Live Video
POLICY
All qualified telehealth services must:
- Meet the same standard of care as in-person care.
- Be medically appropriate and necessary with supporting documentation included in the patient’s clinical medical record.
- Be provided via secure and appropriate equipment to ensure confidentiality and quality in the delivery of the service. The service must be provided using a HIPAA-compliant platform.
- Use appropriate coding as noted in the following tables. Health care professionals must follow CPT®/HCPCS coding guidelines.
SOURCE: ND Div. of Medical Assistance, Telehealth, (May 2025), (Accessed Jun. 2025).
ELIGIBLE SERVICES/SPECIALTIES
Use the Procedure Code Look-up Tool to identify services covered via Telehealth.
Institutional Claims:
- Applicable Revenue Codes(s): 780 – Telehealth – facility charges related to the use of telehealth.
- Applicable Modifiers:
- GT or 95: Via interactive audio and video telecommunication systems. Billed by performing health care professional for real-time interaction between the professional and the patient who is located at a distant site from the reporting professional. Modifiers are not required for Medicare primary claims
Services that are not covered:
- Store and forward (G2010)
- Virtual check-in (G2012)
- Digital Assessment and Management Services (98970-98972)
SOURCE: ND Div. of Medical Assistance, Telehealth, (May 2025), (Accessed Jun. 2025).
Dentistry
Teledentistry code D9995 or D9996 is required when billing ND Medicaid. Service authorization is not required. See manual for covered services.
Patient records must include the CDT© Code(s) that reflect the teledentistry encounter. The claim submission must include all applicable CDT© codes. ND Medicaid will reimburse CDT© code D9995 or D9996 once per date of service. Claim submissions must be billed using place of service (POS)/place of treatment codes:
- 02 Teledentistry provided in a location other than the patient’s home.
- 10 Telehealth provided in patient’s home.
Claims with any other place of service will be denied.
Non Covered Services
- Examinations via online/email/electronic communication
- Patient contact with dentist who provides the consultation using audio means only (no visual component)
- Virtual check-in
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 11 (Jul. 2024), (Accessed Jun. 2025).
Noncovered Services
- Non-face-to-face services, except for services listed in the Telehealth policy
- Services rendered via telehealth that are not on the list of approved telehealth services.
SOURCE: ND Div. of Medical Assistance, Non-Covered Medicaid Services, (May 2025), (Accessed Jun. 2025).
Medicaid Services Rendered in Schools
Health Services billed by schools can be delivered via telehealth; however, no originating site fee is allowed. See Telehealth policy for additional information.
SOURCE: ND Div. of Medical Assistance, School Based Medicaid, p. 7, (Mar. 2025), (Accessed Jun. 2025).
Behavioral Health
Behavioral Health Manual indicates codes that can be delivered via telehealth.
H0031 is not eligible to be delivered via telehealth.
SOURCE: ND Div. of Medical Assistance, Behavioral Health, (May 2025), (Accessed Jun. 2025).
Substance Use Disorder
Substance use manual indicates codes that can be delivered via telehealth.
Telehealth coverage for partial hospitalization is limited to 50% or 10 hours of the weekly 20 hours of structured programming requirement.
SOURCE: ND Div. of Medical Assistance, Substance Use Disorder, (May 2025), (Accessed Jun. 2025).
Indian Health Services and Tribal Health Programs
Coverage and payment of services provided through synchronous telehealth is on the same basis as those provided through face-to-face contact.
The manual lists the types of encounters and providers eligible to render face-to-face (including synchronous telehealth) services.
Pharmacy Manual
Medication Therapy Management (MTM) services: Face-to-Face (including telehealth) visit is required for new patients (CPT 99605).
Allowed for Reimbursement:
- Synchronous telehealth visits with real-time audio/visual conferencing
SOURCE: ND Medicaid Pharmacy Medical Billing Manual, Apr. 2024, (Accessed Jun. 2025).
1915(I) Medicaid State Plan Amendment Home and Community Based Behavioral Health Services
Remote service delivery is allowable as specified within each service.
Telehealth is allowable as specified within each service. Telehealth limits, codes, and modifiers are available at 1915i Codes.Rates_.Limits 2.1.24.pdf (nd.gov)
Medication for Opioid Use Disorder
For OTPs, a clinical assessment that meets the requirements in 42 CFR § 8.12(f)(4) must be conducted, face to face or by telehealth, as clinically appropriate, at least once every three months for the first year of continuous treatment, and at least once every six months for each subsequent year
The member must require at least one face-to-face or telehealth check‐in per month for prescribing or dispensing OBOT/OTP medication. For those receiving buprenorphine based treatment, the prescriber has deemed it medically necessary to treat the member’s opioid addiction with buprenorphine products.
Telehealth must be provided in accordance with applicable federal and state laws and policies and follow the Controlled Substances Act (CSA) (28 USC Part 802) for prescribing and administration of controlled substances.
SOURCE: ND Medicaid, Medication for Opioid Use Disorder, Jan. 2024, (Accessed Jun. 2025).
Preventative Services and Chronic Disease Management
Preventive medicine counseling and risk factor reduction may be rendered via telehealth. See Telehealth policy for telehealth requirements.
Screening, Brief Intervention and Referral to Treatment (SBIRT)
SBIRT may be rendered via telehealth if providers document member pre-screening and the member’s score which indicates the need for a full screen. Providers must also document the member’s standardized assessment score. See Telehealth policy for telehealth requirements.
SOURCE: ND Medicaid, Preventative Services and Chronic Disease Management, Oct. 2024, (Accessed Jun. 2025).
Home Health
A face-to-face encounter for the initial ordering of home health services, must occur no more than 90 days before or 30 days after the start of home health services. Face-to-face encounters: …
- May be performed via telehealth or in-person, telephone encounters are insufficient.
SOURCE: ND Div. of Medical Services, Home Health (Jan. 2025), (Accessed Jun. 2025).
ELIGIBLE PROVIDERS
Payment will be made only to the distant health care professional during the telehealth session. No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site.
Payment is made for services provided by licensed professionals enrolled with ND Medicaid within their licensed scope of practice only. All service limits set by ND Medicaid apply to telehealth services.
Telehealth services provided by an Indian Health Service (IHS) facility or a Tribal Health Program functioning as the distant site, are reimbursed at the All-Inclusive Rate (AIR), regardless of whether the originating site is outside the “four walls” of the facility or clinic.
Revenue code 0780 should only be reported along with Q3014 when the IHS or Tribal Health Program is the originating site.
When providing telehealth services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue codes listed in the FQHC and RHC portions of this manual along with the CPT® or HCPCS code for the service rendered appended with modifier GT or 95.
Refer to the FQHC and RHC policies for the revenue codes to bill for the various services.
SOURCE: ND Div. of Medical Assistance, Telehealth, (May 2025), (Accessed Jun. 2025).
FQHCs and RHCs – Dentistry
Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
Revenue Code 512: Dental Clinic.
One dental encounter is allowed per day. The encounter must be a face to face encounter to qualify for payment. Asynchronous teledentistry performed as a stand-alone service does not qualify for an encounter payment. At least one covered service must be performed as a face to face service to qualify for the dental encounter payment.
Federally Qualified Health Center
Encounter – means a face-to-face visit or synchronous telehealth visit during which a qualifying encounter service is rendered.
Payment to FQHCs for covered services furnished to members is made by means of an all-inclusive rate for each encounter. FQHCs may furnish services that qualify as a medical, dental, or behavior health encounter. Each encounter includes services and supplies incident to the service.
SOURCE: ND Div. of Medical Assistance, Federally Qualified Health Center, (Aug. 2024), (Accessed Jun. 2025).
Indian Health Services and Tribal Health Programs
ND Medicaid covers the same services for members who are enrolled in Medicaid and receiving services at IHS as those members who are enrolled in Medicaid only. Coverage and payment of services provided through synchronous telehealth is on the same basis as those provided through face-to-face contact.
An outpatient encounter can only be claimed for services rendered face-to-face (including synchronous telehealth) by one of the following practitioners compensated by an IHS facility/THP for the services provided:
- Physician
- Physician Assistant
- Clinical Nurse Specialist
- Licensed Registered Dietitian
- Podiatrist
Vision encounters can only be claimed for services rendered face-to-face (including synchronous telehealth). Eligible providers include:
- Optometrists
- Ophthalmologist
Dental encounters include covered services and supplies. Eligible providers include:
- Dentists
A mental health encounter can only be claimed for services separate and distinct from another encounter type which are rendered face-to-face (including synchronous telehealth) by a qualified mental health professional which includes:
Physician
- Licensed Clinical Social Worker
- Licensed Professional Counselor
- Licensed Professional Clinical Counselor
- Licensed Marriage and Family Therapist
- Licensed Psychologist
- Psychiatrist Clinical Nurse Specialist
A substance use disorder encounter can only be claimed for services rendered face-to-face (including synchronous telehealth) by a qualified behavioral health professional which includes:
- Licensed SUD agency
- Licensed Addiction Counselor
Rural Health Clinic
Encounter in this policy is defined as a face-to-face or synchronous telehealth visit with the member during which a qualifying RHC service is rendered.
Payment to RHCs for covered services furnished to members is an all-inclusive rate for each encounter. RHCs may furnish services that qualify as an encounter. Each encounter includes services and supplies incident to the service.
See Telehealth policy for additional information on services rendered via telehealth. A copy of Telehealth Approved Services can be found on the website.
SOURCE: ND Div. of Medical Assistance, Rural Health Clinic, (Aug. 2024), (Accessed Jun. 2025).
ELIGIBLE SITES
Professional Claims – POS listed:
- 02: Telehealth provided in a location other than the patient’s home.
- 10: Telehealth provided in patient’s home
Payment will be made only to the distant health care professional during the telehealth session. No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site
SOURCE: ND Div. of Medical Assistance, Telehealth, (May 2025), (Accessed Jun. 2025).
Dentistry
Claim submissions must be billed using place of service (POS)/place of treatment codes:
- 02 Teledentistry provided in a location other than the patient’s home.
- 10 Telehealth provided in patient’s home.
Claims with any other place of service will be denied.
FQHCs and RHCs – Dentistry
Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
Revenue Code 512: Dental Clinic.
One dental encounter is allowed per day. The encounter must be a face to face encounter to qualify for payment. Asynchronous teledentistry performed as a stand-alone service does not qualify for an encounter payment. At least one covered service must be performed as a face to face service to qualify for the dental encounter payment.
Pharmacy Manual
For services delivered via synchronous telehealth:
- Both the origination site (where the member is located) and the distant site (where the provider is located) must meet the geographic location, privacy, and space requirements outlined above
- Provider is responsible for supplying audio and video equipment permitting two-way, real-time interactive communication between the origination and distant sites
SOURCE: ND Medicaid Pharmacy Medical Billing Manual, Apr. 2024, (Accessed Jun. 2025).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Q3014 is allowed: Telehealth originating site facility fee (If applicable. Cannot be billed if patient is outside of the healthcare facility, or for digital health services).
Institutional Claims: * HCPCS Code Q3014 must be billed in conjunction with Revenue Code 780 to indicate the originating site facility fee.
Payment will be made to the originating site as a facility fee only in the following places of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians, or other technology or personnel utilized in the performance of the telehealth service.
Payment is made for services provided by licensed professionals enrolled with ND Medicaid within their licensed scope of practice only. All service limits set by ND Medicaid apply to telehealth services.
SOURCE: ND Div. of Medical Assistance, Telehealth, (May 2025), (Accessed Jun. 2025).
Teledentistry
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) – Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12 (Jul. 2024), (Accessed Jun. 2025).
Medicaid Services Rendered in Schools
Health Services billed by schools can be delivered via telehealth; however, no originating site fee is allowed. See Telehealth policy for additional information.
SOURCE: ND Div. of Medical Assistance, School Based Medicaid, p. 8, (Mar. 2025), (Accessed Jun. 2025).
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