Georgia

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: No
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, CC, EMS, IMLC, NLC, OT, PSY, PTC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video:  Yes
  • Distant sites explicitly allowed for Live Video:  Yes
  • Store and forward explicitly reimbursed:  No
  • Audio-only explicitly reimbursed:  Yes*
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: Georgia Medicaid
  2. Administrator: Georgia Dept. of Community Health
  3. Regional Telehealth Resource Center: Southeast Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 01/23/2023

Audio Only Delivery

Medicaid: Telehealth Guidance Clarification

STATUS: Active, during COVID-19 State of Emergency

Medicaid: COVID-19 Provider FAQs

STATUS: Active, during COVID-19 State of Emergency

Medicaid: Telehealth Guidance for COVID-19

STATUS: Active, during period of COVID-19 Emergency Response

Medicaid:  COVID-19 FAQs

STATUS: Active

Last updated 01/23/2023

Cross State Licensing

No reference found.

Last updated 01/23/2023

Easing Prescribing Requirements

No reference found.

Last updated 01/23/2023

Miscellaneous

No Reference Found

Last updated 01/24/2023

Originating Site

Medicaid: Telehealth Guidance Clarification

STATUS: Active, during National State of Emergency

Medicaid: Telehealth Guidance for COVID-19

STATUS: Active, during National State of Emergency

Last updated 01/23/2023

Private Payer

No Reference Found

Last updated 01/24/2023

Provider Type

Medicaid: Telehealth Guidance Clarification

STATUS: Active, during National State of Emergency

Medicaid:  COVID-19 FAQs

STATUS: Active

Last updated 01/24/2023

Service Expansion

Medicaid:  02 POS code

STATUS: Active, During Health Emergency

Medicaid: Telehealth Guidance for COVID-19

STATUS: Active, during period of COVID-19 Emergency Response

Medicaid:  COVID-19 FAQs

STATUS: Active

Medicaid: Provider Memo on Additional Telehealth Guidance

STATUS: Active, during PHE period

GA Department of Community Health: OIG FAQs regarding COVID-19

STATUS: Active

Medicaid 1915(c) Waiver: Appendix K – (0112, 4170) Elderly and Disabled Waiver and Independent Care Waiver Program

STATUS: Active until six months after the end of the public health emergency

Medicaid 1915(c) Waiver: Appendix K – (0323, 0175) Comprehensive Supports and New Options Waiver Programs

STATUS: Active until six months after the end of the public health emergency

Last updated 01/24/2023

Definitions

‘Telehealth’ means the use of information and communications technologies, including, but not limited to, telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health related education, public health, and health administration.

‘Telemedicine’ means a form of telehealth which is the delivery of clinical health care services by means of real-time two-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store-and-forward transfer technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care by a health care provider practicing within his or her scope of practice as would be practiced in-person with a patient as prescribed by applicable federal and state laws, rules, and regulations, and legally allowed to practice in this state, while such patient is at an originating site and the health care provider is at a distant site.  Such term includes audio-only telephone only when no other means of real-time two-way audio, visual, or other telecommunications or electronic communications are available to the patient due to lack of availability of such real-time two-way audio, visual, or other telecommunications or electronic communications, due to lack of adequate broadband access, or because the use of other means of real-time two-way audio, visual, or other telecommunications or electronic communications is infeasible, impractical, or otherwise not medically advisable, as determined by the health care provider providing telemedicine services to the patient or as determined by another health care provider with an existing relationship with the patient.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Jan. 2023).

Last updated 01/24/2023

Parity

SERVICE PARITY

An insurer shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis for services provided via telemedicine.

An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine services and is not provided through in-person consultation or contact between a health care provider and a patient for services appropriately provided through telemedicine services.

No insurer shall require an in-person consultation or contact before a patient may receive telemedicine services from a health care provider, except for the purposes of initial installation, setup, or delivery of in-home telehealth devices or services, or as otherwise required by state or federal law, rule, or regulation.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Jan. 2023).


PAYMENT PARITY

Payment must be at least at the rate that the insurer is responsible for coverage for the provision of the same service through in-person consultation or contact; provided, however, that nothing in this subsection shall require:

  1. A health care provider or telemedicine company to accept more reimbursement than they are willing to charge, or
  2. An insurer to pay for a telemedicine service provided through an audio-only call for any service other than mental or behavioral health services.

Payment for telemedicine interactions shall include reasonable compensation to the originating or distant site for the transmission cost incurred during the delivery of health care services; provided, however, that this shall not require the insurer to include payment for transmission costs if the originating or distant site is a home.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Jan. 2023).

Last updated 01/24/2023

Requirements

Each insurer proposing to issue a health benefit policy shall provide coverage for the cost of health care services provided through telehealth or telemedicine as directed through regulations promulgated by the department.

An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine services and is not provided through in-person consultation or contact between a health care provider and a patient for services appropriately provided through telemedicine services.

No insurer shall require an in-person consultation or contact before a patient may receive telemedicine services from a health care provider, except for the purposes of initial installation, setup, or delivery of in-home telehealth devices or services, or as otherwise required by state or federal law, rule, or regulation.

For the originating site, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

No insurer shall require its insureds to use telemedicine services in lieu of in-person consultation or contact.

If a treating provider obtains interprofessional consultation from a consulting provider for a patient for whom the treating provider conducted an examination through telemedicine services, an insurer shall not require the consulting provider to conduct, either in-person or through telemedicine services, an examination of such patient in order to receive reimbursement, unless such examination by the consulting provider would be required for the provision of the same services when the initial examination of the patient by the treating provider was conducted through in-person consultation or contact.

No insurer shall impose any type of utilization review on telemedicine services unless such type of utilization review is imposed when the same services are provided through in-person consultation or contact.

No insurer shall restrict coverage of telehealth or telemedicine services to services provided by a particular vendor, or other third party, or services provided through a particular electronic communications technology platform; provided, however, that nothing in this Code section shall require an insurer to cover any telehealth or telemedicine services provided through an electronic communications technology platform that does not comply with applicable state and federal privacy laws.

No insurer shall place any restrictions on prescribing medications through telemedicine that are more restrictive than what is required under applicable state and federal laws for prescribing medications through in-person consultation or contact.

A health care provider shall maintain documentation of each health care service provided through telemedicine in a manner that is at least as extensive and thorough as when the health care service is provided through in-person consultation or contact and, upon request, make such documentation available in accordance with applicable state and federal law.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Jan. 2023).

Last updated 01/23/2023

Definitions

Telemedicine is the use of medical information exchange from one site to another via electronic communications to improve patient’s health status. It is the use of two-way, real time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video communications equipment.

Closely associated with telemedicine is the term “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Telehealth is the use of telecommunication technologies for clinical care (telemedicine), patient teachings and home health, health professional education (distance learning), administrative and program planning, and other diverse aspects of a health care delivery system.

SOURCE: GA Dept. of Community Health, Physician Services Manual, p. R-1/169 (Jan 1. 2023). (Accessed Jan 2023).

Telehealth is a broad definition of remote healthcare that does not always involve clinical services. Telehealth can be used in telecommunications technologies for patient education, home health, professional health education and training, administrative and program planning, and other diverse aspects of a health care delivery system.

Telehealth involves the use of two-way, real time interactive communication equipment to exchange medical/clinical information between a healthcare practitioner and the member from one site to another via a secure electronic communication system. This includes audio and video communications equipment designed to facilitate delivery of healthcare services in a face-to-face interactive, though distant, engagement.

TeleMental Health is a term defined by Ga. Comp. R. & Regs. R. 135-11-01. and is applicable only to Licensed Social Workers, Professional Counselors and Marriage & Family Therapists when either 1) practicing telehealth as defined above, or 2) providing telephonic intervention when allowable via DCH/DBHDD guidelines). Per this rule and regulation, there are specific practice guidelines and mandatory training pertaining to what is identified as TeleMental Health. Providers shall adhere to these rules and regulations when TeleMental Health is provided by one of these named practitioners.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 6, (Jan 1, 2023).  & GA Community Behavioral Health Rehabilitation Services Manual p. 99 (Jan. 1, 2023).  (Accessed Jan. 2023).

Telemedicine involves the use of two-way, real time interactive communication equipment to exchange medical/clinical information between a healthcare practitioner and the member from one site to another via a secure electronic communication system. This includes audio and video communications equipment designed to facilitate delivery of healthcare services in a face-to-face interactive, though distant, engagement.

SOURCE: GA Community Behavioral Health Rehabilitation Services Manual p. 99 (Jan. 1, 2023).  (Accessed Jan. 2023).

Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site.

SOURCE: GA Department of Behavioral Health & Developmental Disabilities, Provider Manual for Community Behavioral Health Providers (Dec 2022), p. 102 (Mobile Clinics), p. 188 (Assertive Community Treatment), p. 277 (Mobile Crisis), p. 358, p. 480, 506.. (Accessed Jan. 2023).

Last updated 01/24/2023

Email, Phone & Fax

Non-covered Services Modalities

  • Telephone conversations.
  • Electronic mail messages.
  • Facsimile.
  • Services rendered via a webcam or internet-based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance.
  • Video cell phone interactions.
  • The cost of telehealth equipment and transmission.
  • Failed or unsuccessful transmissions.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 11 (Jan 2023). (Accessed Jan. 2023).

Behavioral Health Clinical Consultation

Interprofessional telephone consultation covered, see manual.

SOURCE: FY 23 – 3rd Quarter Provider Manual for Community Behavioral Health Providers, p. 22. (Jan. 1, 2023), (Accessed Jan. 2023).

Traditional/Enhanced Elderly and Disabled Waiver (EDWP) Traditional/Enhanced Case Management

Some case management and screening services may be provided telephonically.

SOURCE: GA Department of Community Health, Division of Medicaid, Policies and Procedures for Elderly and Disabled Waiver EDWP – (CCSP) Traditional/Enhanced Case Management, p. 45-47, 106. (Jan. 1, 2023).  (Accessed Jan. 2023).

Federally Qualified Health Centers

Except for services that meet the criteria for a TCM visit, telephone or electronic communication between a physician and a patient, or between a physician and someone on behalf of a patient, are considered physicians’ services and are included in an otherwise billable visit. They do not constitute a separately billable visit.

Telephone or electronic communication between a CP or CSW and a patient, or between such practitioner and someone on behalf of a patient, are considered CP or CSW services and are included in an otherwise billable visit

SOURCE: GA Department of Community Health, Division of Medicaid, Federally Qualified Health Centers Services and Rural Health Clinic Services, p. 17, 29 (Jan. 1, 2023). (Accessed Jan. 2023).

Community Behavioral Health and Rehabilitation Services

While some CBHRS services allow telephonic interactions, telephonic interventions do not qualify as telemedicine.

SOURCE: GA Department of Community Health, Division of Medicaid, Community Behavioral Health and Rehabilitation Services, p.  100.  (Jan. 2023).  (Accessed Jan. 2023).

Last updated 01/23/2023

Live Video

POLICY

The use of a telecommunications system may substitute for an in-person encounter for professional office visits, pharmacologic management, limited office psychiatric services, limited radiological services and a limited number of other physician fee schedule services. See the telehealth guidelines for program specific policies.

SOURCE: GA Dept. of Community Health, Physician Services Manual, p. 169 (Jan. 1, 2023). (Accessed Jan. 2023).

Medicaid covered services are provided via telehealth for eligible members when the service is medically necessary, the procedure is individualized, specific, and consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 5 (Jan. 1, 2023). (Accessed Jan. 2023).


ELIGIBLE SERVICES/SPECIALTIES

An interactive telecommunications system is required as a condition of payment. The originating site’s system, at a minimum, must have the capability of allowing the distant site provider to visually examine the patient’s entire body including body orifices (such as ear canals, nose and throat). The distant site provider should also have the capability to hear heart tones and lung sounds clearly (using a stethoscope) if medically necessary and currently within the provider’s scope of practice. The telecommunication system must be secure and adequate to protect the confidentiality and integrity of the information transmitted.

SOURCE: GA Dept. of Community Health, Physician Services Manual, p. 169 (Jan 1, 2023). (Accessed Jan. 2023).

Claims must use the appropriate CPT or HCPCS code with the GT modifier and or the use of POS 02. POS 10 will indicate Telehealth services were provided in the patient’s home. CPT modifier ‘‘93’’ can be appended to claim lines, as appropriate, for services furnished using audio only communications technology.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan 1, 2023). (Accessed Jan. 2023).

The service must be medically necessary and the procedure individualized, specific, and consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.

Physician Services:  When an enrolled provider determines that medical care can be provided via electronic communication with no loss in the quality or efficacy of the member’s care, telehealth services can be performed.

See telehealth manual for list of eligible telehealth services and codes for specific programs.

Interactive audio and video telecommunications must be used, permitting real-time communications between the distant site provider or practitioner and the member.

Non-Covered Service Modalities:

  1. Telephone conversations.
  2. Electronic mail messages.
  3. Facsimile.
  4. Services rendered via a webcam or internet-based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance.
  5. Video cell phone interactions.
  6. The cost of telehealth equipment and transmission.
  7. Failed or unsuccessful transmissions.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance, p. 5 & 10-11 (Jan 1, 2023). (Accessed Jan 2023).

Nursing Facilities 

Those residents whose interest is best served by receiving mental health services in the nursing facility or in a nearby telemedicine site can receive services in either of those locations, with the practitioner using out-of-clinic or telehealth/telemedicine procedure codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 48 (Jan 1, 2023) & GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facility Services, p. H-1 (p. 164). (Jan. 1, 2023). (Accessed Jan 2023).

Teledentistry

See dental services manual for teledentistry codes.

SOURCE: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Dental Services, IX-21-22, p. 60-61 (Jan. 2023). GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 40 (Jan. 1, 2023). (Accessed Jan 2023).

Autism Spectrum Disorder Services

Practitioners of Autism Spectrum Disorder (ASD) services can use telehealth to assess, diagnose and provide therapies to patients. Prior authorization is required for all Medicaid-covered adaptive behavior services, behavioral assessment and treatment services (not telehealth specific). See manual for eligible codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 16-17 (Jan. 1, 2023). (Accessed Jan. 2023).

Community Behavioral Health and Rehabilitation Services (CBHRS)

The Departments of Community Health and Behavioral Health and Developmental Disabilities have authorized telehealth to be used to provide some services in the CBHRS program.  The circumstances in which it can be provided are:

  • For some services, any member who consents may receive services via telehealth;
  • For some services, telehealth is allowed only for members who speak English as a second language, and telehealth will enable the member to engage with a practitioner who can deliver services in his/her preferred language (e.g. American Sign Language, etc.) (one-to-one via Telehealth versus interpreters)
  • Telehealth is only allowed for certain CBHRS services and only two-way, real-time interactive audio and video communication as described in the Service Definitions section of this Guidance is allowable. Telehealth may not be used for any other Intervention.
  • See Behavioral Health and Development Disabilities manual for approved codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 21 (Jan 1, 2023). GA Department of Community Health for CBHRS (Jan 2023). (Accessed Jan. 2023).

Those residents whose interest is best served by receiving mental health services in the nursing facility or in a nearby telemedicine site can receive services in either of those locations, with the practitioner using out-of-clinic or telehealth/telemedicine procedure codes.

SOURCE: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Community Behavioral Health Rehabilitation Services, p. 29, (Jan. 2023). (Accessed Jan. 2023).

Dialysis Services

The Centers for Medicaid and Medicare Services (CMS) has added Dialysis Services to the list of services that can be provided under Telehealth. See manual for list of eligible CPT codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 44 (Jan 1, 2023). (Accessed Jan. 2023).

School Based Services

Certain speech language pathology, speech and audiology, and physical therapy services are reimbursable via telehealth in the school-based setting.  This includes time spent assisting the student with learning to use adaptive equipment and assistive technology.

See manual for eligible CPT/HCPCS speech, audiology and physical therapy codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 53-56 (Jan 1, 2023), & GA Dept. of Early and Periodic Screening, Diagnostic and Treatment Services ). pX-7 (Jan 1, 2023). (Accessed Jan. 2023).

Durable Medical Equipment Services

A face-to-face encounter may be made through the use of telehealth technology by reporting the appropriate E&M code.

SOURCE: GA Dept. of Community Health, GA Medicaid Durable Medical Equipment Services Manual, p. 34  (Oct 1, 2022). (Accessed Jan. 2023).

Elderly and Disabled Waiver EDWP Traditional/Enhanced Case Management

Members must be seen by their PCP annually, either in the office of the PCP or via Telehealth with the SNS provider RN performing the call.

SOURCE: GA Dept of Community Health, Division of Medicaid, Policies and Procedures for Elderly and Disabled Waiver EDWP – (CCSP) Traditional/Enhanced Case Management (Jan 1, 2023), p. 21.  (Accessed Jan. 2023).

EDWP (CCSP and Source) Skilled Nursing Services by Private Home Care Providers

Registered Nurse Responsibilities include facilitating telehealth visits with the member and the member’s PCP.

SOURCE:  GA Dept of Community Health, Division of Medicaid, Policies and Procedures for EDWP (CCSP and SOURCE) (Jan 1, 2023), p. 210; Skilled Nursing Services by Private Home Care Providers (Jan 1, 2023), p. 7.; EDWP (CCSP) Traditional/Enhanced Case Management (Jan. 1, 2023), p. 31, 33-34. (Accessed Jan. 2023).

Children’s Intervention Services

The Department of Community Health will allow some speech therapy and audiology services to be rendered via telehealth.  See manual for appropriate codes.

SOURCE: GA Dept. of Community Health, Division of Medicaid, Children’s Intervention Services (Jan 1, 2023), p. 28, 29-30, 40.  (Accessed Jan. 2023).


ELIGIBLE PROVIDERS

The consulting provider must be an enrolled provider in Medicaid in the state of Georgia and must document all findings and recommendations in writing, in the format normally used for recording services in the member’s medical records.  The provider at the distant site must obtain prior approval when services require prior approval.  Both the originating site and distant site must document and maintain the member’s medical records. The report from the distant site provider may be faxed to the originating provider.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 10 (Jan 1, 2023). (Accessed Jan. 2023).

Autism Spectrum Disorder Services

Practitioners of ASD services can use telehealth to assess, diagnose and provide therapies to patients.  Providers must hold either a current and valid license to practice Medicine in Georgia, hold a current and valid license as a Psychologist as required under Georgia Code Chapter 39 as amended, or hold a current and valid Applied Behavior Analysis (ABA) Certification. In addition to licensed Medicaid enrolled Physicians and Psychologists, Georgia Medicaid will enroll Board Certified Behavioral Analysts (BCBAs) as Qualified Health Care Professionals (QHCPs) to provide ASD treatment services. The BCBA must have a graduate-level certification in behavior analysis. Providers who are certified at the BCBA level are independent practitioners who provide behavior-analytic services. In addition, BCBAs supervise the work of Board-Certified Assistant Behavior Analysts (BCaBAs), and Registered Behavior Technicians (RBTs) who implement behavior-analytic interventions.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 16 (Jan 1, 2023). (Accessed Jan. 2023).

Community Behavioral Health and Rehabilitation Services

See manual for eligible practitioner types and levels for CBHRS.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 24 (Jan 1, 2023). (Accessed Jan. 2023).

Teledentistry

Licensed dentists and dental hygienists are eligible providers.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 40 (Jan 1, 2023). (Accessed Jan. 2023).

Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)

FQHCs and RHCs can serve as the originating or distant site. They cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan 1, 2023) & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 30, (Jan 1, 2023). (Accessed Jan. 2023).

Nursing Facility Specialized Services

See manual for eligible providers and levels.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 49 (Jan 1, 2023). (Accessed Jan. 2023).

Advanced Nurse Practitioner

GT modifier must be used in conjunction with the appropriate codes for Telemedicine following full implementation of HIPAA compliance (see “Telemedicine Consultations.”).

SOURCE: GA Dept. of Community Health, GA Medicaid Division, Advanced Nurse Practitioner Services (Jan 1, 2023), p. 23.  (Accessed Jan. 2023).


ELIGIBLE SITES

Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014 with a payment of $20.52. Hospitals are eligible to receive reimbursement for a facility fee for telehealth when operating as the originating site. Claims must be submitted with revenue code 780 (telehealth) and type of bill 131. There is no separate reimbursement for telehealth serves when performed during an inpatient stay, outpatient clinic or emergency room visit or outpatient surgery, as these are all-inclusive payments.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan 1, 2023). (Accessed Jan. 2023).

Ambulance Providers

They may serve as originating sites and the ambulance may bill a separate origination site fee. They are not authorized to provide distant site services.

Limitation (Emergency Ambulance Services Handbook): Emergency ambulance services are reimbursable only when medically necessary. The recipient’s physical condition must prohibit use of any method of transportation except emergency for a trip to be covered.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 14 (Jan 1, 2023). & Emergency Ambulance Services Handbook, p. 17-18 (Jan 2023). (Accessed Jan. 2023).

Community Behavioral Health and Rehabilitation Services

Member may be located at home, schools and other community-based settings or at traditional sites named in the Department of Community Health Telehealth Guidance.  See manual for detailed instructions explanation for when and which type of practitioner can bill for telehealth services.

Traditional sites include:

  • Physician and Practitioner’s Offices;
  • Hospitals;
  • Rural Health Clinics;
  • Federally Qualified Health Centers;
  • Local Education Authorities and School Based Clinics;
  • County Boards of Health;
  • Emergency Medical Services Ambulances; and
  • Pharmacies.

SOURCE: GA Dept. of Community Health, Community Behavioral Health Rehabilitation Services Handbook Appendix O, p.99 (Jan 1, 2023). GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 21 (Jan 1, 2023). (Accessed Jan. 2023).

Teledentistry

Department of Public Health (DPH) Districts and Boards of Health Dental Hygienists shall only perform duties under this protocol at the facilities of the DPH District and Board of Health, at school-based prevention programs and other facilities approved by the Board of Dentistry and under the approval of the District Dentist or dentist approved by the District Dentist.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 40 (Jan 1, 2023). (Accessed Jan. 2023).

Services can now be provided in Federally Qualified Health Centers, volunteer community health settings, senior centers and family violence shelters.

SOURCE: GA Dept. of Community Health, Dental Services p. 60 (IX-21) (Jan. 1, 2023). (Accessed Jan. 2023).

Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)

FQHCs and RHCs can serve as originating sites and are paid an originating site facility fee. They cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan 1, 2023). & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23, (Jan 1, 2023). (Accessed Jan. 2023).

Dialysis Services

Dialysis facilities are eligible originating sites for dialysis services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 44 (Jan 1, 2023).  & GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. 17 (IX-10). (Oct 1, 2022) (Accessed Jan. 2023).

Nursing Facility Specialized Services

Nursing facilities can be eligible sites for nursing facility specialized services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 48 (Jan 1, 2023). & GA Dept. of Community Health, Nursing Facility Services, p. H-7 (p. 170). (Jan 1, 2023). (Accessed Jan. 2023).

School-Based Settings (Local Education Agencies)

Telehealth services are allowed in school-based settings upon enrollment into COS 600.  The following requirements must be met:

  • The provider is an authorized health-care provider enrolled in Georgia Medicaid
  • The client is a child who is receiving the service in a primary or secondary school-based setting
  • The parent or legal guardian of the client provides consent before the service is provided

Telehealth services provided in a school-based setting are also a benefit if the referring provider delegates provision of services to a nurse practitioner, clinical nurse specialist, physician assistant, or other licensed specialist as long as the above-mentioned providers are working within the scope of their professional license and within the scope of their delegation agreement with the provider.

The school must enroll as a Health Check Provider in order to bill the telehealth originating site facility fee.

LEAs must submit an Attestation Form for the provision of telehealth services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 53 (Jan 1, 2023).  (Accessed Jan. 2023).


GEOGRAPHIC LIMITS

No Reference Found

 


FACILITY/TRANSMISSION FEE

Originating sites are paid an originating site facility fee.  Hospitals are eligible to receive reimbursement for a facility fee for telehealth when operating as the originating site. There is no separate reimbursement for telehealth serves when performed during an inpatient stay, outpatient clinic or emergency room visit or outpatient surgery, as these are all-inclusive payments.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan 1, 2023). (Accessed Jan. 2023).

Community Behavioral Health and Rehabilitation Services

Originating fees (as referenced in some of the other Georgia Medicaid programs) are not offered for telemedicine when utilized in the CBHRS category of service. Telemedicine costs are attributed to the services intervention rates.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 22 (Jan 1, 2023). (Accessed Jan. 2023).

School-Based Settings (Local Education Agencies)

LEAs that enroll as Health Check providers to serve as telehealth originating sites only will be allowed to bill the originating site facility fee.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 53 (Jan 1, 2023).  & GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. VI-6. (Jan 1, 2023). (Accessed Jan. 2023).

Ambulance Providers

Ambulances may bill a separate origination site fee. The Telehealth originating fee (03014) cannot be billed in combination with other rendered EMS services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 14 (Jan 1, 2023). & Emergency Ambulance Services Handbook, p. 18 (Jan 2023). (Accessed Jan. 2023).

Dialysis Services

The originating facility/site (Dialysis Facility) will bill with the revenue code and procedure codes listed in the manual.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 44 (Jan 1, 2023). & GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. IX-10 (Oct 1, 2022). (Accessed Jan. 2023).

FQHC/RHC

FQHCs and RHCs that serve as an originating site for telehealth services are paid an originating site facility fee.

FQHCs and RHCs cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan 1, 2023).   GA Dept. of Community Health, GA Medicaid Federally Qualified Health Centers and Rural Health Clinics (Jan 1, 2023), p. 23.  (Accessed Jan. 2023).

Last updated 01/24/2023

Miscellaneous

Both the originating site and distant site must document and maintain the member’s medical records. The report from the distant site provider may be faxed to the originating provider. Additionally, all electronic documentation must be available for review by the Georgia Department of Community Health, Medicaid Division, Division of Program Integrity and all other applicable divisions of the department.

All transactions must utilize acceptable methods of encryption as well as employ authentication and identification procedures for both the sender and receiver.

SOURCE: GA Dept. of Community Health GA Medicaid Telehealth Guidance Handbook, p. 7 & 10 (Jan 2023). (Accessed Jan. 2023).

Last updated 01/24/2023

Out of State Providers

Physicians with licenses in other states may be licensed under the Interstate Medical Licensure Compact.  Providers should see the Georgia Composite Medical Board for additional information.

SOURCE: GA Dept. of Community Health GA Medicaid Telehealth Guidance Handbook, p. 7 (Jan. 2023). (Accessed Jan. 2023).

Last updated 01/24/2023

Overview

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward is not reimbursable as interactive telecommunications is a condition of payment; however, GA Medicaid will reimburse for the technical component of x-rays, ultrasounds, etc. as well as store-and-forward teledentistry. There is no reference to remote patient monitoring.

Last updated 01/23/2023

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 01/23/2023

Store and Forward

POLICY

GA Medicaid defines asynchronous or “store-and-forward” as the “transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous communication does not include telephone calls, images transmitted via fax machines and text messages without visualization of the patient (electronic mail).

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 6 (Jan 1, 2023). (Accessed Jan. 2023).

Certain teledentistry codes can be delivered via store-and-forward.

Department of Public Health (DPH) Districts and Boards of Health Dental Hygienists shall only perform duties under this protocol at the facilities of the DPH District and Board of Health, at school-based prevention programs and other facilities approved by the Board of Dentistry and under the approval of the District Dentist or dentist approved by the District Dentist.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 40 (Jan 1, 2023). & Part II Policies and Procedures for Dental Services, p. IX-22 (Jan 2023). (Accessed Jan. 2023).


ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

The State allows reimbursement for one specific teledentistry store-and-forward code.  See manual for approved code.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 40 (Jan 2023). & Part II Policies and Procedures for Dental Services, p. IX-22 (Jan 2023). (Accessed Jan. 2023).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The originating site fee (billed as D9996) associated with a real-time teledentistry exam is supposed to cover the asynchronous sending of information by a dental hygienist to a dentist for review.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 40 (Jan 2023). & Part II Policies and Procedures for Dental Services, p. IX-22 (Jan 2023). (Accessed Jan. 2023).

Last updated 01/25/2023

Cross State Licensing

The Board is authorized to issue telemedicine licenses to physicians who are licensed in other states but not licensed in Georgia.  See law for specific requirements to qualify for telemedicine license.

SOURCE:  Official Code of GA Annotated Sec. 43-34-31.1. (Accessed Jan. 2023).

All treatment and/or consultations must be done by Georgia licensed practitioners.

SOURCE:  GA Rules & Regulations Sec. 360-3-.07 (Accessed Jan. 2023).

Requirements for Telemedicine Licensure

  • Must meet the requirements of Rule 360-2-.01 and hold a full and unrestricted license to practice medicine in another state.
  • Telemedicine License will be limited to the practice of telemedicine and shall not be used to practice medicine physically in this state on a patient that is in this state, unless an emergency.
  • Must maintain records in accordance with Rule 360-3-.02(16)
  • Must adhere to Rule 360-3-.07
  • Once licensed applicant must notify the Board of any restrictions placed on his or her license or revocation of his or her license by a licensing board or entity in another state.
  • Issuance of this license is at the discretion of the Board.
  • The denial of a telemedicine license is not a contested case, but the applicant shall be entitled to an appearance before the Board.

SOURCE:  GA Rules & Regulations Sec. 360-2-.17 (Accessed Jan. 2023).

Last updated 01/25/2023

Definitions

Applies to: Interactive Physical Therapy Services

“Telehealth” is the use of electronic communications to provide and deliver a host of health-related information and health care services including, but not limited to physical therapy related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions.

SOURCE: GA Rules & Regulations. Sec. 490-9-.06 (Accessed Jan. 2023). 

Applies to: Interactive Occupational Therapy Services

‘Telehealth’ means the application of evaluative, consultative, preventative, and therapeutic services delivered through telecommunication and information technologies by licensed occupational therapy practitioners. This may include, but shall not be limited to, telemedicine, telepractice, telecare, telerehabilitation, and e-health services.

SOURCE:  Official Code of GA Annotated Sec. 43-28-3. (Accessed Jan. 2023).

Last updated 01/25/2023

Licensure Compacts

Member of Nurse Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-26-61 & NLC. (Accessed Jan. 2023).

Member of the Interstate Medical Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-34-301& IMLC (Accessed Jan. 2023).

Member of the Physical Therapy Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-33-31 & PTC (Accessed Jan. 2023).

Member of the Psychology Interjurisdictional Compact.

SOURCE: Official Code of GA Annotated Sec. 43-39-22 & PSYPACT (Accessed Jan. 2023).

Member of the Professional Counselors Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-10A-51 & Counseling Compact (Accessed Jan. 2023)

Member of the Occupational Therapy Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-28-21 & Occupational Therapy Licensure Compact (Accessed Jan. 2023).

Member of the Audiology and Speech-Language Pathology Interstate Compact.

SOURCE: Official Code of GA Annotated Sec. 43-44-31 & ASLP-IC (Accessed Jan. 2023).

Member of EMS Compact.

SOURCE: Official Code of GA Annotated Sec. 38-3-70 & Interstate Commission of EMS Personnel Practice, Member States (Accessed Jan. 2023).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 01/25/2023

Miscellaneous

No Reference Found

Last updated 01/25/2023

Online Prescribing

In order for a physician to practice within the minimum standards of practice while providing treatment and/or consultation recommendations by electronic or other such means, all the following conditions must be met:

  • All treatment and/or consultations must be done by Georgia licensed practitioners;
  • A history of the patient shall be available to the Georgia licensed physician, physician assistant or advanced practice registered nurse who is providing treatment or consultation via electronic or other such means;
  • Georgia licensed physician, physician assistant or advanced practice registered nurse either: (a) Has personally seen and examined the patient and provides ongoing or intermittent care by electronic or other such means; or (b) Is providing medical care by electronic or other such means at the request of a physician, physician assistant or advanced practice registered nurse licensed in Georgia who has personally seen and examined the patient; or (c) Is providing medical care by electronic or other such means at the request of a Public Health Nurse, a Public School Nurse, the Department of Family and Children’s Services, law enforcement, community mental health center or through an established child advocacy center for the protection for a minor, and the physician, physician assistant or advanced practice registered nurse is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care; or (d) Is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care.
  • The Georgia licensed physician, physician assistant or advanced practice registered nurse providing treatment or consultations by electronic or other means must maintain patient records on the patient and must document the evaluation and treatment along with the identity of the practitioners providing the service by electronic or other means, and if there is a referring practitioner, a copy of this record must also be provided to the referring physician, physician assistant or advanced practice registered nurse.
  • To delegate to a nurse practitioner or to supervise a physician assistant doing telemedicine, the physician must document to the board that the provision of care by telemedicine is in his or her scope of practice and that the NP or PA has demonstrated competence in the provision of care by telemedicine.
  • Patients treated by electronic or other such means or patient’s agent must be given the name, credentials and emergency contact information for the Georgia licensed physician, physician assistant and/or advanced practice registered nurse providing the treatment or consultation. Emergency contact information does not need to be provided to those treated within the prison system while incarcerated but should be provided to the referring provider. For the purposes of this rule, “credentials” is defined as the area of practice and training for physicians, and for physician assistants and advanced practice registered nurses, “credentials” shall mean the area of licensure and must include the name of the delegating physician or supervising physician.
  • The patient being treated via electronic or other means or the patient’s agent must be provided with clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment. In the case of prison patients, prison staff will be provided this information if the consult is provided to an inmate.
  • The physician, physician assistant or nurse practitioner who provides care or treatment for a patient by electronic or other such means must make diligent efforts to have the patient seen and examined in person by a Georgia licensed physician, physician assistant or nurse practitioner at least annually.

This rule should not be interpreted to interfere with care and treatment by telephonic communication in an established physician-patient relationship, call coverage for established physician-patients relationships, or telephone and internet consultations between physicians, nurse practitioners, physician assistants, other health care providers or child protection agencies.

This rule does not authorize the prescription of controlled substances for the treatment of pain or chronic pain by electronic or other such means. All treatment of pain or chronic pain must be in compliance with Rule 360-3-.06.

SOURCE: GA Rules & Regulations revised 360-3-.07. (Accessed Jan. 2023). 

Unprofessional conduct shall include but not be limited to prescribing controlled substances and/or dangerous drugs for a patient based solely on a consultation via electronic means with the patient, patient’s guardian or patient’s agent. This shall not prohibit a licensee from prescribing a dangerous drug for a patient pursuant to a valid physician­ patient relationship in accordance with O.C.G.A. 33-24-56.4 or a licensee who is on-call or covering for another licensee from prescribing up to a 30-day supply of medications for a patient of such other licensee nor shall it prohibit a licensee from prescribing medications when documented emergency circumstances exist.

This shall also not prevent a licensed physician from prescribing Schedule II sympathomimetic amine drugs for the treatment of attention deficit disorder to a patient in the physical presence of a licensed nurse, provided the initial diagnosis was made and an initial prescription was issued in accordance with 21 U .S .C. § 829(e), as amended from time to time, including but not limited to the following:

  • The physician has conducted at least one in-person medical evaluation of the patient; or
  • The physician is covering for a licensee who is temporarily unavailable and has conducted at least one in-person medical evaluation of the patient; or
  • The physician is engaged in the practice of telemedicine in accordance with Board Rule 360-3-.07 and with 21 U.S.C. §§ 802(54) and 829(e)(3)(A), including, but not limited to:
    • Where the patient is being treated by, and physically located in, a hospital or clinic registered with the U.S. Drug Enforcement Agency (“DEA”), the physician is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(A) are met; or
    • Where the patient is being treated by, and physically in the presence of, a licensee who is registered with the DEA, and all other requirements of 21 U.S.C. § 802(54)(B) are met; or
    • Where the physician has obtained from the U.S. Attorney General a special registration for telemedicine in accordance with 21 U.S.C. §§ 802(54)(E) and 831(h).

Providing treatment via electronic or other means is considered unprofessional conduct unless a history and physical examination of the patient has been performed by a Georgia licensee.  This shall not prohibit a licensee who is on call or covering for another licensee from treating and/or consulting a patient of such other licensee. Also, this paragraph shall not prohibit a patient’s attending physician from obtaining consultations or recommendations from other licensed health care providers.

SOURCE: GA Rules & Regulations revised 360-3-.02. (Accessed Jan. 2023).

Last updated 01/25/2023

Professional Boards Standards

GA Composite Medical Board

SOURCE:  GA Rules & Regulations Sec. 360-3-.07 (Accessed Jan. 2023).

GA Composite Medical Board – Requirements for Telemedicine Licensure

SOURCE:  GA Rules & Regulations Sec. 360-2-.17 (Accessed Jan. 2023).

GA Board of Physical Therapy

SOURCE: GA Rules & Regulations Sec. 490-9-.06 (Accessed Jan. 2023).

Last updated 01/25/2023

Definition of a Visit

A FQHC or RHC visit is defined as a medically-necessary, face-to-face (one-on-one) encounter between the patient and a physician, NP, PA, CNM, CP, or a CSW during which time one or more FQHC or RHC services are rendered. A Wellness Visit (Health Check/EPSDT) or Transitional Care Management (TCM) services can also be considered a FQHC or RHC visit. A FQHC or RHC visit can also be a visit between a home-bound patient and an RN or LPN under certain conditions. See section 960.1 of this chapter for information on visiting nursing services to home-bound patients.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 8. (Jan 1, 2023). (Accessed Jan. 2023).

Last updated 01/25/2023

Eligible Distant Site

Yes – FQHC’s and RHC’s are authorized to serve as a distant site for telehealth services, and may bill the cost of the visit.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 42 (Jan 1, 2023). Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23. (Jan 1, 2023). (Accessed Jan. 2023).

Last updated 01/25/2023

Eligible Originating Site

Yes – FQHCs and RHCs may serve as an originating site for telehealth services, which is the location of an eligible Medicare beneficiary or enrolled Medicaid member at the time the service being furnished via a telecommunications system occurs.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 42 (Jan 1, 2023).  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23 (Jan 1, 2023). (Accessed Jan. 2023).

Last updated 01/25/2023

Facility Fee

FQHCs serving as an originating site may be paid an originating site facility fee.  FQHCs may not bill for an originating site fee and distant site fee for a telehealth service on the same encounter.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 42 (Jan 1, 2023). Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23. (Jan 1, 2023). (Accessed Jan. 2023).

Last updated 01/25/2023

Home Eligible

A FQHC or RHC visit may take place in the FQHC or RHC, the patient’s residence, an assisted living facility, a Medicare-covered Part A SNF (see Pub. 100-04, Medicare Claims Processing Manual, chapter 6, §20.1.1), or the scene of an accident.

Qualified services provided to a FQHC or RHC patient in a location other than the FQHC or RHC facility are considered FQHC or RHC services if:

  • the practitioner is compensated by the FQHC or RHC for the services provided;
  • the cost of the service is included in the FQHC or RHC cost report; and
  • other requirements for furnishing services are met.

Except for hospital settings, services furnished in a location other than the FQHC or RHC (either during the posted hours of operation or during another time), and services furnished to FQHC or RHC patients (either those seen previously in the FQHC or RHC or those not previously seen), are billed as a FQHC or RHC visit when the FQHC or RHC includes the practitioner’s compensation for these services in the FQHC or RHC cost report and other certification and cost reporting requirements for furnishing services are met. If the cost of a service is not included on the FQHC or RHC cost report, the service may be billed to Part B if appropriate. Only compensation paid for FQHC or RHC services can be claimed on the cost report.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 8-9. (Jan 1, 2023). (Accessed Jan. 2023).

Last updated 01/25/2023

Modalities Allowed

Live Video

FQHCs may serve as distant site providers and bill the cost of the visit. They are referred to the GA Medicaid Telehealth Manual.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23. (Jan 1, 2023). (Accessed Jan. 2023).


Store and Forward

There is no reference found for store-and-forward explicitly for FQHCs although store and forward is allowed under general GA Medicaid policy for teledentistry.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 40 (Jan 1, 2023). (Accessed Jan. 2023).


Remote Patient Monitoring

No reference found.


Audio-Only

No reimbursement for telephone, fax or email.

SOURCE: Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 11 (Jan 1, 2023). (Accessed Jan. 2023).

Except for services that meet the criteria for a TCM visit, telephone or electronic communication between a physician and a patient, or between a physician and someone on behalf of a patient, are considered physicians’ services and are included in an otherwise billable visit. They do not constitute a separately billable visit.

SOURCE: Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 17. (Jan 1, 2023) (Accessed Jan. 2023).

Last updated 01/25/2023

Patient-Provider Relationship

No reference found.

Last updated 01/25/2023

PPS Rate

There is no explicit reference to PPS rate for telehealth found. FQHCs may bill “the cost of the visit.”

In order for the FQHC and RHC per visit rate to be paid as a PPS visit one of the CPT procedure codes listed in Appendix H must be recorded on a claim.

Reimbursement for Federally Qualified Health Center Services is based on an actual clinic encounter or visit (office, emergency room or hospital) even though other services are rendered at the same time. Federally Qualified Health Center Services are reimbursed according to the clinic’s assigned “all inclusive” rate.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 42 (Jan 1, 2023). Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. C-1, G-5 (Jan 1, 2023). (Accessed Jan. 2023).

Last updated 01/25/2023

Same Day Encounters

Except as noted below, encounters with more than one FQHC or RHC practitioner on the same day, or multiple encounters with the same FQHC or RHC practitioner on the same day, constitute a single FQHC or RHC visit, regardless of the length or complexity of the visit, the number or type of practitioners seen, or whether the second visit is a scheduled or unscheduled appointment. This would include situations where a FQHC or RHC patient has a medically necessary face-to-face visit with a FQHC or RHC practitioner, and is then seen by another FQHC or RHC practitioner, including a specialist, for further evaluation of the same condition on the same day, or is then seen by another FQHC or RHC practitioner (including a specialist) for evaluation of a different condition on the same day. More than one medically-necessary face-to-face visit with a FQHC or RHC practitioner on the same day is payable as one visit, except for the following circumstances:

For a new patient: The new patient has a well visit (health check) billed with CPT 99381 – 99385 and an office visit CPT 99202 – 99205 will be reimbursed 1 PPS rate.

For an established patient: The established patient has a well visit (health check) billed with CPT 99391 – 99395, Modifier EP, 25 and an office visit CPT 99211 – 99212 will be reimbursed 2 PPS rates.

The established patient has a well visit (health check) billed with CPT 99391 – 99395, Modifier EP, 25 and an office visit CPT 99213 – 99215 will be reimbursed 1 PPS rate and a DEF rate as listed on the Physician Fee Schedule.

However, if the patient suffers illness or injury on the same day requiring additional diagnosis or treatment subsequent to the initial visit, another visit may be billed. In addition, separate FQHC and RHC per visit payments can be made for “core” services versus other ambulatory services provided on the same day by different types of qualified health care professionals for different procedure and diagnostic codes.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 10-11, C-1. (Jan 1, 2023). (Accessed Jan 2023).