Last updated 08/22/2022
Consent Requirements
Any written information must be provided to the participant before the telehealth appointment in a form and manner which the participant can understand using reasonable accommodations when necessary. The participant must be informed and consent to the delivery models, provider qualifications, treatment methods, or limitations and telehealth technologies. The rendering provider at the distant site must also disclose to the participant their identity, current location, telephone number and Idaho license number. If the participant (or legal guardian) indicates at any point that he wants to stop using the technology, the service should cease immediately and an alternative (in-person) appointment should be scheduled. The partial, interrupted service is not reimbursable.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. July 20, 2022, Section 10.9 p. 128. (Accessed Aug. 2022).
Last updated 08/22/2022
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. July 20, 2022, Section 10.9, 10.9.2 & 10.9.4 p. 128-129. (Accessed Aug. 2022).
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. July 20, 2022, Section 10.9 p. 128 (Accessed Aug. 2022).
Telehealth services that are properly identified in accordance with billing requirements are covered under Medicaid for physicians, within limitations defined by the Department in the Idaho Medicaid Provider Handbook.
SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09), Pg. 25 (Accessed Aug. 2022).
For Home Health, the face-to-face encounter that initiates treatment may occur via telehealth.
SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09), Pg. 102 (Accessed Aug. 2022). ID Medicaid Provider Handbook: Home Health and Hospice Services, 1.2.4.1, p. 6. (Mar. 2, 2021). (Accessed Aug. 2022).
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. July 20, 2022, Section 10.9 p. 128 (Accessed Aug. 2022).
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. July 20, 2022, Section 10.9.4, pg. 129 (Accessed Aug. 2022).
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 June 14, 2022 pg 37 & Idaho Medicaid Provider Handbook. General Information and Requirements for Providers July 20, 2022, p. 124-129. (Accessed Aug. 2022).
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 (June 14, 2022), p. 67. (Accessed Aug. 2022).
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 July 20, 2022 p. 128-129 (Accessed Aug. 2022).
Idaho Medicaid will cover speech therapy (92507) when provided by a licensed speech language pathologist.
SOURCE: ID Medicaid Provider Handbook, Therapy Services June 14, 2022 pg 37 (Accessed Aug. 2022).
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. June 14, 2022, (Accessed Aug. 2022).
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, June 14, 2022, p. 30. (Accessed Aug. 2022).
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. June 14, 2022 p. 30 (Accessed Aug. 2022).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
No Reference Found
Last updated 08/22/2022
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
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. June 9, 2021, Section 10.9.2 p. 127 (Accessed Aug. 2022).
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.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. July 20, 2022, Section 10.9 p. 128-129 (Accessed Aug. 2022).
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. July 20, 2022, p. 129 (Accessed Aug. 2022).
Last updated 08/22/2022
Out of State Providers
Medicaid Providers are required to be licensed, certified, or registered with the appropriate state authority. The claims processing system verifies the effective dates of the provider’s license against the date of service. Provider licensure must be up to date in their provider file or claims will be denied at the header level. Providers are required to split claims for covered and non-covered dates of service, or update their license with Gainwell Technologies and resubmit the claim.
Providers of telehealth services must be licensed by the Idaho Board of Medicine, Board of Nursing, or in the case of therapeutic consultation and crisis intervention for children’s developmental disabilities services, providers must meet staff qualifications. Providers at the distant site, who regularly provide telehealth services to Idaho Medicaid participants are required to maintain current Idaho licensure.
Please refer to Idaho Administrative Code for additional information.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. July 20, 2022 Sections 6.4 & 10.9.1 p. 39 & 129 & IDAPA 16.03.09 Sec.855., p. 106 (Accessed Aug. 2022).
