Last updated 02/21/2023
Live Video
POLICY
Telehealth services are covered and reimbursable fee-for-service if delivered via two-way live video between the provider and the participant. Services must be equal in quality to services provided in-person, and comply with HIPAA privacy requirements, licensure requirements, Medicaid Information Release MA18-07, and all Medicaid rules, regulations and policies.
Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Nov. 18, 2022, Section 10.9, 10.9.2 & 10.9.4 p. 128-129. (Accessed Feb. 2023).
Rendering providers must provide timely coordination of services, within three business days, with the participant’s primary care provider who should be provided in written or electronic format a summary of the visit, prescriptions and DME ordered.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Nov. 18, 2022, Section 10.9 p. 128 (Accessed Feb. 2023).
Services delivered via telehealth as defined in Title 54, Chapter 57, Idaho Code, must be identified as such in accordance with billing requirements published in the Idaho Medicaid Provider Handbook. Telehealth services billed without being identified as such are not covered. Services delivered via telehealth may be reimbursed within limitations defined by the Department in the Idaho Medicaid Provider Handbook. Fee for service reimbursement is not available for an electronic mail message (e-mail), or facsimile transmission (fax).
SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09), Pg. 25 (Accessed Feb. 2023).
For Home Health, the face-to-face encounter that initiates treatment may occur via telehealth.
SOURCE: ID Administrative Code 16.03.09 Sec. 723 (02)(b), Pg. 102, ID Medicaid Provider Handbook: Home Health and Hospice Services, 1.2.4.1, p. 6. (Mar. 2, 2021). (Accessed Feb. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Services must be equal in quality to services provided in-person.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Nov. 18, 2022, Section 10.9 p. 128 (Accessed Feb. 2023).
Place of service 02 (telehealth) is not used by Idaho Medicaid. All normal Place of Service codes are acceptable for telehealth. The place of service used should be the location of the participant. Claims must include a GT modifier (Via interactive audio and video telecommunications systems) on CPT® and HCPCS. FQHC, RHC or IHS providers should not report the GT modifier with encounter code T1015, but should include it with the supporting codes.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Nov. 18, 2022, Section 10.9.4, pg. 129, ID MedicAide Newsletter, January 2023, p. 4 (Accessed Feb. 2023).
Physician/Non-Physician Practitioner Services:
Physicians and non-physician practitioners enrolled as Healthy Connections primary care providers are eligible to provide primary care services via telehealth. Other services available through telehealth (manual lists specific CPT codes):
- Specialty Services
- Health and Behavioral Assessment/Intervention
- Psychiatric Crisis Consultation (Physicians and psychiatric nurse practitioners only)
- Psychotherapy with evaluation and management
- Psychiatric diagnostic interview
- Pharmacological management
- Tobacco Use Cessation
School-based Services
Community Based Rehabilitation Services (CBRS) Supervision is covered via telehealth. Reimbursement is already included in CBRS payment.
Children with Developmental Disabilities
Therapeutic consultation and crisis intervention can be delivered via telehealth technology through the Bureau of Developmental Disability Services. See manual for specific codes.
Early Intervention Services (EIS) for Infants and Toddlers
Eligible services include:
- Family training and counseling for child development, per 15 minutes (HCPCS T1027)
- Home care training, family, per 15 minutes (HCPCS S5110)
- Medical team conference with interdisciplinary team, 30 minutes (CPT 99366)
Therapy Services (Occupational, Physical Therapists & Speech Language Pathologists)
Covered telehealth services are real-time communication through interactive technology that enables a provider and a patient at two locations separated by distance to interact simultaneously through two-way video and audio transmission. Evaluations and reevaluations must be provided in-person and not by telehealth. The therapist must certify that the services can safely and effectively be done with telehealth and the physician or nonphysician practitioner order must specifically allow the services to be provided by telehealth. Therapists must adhere to all requirements of their licensing board for telehealth services. Specific service codes found in manual.
Interpretation Services
Idaho Medicaid will reimburse for interpretation, translation, Braille and sign language services provided to participants in person or through telehealth.
SOURCE: ID Medicaid Provider Handbook, Therapy Services Dec. 19, 2022 pg 37 , ID Medicaid Provider Handbook: Agency Professional (Mar. 2, 2021), p. 29, & Idaho Medicaid Provider Handbook. General Information and Requirements for Providers Nov. 18, 2022, p. 124-129. (Accessed Feb. 2023).
Psychiatric Crisis
Physicians and psychiatric nurse practitioners may provide psychotherapy (CPT® 90839 and 90840) to participants in crisis via telehealth.
SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (Nov. 18, 2022), p. 67. (Accessed Feb. 2023).
Laboratory Services
To be reimbursable, drug tests must be ordered by a licensed or certified healthcare professional who has performed a face-to-face evaluation of the participant (this may include telehealth if the requirements of the telehealth policy are met).
SOURCE: ID Medicaid Provider Handbook: Laboratory Services (Nov. 18, 2022), p. 22. (Accessed Feb. 2023).
Eye and Vision Services
Vision therapy is not covered for group therapy, telehealth or with home computer programs.
SOURCE: ID Medicaid Provider Handbook: Eye and Vision Services (Nov. 18, 2022), p. 54. (Accessed Feb. 2023).
ELIGIBLE PROVIDERS
Physicians and non-physician practitioners enrolled as Healthy Connections primary care providers are eligible to provide primary care services via telehealth.
Idaho Medicaid will cover speech therapy (92507) when provided by a licensed speech language pathologist.
Idaho Medicaid will cover therapy services (97110, 97530) for occupational therapists and physical therapists.
Only one eligible provider may be reimbursed for the same service per participant per date of service.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers Nov. 18 2022 p. 128-129 (Accessed Feb. 2023).
Idaho Medicaid therapy services, see manual for specific codes.
SOURCE: ID Medicaid Provider Handbook, Therapy Services Dec. 19, 2022 pg 37 (Accessed Feb. 2023).
Physicians and psychiatric nurse practitioners may provide psychotherapy to participants in crisis via telehealth, using CPT 90839 and 90840.
Physicians and non-physician practitioners are eligible to receive reimbursement for telehealth services.
SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician Practitioner. Sec. 4.32.3, Pg. 67, (4.36) 71. Nov. 18, 2022, (Accessed Feb. 2023).
FQHCs, RHCs & IHS
Telehealth services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Idaho Medicaid Telehealth Policy and applicable handbooks.
SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services, Nov. 18, 2022, p. 30. (Accessed Feb. 2023).
ELIGIBLE SITES
Telehealth services as an encounter by a facility are reimbursable if the services are delivered in accordance with the ID Medicaid Telehealth Policy.
SOURCE: Idaho Medicaid Provider Handbook: IHS, FQHC, RHC Services. Nov. 18, 2022 p. 30 (Accessed Feb. 2023).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Therapy Services
Therapy services covered via telehealth are listed in the table below. Reimbursement is according to the numerical fee schedule. There is no additional fee for either the originating or the distant site.
SOURCE: ID Medicaid Provider Handbook, Therapy Services Dec. 19, 2022 pg 37 (Accessed Feb. 2023).
Last updated 02/21/2023
Miscellaneous
Technical Requirements:
- Video must be provided in real time with full motion video and audio.
- Transmission of voice must be clear and audible
- Telehealth services that cannot be provided as effectively as in-person services are not covered.
- Video images must be high quality images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication
Provider Requirements
- Providers at the distant site must disclose to the patient the performing provider’s identity, location, telephone number and Idaho license number.
- Telehealth providers must have a systematic quality assurance and improvement program for telehealth that is documented, implemented and monitored.
- If an operator who is not an employee of the involved agency is needed to run the teleconferencing equipment or is present during the conference or consultation, that individual must sign a confidentiality agreement.
- Rendering providers must provide timely coordination of services, within three business days, with the participant’s primary care provider. The PCP should be provided in written or electronic format a summary of the visit, prescriptions and DME ordered, if applicable, and any other pertinent information from the visit.
Documentation Requirements
The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and that services were delivered via telehealth. The documentation must be of the same quality as is originated during an in-person visit. These documentation requirements are specific to delivery via telehealth and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Nov. 18, 2022, p. 128-129 (Accessed Feb. 2023).
