’s mental health problems and psychiatric symptoms.
A psychiatric assessment of the member shall occur within four hours of admission by telephone and within 24 hours following admission in person or via telemedicine, or sooner, as appropriate to the member’s behavioral health condition, and thereafter as medically necessary. A behavioral health-focused assessment at the time of admission shall be performed by a registered nurse or licensed mental health clinician. A licensed registered nurse or licensed practical nurse supervised by a registered nurse shall be responsible for monitoring the member’s progress and administering or monitoring the member’s self-administration of medications.
Additions to the Telehealth Supplement include defining virtual check-in services, identifying covered codes, specifying reimbursement requirements, and outlining fee-for-service (FFS) billing details. See Update for list of codes.
As noted in the Telehealth Supplement (Attachment A), all FFS claims for audio only codes should be billed directly to DMAS, including those delivered in the context of mental health and substance use disorder services. Chapter V of the Physician/Practitioner Manual provides detailed billing instructions for submitting claims to DMAS.
Care Management
Care Management includes care coordination, but is primarily conducted telephonically and is typically performed by a benefits administrator or managed care company. This is in order to include network and claims data and trend analysis for enhanced care planning for individual cases.
Peer Services
Face-to-face services may be provided through telemedicine. Coverage of services delivered by telemedicine are described in the “Telehealth Services Supplement”. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.
Telephone time is supplemental rather than replacement of face-to-face contact and is limited to 25% or less of total time per recipient per calendar year. Justification for services rendered with the member via telephone shall be documented. Any telephone time rendered over the 25% limit will be subject to retraction.
Contact shall be made with the member receiving Peer Support Services or Family Support Partners a minimum of twice each month. At least one of these contacts must be face-to-face and the second may be either face-to-face or telephone contact, subject to the 25% limitation described above, depending on the member’s support needs and documented preferences.
In the absence of the required monthly face-to-face contact and if at least two unsuccessful attempts to make face-to-face contact have been tried and documented, the provider may bill for a maximum of two telephone contacts in that specified month, not to exceed two units. After two consecutive months of unsuccessful attempts to make face-to-face contact, discharge shall occur.
BIS Case Management
Case Management Agency Requirements – The provider agency also must: …
- Guarantee that individuals have access to emergency assistance either directly or on-call 24 hours per day, seven days per week and holidays. This may be done via telephone and face-to face contact and/or coordination with other providers and DBHDS administered crisis services.
Intensive Community Based Services
Crisis intervention must be available 24 hours per day, seven days per week, including holidays, via telephone and face-to face contact.
After hours crisis intervention provided by a qualified ACT team member through audio only telehealth may be included in the 15-minute minimum required to bill the per diem if the provider determines that the crisis can be safely managed through telephonic services as specified in the ISP.
Community Mental Health Rehabilitative Services
Family meetings and contacts, either in person or by telephone, occurs at least once per week to discuss treatment needs and progress. Contacts with parents/guardian include at a minimum the youth’s progress, any diagnostic changes, any ISP changes, and discharge planning. The parent/guardian should be involved in any significant incidents during the school day and be informed of any changes associated with the ISP. Family meetings are not considered to be the same as family therapy.
Psychiatric Services
The following are non-covered services: …
- Telephone consultations
Opioid Treatment Services
In addition, OTP providers must meet the following criteria:
- A physician or physician extender, as defined in 12VAC30-130-5020, must be available during medication dispensing and clinical operating hours, in-person or by telephone
Peer Recovery Specialists may deliver services in-person or through telehealth or audio-only.
Face-to-face Substance Use Care Coordination is encouraged and should be documented. If for some reason the member is unable to meet face-to-face and other forms of communication are conducted, such as telehealth or telephonic mode of delivery, this too must be documented. If the member continues to be unavailable for face-to-face Substance Use Care Coordination, the member should then be re-evaluated to see if the service is appropriate for the member currently within their treatment process.
DMAS intends to update the Telehealth Services Supplement to continue allowing delivery of certain outpatient psychiatric and ARTS services via audio-only telehealth that are at present allowed under the authority of the federal COVID-19 Public Health Emergency (PHE). The federal COVID-19 PHE is set to expire on May 11, 2023 and the planned changes will allow continued audio-only telehealth delivery for specific CPT codes (see bulletin).
Providers must continue to follow the conditions for telehealth reimbursement outlined in the Reimbursable Telehealth Services section of the Telehealth Services Supplement when providing audio-only telehealth services. Documentation for services delivered via audio-only telehealth are the same as for a comparable in-person service. Providers should continue to bill for audio-only telehealth as they normally would if the service was provided in-person until otherwise notified. Additional reimbursement and billing guidelines for audio-only telehealth services will be included in a forthcoming update to the Telehealth Services Supplement.
DMAS will continue to evaluate whether there are additional CPT/HCPCS codes that should be authorized for audio-only telehealth coverage after the end of the Federal PHE. Future audio-only telehealth policy changes will be included in updates to the Telehealth Services Supplement.
Nursing Services
Initial Assessment Visit: During this visit, the RN Supervisor must conduct and document all of the following activities:
- Introduction of the aide to be assigned to the individual, if services start the same day. Each regularly assigned aide must be introduced to the individual by the RN Supervisor, or other staff (this may be done by telephone) and oriented to the individual’s Plan of Care on or prior to the aide’s start of care for that individual
A RN/LPN Supervisor must be available to the aides by telephone at all times that an aide is providing services to an individual.
The SF must be available by telephone to individuals receiving CD services during normal business hours, have voice mail capability, and return phone calls within one business day.
Personal Emergency Response System (PERS) is an electronic device that shall be capable of being activated by a remote wireless device and enables individuals to secure help in an emergency. PERS electronically monitors individual’s safety in the home and provides access to emergency crisis intervention for medical or environmental emergencies through the provision of a two-way voice communication system that dials a 24-hour response or monitoring center upon activation via the individual’s home telephone line or other two way voice communication system. When appropriate, PERS may also include medication monitoring devices.
See manual for additional details.
Development Disabilities Waiver
Telemedicine does not include an audio-only telephone. Telemedicine is the only form of
telehealth allowable for select DD waiver services.
Personal Care Services
The SF must be available by telephone to individuals receiving CD services during normal business hours, have voice mail capability, and return phone calls within 1 business day. The SF is not responsible for supervision of personal care assistants and has no authority in hiring/firing assistants. The EOR is solely responsible for attendant supervision.
Each regularly assigned assistant must be introduced to the individual by the RN Supervisor, or other staff (this may be done by telephone) and oriented to the individual’s Person Centered Plan of Care prior to the assistant’s start of care for that individual. The RN/LPN Supervisor must closely monitor every situation when a new assistant is assigned to an individual so that any difficulties or questions are dealt with promptly.
Home Health
This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine shall not include encounters by telephone or email.
BabyCare
Upon referral or indication that a member may benefit from case management, the case manager must initiate contact to the member or member’s caregiver to schedule a face-to-face meeting. A telephone call or collateral contact must be made, at a minimum, within 15 calendar days from the date the referral was received. A collateral contact is defined as contact with the member, primary care provider and/or the member’s significant others to promote implementation of services. The provider should maintain privacy requirements as set forth by Health Insurance Portability and Accountability Act (HIPAA).
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