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 01/23/2023
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:
- 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 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).
