Last updated 08/17/2021
Live Video
POLICY
Indiana Code requires reimbursement for medically necessary telehealth services 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 telehealth service.
SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).
IN Medicaid will follow the rules laid out in SB 3.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 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, published Mar. 30, 2021, p.1. (Accessed Aug. 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
- Videoconferencing equipment, such as 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, published Mar. 30, 2021, p.1 & 2. (Accessed Aug. 2021).
ELIGIBLE SERVICES/SPECIALTIES
The following services may not be provided using telehealth: surgical procedures, radiological services, laboratory services, anesthesia services, care coordination without the member present, durable medical equipment (DME)/home medical equipment (HME) services, provider-to-provider consultation, and services that require hands-on physical interaction or manipulation with the patient.
In the future, the IHCP plans to return to using a procedure code set for allowable services provided via telehealth, as written in policy prior to the public health emergency. However, the code set will be expanded to allow for healthcare services that can be provided by the practitioners outlined in SB 3 and will incorporate the ability to provide audio-only telehealth. Until the code set is updated and published, IHCP providers should follow the billing guidance released in BT2020106.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 2021).
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, published Mar. 30, 2021, p. 3-4. (Accessed Aug. 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, published Mar. 30, 2021, p. 2. (Accessed Aug. 2021).
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 (Accessed Aug. 2021).
ELIGIBLE PROVIDERS
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 Aug. 2021).
Providers that can deliver healthcare services via telehealth must be listed as an authorized practitioner in SB 3. Providers not listed as authorized practitioners in SB 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 Aug. 2021).
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 provider, as determined by the office to be eligible, providing a covered telehealth service.
SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).
The distant site physician or practitioner must determine if it is medically necessary for a medical professional to be at the originating site.
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 Aug. 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, published Mar. 30, 2021, p. 4. (Accessed Aug 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 Aug. 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
* Word ‘telemedicine’ replaced by ‘telehealth’ in Indiana Code due to passage of Senate Bill 3 (2021 Session).
SOURCE: IN Admin Code, 405 5-38-4(3) & IN Code 12-15-5-11. (Accessed Aug. 2021).
ELIGIBLE SITES
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 Aug. 2021).
Services may be rendered in an inpatient, outpatient or office setting.
SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 2. (Accessed Aug. 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, published Mar. 30, 2021, p. 4-5. (Accessed Aug. 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: IN Admin. Code, Title 405, 5-38-4 & IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 2. (Accessed Aug. 2021).
GEOGRAPHIC LIMITS
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 SB 3 (2021 Session). (Accessed Aug. 2021).
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, published Mar. 30, 2021, p. 4 & 5. (Accessed Aug. 2021).
Last updated 08/24/2021
Miscellaneous
All services delivered through telehealth are subject to the same limitations and restrictions as they would be if delivered in-person.
Documentation must be maintained by the provider to substantiate the services provided and that consent was obtained. Documentation must indicate that the services were rendered via
telehealth, clearly identify the location of the provider and patient and be available for post-payment review.
SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 2021).
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, published Mar. 30, 2021, p. 3. (Accessed Aug. 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, published Mar. 30, 2021, p. 1. (Accessed Aug. 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, published Mar. 30, 2021, p. 7. (Accessed Aug. 2021).
A Medicaid recipient waives confidentiality of any medical information discussed with the health care provider that is:
- Provided during a telehealth visit; and
- Heard by another individual in the vicinity of the Medicaid recipient during a health care service or consultation.
SOURCE: IN Code, 12-15-5-11 (Accessed Aug. 2021).
Last updated 08/24/2021
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 Aug. 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, published Mar. 30, 2021, p. 7. (Accessed Aug. 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 Aug. 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 Aug. 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, published Mar. 30, 2021 p. 6-7. (Accessed Aug. 2021).
Last updated 08/23/2021
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, published Mar. 30, 2021, p. 1. (Accessed Aug. 2021).
“Store and forward” means the transmission of a patient’s medical information from an originating site to the practitioner 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 Aug. 2021)
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
