Last updated 08/10/2021
Live Video
POLICY
Idaho Medicaid reimburses for specific services via live video telehealth, consistent with ID Administrative Code. Telehealth services must be equal in quality to in-person services.
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. June 9, 2021, Section 10.9, 10.9.2 & 10.9.4 p. 126-127. (Accessed Oct. 2021).
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. June 9, 2021, Section 10.9 p. 126. (Accessed Oct. 2021).
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) (7/1/21), Pg. 25 (Accessed Oct. 2021).
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) (7/1/21), Pg. 1873 (Accessed Oct. 2021).
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. June 9, 2021, Section 10.9 p. 126 (Accessed Oct.. 2021).
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. June 9, 2021, Section 10.9.4, pg. 127 (Accessed Oct. 2021).
Physician/Non-Physician Practitioner Services:
- Primary Care Services
- 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 can be delivered via telehealth in educational environments, but not separately reimbursable.
Children with Developmental Disabilities
Therapeutic consultation and crisis intervention can be delivered via telehealth technology through the Bureau of Developmental Disability Services.
Early Intervention Services (EIS) for Infants and Toddlers
Services can be delivered via telehealth as long as the provider is employed by or contracted with the Idaho Infant Toddler Program and meet the IDEA Part C requirements. 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)
Primary Care
Primary care services can be delivered via telehealth. Providers must be licensed by the Idaho Board of Medicine or the Board of Nursing.
Therapy Services
Therapy services can be provided through telehealth. Evaluations and reevaluations must be performed as an in-person visit to the participant and is not covered through telehealth. Therapeutic procedures and activities are covered via telehealth. (Please see manual for a list of telehealth covered services.)
The therapist must certify that the services can be safely and effectively done with telehealth. The physician order must specifically allow the services to be provided via telehealth. The physician or non- physician practitioner order must specifically allow the services to be provided by telehealth.
Interpretation Services
Idaho Medicaid reimburses for interpretation, translation, Braille, and sign language in conjunction with a reimbursable Medicaid service.
SOURCE: ID Medicaid Provider Handbook, Therapy Services March 30, 2021, pg 37 & Idaho Medicaid Provider Handbook. General Information and Requirements for Providers June 9, 2021, p. 126-127. (Accessed Oct. 2021).
Community Based Rehabilitation Services (CBRS) supervision is covered via telehealth.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers June 9, 2021, p. 127. (Accessed Oct. 2021).
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 June 9, 2021, p. 126-127 (Accessed Oct. 2021).
Idaho Medicaid will cover speech therapy (92507) when provided by a licensed speech language pathologist.
SOURCE: ID Medicaid Provider Handbook, Therapy Services March 2021, pg 37 (Accessed Oct. 2021).
Physicians and psychiatric nurse practitioners may provide psychotherapy to participants in crisis via telehealth, using CPT 90839 and 90840.
SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician Practitioner. Sec. 4.32.3, Pg. 67. June 1, 2021, (Accessed Oct. 2021).
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. March 2, 2021 p. 30 (Accessed Oct. 2021).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
No reimbursement for use of equipment at either the remote or originating site.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. June 9, 2021, p. 127. (Accessed Oct. 2021).
Last updated 08/10/2021
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 Oct. 2021).
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.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. June 9, 2021, Section 10.9 p. 126 (Accessed Oct. 2021).
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. June 9, 2021, p. 127 (Accessed Oct. 2021).
Last updated 08/10/2021
Out of State Providers
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.
Please refer to Idaho Administrative Code for additional information.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. June 9, 2021, Section 10.9.1 p. 127, & IDAPA 16.03.09 Sec.855., p. 106 (Accessed Oct. 2021).
Last updated 10/04/2021
Overview
Idaho Medicaid reimburses for live video telehealth for certain providers and for specific services. There is no reference to store-and-forward or remote patient monitoring.
