Last updated 02/28/2021
Consent Requirements
Providers should always give the member the choice between a traditional clinical encounter versus a telemedicine visit. Appropriate consent from the member must be obtained by the originating site and documentation maintained at both the distant and originating sites.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 3. (Accessed Feb. 2021).
Last updated 02/28/2021
Definitions
Telemedicine services are defined as “the use of videoconferencing equipment to allow a medical provider to render an exam or other service to a patient at a distant location.”
Telehealth services are defined as “the scheduled remote monitoring of clinical data through technologic equipment in the member’s home.”
SOURCE: IN Medicaid Telemedicine and Telehealth Module Oct. 1, 2019, p.1. (Accessed Feb. 2021).
“Telemedicine means the delivery of health care services using electronic communications and information technology, including:
- Secure videoconferencing
- Interactive audio-using store-and-forward technology; or
- Remote patient monitoring technology;
Between a provider in one location and a patient in another location. The term does not include:
- Audio-only communication
- A telephone call
- Electronic mail
- An instant messaging conversation
- Facsimile
- Internet questionnaire
- Telephone consultation
- Internet consultation”
SOURCE: IN Code, 25-1-9.5-6. (Accessed Feb. 2021).
Telehealth services means the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across a distance.”
Telemedicine services has the same meaning as “telemedicine” in IN Code 25-1-9.5-6.
SOURCE: IN Code, 12-15-5-11. (Accessed Feb. 2021).
Last updated 02/28/2021
Email, Phone & Fax
Telemedicine is not the use of:
- Telephone transmitter for transtelephonic monitoring; or
- Telephone or any other means of communication for consultation from one provider to another.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019. p. 1. (Accessed Feb. 2021).
Last updated 02/28/2021
Live Video
POLICY
Indiana Code requires reimbursement for video conferencing for FQHCs, Rural Health Clinics, Community Mental Health Centers, Critical Access Hospitals and a provider determined by the office to be eligible, providing a covered telemedicine service.
SOURCE: IN Code, 12-15-5-11 (Accessed Feb. 2021).
The Indiana Health Coverage Programs (IHCP) covers telemedicine services, including medical exams and certain other services normally covered by Medicaid.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct 1, 2019, p.1. (Accessed Feb. 2021).
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.
The patient must be physically present and participating in the visit.
SOURCE: IN Admin. Code, Title 405, 5-38-3 & 4. & IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p.1 & 2. (Accessed Feb. 2021).
ELIGIBLE SERVICES/SPECIALTIES
All services that are available for reimbursement when delivered as telemedicine are subject to the same limitations and restrictions as they would be if not delivered by telemedicine.
There is a specific telemedicine Services Codes list accessible on the Indiana Medicaid website with CPT codes that are reimbursable when the services are rendered via telemedicine at the distant site and billed with modifier 95 and POS code 02. Use of GT modifier is optional.
Although reimbursement for ESRD-related services is permitted in the telemedicine setting, the IHCP requires at least one monthly visit for ESRD-related services to be a traditional clinical encounter to examine the vascular access site.
FQHCs/RHCs: FQHCs and RHCs may bill for telemedicine services if the service rendered is considered a valid FQHC/RHC encounter and a covered telemedicine service. Other requirements and billing instructions are included in the manual.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 3-4. (Accessed Feb. 2021).
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, Title 405, 5-38-4 ; IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 2. (Accessed Feb. 2021).
ELIGIBLE PROVIDERS
The distant site physician or practitioner must determine if it is medically necessary for a medical professional to be at the originating site.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 2. & IN Admin. Code, Title 405, 5-38-4(2). (Accessed Feb. 2021).
Federally qualified health centers and rural health centers are eligible distant sites as long as services meet both the requirements of a valid encounter and a covered telemedicine service as defined in the IHCP’s telemedicine policy. See manual for special billing instructions.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 4. (Accessed Feb. 2021).
Provider types listed under Services Not Reimbursed (under Eligible Services/Specialties section) are not eligible to be reimbursed for telemedicine.
SOURCE: IN Admin. Code, Title 405, 5-38-4(5). (Accessed Feb. 2021).
Reimbursement for telemedicine services is available to the following providers regardless of the distance between the provider and recipient:
- Federally Qualified Health Centers
- Rural Health Clinics
- Community mental health centers
- Critical access hospitals
- A provider, as determined by the office to be eligible, providing a covered telemedicine service
SOURCE: IN Admin Code, 405 5-38-4(3) & IN Code 12-15-5-11. (Accessed Feb. 2021).
ELIGIBLE SITES
Services may be rendered in an inpatient, outpatient or office setting.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 2. (Accessed Feb. 2021).
Federally qualified health centers and rural health clinics acting as the originating site may be reimbursed if it is medically necessary for a medical professional to be with the member, and the service provided includes all components of a valid encounter code. See manual for billing requirements.
All components of the service must be provided and documented, and the documentation must demonstrate medical necessity. All documentation is subject to post-payment review.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 4-5. (Accessed Feb. 2021).
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 (hub-spoke provider reimbursement): IN Admin. Code, Title 405, 5-38-4 & IN Medicaid Telemedicine and Telehealth Module,Oct. 1, 2019, p. 2. (Accessed Feb. 2021).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Healthcare Common Procedure Coding System (HCPCS) code Q3014 – Telehealth originating site facility fee, billed with modifier 95, is reimbursable for providers that render services via telemedicine at the originating site.
FQHCs/RHCs: Separate reimbursement for merely serving as the originating site is not available to FQHCs and RHCs. When the presence of a medical professional is not medically necessary at the originating site, neither the facility fee, as billed by HCPCS code Q3014, nor the facility-specific PPS rate is available, because the requirement of a valid encounter is not met.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 4 & 5. (Accessed Feb. 2021).
Last updated 02/28/2021
Miscellaneous
For patients receiving ongoing telemedicine services, a physician should perform a traditional clinical evaluation at least once a year, unless otherwise stated in policy. The distant site physician should coordinate with the patient’s primary care physician.
Documentation must be maintained at the distant and originating locations to substantiate the services provided. It must indicate the services were provided via telemedicine and location of the distant and originating sites. Documentation is subject to post-payment review.
A provider can use telemedicine to prescribe a controlled substance to a patient who has not been previously examined. Opioids, however, cannot be prescribed via telemedicine, except in cases in which the opioid is a partial agonist (such as buprenorphine) and is being used to treat or manage opioid dependence.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 3. (Accessed Feb. 2021).
The information above applies to Indiana Health Coverage Programs (IHCP) services provided under the fee-for-service (FFS) delivery system. For information about services provided through the managed care delivery system – including Healthy Indiana Plan (HIP), Hoosier Care Connect, or Hoosier Healthwise services – providers must contact the member’s managed care entity (MCE).
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 1. (Accessed Feb. 2021).
Prior authorization (PA) is required for all for telehealth services. Telehealth services are indicated for members who require scheduled remote monitoring of data related to the member’s qualifying chronic diagnoses that are not controlled with medications or other medical interventions. Services may be authorized for up to 60 days. See Telehealth Module for additional requirements.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 7. (Accessed Feb. 2021).
Last updated 02/28/2021
Out of State Providers
Out-of-state providers can perform telemedicine services without fulfilling the out-of-state prior authorization requirement if they have the subtype “telemedicine” attached to their enrollment.
The Provider must be enrolled with a rendering or billing provider classification and be one of the following types:
- Advanced practice registered nurse
- Physician assistant
- Podiatrist
- Optometrist
- Physician
The provider must have a license issued from the Indiana Professional Licensing Agency (IPLA) with the Telemedicine Provider Certification.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 5. (Accessed Feb. 2021).
Last updated 02/28/2021
Overview
Indiana Medicaid reimburses for live video telemedicine for certain services and providers. Indiana Medicaid does not reimburse for store-and-forward although store-and-forward can still be used to facilitate other reimbursable services. Indiana Medicaid defines telehealth as including remote patient monitoring (RPM) services and reimburses home health agencies for RPM for patients with diabetes, congestive heart failure and COPD.
Last updated 02/28/2021
Remote Patient Monitoring
POLICY
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(c). (Accessed Feb. 2021).
CONDITIONS
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, Title 405, 5-16-3.1(d) & IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 7. (Accessed Feb. 2021).
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, Title 405, 5-16-3.1(d)(5) (Accessed Feb. 2021).
OTHER RESTRICTIONS
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, Title 405, 5-16-3.1(e) (Accessed Feb. 2021).
Prior authorization is required for all telehealth services and must be submitted separately from other home health service prior authorization requests. Services may be authorized for up to 60 days. See Telehealth Module for additional requirements.
Member must also be receiving or approved for other IHCP home health services.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 6-7. (Accessed Feb. 2021).
Last updated 02/28/2021
Store and Forward
POLICY
The IHCP allows store-and-forward technology (the electronic transmission of medical information for subsequent review by another healthcare provider) to facilitate other reimbursable services; however, separate reimbursement of the originating-site payment is not provided for store-and-forward technology because of restrictions in 405 IAC 5-38-2(4). Only live video is separately reimbursed by the IHCP.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 1. (Accessed Feb. 2021).
“Store and forward” means the transmission of a patient’s medical information from an originating site to the provider at a distant site without the patient being present for subsequent review by a health care provider at the distant site. Restrictions placed on store and forward reimbursement in this rule shall not disallow the permissible use of store and forward technology to facilitate reimbursable services.
Indiana Medicaid will not reimburse for store-and-forward services. However, restrictions placed on store-and-forward reimbursement shall not disallow the permissible use of store-and-forward technology to facilitate other reimbursable services.
SOURCE: IN Admin. Code, Title 405, 5-38-2 & 4. (Accessed Feb. 2021)
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
