Last updated 02/28/2023
Email, Phone & Fax
The IHCP is updating the telehealth and virtual services code set to allow additional services to be reimbursed when rendered via telephone or other audio-only telecommunications systems. Effective for dates of service (DOS) on and after Dec. 9, 2022, the procedure codes in Table 1 (located in the memo) will be allowable when provided as audio-only telehealth.
As published in IHCP Bulletin BT202239, for a practitioner to receive reimbursement for telehealth services, the procedure code must be listed in the telehealth and virtual services code set (see Telehealth and Virtual Services Codes, accessible from the Code Sets page), and must be a service for which the member is eligible. Additionally, the claim detail must have:
One of the following place of service (POS) codes:
- 02 – Telehealth provided other than in patient’s home
- 10 – Telehealth provided in the patient’s home
One of the following modifiers:
- 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
- 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
Modifier 93 (audio-only) is allowable only for certain, designated telehealth services.
SOURCE: IN Health Coverage Programs “IHCP expands and clarifies telehealth coverage” BT202297 (Nov. 8, 2022), p. 1. (Accessed Feb. 2023).
Most telehealth services must be provided via video and audio, although a few designated telehealth services can be provided via audio only. Audio-only delivery is allowable for all nonhealthcare virtual services.
Unless the practitioner has an established relationship with the patient, telehealth does not include the use of electronic mail, an instant messaging conversation, facsimile, internet questionnaire or an internet consultation.
SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Sept. 27, 2022), p. 1. (Accessed Feb 2023).
For certain telehealth services, an audio-only modifier (93) can be used to signify when a service is delivered via audio-only telehealth. Services eligible for reimbursement when billed with this new modifier are identified within this finalized code set. All other codes must be delivered via video and audio telehealth. See Bulletin for code set. Effective July 21, 2022 through end of 2022 at which point they will be re-evaluated for 2023.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT 202239 (May 19, 2022). (Accessed Feb. 2023).
The IHCP will continue to allow and offer reimbursement for audio-only telehealth. The IHCP will continue to explore the option of audio-only telehealth and its effectiveness in delivering healthcare services and provide updates when more specific policy details have been determined. Until further notice, audio-only telehealth services should be billed according to the guidance released in BT2020106 and used only when the care can be properly delivered via audio-only telehealth.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Feb. 2023).
Physical Therapy
The physical therapy assistant (PTA) is precluded from performing or interpreting tests, conducting initial or subsequent assessments, or developing treatment plans. See the Covered Procedures for Physical Therapist Assistants section for details. The PTA is required to meet with the supervising physical therapist each working day to review treatment, unless the physical therapist or physician is on the premises to provide constant supervision. The consultation can be either face-to-face or by telephone.
SOURCE: IN Therapy Services Module, Jan. 26, 2023, p. 5, (Accessed Feb. 2023).
Last updated 02/26/2023
Live Video
POLICY
The Indiana Health Coverage Programs (IHCP) covers select medical, dental and remote patient monitoring services delivered via telehealth. IHCP coverage is also available for the virtual delivery of certain nonhealthcare services (such as case management) for members who are eligible to receive such services. For applicable procedure codes, see Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 1. (Accessed Feb. 2023).
Indiana Code requires reimbursement for medically necessary telehealth services for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Community Mental Health Centers, Critical Access Hospitals, a home health agency under IC 16-27-1, and a provider determined by the office to be eligible, providing a covered telehealth service.
SOURCE: IN Code, 12-15-5-11 (Accessed Feb. 2023).
All services delivered through telehealth are subject to the same limitations and restrictions as they would be if delivered in-person
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Feb. 2023).
In any telemedicine encounter, there will be the following:
- A distant site;
- An originating site;
- An attendant to connect the patient to the provider at the distant site; and
- A computer or television monitor at the distant and originating sites to allow the patient to have real-time, interactive; and face-to-face communication with the distant provider via IATV technology.
SOURCE: IN Admin. Code, “Article 5,” Title 405, 5-38-3 & 4., p. 185 (Accessed Feb. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Providers are allowed to use telehealth for the medical, dental and remote patient monitoring services listed in Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers. This code set is in effect for dates of service on or after July 21, 2022, and will expire at the end of 2022. The codes will be reevaluated for 2023. The following services may not be provided using telehealth:
- Surgical procedures
- Radiological services
- Laboratory services
- Anesthesia services
- Durable medical equipment (DME)/home medical equipment (HME) services
- Transportation services
Office visits conducted via telehealth are subject to existing service limitations for office visits. Telehealth office visits billed using applicable codes from Telehealth and Virtual Services Codes (accessible from the Code Sets page at in.gov/medicaid/providers) are counted toward the member’s office visit limit. See the Evaluation and Management Services module for information about office visit limitations.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 2-3. Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, p. 2 June 8, 2021, (Accessed Feb. 2023).
IHCP reimbursement for telehealth services is limited to the medical, dental and remote patient monitoring procedure codes listed in the telehealth code set (see the Telehealth Services Allowed and Excluded section). Additionally, the rendering NPI on the claim must be enrolled in the IHCP under one of the specialties allowable for telehealth services (see the Practitioners Eligible to Provide Telehealth Services section). All services delivered via telehealth must be billed with one of the following place of service (POS) codes:
- 02 – Telehealth provided other than in patient’s home
- 10 – Telehealth provided in the patient’s home
In addition, an appropriate telehealth modifier may be required, depending on the type of service:
Medical services – All medical services delivered via telehealth (with the exception of services delivered through a Home- and Community-Based Services [HCBS] or Money Follows the Person [MFP] program) require one of the following modifiers:
- 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
- 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 3-4 Indiana Health Coverage Programs ICHP Bulletin BT202249 (June 30, 2022). (Accessed Feb. 2023).
In December 2022, IHCP expanded and clarified telehealth coverage and note it will be effective December 9, 2022. The updated coverage applies to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid. The telehealth and virtual services code set is used by both fee-for-service (FFS) and managed care delivery systems. This updated code set will remain in place for the remainder of 2022 and 2023, and will be reevaluated by the Office of Medicaid Policy and Planning (OMPP) at the end of 2023.
Updated Code Set as of Dec. 2022.
SOURCE: IN Health Coverage Programs (IHCP) Bulletin BT 202297 (Nov 8, 2022). Past bulletins: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, p. 2 June 8, 2021, ICHP BT2020106 Indiana Health Coverage Programs ICHP Bulletin BT 202239 (May 19, 2022). (Accessed Feb. 2023).
As published in IHCP Bulletin BT202239, for a practitioner to receive reimbursement for telehealth services, the procedure code must be listed in the telehealth and virtual services code set, and must be a service for which the member is eligible. Additionally, the claim detail must have:
One of the following place of service (POS) codes:
- 02 – Telehealth provided other than in patient’s home
- 10 – Telehealth provided in the patient’s home
One of the following modifiers:
- 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
- 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system
Modifier 93 (audio-only) is allowable only for certain, designated telehealth services. Effective Dec. 9, 2022, the IHCP will allow reimbursement for the telehealth services specified in Table 1 when billed with the appropriate POS code and the audio-only modifier (93).
SOURCE: Indiana Health Coverage Programs ICHP Bulletin BT202297 (Nov 8, 2022), p. 1. (Accessed Feb. 2023).
A valid FQHC or RHC encounter is defined as a face-to-face visit (either in person or via telehealth) between an IHCP member and a qualifying practitioner (see the Rendering Providers section) at an FQHC, RHC or other qualifying, non-hospital setting. When billing valid encounters provided by telehealth, FQHC and RHC providers must use POS code 02 with both the encounter code (T1015 or D9999) as well as the procedure codes for the specific allowable services provided during the telemedicine encounter. Modifier 95 is also required for all services provided via telehealth, with the exception of dental services
SOURCE: Medicaid Federally Qualified Health Centers and Rural Health Clinics Module, (Jan 2022 edition, published May 19, 2022), p. 4-5, (Accessed Feb. 2023).
When the FQHC or RHC is the distant site, the service provided by the FQHC or RHC must meet the requirements both for a valid encounter and for an approved telehealth service. The claim must include the following:
- Encounter code T1015 (or D9999 for valid dental encounters), billed with POS code 02, 03, 04, 10, 11, 12, 31, 32, 50 or 72
- One or more appropriate procedure codes for the specific services rendered, billed with modifier 93 or 95, and a POS code of either 02 or 10, depending on the originating site/location of the patient
NOTE: The IHCP authorized the use of POS 10 for FQHCs and RHCs for date of service on and after July 21, 2022.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 6 (Accessed Feb. 2023).
For purposes of a community mental health center, telehealth services satisfy any face to face meeting requirement between a clinician and consumer.
SOURCE: IN Code, 12-15-5-11(f) (Accessed Feb. 2023).
Behavioral and Primary Healthcare Coordination (BPHC) Services
Telehealth may be used for clinical evaluations in the BPHC application process, for developing the Individualized Integrated Care Plan (IICP), and ongoing review of the IICP.
SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Behavioral and Primary Healthcare Coordination Services (July 28, 2022), p. 26, 43, 46. (Accessed Feb. 2023).
Nonhealthcare Virtual Services
Nonhealthcare virtual services are services centering on patient wellness and case management that are delivered between a patient and a provider via interactive electronic communications technology. A licensed practitioner listed under IC 25-1-9.5-3.5 is not required to perform these services, as they are not considered healthcare services under the definition listed in IC 25-1-9.5-2.5. For a list of nonhealthcare procedure codes allowable for virtual delivery, see the Procedure Codes for Nonhealthcare Virtual Services table in Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.
Nonhealthcare virtual services must be billed with POS code 02 or 10. These services and do not require modifiers 93 or 95. All services in this category can be provided either through audio and video technology or via audio only.
NOTE: The nonhealthcare virtual services code set does not include all Home- and Community-Based Services (HCBS) waiver services that were approved to be delivered virtually under Appendix K authority, as part of the federal response to the coronavirus disease 2019 (COVID-19) public health emergency. IHCP waiver providers will continue to be allowed to deliver approved Appendix K support services remotely no later than six months after the end of the public health emergency.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 4-5 (Accessed Feb. 2023).
Nonhealthcare virtual services take place between a patient and a provider via interactive electronic communications technology. These services do not require a licensed practitioner listed in IC 25-1-9.5-3.5 to perform the service virtually, as the services are not considered healthcare services under the definition listed in IC 25-1-9.5-2.5 and, therefore, do not fall under the definition of telehealth by the IHCP. As specified in Table 2, nonhealthcare virtual services must be billed with a POS of 02 or 10, and do not require modifiers 93 or 95. All services in this category can be provided via audio only.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). (Accessed Feb. 2023).
Telehealth Dental Services
Dental services listed in Table 3 are covered when provided through telehealth. These services must be billed with POS code 02 or 10, and do not require modifiers 93 or 95. These services cannot be billed via audio-only telehealth.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 4, Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). (Accessed Feb. 2023).
Intensive Outpatient Treatment via Telehealth
The IHCP reimburses for intensive outpatient treatment (IOT) services (procedure codes H0015 and S9480) when delivered via telehealth. The IHCP is approaching this temporary policy expansion as a pilot initiative, where any healthcare provider engaging in telehealth IOT will be opting in to the analysis of the efficacy of this model through data collection and analysis. This data collection and analysis will be administered through the state and is intended to have a minimal administrative impact on providers. All providers submitting claims for telehealth IOT will automatically be included in the study and are expected to participate by providing data if requested. Telehealth IOT will be available for 12 months after which the data collected will be analyzed by the Division of Mental Health and Addiction (DMHA). IOT requires prior authorization for medical necessity, regardless of whether it is delivered in person or via telehealth. See manual for other criteria.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 6-7 (Accessed Feb. 2023).
After receiving feedback from providers over an allotted 30-day period, the IHCP has determined that IOT services (procedure codes H0015 and S9480) will be reimbursable when delivered via telehealth. This service will be added to the 2022 telehealth and virtual services code set. See bulletin for more instructions.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). (Accessed Feb. 2023).
With the exception of services billed by a federally qualified health center (FQHC) or rural health clinic (RHC) (see the Telehealth Services for FQHCs and RHCs section) or RPM services billed by a home health agency (see the RPM Billing and Reimbursement for Home Health Agencies section), the payment for telehealth services is equal to the current Fee Schedule amount for the procedure codes billed (see the IHCP Fee Schedules page at in.gov/medicaid/providers).
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 4, (Accessed Feb. 2023).
Skills Training and Development Rendered Via Telehealth
As published in BT202249, the IHCP reimburses for H2014 – Skills training and development, per 15 minutes when the service is rendered through an audiovisual telehealth modality. Skills training and development is covered only for members who have access to Medicaid Rehabilitation Option (MRO) services. The OMPP, in partnership with the Division of Mental Health and Addiction (DMHA), developed the following service parameters for when telehealth delivery satisfies the “face-to-face” contact required for this service. Providers are expected to have these service parameters in place by Dec. 9, 2022, when rendering skills training and development via telehealth. See bulletin for additional information.
SOURCE: IHCP Expands and Clarifies Telehealth Coverage BT 202297 (Nov. 8, 2022), p. 2-3. (Accessed Feb. 2023).
ELIGIBLE PROVIDERS
The practitioners listed in IC 25-1-9.5-3.5 are authorized to provide telehealth services under the scope of their licensure within the state of Indiana.
The IHCP will allow these practitioners to provide telehealth services and receive reimbursement for IHCP services, within the established IHCP billing rules and policies. Providers not on this list are not allowed to practice telehealth or receive IHCP reimbursement for such services, even under the supervision of one of these listed practitioners. Providers rendering services within the state of Indiana are encouraged to have a telehealth provider certification filed with the Indiana Professional Licensing Agency. Providers rendering services out of state are required to have a telehealth provider certification under IC 25-1-9.5-9; see the Out-of-State Telehealth Providers section for more information.
NOTE: Not all practitioners that are authorized to provide telehealth services are allowed to enroll as rendering providers in the IHCP. Those that are not eligible for IHCP enrollment must bill under the IHCP-enrolled supervising practitioner’s National Provider Identifier (NPI), using the appropriate modifiers (as applicable). The rendering NPI entered on the claim must be enrolled under a specialty that is allowable for telehealth.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 2, (Accessed Feb. 2023).
For a provider to be reimbursed for telehealth services under the IHCP, the provider must be enrolled with the IHCP and be a licensed practitioner listed in IC 25-1-9.5-3.5. Providers rendering services in state are also encouraged to have a telehealth provider certification filed with the Indiana Professional Licensing Agency. Providers rendering services out of state are required to have a telehealth provider certification under IC 25-1-9.5-9.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). (Accessed Feb. 2023).
The IHCP will allow these providers to provide telehealth services and receive reimbursement for IHCP services, within the established IHCP billing rules and policies:
- A behavior analyst licensed under IC 25-8.5
- A chiropractor licensed under IC 25-10
- A dental hygienist licensed under IC 25-13*
- The following:
- A dentist licensed under IC 25-14
- An individual who holds a dental residency permit issued under IC 25-14-1-5*
- An individual who holds a dental faculty licensed under IC 25-14-1-5.5*
- A diabetes educator licensed under IC 25-14.3*
- A dietitian licensed under IC 25-14.5*
- A genetic counselor licensed under IC 25-17.3
- The following:
- A physician licensed under IC 25-22.5
- An individual who holds a temporary medical permit under IC 22-22.5-5-4*
- A nurse licensed under IC 25-23*
- An occupational therapist licensed under IC 25-23.5
- Any behavioral health and human services professional licensed under IC 25-23.6
- An optometrist licensed under IC 25-24
- A pharmacist licensed under IC 25-26*
- A physical therapist licensed under IC 25-27
- A physician assistant licensed under IC 5-27.5
- A podiatrist licensed under IC 25-29
- A psychologist licensed under IC 25-33
- A respiratory care practitioner licensed under IC 25-34.5*
- A speech-language pathologist or audiologist licensed under IC 25-35.6
Some providers (within the licensure citations above) marked with an asterisk may not be able to enroll as rendering providers in the IHCP and must bill under the IHCP-enrolled supervising practitioner’s National Provider Identifier (NPI) using the appropriate modifiers (as applicable). In addition, providers not on this list are not allowed to practice telehealth and/or receive IHCP reimbursement for such services, even under the supervision of one of these listed practitioners.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Feb. 2023).
Providers that can deliver healthcare services via telehealth must be listed as an authorized practitioner in SB 3(SEA 3). Providers not listed as authorized practitioners in SB 3(SEA 3) are not permitted to practice telehealth and/or receive IHCP reimbursement for telehealth services, even under the supervision of one of these listed practitioners.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202145, June 17, 2021. (Accessed Feb. 2023).
The office shall reimburse the following Medicaid providers for medically necessary telehealth services:
- A federally qualified health center
- A rural health clinic
- A community mental health center
- A critical access hospital
- A home health agency licensed under IC 16-27-1.
- A provider, as determined by the office to be eligible, providing a covered telehealth service.
SOURCE: IN Admin Code, “Article 5” 405 5-38-4(3) p. 183 & IN Code, 12-15-5-11. (Accessed Feb. 2023).
The office may not impose any distance restrictions on providers of telehealth activities or telehealth services. Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.
SOURCE: IN Code, 12-15-5-11 (Accessed Feb. 2023).
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
Special billing considerations apply for federally qualified health center (FQHC) and rural health clinic (RHC) providers. FQHC and RHC providers may bill for telehealth services if the service rendered is considered a valid FQHC or RHC encounter (as defined in the Federally Qualified Health Centers and Rural Health Clinics module) and a covered telehealth service (as defined by the Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers). Subject to the following criteria, reimbursement is available to FQHCs and RHCS when they are serving as either the distant site or the originating site for telehealth services.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 5, (Accessed Feb. 2023).
A valid FQHC or RHC encounter is defined as a face-to-face visit (either in person or via telemedicine) between an IHCP member and a qualifying practitioner (see the Rendering Providers section) at an FQHC, RHC, or other qualifying, non-hospital setting.
SOURCE: Medicaid Federally Qualified Health Centers and Rural Health Clinics Module, Jan. 1, 2022 (published May 19, 2022), p. 4, (Accessed Feb. 2023).
Non-Eligible Providers
IHCP does not reimburse the following provider types for telemedicine:
- Ambulatory surgical centers;
- Outpatient surgical services;
- Home health agencies or services (For information about home health agency reimbursement for telehealth services, see the Telehealth Services section);
- Radiological services;
- Laboratory services;
- Long-term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled;
- Anesthesia services or nurse anesthetist services;
- Audiological services;
- Chiropractic services;
- Care coordination services;
- Durable medical equipment, and home medical equipment providers
- Optical or optometric services;
- Podiatric services;
- Physical therapy services;
- Transportation services;
- Services provided under a Medicaid home and community-based services waiver.
- Provider to provider consultations
SOURCE: IN Admin. Code, “Article 5” Title 405, 5-38-4, p. 195 (Accessed Feb. 2023).
ELIGIBLE SITES
Telehealth services may be rendered in an inpatient, outpatient or office setting. The provider and/or patient may be located in their home during the time of these services. For IHCP reimbursement of telehealth services, the member must be physically present at the originating site and must participate in the visit.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p.1 , (Accessed Feb. 2023).
The office may not impose any distance restrictions on providers of telehealth activities or telehealth services. Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.
SOURCE: IN Code, 12-15-5-11 (Accessed Feb. 2023).
Separate reimbursement for a provider at the originating site is payable only if that provider’s presence is medically necessary. Documentation must be maintained in the patient’s medical record to support the need for the provider’s presence at the originating site during the visit. Such documentation is subject to post-payment review. If a healthcare provider’s presence at the originating site is medically necessary, billing of the appropriate evaluation and management code is permitted.
SOURCE: IN Admin. Code, “Article 5” Title 405, 5-38-4, p. 183 (Accessed Feb. 2023).
GEOGRAPHIC LIMITS
The office may not impose any distance restrictions on providers of telehealth activities or telehealth services. Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.
SOURCE: IN Code 12-15-5-11 (Accessed Feb. 2023)
FACILITY/TRANSMISSION FEE
If the member is located in a medical facility (such as a hospital, clinic or physician’s office) while receiving the telehealth service, and it is medically necessary for a medical professional to be physically present with the member during the service, the IHCP covers Healthcare Common Procedure Coding System (HCPCS) code Q3014 – Telehealth originating site facility fee, billed with modifier 95, for the provider e at the originating site.
If the originating site is a hospital or other location that bills on an institutional claim, HCPCS code Q3014 is reimbursable when billed with revenue code 780 – Telemedicine – General. If a different, separately reimbursable treatment room revenue code is provided on the same day as the telehealth service, the appropriate treatment room revenue code should also be included on the claim. Documentation must be maintained in the patient’s record to indicate that services were provided separately from the telehealth visit.
If the originating site is a physician’s office, clinic or other location that bills on a professional claim, POS code 02 must be used for Q3014, along with modifier 95. If other services are provided on the same date as the telehealth service, the medical professional should bill Q3014 as a separate line item from other professional services.
If the originating site is an FQHC or RHC, additional billing requirements apply. See the Telehealth Services for FQHCs and RHCs section.
SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Sept. 27, 2022), p. 5. (Accessed Feb. 2023).
When the FQHC or RHC is the originating site (the location where the patient is physically located), the FQHC or RHC may be reimbursed if it is medically necessary for a medical professional to be present with the member, and the service provided includes all components of a valid encounter code. The claim must include the following:
- Encounter code T1015 (or D9999 for valid dental encounters), billed with POS code 02, 03, 04, 11, 12, 31, 32, 50 or 72
- Procedure code Q3014 – Telehealth originating site facility fee, billed with POS code 02 and modifier 95
- One or more appropriate procedure codes for the specific services rendered, billed with modifier 93 or 95, and a POS code of either 02 or 10, depending on the originating site/location of the patient
Note: The procedure code must appear on one of the code tables in this bulletin, and must be on the list of procedure codes allowable for an FQHC/RHC medical or dental encounter.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202239 (May 19, 2022). IHCP Bulletin BT 202253 (July 14, 2022). (Accessed Feb. 2023).
Last updated 02/26/2023
Remote Patient Monitoring
POLICY
Remote patient monitoring (RPM) is the scheduled monitoring of clinical data transmitted through technologic equipment in the member’s home. Data is transmitted from the member’s home to the provider location to be read and interpreted by a qualified practitioner. The technologic equipment enables the provider to detect minute changes in the member’s clinical status, which allows providers to intercede before the member’s condition advances and requires emergency intervention or inpatient hospitalization.
The IHCP has implemented a single RPM coverage and prior authorization policy to be used for fee-forservice (FFS) and managed care delivery systems. This coverage and PA policy applies to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.
The IHCP covers the RPM services listed in the Procedure Codes Covered for Remote Patient Monitoring table on Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers. The service must be billed with POS code 02 or 10 and with modifier 95, as described in the Billing and Reimbursement for Telehealth Services section.
Prior authorization is required for specified RPM services, as indicated in the Procedure Codes for Remote Patient Monitoring Services table, in Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.
See manual for further details.
SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Sept. 27, 2022), p. 8. (Accessed Feb. 2023).
Effective for dates of service on or after July 21, 2022, procedure codes 99091, 99453, 99454, 99457 and 99458 will be covered RPM services. RPM or “remote patient monitoring technology” is listed under the definition of telehealth services per Indiana Code IC 25-1-9.5-6.
The IHCP is implementing a single RPM coverage and prior authorization (PA) policy to be used for fee-for service (FFS) and managed care delivery systems. This coverage and PA policy apply to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.
See Bulletin for more information.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202238 (May 17, 2022). (Accessed Feb 2023).
Indiana Code requires Medicaid to reimburse providers who are licensed as a home health agency for telehealth services.
SOURCE: IN Code, 12-15-5-11(b)(5). (Accessed Feb. 2023).
Medicaid will reimburse Home Health Agencies for telehealth services.
SOURCE: IN Admin Code Title 405, 1-4.2-3 & 5-16-2 & IHCP Home Health Services (Oct. 7, 2022), p. 2. (Accessed Feb. 2023).
CONDITIONS
The member must meet one or more of the following criteria to receive prior authorization for an RPM service:
- Received an organ transplantation within one year following the date of surgery
- Had a surgical procedure (three-month service authorization following the date of surgery)
- Had one or more uncontrolled chronic conditions that significantly impaired the patient’s health or resulted in two or more related hospitalizations or emergency department visits in the previous 12 months
- Had been readmitted within 30 days for the same or similar diagnosis or condition
- Identified as having a high-risk pregnancy (up to three-month service authorization postpartum); see the Obstetrical and Gynecological Services provider reference module for more information about high-risk pregnancy
The duration of initial service authorization is six months, unless otherwise indicated. Reauthorizations will be permitted for select services as appropriate.
SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Sept. 27, 2022), p. 9. (Accessed Feb. 2023).
The member must be receiving services from a home health agency. Member must initially have two or more of the following events related to one of the conditions listed below within the previous twelve months:
- Emergency room visit
- Inpatient hospital stay
An emergency room visit that results in an inpatient hospital admission does not constitute two separate events.
The two qualifying events must be for the treatment of one of the following diagnoses:
- Chronic obstructive pulmonary disease
- Congestive heart failure
- Diabetes
SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(d), p. 47 (Accessed Feb. 2023).
PROVIDER LIMITATIONS
Reimbursement for home health agencies under certain conditions. A registered nurse must perform the reading of transmitted health information provided from the member in accordance with the written order of the physician.
SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(d)(5), p. 47. (Accessed Feb. 2023).
OTHER RESTRICTIONS
The IHCP is implementing a single RPM coverage and prior authorization (PA) policy to be used for fee-for service (FFS) and managed care delivery systems. This coverage and PA policy apply to all IHCP programs that offer such services – including but not limited to Healthy Indiana Plan (HIP), Hoosier Care Connect, Hoosier Healthwise and Traditional Medicaid.
See Bulletin for more information.
SOURCE: Indiana Health Coverage Programs IHCP Bulletin BT 202238 (May 17, 2022). (Accessed Feb. 2023).
Treating physician must certify the need for home health services and document that there was a face-to-face encounter with the individual.
SOURCE: IN Admin Code, “Article 5” Title 405, 5-16-3.1(e), p. 47 (Accessed Feb. 2023).
Approved telehealth services are reimbursed separately from other home health services. The unit of reimbursement for telehealth services provided by an HHA is one (1) calendar day.
Reimbursement is available for telehealth services as follows:
- One-time amount per client of fourteen dollars and forty-five cents ($14.45) related to an initial face-to-face visit necessary to train the member to appropriately operate the telehealth equipment.
- One (1) payment of nine dollars and eighty-four cents ($9.84) for each day the telehealth equipment is used by a registered nurse (RN) to monitor and manage the client’s care in accordance with the written order from a physician.
Rates for telehealth services shall not be adjusted annually.
SOURCE: IN Admin Code, “Article 1” Title 405, 1-4.2-6, p. 41 (Accessed Feb. 2023).
