Live Video
POLICY
Services delivered via telehealth will be eligible for reimbursement when all of the following conditions are met:
- The Provider at the distant site deems that the service being provided is clinically appropriate to be delivered via telehealth;
- The service delivered via telehealth meets the procedural definition and components of the CPT or HCPCS code, as defined by the American Medical Association (AMA), unless otherwise noted in Table 1 – Table 6 in this Supplement;
- The service provided via telehealth meets all state and federal laws regarding confidentiality of health care information and a patient’s right to his or her medical information;
- Services delivered via telehealth meet all applicable state laws, regulations and licensure requirements on the practice of telehealth; and
- DMAS deems the service eligible for delivery via telehealth.
In order to be reimbursed for services using telehealth that are provided to MCO-enrolled individuals, Providers must follow their respective contract with the MCO.
ELIGIBLE SERVICES/SPECIALTIES
The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services. Such plan shall include:
- A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services, as defined in § 38.2-3418.16, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.
Medicaid state plan shall include shall include … provision for payment of medical assistance for health care services provided through telemedicine services, as defined in § 38.2-3418.16. No health care provider who provides health care services through telemedicine shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
SOURCE: VA Code Annotated Sec. 32.1-325, (Accessed Apr. 2024).
Telehealth Services:
Coverage of services delivered by telehealth are described in the “Telehealth Services Supplement”.
MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.
Attachment A in the Telehealth Supplement lists covered services that may be reimbursed when provided via telehealth.
Services delivered via telemedicine must be provided with the same standard of care as services provided in person.
Telemedicine 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 visit, the telemedicine 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 individual (e.g., services delivered in-person; services delivered via telemedicine when conditions allow telemedicine to meet requirements stipulated in the “Reimbursable Telehealth Services” section). In this circumstance, the Provider shall be reimbursed only for services successfully delivered.
Unless otherwise noted in Attachment A, limitations for services delivered via telehealth are the same as for those delivered in-person.
All coverage requirements for a particular covered service described in the DMAS Provider Manuals apply regardless of whether the service is delivered via telehealth or in-person.
Clinicians shall use their clinical judgment to determine the appropriateness of service delivery via telehealth considering the needs and presentation of each individual. See Attachment A for code lists.
Virtual Check-In: A Virtual Check-In is a brief patient-initiated asynchronous or synchronous communication and technology-based service intended to be used to decide whether an office visit or other service is needed.
See table 5 for eligible virtual check-in services.
- Services must be patient-initiated.
- Patients must be established with the provider practice.
- Must not be billed if services originated from a related service provided within the previous 7 days or lead to a service or procedure within the next 24 hours or at the soonest available appointment.
No billing modifier is required on claims for the covered Virtual Check-In codes listed, in Table 5 of Attachment A.
Virtual Check-In services do not require service authorization. Only physicians and other qualified health care professionals – previously defined by the American Medical Association as being an individual who by education, training, licensure/regulation, and facility privileging (when applicable) performs a professional service within his/her scope of practice and independently reports a professional service – may furnish and bill for Virtual Check-In services.
Place of Service (POS), the two-digit code placed on claims used to indicate the setting, should reflect the location in which patients would have received services had the service occurred in-person and not virtually. For example, if the member would have come to a private office to discuss management of the condition being addressed via virtual check-in, a POS 11 would be applied. Providers should not use POS 02 on telehealth claims, even though this POS is referred to as “telehealth” for other payers. Place of service codes can be found at https://www.cms.gov/Medicare/Coding/place-ofservice-codes/Place_of_Service_Code_Set.
The following school-based services may be provided via telemedicine: PT, OT, speech and language, behavioral health, and medical evaluation services. DMAS does not require the presence of a paid staff person with the student at the time of the service; however, if a paid staff person is present in a supervisory capacity at the time of the service, the LEA may submit a claim for the “originating site fee.”
Durable Medical Equipment (DME) and Supplies
The face-to-face encounter may occur through telehealth, which is defined as the real time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment (DMAS Medicaid Memo dated May 20, 2014). Telehealth shall not include by telephone or email.
Telehealth visits may be used for face-to-face nutritional assessments.
NOTE: Home health visits for the sole purpose of performing a nutritional assessment for individuals whose conditions are stable and chronic in nature will not be covered under the home health program. Telehealth visits should be considered for these cases and for those who are not able to travel due to complex health conditions.
Face-to-face encounters may occur through telemedicine, which is defined as the twoway, real time interactive electronic communication between the member and the Provider located at a site distant from the member. This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine shall not include encounters by telephone or email.
Opioid Treatment Services
“Face-to-face” means encounters that occur in person or through telehealth.
Substance use case management shall include an active ISP which requires: …
- At least one face-to-face contact, separate from the two distinct activities per month minimum, with the member at least every 90 calendar days. The face-toface contacts may be met delivered via telehealth.
Outpatient services (ASAM Level 1) shall include the following service components as medically necessary and indicated in the member’s ISP: …
- Individual psychotherapy between the member and a CATP. Services provided face-to-face or by telemedicine shall qualify as reimbursable.
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 Services (ASAM Level 3.1) co-occurring enhanced programs shall offer the following:
- 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
See manual for other services that can be provided with telephone or telemedicine.
DMAS expects Preferred OBAT services to be primarily delivered in-person/on-site and utilize telemedicine as an option to increase access to services as needed. Preferred OBATs services must have regular access to in-person/on-site visits and services shall not be delivered solely or predominantly through telemedicine. The practitioners must be credentialed by DMAS, the DMAS fee-for-service contractor or MCOs to perform Preferred OBAT services. Preferred OBAT providers do not require a separate DBHDS license.
DMAS recognizes that there may be situations that telemedicine is necessary to engage the member in treatment and recovery, especially if the member makes this request. Thus Preferred OBAT services may be provided via telemedicine based on the individualized needs of the member and reasons why the in-person interactions are not able to meet the member’s specific needs must be documented. The primary means of services delivery shall in-person for the Preferred OBAT model with the exception of telemedicine for specific member circumstances. These circumstances may include but are not limited to: member transportation issues, member childcare needs, member employment schedule, member co-morbidities, member distance to provider, etc.). Where these situations may impede member’s access to treatment, telemedicine may be utilized as clinically appropriate and to help to remove these barriers to treatment. Providers delivering services using telemedicine shall bill according to the requirements in the DMAS Telehealth Services Supplemental Manual.
The Board of Medicine requires the prescriber to see the member weekly during the induction phase for prescribing MOUD … These visits shall be in-person/onsite however may be delivered through telemedicine based on the individual needs of the member to ensure access during this critical phase. The member must have documented clinical stability before spacing out visits beyond weekly. This applies to all members regardless of SUD diagnosis.
Providers working in the Mobile OBAT setting shall provide services in-person as well as be permitted to utilize technology to provide telemedicine sessions with providers located at the Preferred OBAT’s primary location. Providers delivering services using telemedicine shall follow the requirements set forth in the DMAS Telehealth Services Supplemental Manual.
Preferred OBAT and OTPs must include the following activities, which must be documented in each member’s record:
- These visits shall be inperson/onsite however may be delivered through telemedicine based on the individual needs of the member to ensure access during this critical phase. The member must have documented clinical stability as defined earlier in this Supplement before spacing out visits beyond weekly. This applies to all members regardless of SUD diagnosis. The IPOC must be updated to reflect these changes.
MAT for Opioid Use Disorder
Prescribing controlled substances for the treatment of addiction delivered via telemedicine must include a qualified provider and a telepresenter located at the originating site, as well as a qualified prescribing provider located at the remote site. Psychotherapy and SUD counseling may also be provided via telemedicine by a qualified provider who is a credentialed addiction treatment professional as defined in this memorandum and DMAS ARTS Provider Manual. See manual for eligible MAT codes.
Residential Treatment Service
DMAS reimburses for telemedicine services under limited circumstances. Telemedicine is the real-time or near real-time exchange of information for diagnosing and treating medical conditions. Telemedicine utilizes audio/video connections linking medical practitioners in one locality with medical practitioners in another locality. DMAS recognizes telemedicine as a means for delivering some covered Medicaid services. Please refer to the Virginia Medicaid Memo dated May 13, 2014: “Updates to Telemedicine Coverage”. Medicaid Memos are posted at: https://www.virginiamedicaid.dmas.virginia.gov under Provider Services. For managed care enrolled members, the member’s plan may cover additional telemedicine/telehealth services and have different requirements. Providers should direct specific telemedicine/telehealth coverage questions to the member’s MCO.
See manual for comprehensive list of authorized services.
Comprehensive Crisis Services
“Telemedicine assisted assessment” means the in-person service delivery encounter by a QMHPA, QMHP-C, CSAC with synchronous audio and visual support from a remote LMHP, LMHPR, LMHP-RP or LMHP-S to: obtain information from the individual or collateral contacts, as appropriate, about the individual’s mental health status; provide assessment and early intervention; and, develop an immediate plan to maintain safety in order to prevent the need for a higher level of care. The assessment includes documented recent history of the severity, intensity, and duration of symptoms and surrounding psychosocial stressors.
Mobile Crisis Response – Covered service components of Mobile Crisis Response include:
- Assessment, including telemedicine assisted assessment
Providers conducting an assessment through telemedicine or a telemedicine assisted assessment must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement” including the use of the GT modifier for units billed for assessments completed through telemedicine or a telemedicine assisted assessment. Mobile Crisis Response services are not eligible for originating site fee reimbursement. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.
23-Hour Crisis Stabilization Billing Requirements – Psychiatric evaluation may be provided through telemedicine. Providers must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement”, including the use of telemedicine modifiers. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.
Residential Crisis Stabilization Billing Requirements – Psychiatric evaluations and individual, group and family therapy may be provided through telemedicine. Providers must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement” including the use telemedicine modifiers. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.
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. Billing codes covered by this policy, when conditions of coverage are met, and for services with dates of service on and after April 18, 2022, include the following:
- G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
- G2251: Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
- G2252: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
The Comprehensive Needs Assessment serves to gather information to assess the needs, strengths and preferences of the individual. For information on whether a service assessment is required in-person or is allowed through telemedicine, refer to the service specific sections located in Appendices to this manual.
Development Disabilities Waiver
For therapeutic consultation behavioral services, direct therapy consists of the behavioral consultant implementing strategies with the individual that can only be accomplished while being physically present in the same environment as the individual and cannot be accomplished via telehealth modalities.
IFCT services may be rendered via an in-person or telehealth model, based upon the structure of training provided. Any training provided via a telehealth model must include both an audio and visual component.
PAP Supplement
Telehealth services will not be eligible for payment at this time. Any change will be announced in future editions of this supplement.
Teledentistry codes for synchronous and asynchronous encounters are listed as covered.
SOURCE: VA Dept. of Medical Assistant Svcs., DentaQuest, (6/2/23) (Accessed Apr. 2024).
Intensive Clinic Based Support
In addition to the required activities for all mental health services providers located in Chapter IV, the following required activities apply to MH-PHP: …
- Initial medication evaluation must be conducted by the Psychiatrist, Nurse Practitioner, or Physician Assistant with the individual via in-person or telemedicine evaluation within 48 hours of admission.
ELIGIBLE PROVIDERS
The term “Provider” refers to the billing provider – either a qualified, licensed practitioner of the healing arts or a facility – who is enrolled with DMAS.
Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider or originating site and bill under the encounter rate. The encounter rate methodology for FQHCs and RHCs is described in 12VAC30-80-25; the encounter rate for IHCs (including Tribal clinics) is the All Inclusive Rate set by Indian Health Services.
The Member is located at an approved originating site with the Medicaid enrolled telepresenter. The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.
DMAS expects Preferred OBAT services to be primarily delivered in-person/on-site and utilize telemedicine as an option to increase access to services as needed. Preferred OBATs services must have regular access to in-person/on-site visits and services shall not be delivered solely or predominantly through telemedicine. The practitioners must be credentialed by DMAS, the DMAS fee-for-service contractor or MCOs to perform Preferred OBAT services. Preferred OBAT providers do not require a separate DBHDS license.
The Credentialed Addiction Treatment Professional must work with the prescriber in an interdisciplinary team setting. The Credentialed Addiction Treatment Professionals may utilize telehealth as an option to increase access to services as needed.
Preferred OBATs may utilize telehealth as needed as a resource for home inductions as well as maintenance prescriptions.
DMAS recognizes that there may be situations that telemedicine is necessary to engage the member in treatment and recovery, especially if the member makes this request. Thus Preferred OBAT services may be provided via telemedicine based on the individualized needs of the member and reasons why the in-person interactions are not able to meet the member’s specific needs must be documented. The primary means of services delivery shall in-person for the Preferred OBAT model with the exception of telemedicine for specific member circumstances. These circumstances may include but are not limited to: member transportation issues, member childcare needs, member employment schedule, member co-morbidities, member distance to provider, etc.). Where these situations may impede member’s access to treatment, telemedicine may be utilized as clinically appropriate and to help to remove these barriers to treatment. Providers delivering services using telemedicine shall bill according to the requirements in the DMAS Telehealth Services Supplemental Manual.
The Board of Medicine requires the prescriber to see the member weekly during the induction phase for prescribing MOUD … These visits shall be in-person/onsite however may be delivered through telemedicine based on the individual needs of the member to ensure access during this critical phase. The member must have documented clinical stability before spacing out visits beyond weekly. This applies to all members regardless of SUD diagnosis.
Providers working in the Mobile OBAT setting shall provide services in-person as well as be permitted to utilize technology to provide telemedicine sessions with providers located at the Preferred OBAT’s primary location. Providers delivering services using telemedicine shall follow the requirements set forth in the DMAS Telehealth Services Supplemental Manual.
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.
23-Hour Crisis Stabilization Billing Requirements – Psychiatric evaluation may be provided through telemedicine. Providers must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement”, including the use of telemedicine modifiers. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.
Residential Crisis Stabilization Billing Requirements – Psychiatric evaluations and individual, group and family therapy may be provided through telemedicine. Providers must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement” including the use telemedicine modifiers. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.
Residential Treatment Services – IACCT Appendix
The LMHP, LMHP-R, LMHP-RP or LMHP-S will assess the youth (expedited, if possible) through either a face-to-face or telemedicine contact. For youth who are currently in an inpatient setting where telemedicine is not available and distance is a barrier for the IACCT LMHP, LMHP-R, LMHP-RP or LMHP-S, a telephonic interview with the youth may be conducted while the IACCT LMHP, LMHP-R, LMHP-RP or LMHP-S conducts a face to face with the legal guardian.
ELIGIBLE SITES
The originating site is the location of the member at the time the service is rendered, or the site where the asynchronous store-and-forward service originates (i.e., where the data are collected). Examples of originating sites include: medical care facility; Provider’s outpatient office; the member’s residence or school; or other community location (e.g., place of employment).
Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider or originating site and bill under the encounter rate. The encounter rate methodology for FQHCs and RHCs is described in 12VAC30-80-25; the encounter rate for IHCs (including Tribal clinics) is the All Inclusive Rate set by Indian Health Services.
The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services. Such plan shall include:
- A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services, as defined in § 38.2-3418.16, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.
SOURCE: VA Code Annotated Sec. 32.1-325, (Accessed Apr. 2024).
Mobile OBAT
Preferred OBAT Providers of an opportunity to provide OBAT services through a new mode of delivery called “Mobile Preferred OBATs.” Note this is separate from the Drug Enforcement Administration (DEA) recent approval in July 2021, of adding a “mobile component” to OTPs certified by SAMSHA. DMAS is working with DBHDS and will follow with updated policies when this is implemented in Virginia.
The Mobile Preferred OBAT model shall allow Preferred OBAT providers to provide the same services in a Mobile Unit as in a traditional Preferred OBAT setting. As indicated by the Centers for Medicare and Medicaid Services (CMS), and accepted by the Medicaid MCOs and the DMAS fee-for-service contractor, a “Mobile Unit” is designated as place of service (POS) 15 and is defined as a facility or unit that moves from place to place equipped to provide preventive, screening, diagnostic, and/or treatment services: https://www.cms.gov/Medicare/Coding/place-of-servicecodes/Place_of_Service_Code_Set.
A Mobile Unit shall also be permitted to operate as an extension of an established Preferred OBAT’s primary location. This shall allow providers at a Preferred OBAT to also provide services in the community using the POS “015” for a Mobile Unit. Providers working in the Mobile OBAT setting shall provide services in-person as well as be permitted to utilize technology to provide telemedicine sessions with providers located at the Preferred OBAT’s primary location. Providers delivering services using telemedicine shall follow the requirements set forth in the DMAS Telehealth Services Supplemental Manual. Current Preferred OBAT Providers shall notify the MCOs and the DMAS fee-for-services contractor prior to providing services in a Mobile Unit.
GEOGRAPHIC LIMITS
No reference found.
FACILITY/TRANSMISSION FEE
In the event it is medically necessary for a Provider to be present at the originating site at the time a synchronous telehealth service is delivered, said Provider may bill an originating site fee (via procedure code Q3014) when the following conditions are met:
- The Medicaid member is located at a provider office or other location where services are delivered on an in-person basis (this does not include the member’s residence);
- The member and distant site Provider are not located in the same location; and
- The Provider (or the Provider’s designee), is affiliated with the provider office or other location where the Medicaid member is located and attends the encounter with the member. The Provider or designee may be present to assist with initiation of the visit but the presence of the Provider or designee in the actual visit shall be determined by a balance of clinical need and member preference or desire for confidentiality.
Originating site fee guidance specific to emergency ambulance transport providers is contained in the Transportation manual (Chapter 5).
Originating site Providers, such as hospitals and nursing homes, submitting UB04/CMS-1450 claim forms, must include the appropriate telemedicine revenue code of 0780 (“Telemedicine-General”) or 0789 (“Telemedicine-Other”).
Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider or originating site and bill under the encounter rate. The encounter rate methodology for FQHCs and RHCs is described in 12VAC30-80-25; the encounter rate for IHCs (including Tribal clinics) is the All Inclusive Rate set by Indian Health Services.
The following school-based services may be provided via telemedicine: PT, OT, speech and language, behavioral health, and medical evaluation services. DMAS does not require the presence of a paid staff person with the student at the time of the service; however, if a paid staff person is present in a supervisory capacity at the time of the service, the LEA may submit a claim for the “originating site fee.”
Reference the “DMAS Telehealth Manual Supplement” for additional details on DMAS’s requirements for telemedicine.
SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Local Education Agency Provider Manual, Covered Svcs. and Limitations, (1/12/24), (Accessed Apr. 2024).
Service providers must include the modifier GT on claims for services delivered via telemedicine.
Place of Service (POS), the two-digit code placed on claims used to indicate the setting where the service occurred, must reflect the location in which a telehealth service would have normally been provided, had interactions occurred in person. The school setting code is 03. (Providers should not use POS 02 on telehealth claims, even though this POS is referred to as “telehealth” for other payers.
The services of a school employee supervising the student at the originating school site (the site where the student is located during the telehealth service), must be billed using procedure code, Q3014.
SOURCE: VA Local Education Manual, Billing Instructions, (Oct. 2021), (Accessed Apr. 2024).
Medication Assisted Treatment
The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.
Medication Assisted Treatment (MAT) – Outpatient Settings – non OTP/OBAT Settings
The telehealth originating site facility fee is not authorized.
The Board shall include in the Medicaid State plan: A provision for payment of the originating site fee to emergency medical services agencies for facilitating synchronous telehealth visits with a distant site provider delivered to a Medicaid member. As used in this subdivision, “originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.
SOURCE: VA Code Annotated Sec. 32.1-325, (Accessed Apr. 2024).
Emergency ambulance transportation providers may submit a claim for providing a telemedicine “originating site fee” service (CPT Q3014) under the following conditions:
- The Emergency Ambulance Transport provider is licensed as a Virginia Emergency Medical Services (EMS) ambulance provider.
- The Emergency Ambulance Transport provider must be enrolled as such with DMAS.
- The Medicaid member is in a physical location where telemedicine services can be received per requirements set forth in the Telehealth Supplement.
- The member and provider of telemedicine services are not in the same physical location during the consultation.
- The Emergency Ambulance Transport provider assists with initiation of the visit but the presence of the Emergency Ambulance Transportation provider in the actual visit shall be determined by a balance of clinical need and member preference or desire for confidentiality.