Live Video
POLICY
SoonerCare (Oklahoma’s Medicaid program) reimburses providers for live video. Providers must:
- Be contracted with SoonerCare and appropriately licensed,
- Bill for services using the appropriate modfier (GT, 95, FQ, or 93), and
- Maintain documentation of services, to include: service rendered, location at which service was rendered, and that service was provided via telehealth. (Documentation of services must follow all other SoonerCare documentation guidelines as well.)
Additionally, out-of-state providers must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jan. 1, 2025. (Accessed Mar. 2025).
Oklahoma Health Care Authority issued letter regarding HIPAA Compliancy for Telehealth and Audio-Only Services.
ELIGIBLE SERVICES/SPECIALTIES
To participate, a member:
- May receive telehealth services outside of Oklahoma when medically necessary;
- Retains right to withdraw from telehealth services at any time; and
- Should be aware that all telehealth activities must comply with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule, OHCA policy and all other applicable state and federal laws and regulations.
Also, if member is a minor child, a parent or legal guardian must present the child for services unless exempted by state or federal law. The parent or guardian need not attend the session unless attendance is therapeutically appropriate.
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jan. 1, 2025. (Accessed Mar. 2025).
See Medical Codes allowed for telehealth post-PHE.
See behavioral health codes allowed for telehealth post-PHE.
The OHCA has discretion and the final authority to approve or deny any telehealth services based on agency and/or SoonerCare members’ needs.
SOURCE: OK Admin. Code Sec. 317:30-3-27(g) (Accessed Mar. 2025).
A telehealth service is subject to the same SoonerCare program restrictions, limitations, and coverage which exist for the service when not provided through telehealth; provided, however, that only certain telehealth codes are reimbursable by SoonerCare. For a list of the SoonerCare-reimbursable telehealth codes, refer to the OHCA’s Behavioral Health Telehealth Services and Medical Telehealth Services, available on OHCA’s website, www.okhca.org.
Where there are established service limitations, the use of telehealth to deliver those services will count towards meeting those noted limitations. Service limitations may be set forth by Medicaid and/or other third-party payers.
SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(11) &(12). (Accessed Mar. 2025).
Effective July 1, 2024, OHCA will add modifier 95 (synchronous telemedicine service rendered via real-time interactive audio and video telecommunications systems) as an allowed modifier to report services delivered via telehealth. More information about telehealth and services allowed to be delivered via telehealth can be found on the provider telehealth page.
SOURCE: OK Health Care Authority, Global Messages, 2024 Messages, 6/26/24, (Accessed Mar. 2025).
Physical, Occupational and Speech and Hearing Services
Even though physical therapy, occupational therapy, and/or speech and hearing services are not subject to the notification requirements of OAC 317:30-3-27(d)(2), said services must still comply with all other State and Federal Medicaid requirements, in order to be reimbursable by Medicaid. Accordingly, for those physical therapy, occupational therapy, and/or speech and hearing services that are provided in a primary or secondary school setting, but that are not school-based services (i.e., not provided pursuant to an IEP), providers must adhere to all state and federal requirements relating to prior authorization and prescription or referral, including, but not limited to, 42 C.F.R. § 440.110, OAC 317:30-5-291, 317:30-5-296, and 317:30-5-676.
SOURCE: OK Admin. Code Sec. 317:30-3-27(d). (Accessed Mar. 2025).
Psychiatric Services
Payment is made for procedure codes listed in the psychiatry section of the most recent edition of the American Medical Association Current Procedural Terminology (CPT) codebook. Check administrative rules for certain exceptions. Psychiatric services performed via telemedicine are subject to the requirements found in Oklahoma Administrative Code (OAC) 317:30-3-27.
SOURCE: OK Admin. Code Sec. 317:30-5-11(a) & (d) (Accessed Nov. 2024).
Certified Community Behavioral Health Clinics – Care coordination
Transitional care will be provided by the facility for consumers who have been hospitalized or placed in other non-community settings, such as psychiatric residential treatment facilities. The CCBHC will provide care coordination while the consumer is hospitalized as soon as it becomes known. A team member will go to the hospital setting to engage the consumer in person and/or will connect through telehealth as a face to face meeting. Reasonable attempts to fulfill this important contact shall be documented. In addition, the facility will make and document reasonable attempts to contact all consumers who are discharged from these settings within 24 hours of discharge.
SOURCE: OK Admin. Code Sec. 450:17-5-183. (Accessed Mar. 2025).
Outpatient therapy services
The facility will directly provide outpatient mental health and substance use disorder services in accordance with 450:17-3 Part 7. In the event specialized services outside the expertise of the facility are required to meet the needs of the consumer, the facility will make them available through referral or other formal arrangement with other providers or, where necessary and appropriate, through the use of telemedicine services.
SOURCE: OK Admin. Code Sec. 450:17-5-185. (Accessed Mar. 2025).
Certified Community Behavioral Health Clinics
To the extent allowed by state law, facility will make services available via telemedicine in order to ensure consumers have access to all required services.
SOURCE: OK Admin. Code Sec. 450:17-5-176. (Accessed Mar. 2025).
Developmental Disabilities Services
Telehealth services do not expand services covered through Developmental Disabilities Services (DDS) Home and Community-Based Services (HCBS) waivers. Telehealth services are a delivery option for certain covered services. Telehealth services apply to contract professional services, including speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental care.
Telehealth services are billed with the appropriate modifier. See administration code for additional requirements.
SOURCE: OK Admin Code 340:100-3-41. (Accessed Mar. 2025).
Doula Services
Prenatal and postpartum visits can also be conducted via telehealth.
Prenatal and postpartum visits may be conducted via telehealth.
Labor and delivery services may not be conducted via telehealth.
SOURCE: OK Admin Code 317:30-5-1217. (Accessed Mar. 2025).
Mobile Medication Units
Mobile medication units that provide appropriate privacy and adequate space may additionally provide the following services: …
- Clinical services, such as therapy, provided in-person or when permissible through use of telehealth services.
SOURCE: OK Admin Code 450:70-6-10.1. (Accessed Mar. 2025).
Crisis Intervention
Onsite CIS is the provision of CIS to the member at the treatment facility, either in-person or via telehealth.
SOURCE: OK Admin Code 317:30-5-241.4. (Accessed Mar. 2025).
Human Immunodeficiency Virus (HIV) Counseling (OK SPA 23-0032)
The GT modifier (interactive audio and video telecommunications system) is allowed for Human Immunodeficiency Virus (HIV) counseling.
Training requirements for community staff
Virtual training may be used as an alternative to both classroom and online training as referenced in this Section. Virtual training is an instructor-led, interactive, online learning experience with participants who are connected from geographically dispersed locations. This does not include telehealth services, webinars, webcasts, virtual meetings, or other similar platforms. Participants are expected to actively participate and engage with the trainer and the group during group discussions and activities. Refer to (c)(1) of this Section regarding reasons for dismissal from virtual training. See rule for additional requirements.
SOURCE: OK Admin Code 340-100-3-38 (Accessed Mar. 2025).
ABA Services – Emergency Rule
ABA treatment may be rendered via in-person service delivery, telehealth, or a hybrid of in-person and telehealth. The modality selected for delivery of ABA services must be clearly defined in the prior authorization template and treatment plan. If services will be provided via telehealth, the ABA provider must provide the justification of how treatment will be beneficial to the member and parents(s)/guardian(s) when rendered this way.
Documentation of services must be maintained, to include: service rendered, location at which service was rendered, and that service was provided via telehealth. Documentation of services must also follow all other SoonerCare documentation requirements.
SOURCE: OK Admin Code Sec. 317.30-5-314, (Accessed Mar. 2025).
ELIGIBLE PROVIDERS
To participate, a provider must:
- Be contracted with SoonerCare and appropriately licensed
- Bill for services using the appropriate modfier (GT, 95, FQ, or 93), and
- Maintain documentation of services, to include: service rendered, location at which service was rendered, and that service was provided via telehealth. (Documentation of services must follow all other SoonerCare documentation guidelines as well.)
Additionally, out-of-state providers must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 27, 2024. (Accessed Mar. 2025).
The provider must be contracted with SoonerCare and appropriately licensed or certified, in good standing. Services that are provided must be within the scope of the practitioner’s license or certification. If the provider is outside of Oklahoma, the provider must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Mar. 2025).
OHCA is expanding the use of telehealth to include certain occupational and physical therapy services. Effective May 12, 2023, OHCA began reimbursing for therapy services utilizing the following service codes delivered via telehealth: 97110, 97112, 97116, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97535, and 97755.
OHCA asks that providers use modifier GT to denote services were performed utilizing telehealth. For providers unable to submit a claim with the GT modifier for an OHCA approved telehealth-rendered service, please utilize Place of Service (POS) code 02 to denote when telehealth is used.
Indian Health Service/Tribal 638
An I/T/U encounter means a face to face, a telehealth contact, or an audio-only telecommunications contact between a health care professional and an Indian Health Services (IHS) eligible SoonerCare member for the provision of medically necessary Title XIX or Title XXI covered services through an IHS or Tribal 638 facility or an urban Indian clinic within a twenty-four (24) period ending at midnight, as documented in the patient’s record.
SOURCE: OK Admin. Code Sec. 317:30-5-1098. I/T/U outpatient encounters. (Accessed Mar. 2025).
Clinic Services
Teleheath and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to 42 Code of Federal Regulations (CFR) § 440.90. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.
SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Nov. 2024).
Rural Health Center Services
RHC services are covered when medically necessary and furnished at the clinic or other outpatient setting, including the member’s place of residence, delivered via telehealth, or via audio-only telecommunications pursuant to Oklahoma Administrative Code (OAC) 317:30-3-27 and OAC 317:30-3-27.1.
SOURCE: OK Admin Code Sec. 317.30-5-355.2, (Accessed Mar. 2025).
ELIGIBLE SITES
The medical or behavioral health related service must be provided at an appropriate site for the delivery of telehealth services. An appropriate telehealth site is one that has the proper security measures in place; the appropriate administrative, physical, and technical safeguards should be in place that ensures the confidentiality, integrity, and security of electronic protected health information. The location of the room for the encounter at both ends should ensure comfort, privacy, and confidentiality. Both visual and audio privacy are important, and the placement and selection of the rooms should consider this. Appropriate telehealth equipment and networks must be used considering factors such as appropriate screen size, resolution, and security. Providers and/or members may provide or receive telehealth services outside of Oklahoma when medically necessary; however, prior authorization may be required, per OAC 317:30-3-89 through 317:30-3-91.
SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(3). (Accessed Mar. 2025).
School Setting
In order for OHCA to reimburse medically necessary telehealth services provided to SoonerCare members in a primary or secondary school setting, all of the requirements in (c) above must be met, with the exception of (c)(5), as well as all of the requirements shown below, as applicable.
There are special consent and notification requirements for school-based sites. See Oklahoma Code.
Accordingly, for those physical therapy, occupational therapy, and/or speech and hearing services that are provided in a primary or secondary school setting, but that are not school-based services (i.e., not provided pursuant to an IEP), providers must adhere to all state and federal requirements relating to prior authorization and prescription or referral, including, but not limited to, 42 C.F.R. § 440.110, OAC 317:30-5-291, 317:30-5-296, and 317:30-5-676.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Mar. 2025).
Clinic Services
Teleheath and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to 42 Code of Federal Regulations (CFR) § 440.90. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.
SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Mar. 2025).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.
SOURCE: OK Admin. Code Sec. 317:30-3-27(e)(4). (Accessed Mar. 2025).
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