Illinois

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: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, PSY
  • Consent Requirements: No

STATE RESOURCES

  1. Medicaid Program: Illinois Medicaid
  2. Administrator: Illinois Dept. of Healthcare and Family Services
  3. Regional Telehealth Resource Center: Upper Midwest Telehealth Resource Center

Last updated 02/26/2022

Audio Only Delivery

Medicaid:  Provider Notice on Telehealth Service Expansion

STATUS: Active

Medicaid:  Allows Assisters to Assist Clients Telephonically

STATUS: Active

Medicaid:  Telehealth Expansion Billing Instructions

STATUS: Active

Medicaid:  Emergency Rule on Telehealth Services

STATUS: Active

Medicaid: 1135 Combined Waiver Additive Extension of waiver

STATUS: Active, until 6 months after the conclusion of the public health emergency

Medicaid: 1135 Combined Waiver Additive Extension of waiver

STATUS: Active, until 6 months after the conclusion of the public health emergency

Medicaid: Administrative Amendment  Telehealth Requirements During a Public Health Emergency.

STATUS: Active

Last updated 02/26/2022

Cross State Licensing

Dept. of Financial and Professional Regulation: Proclamation to Invoke Emergency Powers to Modify Professional License and Certification Statutes and Regulations

STATUS: Active Jan. 10, 2022 – May 31, 2022

Dep. Of Financial and Professional Regulation:  Guidance for Out-of-State Providers and Telehealth

STATUS: Expired

Department of Financial and Professional Regulation: Proclamation and extension of Out-of State Professional Licensure

STATUS: Expired

Last updated 02/26/2022

Easing Prescribing Requirements

No Reference Found

Last updated 02/26/2022

Miscellaneous

Division of Professional Regulation: Guidance to Applicants for Mental Health Professional Licensure

STATUS: Active

Medicaid:  RPM COVID-19 Program

STATUS: Active

Office of the Governor: Extends Order on Telehealth Services

STATUS: Active until Apr. 4, 2022

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

STATUS: Expired

STATUS: Expired

STATUS: Expired

STATUS: Expired

Department of Financial and Professional Regulation: Proclamation and extension of Out-of State Professional Licensure

STATUS: Expired

Last updated 02/26/2022

Originating Site

Medicaid:  Provider Notice on Telehealth Service Expansion

STATUS: Active

Medicaid:  Emergency Rule on Telehealth Services

STATUS: Active

Medicaid: Adopted Amendments to Emergency Rule on Telehealth Services

STATUS: Active

Medicaid: Provider Notice re: Modifier 93 and Place of Service Code 10 Implementation April 1, 2022

STATUS: Effective April 1, 2022

Last updated 02/26/2022

Private Payer

Illinois General Assembly: HB 3308 – Codified Private Payer EO Provisions in Statute/215 ILCS 5/356z.22

STATUS: Enacted

Office of the Governor: Extends Order on Telehealth Services

STATUS: Active until Apr. 4, 2022

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

STATUS: Expired

Office of the Governor: Revises and Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends Order on Telehealth Services

STATUS: Expired

Office of the Governor: Extends and Revises Executive Order to Expand Telehealth Services

Status: Expired

Office of the Governor: Executive Order to Expand Telehealth Services

STATUS: Expired

Last updated 02/26/2022

Provider Type

Medicaid:  Provider Notice on Telehealth Service Expansion

STATUS: Active

Medicaid:  Teledentistry Services Prompted by COVID-19

STATUS: Active

Medicaid:  Allows Assisters to Assist Clients Telephonically

STATUS: Active

Medicaid:  Telehealth Expansion Instructions

STATUS: Active

Division of Financial and Professional Regulation: Guidance to Applicants for Mental Health Professional Licensure with Face-to-Face Supervision or Experiential Requirements

STATUS: Active

Medicaid:  Emergency Rule on Telehealth Services

STATUS: Active

Medicaid: Emergency Rule Amendment

STATUS: Active

Medicaid: Provider Notice re: Modifier 93 and Place of Service Code 10 Implementation April 1, 2022

STATUS: Effective April 1, 2022

Last updated 03/14/2022

Definitions

“Telemedicine” is the use of a telecommunication system to provide medical services for the purpose of evaluation and treatment when the patient is at one medical provider location and the rendering provider is at another location.

Source: IL Admin. Code, Title 89,140.403(a)(9) & IL Dept. of Healthcare and Family Svcs., Handbook for Podiatrists, F-200 (VI), p. 7 (Oct. 2016). (Accessed Mar. 2022).

Telehealth is the use of a telecommunication system to provide medical services between places of lesser and greater medical capability and/or expertise, for the purpose of evaluation and treatment. Medical data exchanged can take the form of multiple formats: text, graphics, still images, audio and video. The information or data exchanged can occur in real time (synchronous) through interactive video or multimedia collaborative environments or in near real time (asynchronous) through “store and forward” applications.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7, p. 25 (June 2021).Handbook for Podiatrists, F-200(220.6) (Oct. 2016) & Handbook for Encounter Clinic Services, D-210.2,  pg. 16-17 (Aug. 2016). (Accessed Mar. 2022).

“Telehealth” means services provided via a telecommunication system.

SOURCE: IL Admin. Code, Title 89,140.403(8). (Accessed Mar. 2022). 

Telepsychiatry: Originating Site: The use of a telecommunication system to provide medical services between places of lesser and greater medical capability and/or expertise, for the purpose of evaluation and treatment. Medical data exchanged can take the form of multiple formats: text, graphics, still images, audio and video. The information or data exchanged can occur in real time (synchronous) through interactive video or multimedia collaborative environments or in near real time (asynchronous) through “store and forward” applications.  The Originating Site is the site where the customer is located.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Community-Based Behavioral Services Providers, 208.3.1 pg. 44 (Oct., 2021). (Accessed Mar. 2022).

Last updated 03/14/2022

Email, Phone & Fax

Audio-Only

Modifier 93 is a new modifier used to identify services that are provided via telephone or other real-time interactive audio-only telecommunication systems. It does not replace modifier GT, which should continue to be used to identify telehealth interactions using both audio and video telecommunications systems. When using modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of a face-to-face interaction. Modifier 93 is effective with dates of service beginning April 1, 2022.

SOURCE: IL Dept. of Healthcare and Family Services, Provider Notice 03/21/2022, Modifier 93 and Place of Service 10 Implementation April 1, 2022. (Accessed Mar. 2022).

No reimbursement for telephone.

No reimbursement for FAX.

No reimbursement for text or email.

SOURCE: IL Dept. of Healthcare and Family Services, Handbook for Practitioners Rendering Medical Services, Chapter 200 (June 2021). 220.5.7 p. 25; Handbook for Podiatrists, F-200, 220.6 p. 27 (Oct. 2016); Handbook for Encounter Clinic Services, Chapter D-200 Policy & Procedures, p. 17 (Aug 2016). & IL Administrative Code, Title 89 ,140.403. (Accessed Mar. 2022).

See regulations for exceptions during a public health emergency.

SOURCE: IL Admin. Code, Title 89,140.403. (Accessed Mar. 2022). 

Last updated 03/14/2022

Live Video

POLICY

The Department of Healthcare and Family Services shall reimburse psychiatrists, federally qualified health centers as defined in Section 1905(l)(2)(B) of the federal Social Security Act, clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing, and mental health professionals and clinicians authorized by Illinois law to provide behavioral health services to recipients via telehealth.  The Department, by rule, shall establish: (i) criteria for such services to be reimbursed, including appropriate facilities and equipment to be used at both sites and requirements for a physician or other licensed health care professional to be present at the site where the patient is located; however, the Department shall not require that a physician or other licensed health care professional be physically present in the same room as the patient for the entire time during which the patient is receiving telehealth services; and (ii) a method to reimburse providers for mental health services provided by telehealth.

SOURCE:  305 ILCS 5/5-5.25.  (Accessed Mar. 2022).

Health insurance providers must include coverage for licensed dietitians, nutritionists, and diabetes educators who counsel diabetes patients, via telehealth, in the patients’ homes to remove the hurdle of transportation for patients to receive treatment.

SOURCE: 215 ILCS 5/356z.22 .  (Accessed Mar. 2022).

Illinois Medicaid will reimburse for live video under the following conditions:

  • A physician or other licensed health care professional or other licensed clinician, mental health professional or qualified mental health professional must be present with the patient at all times with the patient at the originating site;
  • The distant site provider must be a physician, physician assistant, podiatrist or advanced practice nurse who is licensed by Illinois or the state where the patient is located.  For telepsychiatry, it must be a physician who has completed an accredited general psychiatry residency program or an accredited child and adolescent psychiatry residency program;
  • The originating and distant site provider must not be terminated, suspended or barred from the Department’s medical programs;
  • Telepsychiatry: The distant site provider must personally render the telepsychiatry service;
  • Medical data may be exchanged through a telecommunication system.  For telepsychiatry it must be an interactive telecommunication system;
  • The interactive telecommunication system must, at a minimum, have the capability of allowing the consulting distant site provider to examine the patient sufficiently to allow proper diagnosis of the involved body system.  The system must also be capable of transmitting clearly audible heart tones and lung sounds, as well as clear video images of the patient and any diagnostic tools, such as radiographs;
  • Telepsychiatry:  Group psychotherapy is not a covered telepsychiatry service.

SOURCE: IL Admin. Code Title 89, 140.403(b). (Accessed Mar. 2022). 

For telemedicine services, a physician or other licensed health care professional must be present at all times with the patient at the originating site.

For telepsychiatry services, a staff member meeting the minimum qualifications of a mental health professional (MHP) must be present at all times with the patient at the originating site.

When medically appropriate, more than one Distant Site provider may bill for services rendered during the telehealth visit.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7 p. 26-27, (June 2021). (Accessed Mar. 2022).

See regulations for requirements during a public health emergency.

SOURCE: IL Admin. Code, Title 89,140.403. (Accessed Mar. 2022). 


ELIGIBLE SERVICES/SPECIALTIES

Appropriate CPT codes must be billed with the GT modifier for telemedicine and telepsychiatry services and the appropriate Place of Service code, 02, telehealth. Enrolled distant site providers may not seek reimbursement from the Department for their services when the originating site is an encounter clinic. The originating site encounter clinic is responsible for reimbursement to the distant site provider. Non-enrolled providers rendering services as a distant site provider shall not be eligible for reimbursement from the Department, but may be reimbursed by the originating site provider from their facility fee payment.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7 p. 26, (June 2021),  IL Dept. of Healthcare and Family Svcs, Handbook for Podiatric Services, Ch F-200 Policy and Procedures 220.6.2, p. 27. (Oct. 2016). (Accessed Mar. 2022).

Modifier 93 is a new modifier used to identify services that are provided via telephone or other real-time interactive audio-only telecommunication systems. It does not replace modifier GT, which should continue to be used to identify telehealth interactions using both audio and video telecommunications systems. When using modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of a face-to-face interaction. Modifier 93 is effective with dates of service beginning April 1, 2022.

SOURCE: Provider Notice Issued 3/21/22: Modifier 93 and Place of Service Code 10 Implementation. (Accessed Mar. 2022).

There is no reimbursement for group psychotherapy as a telepsychiatry service.

SOURCE: IL Admin. Code Title 89, 140.403. (Accessed Mar. 2022).

Home Health Services

A face-to-face encounter may occur through telehealth.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Home Health Services. Ch. R-200 Policy and Procedures, R-205.1 p. 19, (May 2016). (Accessed Mar. 2022).

POS 10 is a new place of service code that specifies a distant site telehealth service rendered to a patient who is located in their home. It does not replace POS 02. The description for POS 02 has been changed to, “Telehealth Provided Other than in Patient’s Home” and it is still a valid distant site telehealth service POS code. POS 10, when applicable, should be submitted for claims with dates of service beginning April 1, 2022.

SOURCE: Provider Notice Issued 3/21/22: Modifier 93 and Place of Service Code 10 Implementation. (Accessed Mar. 2022).

This notice informs “Community Based Behavioral Services” providers of new billing instructions related to the use of procedure code modifier GT – Via Audio and Video Telecommunications Systems and Place of Service Code 02 – Telehealth — effective October 1, 2021.

Effective with dates of service beginning October 1, 2021, providers billing a service from the Community Based Behavioral  Services Fee Schedule that was performed via audio or video communication must append the procedure code with modifier GT and use Place of Service Code 02. This coding is needed for HFS to track the mode of service delivery. The GT modifier and Place of Service Code 02 are for reporting purposes only and do not affect current payment methodology.

The new billing instructions apply to any service being billed as a telehealth service, whether it is:

  • A code identified in the Community Based Behavioral Services Handbook that historically could be provided via phone and/or video delivery modes independent of the current public health emergency, or
  • A behavioral health service allowed via telehealth per the current public health emergency telehealth policy stated in the March 20, 2020 provider notice. This list of codes includes the following services from the CBS Fee Schedule: 96110, 96112, 96127 and H1000.

SOURCE: Medicaid Provider Notice “Use of Modifier GT and Place of Service Code 02 to Specify Telehealth Delivery Mode for Behavioral Health Services” & IL Dept. of Healthcare and Family Svcs., Handbook for Community-Based Behavioral Services Providers, 208.3.1 pg. 23-24 (Oct., 2021). (Accessed Mar. 2022).

The Department shall reimburse epilepsy specialists, as defined by the Department by rule, who are authorized by Illinois law to provide epilepsy treatment services to persons with epilepsy or related disorders via telehealth.

SOURCE:  ILCS 5/5.25, (Accessed Mar. 2022).

Department provides coverage for epilepsy treatment services via telehealth as required under Public Act 102-0207. Coverage is provided under both Medicaid fee-for-service and the managed care plans.

SOURCE: Medicaid Provider Notice “Confirmation of Reimbursement for Epilepsy Specialists via Telehealth” (Accessed Mar. 2022).


ELIGIBLE PROVIDERS

The Department of Healthcare and Family Services required to reimburse psychiatrists, federally qualified health centers, clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing and mental health professionals and clinicians authorized by Illinois law to provide behavioral health services via telehealth.

SOURCE:  ILCS 5/5.25, (Accessed Mar. 2022).

For telemedicine services, the distant site provider must be a physician, physician assistant, podiatrist, or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.

  • Practitioner Handbook:  When medically appropriate, more than one Distant Site provider may bill for services rendered during the telehealth visit.  Enrolled distant site providers may not seek reimbursement from the Department for their services when the originating site is an encounter clinic. The originating site encounter clinic is responsible for reimbursement to the distant site provider. Non-enrolled providers rendering services as a distant site provider shall not be eligible for reimbursement from the Department, but may be reimbursed by the originating site provider from their facility fee payment.
  • Podiatry Handbook:  Services rendered by an APN can be billed under the collaborating physician’s NPI, or if the APN is enrolled, under the APN’s NPI. When medically appropriate, more than one Distant Site provider may bill for services rendered during the telehealth visit.

For telepsychiatry, the distant site provider must be a physician who is licensed by the State of Illinois or by the state where the patient is located who has completed an accredited general psychiatry residency program or an accredited child and adolescent psychiatry residency program.

  • Practitioner Handbook: To be eligible for reimbursement for telepsychiatry services, physicians must enroll in the correct specialty/sub-specialty in IMPACT.
  • Encounter Clinic Handbook:  Telepsychiatry is not a covered service when rendered by an APN or PA.  Group psychotherapy is not a covered telepsychiatry service.

SOURCE: IL Admin. Code Title 89, 140.403(b) ; IL Dept. of Healthcare and Family Svcs., Handbook for Podiatrists (physician services only), F-200, F-220.6.2 p. 28 (Oct. 2016);   & Handbook for Practitioner Services. Ch. 200, 220.5.7 p. 26 (June 2021) & Handbook for Encounter Clinic Services. Ch. 200, 210.2.2 pg. 17. (Aug. 2016). (Accessed Mar. 2022).

An encounter clinic serving as the distant site shall be reimbursed as follows:

  • If the originating site is another encounter clinic, the distant site encounter clinic shall receive no reimbursement from the Department.  The originating site encounter clinic is responsible for reimbursement to the distant site encounter clinic; and
  • If the originating site is not an encounter clinic, the distant site encounter clinic shall be reimbursed for its medical encounter.  The originating site provider will receive a facility fee.

See handbook supplement for telehealth billing examples.

SOURCE: IL Admin. Code Title 89, 140.403IL Dept. of Healthcare and Family Svcs., Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010; Handbook for Encounter Clinic Services. Ch. 200, pg. 17.  Aug. 2016 & IL All Providers Handbook Supplement (Sept. 2020), pg. 43-45. (Accessed Mar. 2022).

Encounter Rate Clinics, Federally Qualified Health Centers (FQHC), and Rural Health Clinics, are allowed to render telemedicine services.

SOURCE:  Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010 (Accessed Mar. 2022). 

Effective with dates of service beginning October 1, 2021, providers billing a service from the Community Based Behavioral  Services Fee Schedule that was performed via audio or video communication must append the procedure code with modifier GT and use Place of Service Code 02. This coding is needed for HFS to track the mode of service delivery. The GT modifier and Place of Service Code 02 are for reporting purposes only and do not affect current payment methodology.

The new billing instructions apply to any service being billed as a telehealth service, whether it is:

  • A code identified in the Community Based Behavioral Services Handbook that historically could be provided via phone and/or video delivery modes independent of the current public health emergency, or
  • A behavioral health service allowed via telehealth per the current public health emergency telehealth policy stated in the March 20, 2020 provider notice. This list of codes includes the following services from the CBS Fee Schedule: 96110, 96112, 96127 and H1000.

The following providers billing from the Community Based Behavioral Services Fee Schedule are impacted:

  • Community Mental Health Centers
  • Behavioral Health Clinics
  • Physicians
  • Licensed Clinical Psychologists
  • Licensed Clinical Social Workers

SOURCE: Medicaid Provider Notice “Use of Modifier GT and Place of Service Code 02 to Specify Telehealth Delivery Mode for Behavioral Health Services” (Accessed Mar. 2022)

Local education agencies may submit telehealth services as a certified expenditure.

SOURCE: IL Admin. Code Title 89, 140.403(c)(1)(B). (Accessed Mar. 2022).

For medical services, the provider rendering the service at the distant site can be a physician, physician assistant, podiatrist or advanced practice nurse, who is licensed by the State of Illinois or by the state where the patient is located.

SOURCE: Handbook for Podiatrists, F-200, 220.6.2 p. 27 (Oct. 2016), IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7  p. 27, (June 2021). (Accessed Mar. 2022).

 


ELIGIBLE SITES

The Department shall reimburse any Medicaid certified eligible facility or provider organization that acts as the location of the patient at the time a telehealth service is rendered, including substance abuse centers licensed by the Department of Human Services’ Division of Alcoholism and Substance Abuse.

SOURCE:  ILCS 5/5.25(c), (Accessed Mar. 2022).  

POS 10 is a new place of service code that specifies a distant site telehealth service rendered to a patient who is located in their home. It does not replace POS 02. The description for POS 02 has been changed to, “Telehealth Provided Other than in Patient’s Home” and it is still a valid distant site telehealth service POS code. POS 10, when applicable, should be submitted for claims with dates of service beginning April 1, 2022.

SOURCE: Provider Notice Issued 3/21/22: Modifier 93 and Place of Service Code 10 Implementation. (Accessed Mar. 2022).

For telemedicine services, a physician or other licensed health care professional must be present at all times with the patient at the originating site.

For telepsychiatry services, A physician, licensed health care professional or other licensed clinician, mental health professional (MHP), or qualified mental health professional (QMHP), must be present at all times with the patient at the originating site.

SOURCE: IL Admin. Code Title 89, 140.403(b) &  IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7  p. 25, (June 2021). (Accessed Mar. 2022).

IL Healthcare and Family Services recognizes the following as valid originating sites: physician’s office, podiatrist’s office, local health department, Community Mental Health Center, Encounter Rate Clinics, and outpatient hospital.

For telepsychiatry services, a staff member meeting the minimum qualifications of a mental health professional (MHP) must be present at all times with the patient at the originating site.

SOURCE:  IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7  p. 25, (June 2021). (Accessed Mar. 2022).

See handbook supplement for telehealth billing examples.

SOURCE: All Providers Handbook Supplement (Sept. 2020), pg. 43-45. (Accessed Mar. 2022). 

An encounter clinic is eligible as an originating site and is responsible for ensuring and documenting that the distant site provider meets the department’s requirements for telehealth and telepsychiatry services, since the clinic is responsible for reimbursement to the distant site provider.

Enrolled distant site providers may not seek reimbursement from the Department for their services when the originating site is an encounter clinic. The originating site encounter clinic is responsible for reimbursement to the distant site provider.

SOURCE: IL Dept. of Healthcare and Family Svcs., Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. 200, p. 25Handbook for Podiatrists, F-200, p. 27 (Oct. 2016); & Handbook for Encounter Clinic Services. Ch. D-200, pg. 17.  Aug. 2016. (Accessed Mar. 2022).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

There is reimbursement for originating site facility fees.

Eligible facilities include:

  • Physician’s office;
  • Podiatrist’s office
  • Local health departments
  • Community mental health centers
  • Outpatient hospitals

SOURCE: IL Handbook for Practitioners Rendering Medical Services, Ch. 200, p. 25 (June 2021) & Handbook for Podiatrists, F-200, p. 27 (Oct. 2016). (Accessed Mar. 2022).

Hospitals BIlling with Revenue Code 0780 and HCPCS Code Q3014

HCPCS code Q3014 must be identified on the same revenue line with Revenue Code 0780. If any other procedure code is billed with Revenue Code 0780, the claim will be rejected with error code T55 – Missing/Invalid HCPCS for Revenue Code 0780.

Other services may be billed as necessary on the same outpatient claim with a telehealth facility fee, but the telehealth service must be identified as described in this provider notice. No modifier is required for the telehealth service.

SOURCE: Medicaid Provider Notice “Hospitals Billing as the Telehealth Originating Site” (Accessed Mar. 2022)

Last updated 03/14/2022

Miscellaneous

Specific documentation requirements apply for telehealth services.  See administrative code for details.

SOURCE: IL Administrative Code, Title 89 ,140.403(d). (Accessed Mar. 2022).

Last updated 03/14/2022

Out of State Providers

For medical services, the provider rendering the service at the distant site can be a physician, physician assistant, podiatrist or advanced practice nurse, who is licensed by the State of Illinois or by the state where the patient is located.

For psychiatric services, the provider rendering the service at the distant site must be a physician licensed by the State of Illinois, or by the state where the patient is located, who has completed an approved general psychiatry residency program or a child and adolescent psychiatry residency program.

SOURCE: IL Handbook for Practitioners Rendering Medical Services, Chapter 200, 220.5.7 p. 26, (June 2021); Handbook for Podiatric Services, Chapter F-200 Policy & Procedures, p. 28 (Oct. 2016), & Handbook for Encounter Clinic Services 210.2.2 pg. 17-18 (Aug. 2016). (Accessed Mar. 2022).

Last updated 03/14/2022

Overview

IL Medicaid reimburses for live video telemedicine and telepsychiatry services for specific providers.  Although IL definitions of telemedicine and telehealth encompass store-and-forward there is no mention of store-and-forward reimbursement.  IL Medicaid will provide reimbursement for home uterine monitoring and some audio-only services.

Last updated 03/14/2022

Remote Patient Monitoring

POLICY

IL Medicaid will cover home uterine monitoring with prior approval and when patient meets specific criteria.  Payment is only for the items and not for the service.

SOURCE: IL Dept. of Healthcare and Family Services, Handbook for Durable Medical Equipment, Chapter M-200, Policy and Procedures for Medical Equipment and Supplies, p. 56 (Sept. 2015). (Accessed Mar. 2022).


CONDITIONS

Only for home uterine monitoring.

  • Home uterine monitoring
  • Must be at least 24 weeks gestation; gestation of less than 24 weeks may require additional information
  • Hospitalized for preterm labor at 24-36 weeks
  • Cessation of labor accomplished by administration of tocolytics (terbutaline, procardia, etc.)
  • Discharged to home on oral or subcutaneous tocolytics
  • Multiple gestation pregnancy
  • History of preterm labor and delivery
  • Cervical status change (lengthening or dilation)
  • Cervical effacement
  • Contraction threshold
  • Gravida/para

Pregnancy-Induced Hypertension Monitor

  • Covered for diagnosis of pregnancy-induced hypertension, previous pregnancy induced hypertension or pre-eclampsia
  • Hospitalizations for symptoms related to pregnancy induced; i.e., hypertension, headaches, edema in face, hands and feet
  • Blurred vision
  • Right upper quadrant pain
  • 24-hour urine results greater than 300 mg of total protein
  • Antihypertensive medications
  • Pre-pregnancy and current blood pressure readings.

Will not be covered for patients with a diagnosis of chronic hypertension.

SOURCE: IL Dept. of Healthcare and Family Services, Handbook for Durable Medical Equipment, Chapter M-200, Policy and Procedures for Medical Equipment and Supplies, p. 56 (Sept. 2015). (Accessed Mar. 2022).


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 03/14/2022

Store and Forward

POLICY

Although store-and-forward is included within the definitions of telehealth in IL Medicaid manuals and administrative code (see descriptions below), there are no details provided on store-and-forward reimbursement and other areas of policy only indicate that the GT (live video) modifier is required for telehealth services.

SOURCE:  Provider Notice Changes to Professional Claims for Telehealth Services.  Jan. 10, 2018. (Accessed Mar. 2022). 

The Illinois Medicaid definition encompasses store-and-forward.  “The information or data exchanged can occur in real time (synchronous) through interactive video or multimedia collaborative environments or in near real time (asynchronous) through ‘store-and-forward’ applications.”

SOURCE: IL Dept. of Healthcare and Family Svcs., Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. 200, p. 24, June 2021; Handbook for Podiatrists, F-200, p. 27 (Oct. 2016);  & Handbook for Encounter Clinic Services pg. 16-17 (Aug. 2016). (Accessed Mar. 2022).

Additionally, IL Admin Code encompasses store-and-forward, addressing that a provider at a distant site can “review the medical case without the patient being present.”

“Asynchronous Store and Forward Technology” means the transmission of a patient’s medical information from an originating site to the provider at the distant site.  The provider at the distant site can review the medical case without the patient being present.  An asynchronous telecommunication system in single media format does not include telephone calls, images transmitted via facsimile machines and text messages without visualization of the patient (electronic mail).  Photographs visualized by a telecommunication system must be specific to the patient’ s medical condition and adequate for furnishing or confirming a diagnosis and/or treatment plan.  Dermatological photographs (for example, a photograph of a skin lesion) may be considered to meet the requirement of a single media format under this provision.

SOURCE: IL Administrative Code, Title 89 ,140.403. (Accessed Mar. 2022).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No Reference Found

Last updated 03/14/2022

Definition

“Telehealth services” has the meaning given to that term in Section 5 of the Telehealth Act. As used in this Section, “telehealth services” do not include asynchronous store and forward systems, remote patient monitoring technologies, e-visits, or virtual check-ins.

“Interactive telecommunications system” has the meaning given to that term in Section 5 of the Telehealth Act. As used in this Section, “interactive telecommunications system” does not include virtual check-ins.

SOURCE: IL Insurance Code. Sec. 356z.22.  (Accessed Mar. 2022).

Last updated 03/14/2022

Parity

SERVICE PARITY

An individual or group policy of accident or health insurance shall cover telehealth services, e-visits, and virtual check-ins rendered by a health care professional when clinically appropriate and medically necessary to insureds, enrollees, and members in the same manner as any other benefits covered under the policy. An individual or group policy of accident or health insurance may provide reimbursement to a facility that serves as the originating site at the time a telehealth service is rendered.

SOURCE: IL Insurance Code. Sec. 356z.22.  (Accessed Mar. 2022).


PAYMENT PARITY

For purposes of reimbursement, an individual or group policy of accident or health insurance shall reimburse an in-network health care professional or facility, including a health care professional or facility in a tiered network, for telehealth services provided through an interactive telecommunications system at the same reimbursement rate that would apply to the services if the services had been delivered via an in-person encounter by an in-network or tiered network health care professional or facility.

This subsection applies only to those services provided by telehealth that may otherwise be billed as an in-person service. This subsection is inoperative on and after January 1, 2028, except that this subsection is operative after that date with respect to mental health and substance use disorder telehealth services.

Nothing in this Section is intended to limit the ability of an individual or group policy of accident or health insurance and a health care professional or facility to voluntarily negotiate alternate reimbursement rates for telehealth services. Such voluntary negotiations shall take into consideration the ongoing investment necessary to ensure these telehealth platforms may be continuously maintained, seamlessly updated, and integrated with a patient’s electronic medical records.

SOURCE: IL Insurance Code. Sec. 356z.22.  (Accessed Mar. 2022).

Last updated 03/14/2022

Requirements

New Law in Effect:

An individual or group policy of accident or health insurance shall cover telehealth services, e-visits, and virtual check-ins rendered by a health care professional when clinically appropriate and medically necessary to insureds, enrollees, and members in the same manner as any other benefits covered under the policy. An individual or group policy of accident or health insurance may provide reimbursement to a facility that serves as the originating site at the time a telehealth service is rendered.

To ensure telehealth service, e-visit, and virtual check-in access is equitable for all patients in receipt of health care services under this Section and health care professionals and facilities are able to deliver medically necessary services that can be appropriately delivered via telehealth within the scope of their licensure or certification, coverage required under this Section shall comply with all of the following:

  • An individual or group policy of accident or health insurance shall not:
    • require that in-person contact occur between a health care professional and a patient before the provision of a telehealth service;
    • require patients, health care professionals, or facilities to prove or document a hardship or access barrier to an in-person consultation for coverage and reimbursement of telehealth services, e-visits, or virtual check-ins;
    • require the use of telehealth services, e-visits, or virtual check-ins when the health care professional has determined that it is not appropriate;
    • require the use of telehealth services when a patient chooses an in-person consultation;
    • require a health care professional to be physically present in the same room as the patient at the originating site, unless deemed medically necessary by the health care professional providing the telehealth service;
    • create geographic or facility restrictions or requirements for telehealth services, e-visits, or virtual check-ins;
    • require health care professionals or facilities to offer or provide telehealth services, e-visits, or virtual check-ins;
    • require patients to use telehealth services, e-visits, or virtual check-ins, or require patients to use a separate panel of health care professionals or facilities to receive telehealth service, e-visit, or virtual check-in coverage and reimbursement; or
    • impose upon telehealth services, e-visits, or virtual check-ins utilization review requirements that are unnecessary, duplicative, or unwarranted or impose any treatment limitations, prior authorization, documentation, or recordkeeping requirements that are more stringent than the requirements applicable to the same health care service when rendered in-person, except procedure code modifiers may be required to document telehealth.

Deductibles, copayments, coinsurance, or any other cost-sharing applicable to services provided through telehealth shall not exceed the deductibles, copayments, coinsurance, or any other cost-sharing required by the individual or group policy of accident or health insurance for the same services provided through in-person consultation.

An individual or group policy of accident or health insurance shall notify health care professionals and facilities of any instructions necessary to facilitate billing for telehealth services, e-visits, and virtual check-ins.

An individual or group policy of accident or health insurance shall provide coverage for telehealth services for licensed dietitian nutritionists and certified diabetes educators who counsel diabetes patients in the diabetes patients’ homes to remove the hurdle of transportation for diabetes patients to receive treatment, in accordance with the Dietitian Nutritionist Practice Act.

Any policy, contract, or certificate of health insurance coverage that does not distinguish between in-network and out-of-network health care professionals and facilities shall be subject to this Section as though all health care professionals and facilities were in-network.

Health care professionals and facilities shall determine the appropriateness of specific sites, technology platforms, and technology vendors for a telehealth service, as long as delivered services adhere to all federal and State privacy, security, and confidentiality laws, rules, or regulations, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 and the Mental Health and Developmental Disabilities Confidentiality Act.

Nothing in this Section shall be deemed as precluding a health insurer from providing benefits for other telehealth services, including, but not limited to, services not required for coverage provided through an asynchronous store and forward system, remote patient monitoring services, other monitoring services, or oral communications otherwise covered under the policy.

There shall be no restrictions on originating site requirements for telehealth coverage or reimbursement to the distant site under this Section other than requiring the telehealth services to be medically necessary and clinically appropriate.

The Department may adopt rules, including emergency rules subject to the provisions of Section 5-45 of the Illinois Administrative Procedure Act, to implement the provisions of this Section.

The Department and the Department of Public Health shall commission a report to the General Assembly administered by an established medical college in this State wherein supervised clinical training takes place at an affiliated institution that uses telehealth services, subject to appropriation. The report shall study the insurer telehealth coverage and reimbursement policies to determine if the policies improve access to care, reduce health disparities, promote health equity, have an impact on utilization and cost-avoidance, including direct or indirect cost savings to the patient, and to provide any recommendations for telehealth access expansion in the future. An individual or group policy of accident or health insurance shall provide data necessary to carry out the requirements of this subsection upon request of the Department. The Department and the Department of Public Health shall submit the report by December 31, 2026. The established medical college may utilize subject matter expertise to complete any necessary actuarial analysis.

SOURCE: IL Insurance Code Chap. 215, Sec. 5/356z.22.  (Accessed Mar. 2022).

Insurers are required to include information on the use of telehealth or telemedicine in an electronic provider directory, including but not limited to:

  • whether the provider offers the use of telehealth or telemedicine to deliver services to patients for whom it would be clinically appropriate;
  • what modalities are used and what types of services may be provided via telehealth or telemedicine; and
  • whether the provider has the ability and willingness to include in a telehealth or telemedicine encounter a family caregiver who is in a separate location than the patient if the patient wishes and provides his or her consent

SOURCE: IL Compiled Statutes, Chapter 215, 124/25.  (Accessed Mar. 2022).

Last updated 03/14/2022

Cross State Licensing

Must have an IL medical license.  An out-of-state person providing a service to a patient in IL through telemedicine submits himself or herself to the jurisdiction of the courts of IL.

SOURCE: IL Compiled Statutes, Chapter 225, 60/49.5(e) (Accessed Mar. 2022).

A health care professional treating a patient located in this State through telehealth services must be licensed or authorized to practice in Illinois.

SOURCE: IL Compiled Statutes, Chapter 225, 150/10. (Accessed Mar. 2022).

An optometrist treating a patient located in this State through telehealth must be licensed under this Act.

SOURCE: IL Compiled Statutes Chapter 225, 80/15.4. (Accessed Mar. 2022).

Last updated 03/22/2022

Definitions

“Telehealth services” means the evaluation, diagnosis, or interpretation of electronically transmitted patient-specific data between a remote location and a licensed health care professional that generates interaction or treatment recommendations. “Telehealth services” includes telemedicine and the delivery of health care services, including mental health treatment and substance use disorder treatment and services to a patient, regardless of patient location, provided by way of an interactive telecommunications system, asynchronous store and forward system, remote patient monitoring technologies, e-visits, or virtual check-ins.

“Virtual check-in” means a brief patient-initiated communication using a technology-based service, excluding facsimile, between an established patient and a health care professional. “Virtual check-in” does not include communications from a related office visit provided within the previous 7 days, nor communications that lead to an office visit or procedure within the next 24 hours or soonest available appointment.

“E-visit” means a patient-initiated non-face-to-face communication through an online patient portal between an established patient and a health care professional.

“Asynchronous store and forward system” means the transmission of a patient’s medical information through an electronic communications system at an originating site to a health care professional or facility at a distant site that does not require real-time or synchronous interaction between the health care professional and the patient.

“Interactive telecommunications system” means an audio and video system, an audio-only telephone system (landline or cellular), or any other telecommunications system permitting 2-way, synchronous interactive communication between a patient at an originating site and a health care professional or facility at a distant site. “Interactive telecommunications system” does not include a facsimile machine, electronic mail messaging, or text messaging.

“Remote patient monitoring” means the use of connected digital technologies or mobile medical devices to collect medical and other health data from a patient at one location and electronically transmit that data to a health care professional or facility at a different location for collection and interpretation.

“Health care professional” includes, but is not limited to, physicians, physician assistants, optometrists, advanced practice registered nurses, clinical psychologists licensed in Illinois, prescribing psychologists licensed in Illinois, dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists, hearing instrument dispensers, licensed certified substance use disorder treatment providers and clinicians, and mental health professionals and clinicians authorized by Illinois law to provide mental health services, and qualified providers listed under paragraph (8) of subsection (e) of Section 3 of the Early Intervention Services System Act, dietitian nutritionists licensed in Illinois, and health care professionals associated with a facility.

“Facility” includes a facility that is owned or operated by a hospital under the Hospital Licensing Act or University of Illinois Hospital Act, a facility under the Nursing Home Care Act, a rural health clinic, a federally qualified health center, a local health department, a community mental health center, a behavioral health clinic as defined in 89 Ill. Adm. Code 140.453, an encounter rate clinic, a skilled nursing facility, a substance use treatment program licensed by the Division of Substance Use Prevention and Recovery of the Department of Human Services, a school-based health center as defined in 77 Ill. Adm. Code 641.10, a physician’s office, a podiatrist’s office, a supportive living program provider, a hospice provider, home health agency, or home nursing agency under the Home Health, Home Services, and Home Nursing Agency Licensing Act, a facility under the ID/DD Community Care Act, community-integrated living arrangements as defined in the Community-Integrated Living Arrangements Licensure and Certification Act, and a provider who receives reimbursement for a patient’s room and board.

“Established patient” means a patient with a relationship with a health care professional in which there has been an exchange of an individual’s protected health information for the purpose of providing patient care, treatment, or services.

SOURCE: IL Compiled Statutes, Chapter 225, 150/5.  (Accessed Mar. 2022).

Telemedicine means the performance of any of the activities listed in Section 49, including, but not limited to, rendering written or oral opinions concerning diagnosis or treatment of a patient in Illinois by a person in a different location than the patient as a result of transmission of individual patient data by telephonic, electronic, or other means of communication. “Telemedicine” does not include the following:

  1. periodic consultations between a person licensed under this Act and a person outside the State of Illinois;
  2. a second opinion provided to a person licensed under this Act;
  3. diagnosis or treatment services provided to a patient in Illinois following care or treatment originally provided to the patient in the state in which the provider is licensed to practice medicine; and
  4. health care services provided to an existing patient while the person licensed under this Act or patient is traveling.

SOURCE: IL Compiled Statutes, Chapter 225, 60/49.5(c). (Accessed Mar. 2022). 

Under the Department of Public Health, telemedicine means the provision of clinical services to patients by physicians and practitioners from a distance via electronic communications.

SOURCE: IL Admin. Code, Title 77, Sec. 250.310(a)(8) (Accessed Mar. 2022). 

“Teledentistry” means the use of telehealth systems and methodologies in dentistry and includes patient care and education delivery using synchronous and asynchronous communications under a dentist’s authority as provided under this Act.

SOURCE:  IL Code 225, Sec. 25/4. (Accessed Mar. 2022).

Optometrists: Effective January 1, 2022

“Telehealth” means the evaluation, diagnosis, or interpretation of patient-specific data that is transmitted by way of an interactive telecommunication system between a remote location and an optometrist located at a distant site that generates interaction or treatment recommendations for a patient located at a remote location. “Telehealth” includes the performance of any of the activities set forth in Sections 3 and 15.1.

“Interactive telecommunications system” means an audio and video system permitting 2-way, real-time interactive communication between a patient located at a remote location and an optometrist located at a distant site.

“Provider-patient relationship” means a relationship in which the optometrist has provided services to the patient at an in-person consultation no more than 3 years prior to the date on which telehealth services are provided.

SOURCE: IL Compiled Statutes Chapter 225, 80/9.  IL Compiled Statutes Chapter 225, 80/15.4.   (Accessed Mar. 2022).

Last updated 03/14/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (Accessed Mar. 2022).

Member of Psychology Interjurisdictional Compact.

SOURCE:  Psychology Interjurisdictional Compact. Legislative Updates. (Accessed Mar. 2022).

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

Last updated 03/14/2022

Miscellaneous

A health care professional may engage in the practice of telehealth services in Illinois to the extent of his or her scope of practice as established in his or her respective licensing Act consistent with the standards of care for in-person services. This Act shall not be construed to alter the scope of practice of any health care professional or authorize the delivery of health care services in a setting or in a manner not otherwise authorized by the laws of this State.

Telehealth services shall be consistent with all federal and State privacy, security, and confidentiality laws, rules, or regulations.

“Health care professional” includes, but is not limited to, physicians, physician assistants, optometrists, advanced practice registered nurses, clinical psychologists licensed in Illinois, prescribing psychologists licensed in Illinois, dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists, hearing instrument dispensers, licensed certified substance use disorder treatment providers and clinicians, and mental health professionals and clinicians authorized by Illinois law to provide mental health services, and qualified providers listed under paragraph (8) of subsection (e) of Section 3 of the Early Intervention Services System Act, dietitian nutritionists licensed in Illinois, and health care professionals associated with a facility.

SOURCE: IL Compiled Statutes, Chapter 225, 150/5 &  IL Compiled Statutes Chapter 225, 150/15. (Accessed Mar. 2022).

Optometrists: Effective January 1, 2022

An optometrist may practice optometry through telehealth and must be licensed in the state to treat a patient in the state.

An optometrist practicing optometry through telehealth is subject to the same standard of care and practice standards that are applicable to optometric services provided in a clinic or office setting.

An optometrist may not provide telehealth services unless the optometrist has established a provider-patient relationship with the patient.

An in-person consultation is not required for new conditions relating to a patient with whom the optometrist has a provider-patient relationship unless the optometrist deems an in-person consultation is necessary to provide appropriate care. An optometrist may treat a patient through telehealth in the absence of a provider-patient relationship when, in the professional judgment of the optometrist, emergency care is required.

SOURCE:  IL Compiled Statutes Chapter 225, 80/15.4. (Accessed Mar. 2022).

Last updated 03/14/2022

Online Prescribing

Optometrists: Effective January 1, 2022

An optometrist treating a patient through telehealth must perform at least a minimum eye examination as required by 68 Ill. Adm. Code 1320.90 before prescribing eyeglasses or contact lenses to the patient. Nothing in this Section authorizes an eye examination that:

  • does not assess the ocular health and visual status of a patient, or
  • consists solely of objective refractive data or information generated by an automated testing device, including an autorefractor, in order to establish a medical diagnosis or to determine a refractive error.

SOURCE:  Illinois Consolidated Statute 225, 80/15.4. (Accessed Mar. 2022).

Last updated 03/14/2022

Professional Boards Standards

No Reference Found