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

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 01/31/2024

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 2024).

Last updated 01/31/2024

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 2024).


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 2024).

Last updated 01/31/2024

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 2024).

Newly Passed Legislation

An insurer shall not:

  • Require prior authorization, medical review, or administrative clearance for a telehealth service that would not be required if such service were provided in person;
  • Require demonstration that it is necessary to provide a service to a covered person through telehealth;
  • Require a provider to be employed by another provider or agency in order to provide a telehealth service that would not be required if such service were provided in person;
  • Restrict or deny coverage of a telehealth service based solely on the communication technology or application used to deliver such service;
  • Require a provider to be part of a telehealth network;
  • Require a covered person to utilize telehealth or telemedicine in lieu of a nonparticipating provider accessible for in-person consultation or contact; or
  • Be required to pay a facility fee to a hospital for telehealth services unless the hospital is the originating site as defined in subsection (b) of Code Section 33-24-56.4.

SOURCE Official Code of GA Annotated Sec. 33-20E-24(e).  (Accessed Jan. 2024).

Last updated 01/29/2024

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-1/170 (Jan. 2024). (Accessed Jan 2024).

Telehealth 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 telehealth is the term “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. (CCHP NOTE: We believe the previous sentence contains a typo and that the first use of the term “telehealth” was meant to be “telemedicine”.) Telehealth is the use of telecommunications technologies for clinical care (telehealth), patient teachings and home health, health professional education (distance learning), administrative and program planning, and other diverse aspects of a health care delivery system.

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.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 6, 8, (Jan 1, 2024). GA Community Behavioral Health Rehabilitation Services Manual p. 99 (Jan. 1, 2024) (Accessed Jan. 2024).

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.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 6, 8, (Jan 1, 2024). (Accessed Jan. 2024).

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. 98 (Jan. 1, 2024) (Accessed Jan. 2024).

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. 9, (Jan 1, 2024)  (Accessed Jan. 2024).

Telemedicine is the use of medical information exchanged from one secured 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 (defined in the DBHDD Behavioral Health Provider Manual, Glossary).

SOURCE: GA Department of Behavioral Health & Developmental Disabilities, Provider Manual for Community Behavioral Health Providers (Dec 2023), p. 395 (Accessed Jan. 2024).

Last updated 01/31/2024

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. 17 (Jan. 1, 2024). (Accessed Jan 2024).

Behavioral Health Clinical Consultation

Interprofessional telephone consultation and certain other services are covered, see manual.

SOURCE: FY 24 – Quarter 2 Provider Manual for Community Behavioral Health Providers, p. 34 & 142. (Jan  1, 2024), (Accessed Jan 2024).

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. 11. (Jan. 1, 2024).  (Accessed Jan 2024).

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, 2024). (Accessed Jan 2024).

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.  1010  (Jan. 1, 2024).  (Accessed Jan 2024).

Comprehensive Supports Waiver Program

Telephone calls and store and forward (asynchronous) modalities are not allowed for billable therapy evaluation and services.

SOURCE: GA Dept. of Community Health, Division of Medicaid, Comprehensive Supports Waiver Program Chapters 1300-3700. (Jan. 1, 2024).  (Accessed Jan. 2024).

Psychology and Therapy Services

Non-covered services include telephone referrals and consultations.

SOURCE: GA Dept. of Community Health, Division of Medicaid, Psychology and Therapy Services, p. 12. (Jan. 1, 2024).  (Accessed Jan. 2024).

Last updated 01/29/2024

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. 170 (Jan. 1, 2024). (Accessed Jan. 2024).

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. 7 (Jan. 1, 2024). (Accessed Jan 2024).


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. 170 (Jan. 1, 2024). (Accessed Jan. 2024).

Claims for telehealth services must use the appropriate CPT or HCPCS code for the professional service. The GT modifier is required as applicable, and/or the use of either POS 02 or POS 10. POS 02 will indicate Telehealth services that were utilized at a location other than at the patient’s home. The GQ modifier is still required as applicable. By coding and billing with the covered telehealth procedure code, providers are certifying that the member was present at an eligible originating site when you furnished the telehealth service. CPT modifier ‘‘93’’ can be appended to claim lines, as appropriate, for services furnished using audio only communications technology. Interactive audio and video telecommunications must be used, permitting real time communications between the distant site provider or practitioner and the member.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 12, 16 (Jan. 1, 2024). (Accessed Jan. 2024).

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.

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). Depending upon an enrolled provider’s specialty and scope of practice, the distant provider should also have the capability to hear heart tones and lung sounds clearly (using 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.

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. 6-7 & 17 (Jan. 1, 2024). (Accessed Jan 2024).

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. See manual for codes.

Though not available in all areas of the State, Medicare-funded mental health services are currently provided to nursing home residents via telemedicine, face-to-face visits by providers Rev. 04/12 in the nursing home, and nursing home resident visits to psychiatric/mental health clinics/offices for those individuals able to travel outside the nursing facility.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 45-46 (Jan. 1, 2024) & GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facility Services, p. H-1 , H-8 (p. 217, 223). (Jan. 1, 2024). (Accessed Jan 2024).

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 (Oct. 2023). GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 36 (Jan. 1, 2024). (Accessed Jan 2024).

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. 24-29 (Jan. 1, 2024). (Accessed Jan 2024).

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.  See Behavioral Health and Development Disabilities manual for more detailed information.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 31-34 (Jan. 1, 2024). GA Department of Community Health for CBHRS, p. 98-99 (Jan. 1, 2024). GA Dept. of Behavioral Health & Developmental Disabilties, Provider Manual for Community Behavioral Health Providers (Dec. 2023).  (Accessed Jan 2024).

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. 67, (Jan. 1, 2024). (Accessed Jan 2024).

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. 40-43 (Jan. 1, 2024). (Accessed Jan. 2024).

School Based Services

Telehealth benefits are allowed if all the following criteria are 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.

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. 49-53 (Jan. 1, 2024). (Accessed Jan. 2024).

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  (Jan. 1, 2024). (Accessed Jan 2024).

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, 2024), p. 23.  (Accessed Jan 2024).

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): General Services (Jan.1, 2024), p. 212-213; Skilled Nursing Services by Private Home Care Providers (Jan. 1, 2024), p. 7, 11-12.; (Accessed Jan 2024).

Department of Community Health

The Department of Community Health (DCH) will allow medically necessary services to be rendered via telehealth. Each billed procedure code must be submitted with the usual program modifier(s). Place of service code 02 must be added to the allowed procedure codes to indicate the services are related to telehealth services.

SOURCE: GA Dept of Community Health: Early Intervention Case Management Program, p. 28 (Jan. 1, 2024).  (Accessed Jan. 2024).

Children’s Intervention Services

The Department of Community Health will allow some speech therapy, 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, 2024), p. 47.  GA Dept. of CommunityHealth, Childrens Intervention School Services (Jan. 1, 2024). (Accessed Jan 2024).

Comprehensive Supports Waiver Program (COMP)

All components of Adult Occupational Therapy, Adult Physical Therapy, Speech and Language Therapy, Adult Nutrition Services,  Interpreter Services can be safely provided via telehealth modalities according to prevailing best practice standards published by the American Speech and Language Hearing (Occupational or Physical Therapy) Association and in accordance with the Georgia license requirements under O.C.G.A. § 43-44-7. Therapists are expected to use synchronous “in real time” audio/video technology for telehealth sessions. Telephone calls and store and forward (asynchronous) modalities are not allowed for billable therapy evaluation and services.

Some components of Behavior Supports Services can be provided via a telehealth modality to supplement in-person service delivery. The following components are the only components that are allowable for a telehealth option:

  • Indirect assessment component for functional behavior assessment;
  • Follow up or refresher staff training for behavior support plans;
  • Additional fidelity monitoring of plan implementation and oversight;
  • Distant site observations of the individual for the purposes of consultation, modeling, and recommendations for interventions to staff/caregivers in real time;
  • Team meetings for the purpose of gathering feedback related to behavior support plans effectiveness; and
  • Review of data analysis summaries and behavior graphing.

See manual for more details.

SOURCE: GA Dept. of Community Health, Comprehensive Supports Waivers Program (COMP) Chapters 1300-3700 (Jan. 1, 2024), GA Dept. of CommunityHealth, New Options Waiver Program (NOW) (Jan. 1, 2024).  (Accessed Jan 2024).

Independent Care Waiver Services

Counseling services are available to members needing treatment for personal, social or behavioral disorders to maintain and improve effective functioning. Counseling services can be provided via telehealth with or without a visual component.

SOURCE: GA Dept. of Community Health, Independent Care Waiver Services (Jan. 1, 2024), p. 78.  (Accessed Jan. 2024).


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. 15 (Jan. 1, 2024). (Accessed Jan. 2024).

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. 24 (Jan. 1, 2024). (Accessed Jan 2024).

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. 33-34 (Jan. 1, 2024). (Accessed Jan 2024).

Teledentistry

Licensed dentists and dental hygienists are eligible providers.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 36 (Jan. 1, 2024). (Accessed Jan 2024).

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. 38 (Jan. 1, 2024) & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23, (Jan. 1, 2024). (Accessed Jan 2024).

Nursing Facility Specialized Services

See manual for eligible providers and levels.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 46 (Jan. 1, 2024). (Accessed Jan. 2024).

Advanced Nurse Practitioner & Nurse Midwifery Services

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, 2024), p. 23.  GA Dept. of Community Health, GA Medicaid Division, Nurse Midwifery Services, p. 36 (Jan. 1, 2024).  (Accessed Jan 2024).

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. 50 (Jan. 1, 2024)., GA Dept. of CommunityHealth, Childrens Intervention School Services (Jan. 1, 2024), p. 9. (Accessed Jan 2024).


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. 12 (Jan. 1, 2024). (Accessed Jan 2024).

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. See Emergency Ambulance Handbook for more specific information.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 21 (Jan. 1, 2024). & Emergency Ambulance Services Handbook, p. 18 (Jan. 1, 2024). (Accessed Jan 2024).

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.98 (Jan. 1, 2024). GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 31 (Jan. 1, 2024). (Accessed Jan 2024).

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. 36 (Jan. 1, 2024). (Accessed Jan 2024).

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) (Oct. 2023). (Accessed Jan 2024).

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. 38 (Jan. 1, 2024). & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23, (Jan. 1, 2024). (Accessed Jan 2024).

Dialysis Services

Dialysis facilities are eligible originating sites for dialysis services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 40 (Jan. 1, 2024).  & GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. 17 (IX-10). (Jan. 1, 2024) (Accessed Jan  2024).

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. 45 (Jan. 1, 2024). & GA Dept. of Community Health, Nursing Facility Services, p. H-7 (p. 223). (Jan. 1, 2024). (Accessed Jan 2024).

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. 50 (Jan. 1, 2024)., GA Dept. of CommunityHealth, Childrens Intervention School Services (Jan. 1, 2024), p. 9. (Accessed Jan 2024).


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. 12 (Jan. 1, 2024). (Accessed Jan 2024).

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: Community Behavioral Health and Rehabilitation Services, p. 99 (Jan. 1, 2024),  GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 33 (Jan. 1, 2024). (Accessed Jan 2024).

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. The telehealth originating facility fee is reimbursed at the current DEFAULT rate.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 50-1 (Jan. 1, 2024).  & GA Dept. of Community Health, Children’s Intervention Services, p. 46 (Jan. 1, 2024) GA Dept. of CommunityHealth, Childrens Intervention School Services (Jan. 1, 2024), p. 9. (Accessed Jan 2024).

Ambulance Providers

Ambulances may bill a separate origination site fee. The Telehealth originating fee (Q3014) cannot be billed in combination with other rendered EMS services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 21 (Jan. 1, 2024). & Emergency Ambulance Services Handbook p. 17 (Jan. 1, 2024). (Accessed Jan 2024).

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. 40 (Jan. 1, 2024). & GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. IX-10 (17) (Jan. 1, 2024). (Accessed Jan 2024).

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. 38 (Jan. 1, 2024).   GA Dept. of Community Health, GA Medicaid Federally Qualified Health Centers and Rural Health Clinics (Jan. 1, 2024), p. 23.  (Accessed Jan 2024).

EPSDT Services – Health Check Program

LEAs enrolled as Health Check providers to serve as telemedicine originating sites only will be allowed to bill the telemedicine originating site facility fee (procedure code Q3014).

SOURCE: GA Dept. of Community Health, EPSDT Services – Health Check Program, p. 70  (X-7). (Jan. 1, 2024). (Accessed Jan 2024).

Children’s Intervention Services

Originating sites are paid an originating site facility fee for telehealth services by billing procedure code Q3014.

SOURCE: GA Dept. of Community Health, Division of Medicaid, Children’s Intervention Services (Jan. 1, 2024), p. 46. (Accessed Jan. 2024).

Last updated 01/31/2024

Miscellaneous

The referring provider must be the member’s attending physician, practitioner, or provider in charge of their care. The request must be documented in the member’s record. The physician or practitioner providing the referral must provide pertinen medical information and/or records to the distant site provider via a secure transmission. Notwithstanding the foregoing, referrals for evaluation of physical, mental, or sexual abuse may be made by an appropriate agency or group, including but not limited to, law enforcement or social services agencies.

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. 14-17 (Jan. 1, 2024). (Accessed Jan 2024).

Prescribing Medications Via Telehealth:

Providers may prescribe medications through the use of Telemedicine/Telehealth. All prescribers, whether in-state or out-of-state, must have and use his or her unique Drug Enforcement Administration (DEA) registration number to authorize controlled substance prescriptions. DEA regulations require practitioners to obtain a separate DEA registration in each state in which he or she prescribes controlled substances.

Accordingly, out of state practitioners, must obtain a Georgia DEA registration number if prescribing controlled substances to Georgia Medicaid and PeachCare for Kids members who are located within the state of Georgia.  Out-of-state practitioners, who do not prescribe controlled substances to Georgia Medicaid and PeachCare for Kids members within the state of Georgia are not required to have a Georgia DEA registration number.

Ordering, Prescribing, and Referring (OPR) Requirements for Telehealth Services:

  • The physician or non-physician practitioner who wrote the order, prescription or referral must be enrolled in Medicaid as either a participating Medicaid provider or as an OPR provider and his or her NPI number must be included on the claim.
  • The provider’s NPI number must be for an individual physician or non-physician practitioner (not an organizational NPI).
  • The physician or non-physician practitioner must be of a specialty type that is eligible to order, prescribe, or refer.

Professional Liability Insurance Requirements for Providers Rendering Services via Telehealth:

Each individual practitioner providing services through the use of Telemedicine/Telehealth is required to maintain professional liability insurance in the amount of $1 million per occurrence/$3 million per aggregate. Shared policies are prohibited and will not be accepted.  Umbrella and/or Excess Coverage policies will be accepted if the policy indicates professional liability (malpractice) coverage is included. Umbrella policies must include professional liability insurance in the amount of $1 million per occurrence/$3 million per aggregate for each individual practitioner.  The umbrella policy must list each individual practitioner by name and clearly state that the $1m/$3m umbrella reflects individual limits (not shared).

SOURCE: GA Department of Community Health, Provider Messages (All Providers) Sept. 16, 2022. (Accessed Jan 2024).

Elderly and Disabled Waiver Program (CCSP/Community Services)

Provider/member telehealth communication in EDWP will involve a camera telehealth modality encrypted (end to end encryption) software product with established business agreement that protects PHI (protected health information). PHI is information about health status, provision of health care, or payment for health care that is created or collected by a covered entity and can be linked to a specific individual. Applicant/member or Provider with access to landline phone (one way) can be utilized in place of the software requirement. Landline/non internet use is appropriate (copper wires that carry their own power and work during blackouts). Calls not involving billable service work requires I phone or Android encryption cell settings use or landline. Use of electronic health records, member portal access or app use are to be encrypted (end to end encryption) with business agreement as well.

SOURCE: GA Dept. of Health Elderly and Disabled Waiver Program General Services, p. 27 (Jan. 1, 2024).  (Accessed Jan. 2024).

 

Last updated 01/31/2024

Out of State Providers

The Georgia Composite Medical Board is authorized to administer the compact in this state. Under the compact, physicians must meet certain requirements, including: possess a full and unrestricted license to practice medicine in a Compact state; possess specialty certification or be in possession of a time unlimited specialty certificate; have no discipline on any state medical license; have no discipline related to controlled substance; not be under investigation by any licensing or law enforcement agency; have passed the USMLE or COMLEX within three attempts; and have successfully completed a graduate medical education (GME) program. License to practice medicine obtained through this compact will be issued by the State’s Medical Composite Board. Providers should see the Georgia Composite Medical Board for additional information.

SOURCE: GA Dept. of Community Health GA Medicaid Telehealth Guidance Handbook, p. 11 (Jan. 1, 2024). (Accessed Jan 2024).

All enrolled providers, rendering services through the use of Telemedicine or Telehealth must possess the required credentials and be legally allowed to practice within the state of Georgia.  All enrolled providers must be credentialed by DCH’s Centralized Credentialing Verification Organization (CVO) or through a delegated credentialing arrangement with a Care Management Organization (CMO).

All individual practitioners must possess the appropriate Georgia license (this includes a Telemedicine License, Temporary License or Emergency Practice Permit), permit, certificate, approval, registration, or other form of permission issued by an entity other than the Department of Community Health (DCH), which form of permission is required by law.  All enrolled individual practitioners must act within the scope of his or her practice as defined by federal and state laws, rules, and regulations.

Telemedicine/Telehealth services shall be subject to utilization review and auditing requirements.

Providers must maintain documentation of all services provided through the use of Telemedicine/Telehealth in accordance with DCH policy.

SOURCE: GA Department of Community Health, Provider Messages (All Providers) Sept. 16, 2022. (Accessed Jan 2024).

Last updated 01/31/2024

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 01/31/2024

Remote Patient Monitoring

POLICY

Pilot Program to Reduce Infant and Maternal Mortality

The Department of Public Health shall conduct a pilot program to provide home  visiting in at-risk and underserved rural communities during pregnancy and early childhood  to improve birth outcomes, reduce preterm deliveries, and decrease infant and maternal  mortality.

 

Source: SB 106. (Accessed Jan 2024).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 01/31/2024

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. 8 (Jan. 1, 2024). (Accessed Jan 2024).

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. 36 (Jan. 1, 2024). & Part II Policies and Procedures for Dental Services, p. IX-21 (p. 60) (Jan. 1, 2024). (Accessed Jan 2024).


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. 36 (Jan. 1, 2024). & Part II Policies and Procedures for Dental Services, p. IX-21 (p. 60) (Jan. 1, 2024). (Accessed Jan 2024).

Comprehensive Supports Waiver Program

Telephone calls and store and forward (asynchronous) modalities are not allowed for billable therapy evaluation and services.

SOURCE: GA Dept. of Community Health, Division of Medicaid, Comprehensive Supports Waiver Program Chapters 1300-3700. (Jan. 1, 2024).  (Accessed Jan. 2024).


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. 36 (Jan. 1, 2024). & Part II Policies and Procedures for Dental Services, p. IX-21 (p. 60) (Jan. 1, 2024). (Accessed Jan 2024).

Last updated 01/31/2024

Cross State Licensing

A person who is physically located in another state or foreign country and who, through the use of any means, including electronic, radiographic, or other means of telecommunication, through which medical information or data are transmitted, performs an act that is part of a patient care service located in this state, including but not limited to the initiation of imaging procedures or the preparation of pathological material for examination, and that would affect the diagnosis or treatment of the patient is engaged in the practice of medicine in this state. Any person who performs such acts through such means shall be required to have a license to practice medicine in this state or a telemedicine license issued pursuant to Code Section 43-34-31.1 and shall be subject to regulation by the board. Any such out-of-state or foreign practitioner shall not have ultimate authority over the care or primary diagnosis of a patient who is located in this state.

This Code section shall not apply to:

(1) The acts of a doctor of medicine or doctor of osteopathic medicine located in another state or foreign country who:

  • Provides consultation services at the request of a physician licensed in this state; and
  • Provides such services on an occasional rather than on a regular or routine basis;

(2) The acts of a physician or osteopathic physician licensed in another state or foreign country who:

  • Provides consultation services in the case of an emergency;
  • Provides consultation services without compensation, remuneration, or other expectation thereof; or
  • Provides consultation services to a medical school which is located within this state and approved by the board; or
(3) The acts of a physician or osteopathic physician located in another state or foreign country when invited as a guest of any medical school or osteopathic medical school approved by the board or a state medical society or component thereof, for the sole purpose of engaging in professional education through lectures, clinics, or demonstrations, provided that such physician or osteopathic physician is licensed to practice medicine or osteopathic medicine in the state or foreign country in which he or she is located.

SOURCE:  GA OCGA Sec. 43-34.31.  (Accessed Jan. 2024).

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. 2024).

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

SOURCE:  GA Rules & Regulations Sec. 360-3-.07 (Accessed Jan. 2024).

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. 2024).

Last updated 01/31/2024

Definitions

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 2024). 

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 2024).

Last updated 01/31/2024

Licensure Compacts

Member of Nurse Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-26-61 & NLC. (Accessed Jan. 2024).

Member of the Interstate Medical Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-34-301& IMLC (Accessed Jan. 2024).

Member of the Physical Therapy Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-33-31 & PTC (Accessed Jan. 2024).

Member of the Psychology Interjurisdictional Compact.

SOURCE: Official Code of GA Annotated Sec. 43-39-22 & PSYPACT (Accessed Jan. 2024).

Member of the Professional Counselors Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-10A-51 & Counseling Compact (Accessed Jan. 2024)

Member of the Occupational Therapy Licensure Compact.

SOURCE: Official Code of GA Annotated Sec. 43-28-21 & Occupational Therapy Licensure Compact (Accessed Jan. 2024).

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

SOURCE: Official Code of GA Annotated Sec. 43-44-31 & ASLP-IC (Accessed Jan. 2024).

Member of EMS Compact.

SOURCE: Official Code of GA Annotated Sec. 38-3-70 & Interstate Commission of EMS Personnel Practice, Member States (Accessed Jan. 2024).

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

Last updated 01/31/2024

Miscellaneous

When a law enforcement agency that has entered into a co-responder partnership with a community service board responds to an emergency call involving an individual with a behavioral health crisis and a co-responder team is dispatched, a community service board team member shall be available to accompany the officer team member in person or via virtual means or shall be available for consultation via telephone or telehealth during such emergency call. The officer team member may consider input from the community service board team member in determining whether to refer an individual for behavioral health treatment or other community support or to transport the individual for emergency evaluation in accordance with Code Section 37-3-42 or 37-7-42, rather than making an arrest.

SOURCE: GA OCGA Sec. 37-12-2. (Accessed Jan. 2024).

Last updated 01/31/2024

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. 2024). 

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. 2024).

Contact Lenses & Spectacles

No person in this state shall sell, dispense, or serve as a conduit for the sale or dispensing of contact lenses or spectacles to the ultimate user of such contact lenses or spectacles except persons licensed and regulated by Chapter 29, 30, or 34 of Title 43.
No person in this state shall write a prescription for contact lenses or spectacles unless he or she is a prescriber.
No person in this state shall write a prescription for contact lenses or spectacles unless an eye examination is conducted or, pursuant to the conditions in subsection (d) of this Code section, an eye assessment is performed.

An assessment mechanism to conduct an eye assessment or to generate a prescription for contact lenses or spectacles in this state shall:

  • Be conducted in accordance with the provisions of Code Section 33-24-56.4, the ‘Georgia Telehealth Act’;
  • Collect the patient’s medical history, previous prescription information for corrective eyewear, and length of time since the patient’s most recent in-person eye health examination;
  • Provide any applicable accommodation required by the federal Americans with Disabilities Act, 42 U.S.C. Section 12101, et seq., as amended;
  • Gather and transmit protected health information in compliance with the federal Health Insurance Portability and Accountability Act of 1996, as amended; and
  • Perform a procedure with a recognized current procedural terminology code maintained by the American Medical Association, if applicable.
“Eye assessment” means an assessment of the ocular health and visual status of a patient that may include, but is not limited to, objective refractive data or information generated by an automated testing device, including an autorefractor, in order to establish a refraction diagnosis for the correction of vision disorders. This may include synchronous or asynchronous telemedicine technologies.
“Eye examination” means a real-time examination, which includes the use of telemedicine, in accordance with the applicable standard of care of the prescriber, of the ocular health and visual status of an individual that does not consist solely of objective refractive data or information generated by an automated testing device, including an autorefractor or kiosk, in order to establish a medical diagnosis or refractive diagnosis for the establishment of refractive error, conducted with the patient and prescriber in the same physical location or via telemedicine. If the eye examination is conducted via telemedicine, the patient and prescriber shall be required to be in synchronous verbal and visual contact during such parts of the examination necessary to ensure that the examination is, at a minimum, equivalent to an eye examination conducted in person.
“Assessment mechanism” means automated or virtual equipment, application, or technology designed to be used on a telephone, a computer, or an internet accessible device that may be used either in person or via telemedicine to conduct an eye assessment, and includes artificial intelligence devices and any equipment, electronic or nonelectronic, that are used to conduct an eye assessment.

 

SOURCE: GA OCGA Section 31-12-12. (Accessed Jan. 2024).

Last updated 01/31/2024

Professional Boards Standards

GA Composite Medical Board

SOURCE:  GA Rules & Regulations Sec. 360-3-.07 (Accessed Jan. 2024).

GA Composite Medical Board – Requirements for Telemedicine Licensure

SOURCE:  GA Rules & Regulations Sec. 360-2-.17 (Accessed Jan. 2024).

GA Board of Physical Therapy

SOURCE: GA Rules & Regulations Sec. 490-9-.06 (Accessed Jan. 2024).

Last updated 01/31/2024

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, 2024). (Accessed Jan. 2024).

Last updated 01/31/2024

Eligible Distant Site

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. 38 (Jan. 1, 2024).  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 24 (Jan. 1, 2024). (Accessed Jan. 2024).

Last updated 01/31/2024

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. 38 (Jan. 1, 2024).  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 24 (Jan. 1, 2024). (Accessed Jan. 2024).

Last updated 01/31/2024

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. 38 (Jan. 1, 2024).  Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23 (Jan. 1, 2024). (Accessed Jan. 2024).

Last updated 01/31/2024

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, 2024). (Accessed Jan. 2024).

Last updated 01/31/2024

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, 2024). (Accessed Jan. 2024).


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. 36 (Jan. 1, 2024). (Accessed Jan. 2024).


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. 17 (Jan. 1, 2024). (Accessed Jan. 2024).

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, 2024) (Accessed Jan. 2024).

Last updated 01/31/2024

Patient-Provider Relationship

No reference found.

Last updated 01/31/2024

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. 38 (Jan. 1, 2024). Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23, C-1, G-5 (Jan. 1, 2024). (Accessed Jan. 2024).

Last updated 01/31/2024

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.

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, (Jan. 1, 2024). (Accessed Jan 2024).