Idaho

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: No
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: No
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, EMS, IMLC, NLC, PSY
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video:  No
  • Distant sites explicitly allowed for Live Video:  Yes
  • Store and forward explicitly reimbursed:  No
  • Audio-only explicitly reimbursed:  Yes
  • Allowed to collect PPS rate for telehealth:  No

STATE RESOURCES

  1. Medicaid Program: Idaho Medicaid
  2. Administrator: Idaho Dept. of Health and Welfare
  3. Regional Telehealth Resource Center: Northwest Regional 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 06/29/2023

Cross State Licensing

ID Division of Occupational & Professional Licenses: COVID-19 Guidance Allowing Out-of-State Providers to Deliver Services in or into ID

STATUS: Expired

Board of Medicine: Administrative Rules Temporarily Suspended

STATUS: Expired with end of ID State of Emergency

Board of Medicine: Idaho Telehealth Access Act COVID-19 Guidance

STATUS: Expired with end of ID State of Emergency

Board of Medicine: Coronavirus (COVID-19) Information

STATUS: Expired with end of ID State of Emergency

Last updated 06/29/2023

Easing Prescribing Requirements

ID Statute 54-5707: Allows prescribing via telehealth in compliance with federal law

STATUS: Enacted

HB 394: Extends effective dates including HB 38/ID Statute 54-5707 to on and after July 1, 2021.

STATUS: Enacted

Last updated 06/29/2023

Miscellaneous

Medicaid: MedicAide ID Dept of Health and Welfare, Division of Medicaid Bulletin Feb. 2022

STATUS: Expired, updated Telehealth policy post-PHE.

Executive Order: Regulatory Relief to Support Economic Recovery

STATUS: Expired

ID Division of Occupational & Professional Licenses: COVID-19 Guidance Allowing Out-of-State Providers to Deliver Services in or into ID

STATUS: Expired

Medicaid:  COVID-19 Telehealth HIPAA Guidance

STATUS: Expired

Last updated 06/29/2023

Private Payer

Department of Insurance:  Temporary Waiver of Provider Restrictions

STATUS:Expired with end of ID State of Emergency

Last updated 06/30/2023

Definitions

No reference found.

Last updated 06/30/2023

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 06/30/2023

Requirements

No Reference Found

Last updated 06/29/2023

Definitions

Virtual care or telehealth means providing medically necessary health care services without actual physical contact, through the use of electronic means. Under Idaho Medicaid this means the participant and the provider are interacting in real-time or “live” from two physically different locations, by video or telephone.

Source: Medicaid Telehealth Policy, General Information and Requirements for Providers. Section 9.12 Pg. 131. Rev. May 26, 2023 ,Idaho MedicAide May 2023.  (Accessed Jun. 2023).

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.

SOURCE: Idaho Medicaid Provider Handbook: Therapy Services, Section 4.6, p. 37, Dec. 19, 2022. (Accessed Jun. 2023).

Last updated 06/29/2023

Email, Phone & Fax

Virtual care or telehealth means providing medically necessary health care services without actual physical contact, through the use of electronic means. Under Idaho Medicaid this means the participant and the provider are interacting in real-time or “live” from two physically different locations, by video or telephone.

Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers: • FQ – A telehealth service was furnished using real-time audio-only communication technology. • GT – A telehealth service was furnished using real-time audio-visual communication technology.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  May 26, 2023, Sections 9.12 7 9.12.3 p. 131-132, Idaho MedicAide May 2023.  (Accessed Jun. 2023).

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), p. 25. (Accessed Jun. 2023).

Last updated 06/29/2023

Live Video

POLICY

Services delivered through virtual care will be considered for reimbursement when rendered within the provider’s scope of practice and billed according to all applicable administrative rules, policy, federal and state regulations. Any covered service may be delivered via virtual care when:

  • The service can be safely and effectively delivered via virtual care and the medium utilized;
  • The service fully meets the code definition when provided via virtual care;
  • The service is billed with the FQ or GT modifier; and
  • All other existing coverage criteria are met.

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.  May 26, 2023, Section 9.12 & 9.12.2 p. 131-132. Idaho MedicAide May 2023.  (Accessed Jun. 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 Jun. 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 Jun. 2023).


ELIGIBLE SERVICES/SPECIALTIES

Any covered service may be delivered via virtual care when:

  • The service can be safely and effectively delivered via virtual care and the medium utilized;
  • The service fully meets the code definition when provided via virtual care;
  • The service is billed with the FQ or GT modifier; and
  • All other existing coverage criteria are met.

Only one eligible provider may be reimbursed per service per participant per date of service. No reimbursement is available for the use of equipment at the originating or remote sites. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties. Claims for services delivered via virtual care will be reimbursed at the same rate as face-to-face services. Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers:

  • FQ – A telehealth service was furnished using real-time audio-only communication technology.
  • GT – A telehealth service was furnished using real-time audio-visual communication technology.

Additionally, providers can also use the following modifier in conjunction with one of the above:

  • FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  May 26, 2023, Sections 9.12 & 9.12.3 p. 131-132, Idaho MedicAide May 2023.  (Accessed Jun. 2023).

Physician/Non-Physician Practitioner Services:

Physicians and non-physician practitioners are eligible to receive reimbursement for telehealth services.

SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (May 26, 2023), p. 72. (Accessed Jun. 2023).

Children with Developmental Disabilities

Children’s DD Telehealth services are reimbursable if provided and billed in accordance with the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook.

SOURCE: ID Medicaid Provider Handbook Agency Professional (Feb. 22, 2023), p. 28. (Accessed Jun. 2023).

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.

SOURCE:  ID Medicaid Provider Handbook, Therapy Services Dec. 19, 2022 pg 37 , (Accessed Jun. 2023).

Psychiatric Crisis

Physicians and psychiatric nurse practitioners may provide psychotherapy (CPT® 90839 and 90840) to participants in crisis via telehealth.  The medical record of the participant must support a crisis service was provided for the full duration billed and demonstrate that an urgent assessment of the participant’s mental state was necessary, and/or their health or safety was at risk. The participant must be in the room for the duration of the visit or a majority of the service, which is focused on the individual. 90839 is a stand-alone code not to be reported with psychotherapy or psychiatric diagnostic evaluation codes, the interactive complexity code, or any other psychiatry section code.

SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (May 26, 2023), p. 74. (Accessed Jun. 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 (May 26, 2023), p. 22. (Accessed Jun. 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 Jun. 2023).


ELIGIBLE PROVIDERS

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.  May 26, 2023, Sections 9.12.3 p. 132, Idaho MedicAide May 2023.  (Accessed Jun. 2023).

Idaho Medicaid therapy services, see manual for specific codes.

SOURCE: ID Medicaid Provider Handbook, Therapy Services Dec. 19, 2022 pg 37  (Accessed Jun. 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) 72. May 26, 2023, (Accessed Jun. 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.

FQHC, RHC or IHS providers should not report the GT or FQ modifier with encounter code T1015 but should include it with each applicable supporting codes.

SOURCE:  ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services, Nov. 18, 2022, p. 30. Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  May 26, 2023, Sections 9.12.3 p. 132, Idaho MedicAide May 2023.  (Accessed Jun. 2023).


ELIGIBLE SITES

Idaho Medicaid will now accept places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers should use these places of service on claims from telehealth going forward.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  May 26, 2023, Sections 9.12.3 p. 132, Idaho MedicAide May 2023.  (Accessed Jun. 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 Jun. 2023).

Last updated 06/30/2023

Miscellaneous

 Technical Requirements:

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.

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. May 26, 2023 p. 131, ID MedicAide May 2023.  (Accessed Jun. 2023).

Last updated 06/30/2023

Out of State Providers

No reference found.

Last updated 06/30/2023

Overview

Idaho Medicaid reimburses for live video virtual services (they have changed the term from “telehealth”), remote patient monitoring and audio-only. The Medicaid program does not reimburse for store-and-forward.

Last updated 06/29/2023

Remote Patient Monitoring

POLICY

Services provided via asynchronous communication are not reimbursable under Idaho Medicaid. However, remote monitoring services are covered.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  May 26, 2023, Sections 9.12 p. 131, Idaho MedicAide May 2023.  (Accessed Jun. 2023).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 06/29/2023

Store and Forward

POLICY

Services provided via asynchronous communication are not reimbursable under Idaho Medicaid. However, remote monitoring services are covered.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  May 26, 2023, Sections 9.12 p. 131, Idaho MedicAide May 2023.  (Accessed Jun. 2023).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 06/30/2023

Cross State Licensing

Prior to delivering health care services via virtual care, a provider must obtain a license from the applicable licensing board, except a license is not required for virtual care when a provider licensed and in good standing in another state or jurisdiction of the United States:
  • Has established a patient-provider relationship with a person who is in Idaho temporarily for business, work, education, vacation, or other reasons and such person requires health care services from that provider;
  • Has established a patient-provider relationship with a person and provides temporary or short-term follow-up health care services to such person to ensure continuity of care;
  • Is employed by or contracted with an Idaho facility or hospital to provide care services for which the provider has been privileged and credentialed;
  • Renders health care services in a time of disaster and provides follow-up health care services to ensure continuity of care;
  • Provides health care services in preparation for a scheduled in-person care visit; or
  • Consults with or refers a patient to an Idaho licensed provider.
By engaging in virtual care with a patient located in Idaho, a provider exempted from Idaho licensure under subsection (1) of this section consents to the applicable Idaho laws, rules, and regulations governing the provider’s profession, including this chapter and the Idaho community standard of care, the jurisdiction of Idaho courts, the jurisdiction of the division of occupational and professional licenses, and the jurisdiction of the applicable licensing board regulating the provider’s profession, including the division’s and licensing board’s complaint, investigation, and hearing process and ability to seek injunctions and impose civil penalties and fines.

SOURCE: ID Statutes 54-5713.  (Accessed Jun. 2023).

For purposes of this section, any act that constitutes the delivery of health care services is deemed to occur at the place where the patient is located at the time the act is performed. Venue for a civil or administrative action initiated by the appropriate regulatory licensing authority or by a patient who receives virtual care services from an out-of-state provider may be located in the patient’s county of residence, an applicable county in Idaho, or another venue as deemed proper by a court of competent jurisdiction.

SOURCE: ID Statute 54-5712(2). (Accessed Jun. 2023).

Mental and Behavioral Health
For purposes of this section, a mental or behavioral health provider is a provider pursuant to section 54-5703(4), Idaho Code, who is licensed or registered in another state, district, or territory of the United States to practice mental or behavioral health care.
A mental or behavioral health provider who is not licensed in Idaho may provide telehealth services to an Idaho resident or person located in Idaho, notwithstanding any provision of law or rule to the contrary, pursuant to the requirements and limitations of this section.
  • In addition to the other requirements of this section, a mental or behavioral health provider who engages in interstate telehealth services pursuant to this section must:
  • Hold current, valid, and unrestricted licensure from an applicable health care licensing authority in a state, district, or territory of the United States that has substantially similar requirements for licensure as the corresponding Idaho licensing authority;
  • Not be subject to any past or pending disciplinary proceedings, excluding any action related to nonpayment of fees related to a license;
  • Act in full compliance with all applicable laws, rules, and regulations, including this chapter and laws and rules of the applicable Idaho licensing authority regarding such mental or behavioral health care practice;
  • Act in compliance with any existing Idaho requirements regarding the maintenance of liability insurance;
  • Consent to Idaho jurisdiction; and
  • Biennially register in Idaho to provide telehealth services.
The standard of care under this section shall be the Idaho community standard of care.
A mental or behavioral health provider who fails to comply with applicable Idaho laws, rules, and regulations shall be subject to investigation and disciplinary action by an applicable Idaho licensing authority. Disciplinary action may include but is not limited to revoking the mental or behavioral health provider’s Idaho practice privileges, referring the matter to licensing authorities in any states where the mental or behavioral health provider possesses licensure, and civil penalties.
Venue for a civil or administrative action initiated by a licensing authority or by a patient who receives telehealth services from an out-of-state mental or behavioral health provider shall be located in the patient’s county of residence or in any applicable county in Idaho.
Nothing in this section shields a mental or behavioral health provider from personal jurisdiction in Idaho.
A licensing authority responsible for issuing licenses to provide mental or behavioral health care services in this state shall register interstate telehealth providers pursuant to this section.
A licensing authority shall require an applicant for an Idaho registration to complete an application in a form prescribed by the licensing authority that demonstrates to the licensing authority that the applicant is in compliance with the provisions of this section and that such applicant consents to the requirements of this section. The licensing authority may establish an application registration fee not to exceed thirty-five ($35.00) dollars.
If a licensing authority finds that grounds for discipline against a registered provider exist, such licensing authority:
  • May impose upon the practice privileges of the registration holder any of the penalties that such licensing authority is authorized to impose;
  • Shall promptly notify licensing authorities in any state where a provider possesses licensure of any action taken against the telehealth registration practice privileges of a licensee pursuant to this section; and
  • May bring a civil or administrative action against such provider pursuant to subsection (6) of this section.
The registration provided for in this section is not equivalent to Idaho licensure for purposes of in-person services and shall not permit a registrant to provide any in-person services in Idaho. The registration cannot be used as a basis for reciprocal licensure or full licensure in Idaho.

SOURCE:  ID Statute 54-5714. (Accessed Jun. 2023).

 

Where permitted by law, an applicant, in good standing with no restrictions upon or actions taken against their license to practice in a state, territory or district of the United States or Canada is eligible for licensure by endorsement to practice medicine in Idaho.

SOURCE: IDAPA – Division Of Occupational And Professional Licenses -24.33.03, p. 3 (Accessed Jun. 2023)

Last updated 06/30/2023

Definitions

 “Virtual care” means technology-enabled health care services in which the patient and provider are not in the same location. Virtual care is an umbrella term that encompasses terms associated with a wide variety of synchronous and asynchronous care delivery modalities enabled by technology, such as telemedicine, telehealth, m-health, e-consults, e-visits, video visits, remote patient monitoring, and similar technologies. Virtual care is considered to be rendered at the physical location of the patient.

SOURCE: ID Code Sec. 54-5703(6),  (Accessed Jun. 2023).

“Telehealth technologies” means synchronous or asynchronous telecommunications technologies capable of assisting a provider to deliver patient health care services, including but not limited to assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration.

SOURCE: ID Admin Code 24.33.03 (201)(06). (Accessed Jun. 2023).

Telepsychology Services mean psychological services provided by a provider through the use of electronic communications, information technology, asynchronous store and forward transfer of information or synchronous interaction between the provider at a distant site and a service recipient at an original site. Such services include, but are not limited to, assessing, testing, diagnosing, treating, education, and consulting.

SOURCE: ID Admin Code 24.12.01 (601). (Accessed Jun. 2023).

Last updated 06/30/2023

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: ID Code Sec. 54-1842. & IMLC. (Accessed Jun. 2023).

Member of Nurses Licensure Compact.

SOURCE: Nurse Licensure Compact. Current NLC States and Status. (Accessed Jun. 2023) 

Member of EMS Compact.

SOURCE: Interstate Commission for EMS Personnel Practice, EMS Compact, (Accessed Jun. 2023).

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

SOURCE:  Audiology and Speech-Language Pathology Interstate Compact. (Accessed Jun. 2023).

Member of the Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Compact Map (Accessed Jun. 2023).

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

Last updated 06/30/2023

Miscellaneous

No Reference Found

Last updated 06/30/2023

Online Prescribing

A provider may provide virtual care to a patient if such provider has first established a provider-patient relationship with the patient, the patient has a provider-patient relationship with another provider in the provider group, the provider is covering calls for a provider with an established relationship with the patient, or the provider is performing any activities set forth in section 54-1733(2), Idaho Code. A provider-patient relationship may be established by use of virtual care technologies, provided that the applicable Idaho community standard of care is satisfied.

SOURCE: ID Code 54-5705. (Accessed Jun. 2023).

A provider with an established provider-patient relationship, including a relationship established pursuant to section 54-5705, Idaho Code, may issue prescription drug orders and prescription medical device orders via virtual care within the scope of the provider’s license and according to any applicable state and federal laws, rules, and regulations, including the Idaho community standard of care. However, the prescription drug shall not be a controlled substance unless prescribed in compliance with 21 U.S.C. A prescription drug order and prescription medical device order must be issued for a legitimate medical purpose by a provider acting in a manner consistent with the provider’s scope of practice.
Nothing in this chapter shall be construed to expand or restrict the prescriptive authority of any provider beyond what is authorized by the applicable licensing boards.

SOURCE ID Code Section 54-5707 (Accessed Jun. 2023).

Prescribers must have prescriber-patient relationship, which includes a documented patient evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to the treatment.  A valid prescriber-patient relationship may be established through virtual care technologies, provided that the applicable Idaho community standard of care must be satisfied.

Prescriptions based solely on online questionnaires or consultation outside of an ongoing clinical relationship does not constitute a legitimate medical purpose.

SOURCE: ID Code § 54-1733. (Accessed Jun. 2023).

Last updated 06/30/2023

Professional Boards Standards

ID Board of Dentistry

SOURCE: IDAPA 24.31.01 (Accessed Jun. 2023).

Any dentist who provides any telehealth services to patients located in Idaho must hold an active Idaho license.

SOURCE: IDAPA 24.31.01 as amended by Executive Order 2020-13, p. 163 (Accessed Jun. 2023)

ID Board of Psychologist Examiners (Telepsychology)

SOURCE: IDAPA 24.12.01 (Accessed Jun. 2023)

Idaho State Board Of Medicine

SOURCE: IDAPA -24.33.03, (Accessed Jun. 2023)

Idaho Board of Physical Therapy

SOURCE: IDAPA 24.13.01.  (Accessed Jun. 2023).

Idaho Speech, Hearing and Communication Services Licensure Board

SOURCE:  IDAPA 24.23.01 (Accessed Jun. 2023).

Last updated 06/30/2023

Definition of a Visit

Encounters fall into one of two categories depending on the provider. Indian Health Service Clinics (IHS) and Federally Qualified Health Centers (FQHC) provide either dental or medical/mental health encounters. An encounter is defined as a face-to-face contact for the provision of one of these types of services between a participant and one of the following:

  • A physician;
  • A physician assistant;
  • A nurse practitioner;
  • A podiatrist;
  • A chiropractor;
  • A clinical social worker;
  • A clinical psychologist;
  • An other specialized nurse practitioner; or
  • A visiting nurse.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Nov 18, 2022)., p. 15.  (Accessed Jun. 2023).

Last updated 06/30/2023

Eligible Distant Site

Medicaid policy is not subject to Medicare restrictions for virtual care unless the participant has Medicare primary. Otherwise, all Medicaid providers, including federally qualified health centers (FQHC’s), rural health centers (RHC’s), and Indian health clinics (IHC’s) may bill for virtual care services according to these guidelines.

FQHC, RHC or IHS providers should not report the GT or FQ modifier with encounter code T1015 but should include it with each applicable supporting codes.

SOURCE: ID Medicaid Provider Handbook: General Information and Requirements for Providers (May 26 2023), p. 131ID MedicAide May 2023.  (Accessed Jun. 2023).

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. See the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook for more information about eligible services and billing requirements.

SOURCE: ID Medicaid Provider Handbook, IHS, fQHC, and RHC Services, p. 30 (Nov. 18, 2022).  (Accessed Jun. 2023).

Last updated 06/30/2023

Eligible Originating Site

No reference found.

Last updated 06/30/2023

Facility Fee

No reference found.

Last updated 06/30/2023

Home Eligible

No reference found.

Last updated 06/30/2023

Modalities Allowed

Live Video

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 Jun. 2023).

Only one eligible provider may be reimbursed per service per participant per date of service. No reimbursement is available for the use of equipment at the originating or remote sites. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties. Claims for services delivered via telehealth will be reimbursed at the same rate as face-to-face services.

Idaho Medicaid will now accept places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers should use these places of service on claims from telehealth going forward. Claims for telehealth must include one of the following modifiers:

  • FQ – A telehealth service was furnished using real-time audio-only communication technology.
  • GT – A telehealth service was furnished using real-time audio-visual communication technology.

Additionally, providers can also use the following modifier in conjunction with one of the above:

  • FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology.

FQHC, RHC or IHS providers should not report the GT or FQ modifier with encounter code T1015 but should include it with each applicable supporting codes.

SOURCE: ID Medicaid Provider Handbook: General Information and Requirements for Providers (NMay 26, 2023), p. 132.  MedicAide May 2023.  (Accessed Jun. 2023).


Store and Forward

Idaho Medicaid does not reimburse for Store and Forward. See ID Medicaid Store and Forward. No specific mention of FQHCs.


Remote Patient Monitoring

Idaho Medicaid reimburses for RPM.  See ID Medicaid RPM. No specific mention of FQHCs.


Audio-Only

Idaho Medicaid will now accept places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers should use these places of service on claims from telehealth going forward. Claims for telehealth must include one of the following modifiers:

  • FQ – A telehealth service was furnished using real-time audio-only communication technology.
  • GT – A telehealth service was furnished using real-time audio-visual communication technology.

Additionally, providers can also use the following modifier in conjunction with one of the above:

  • FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology.

FQHC, RHC or IHS providers should not report the GT or FQ modifier with encounter code T1015 but should include it with each applicable supporting codes.

SOURCE: ID Medicaid Provider Handbook: General Information and Requirements for Providers (NMay 26, 2023), p. 132.  MedicAide May 2023.  (Accessed Jun. 2023).

Last updated 06/30/2023

PPS Rate

The services of Indian Health Services (IHS), Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) are a covered benefit under Idaho Medicaid. Covered services are indicated on the Idaho Medicaid Numerical Fee Schedule with a reimbursement amount. Amounts of $0.00 are covered and require manual pricing per the General Billing Instructions, Idaho Medicaid Provider Handbook. Services must meet the criteria for the procedure found in the Physician and Non-Physician Practitioner and Hospital, Idaho Medicaid Provider Handbooks. Certain procedures must be prior authorized to be covered. See the Prior Authorizations section for more information. Services that qualify as described in the Encounters section shall be billed at the encounter rate.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Nov. 18 2022)., p. 15.  (Accessed Jun. 2023).

Last updated 06/30/2023

Provider-Patient Relationship

No reference found.

Last updated 06/30/2023

Same Day Encounters

All contact with providers for the same type of encounter counts as a single encounter. An encounter with more than one health professional, or multiple contacts with the same professional, in the same day, and all incidental services constitutes a single encounter. If a participant has a visit with a healthcare professional that qualifies as an encounter, any group education or activities provided on the same day are included in the encounter. Missed appointments, visits to pick up medication, or incidental services on the day of the encounter are not considered a separate encounter. Encounters are limited to three per day for FQHCs. An exception is allowed for an additional encounter of the same type when a participant, subsequent to the first encounter, suffers an illness or injury that requires additional diagnosis and treatment and is supported by documentation. Qualifying additional encounters should be billed with Modifier 59.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Nov. 18, 2022)., p. 16.  (Accessed Jun. 2023).