Store and Forward
POLICY
Reimbursement for asynchronous store-and-forward may be capped at the reimbursement rate had the service been provided in person.
SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Apr. 2025).
Asynchronous store-and-forward shall mean the transfer of a participant’s clinically important digital samples, such as still images, videos, audio, text files, and relevant data from an originating site through the use of a camera or similar recording device that stores digital samples that are forwarded via telecommunication to a distant site for consultation by a consulting provider without requiring the simultaneous presence of the participant and the participant’s treating provider.
- Asynchronous store-and-forward technology shall mean cameras or other recording devices that store images which may be forwarded via telecommunication devices at a later time.
- Asynchronous store-and-forward transfer shall mean the collection of a participant’s relevant health information and the subsequent transmission of that information from an originating site to a provider at a distant site without the participant being present.
Distant site shall mean a telemedicine site where the health care provider providing the telemedicine service is physically located.
Originating site shall mean a telemedicine site where the MO HealthNet participant receives the telemedicine service. Originating sites include, but are not necessarily limited to health care provider facilities, participants’ homes, and schools. For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location from which the referring provider transfers information to the distant site.
Licensed health care provider-patient relationship shall mean that a health care provider licensed under Chapter 334, RSMo, and/or other providers utilizing telemedicine, shall ensure that a properly established provider-patient relationship exists with the participant who receives telemedicine services.
Telemedicine shall mean the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.
Health care professional shall mean a physician or other health care practitioner licensed, accredited, or certified by the state of Missouri to perform specified health services consistent with state law.
Health care provider or provider shall mean a health care professional or a health care facility.
Health care service shall mean a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease, including but not limited to the provision of drugs or durable medical equipment.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(1), (Accessed Apr. 2025).
Interprofessional Consultations
MHD’s Physician Program currently covers interprofessional consultation. Effective April 15, 2024, MHD is implementing interprofessional consultation for behavioral health practitioners.
- Interprofessional consultation must be for the direct benefit of the participant. This means the services must be directly relevant to the participant’s diagnosis and treatment, and the consultant must have specialized expertise in the particular health concerns of the participant.
- Interprofessional consultation is intended to expand access to specialty care and foster interdisciplinary input on patient care. It is not intended to replace direct specialty care when such care is clinically indicated. Interprofessional consultation may be delivered via telehealth technology.
- The treating/requesting physician and the consultant must both be MHD enrolled. For consultations that cross state lines, the consulting practitioner must be enrolled in the state where the participant resides.
- An interprofessional telephone/internet/electronic health record (EHR) consultation is an assessment and management service in which a participant’s treating physician requests the opinion and/or treatment advice of another professional with specialty expertise (the consultant) to assist the treating physician in the diagnosis and/or management of the participant’s problem without patient face-to-face contact with the consultant.
- The consultant should not have seen the patient in a face-to-face (or telehealth) encounter within the last 14 days.
- When the telephone/internet/EHR consultation leads to a transfer of care or other face-to-face (or telehealth) service within the next 14 days, the codes are not reported.
- If more than one telephone/internet/EHR contact is required to complete the consultation request, the entirety of the service and the cumulative discussion and information review time should be reported with a single code. Do not report 99446, 99447, 99448, 99449, or 99451 more than once within a seven-day interval.
- The written or verbal request for telephone/internet/EHR advice by the treating/requesting physician must be documented in the participant’s medical record, including the reason for the request.
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Documentation from the consultant must be provided to the treating/requesting provider in writing. Documentation from the consultant must meet the MHD requirements for adequate documentation at 13 CSR 70-3.030(2)(A).
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When the sole purpose of the telephone/internet/EHR communication is to arrange a transfer of care or other face-to-face service, these codes are not reported
Psychiatrists and advanced practice psychiatric nurses bill the below interprofessional consultation codes with no modifier. Rates for the below codes without a modifier are equivalent to the AH modifier rates. For other behavioral health practitioners, see the modifier key below the table for a refresher.
See bulletin for codes.
Independent Rural Health Clinic Billing: When Independent RHCs render any of the services outlined in this bulletin, they must bill according to their standard MHD billing procedures. Specifically, Independent RHCs bill the visit code T1015 on the outpatient claim form. It must be entered in the HCPCS/Rates field of the outpatient claim form in order to receive MHD reimbursement based on the Medicare established all-inclusive rate for each visit. In order to comply with federal guidelines and MHD policies, the services that comprise each visit must also be shown in the Principal Procedure Code and Other Procedure Code fields of the outpatient claim form.
SOURCE: MO HealthNet, Provider Bulletin, Vo. 46, No. 54, April 19, 2024, (Accessed Apr. 2025).
ELIGIBLE SERVICES/SPECIALTIES
Teledentistry
MHD covers teledentistry services for participants under the age of 21, blind, pregnant or in a SNF. This benefit allows any licensed dental provider, enrolled with MO HealthNet, to provide teledentistry services if the services are within the scope of practice for which the dental provider is licensed. Teledentistry services must be performed with the same standard of care as an in-person, face-to-face service.
Prior to the delivery of teledentistry services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via teledentistry in the school for the remainder of the school year.
The MO HealthNet Dental Program allows reimbursement for CDT codes D9995 (Synchronous; real time encounter) and D9996 (Asynchronous; information stored and forwarded to dentist for subsequent review).
Teledentistry services must be billed by the distant site facility (physical location of the dentist or clinic providing the dental service to an eligible Medicaid participant through teledentistry). Dentists must bill either D9995 or D9996 and the CDT code(s) for services provided. Reimbursement to dental providers delivering the service at the distant site is equal to the current fee schedule amount for the service provided. There is not a separate teledentistry fee schedule. The originating site (physical location of the participant) is where diagnostic data is collected to be communicated to an off-site dentist for diagnosis or where a dental service is performed. The originating site cannot bill MHD for CDT codes D9995 or D9996. The originating site can bill procedure code Q3014 on the CMS-1500 claim form to receive reimbursement for use of the facility where teledentistry services were rendered. The distant site service must be billed on the 2019 ADA Dental Claim Form with the CDT code (D9995 or D9996) and any additional services provided, using place of service code 02 – Telehealth.
Health care service shall mean a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease, including but not limited to the provision of drugs or durable medical equipment.
A telemedicine service shall be covered only if it is medically necessary.
A telemedicine service must be performed with the same standard of care as an in-person, face-to-face service. If the same standard of care cannot be met, a telemedicine service shall not be provided.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(B)(8) & (3), (Accessed Apr. 2025).
Interprofessional Consultations
MHD’s Physician Program currently covers interprofessional consultation. Effective April 15, 2024, MHD is implementing interprofessional consultation for behavioral health practitioners.
- Interprofessional consultation is intended to expand access to specialty care and foster interdisciplinary input on patient care. It is not intended to replace direct specialty care when such care is clinically indicated. Interprofessional consultation may be delivered via telehealth technology.
- The treating/requesting physician and the consultant must both be MHD enrolled. For consultations that cross state lines, the consulting practitioner must be enrolled in the state where the participant resides.
Psychiatrists and advanced practice psychiatric nurses bill the below interprofessional consultation codes with no modifier. Rates for the below codes without a modifier are equivalent to the AH modifier rates. For other behavioral health practitioners, see the modifier key below the table for a refresher.
See bulletin for codes.
Independent Rural Health Clinic Billing: When Independent RHCs render any of the services outlined in this bulletin, they must bill according to their standard MHD billing procedures. Specifically, Independent RHCs bill the visit code T1015 on the outpatient claim form. It must be entered in the HCPCS/Rates field of the outpatient claim form in order to receive MHD reimbursement based on the Medicare established all-inclusive rate for each visit. In order to comply with federal guidelines and MHD policies, the services that comprise each visit must also be shown in the Principal Procedure Code and Other Procedure Code fields of the outpatient claim form.
SOURCE: MO HealthNet, Provider Bulletin, Vo. 46, No. 54, April 19, 2024, (Accessed Apr. 2025).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
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