Indiana

Last updated 04/07/2022

Consent Requirements

Appropriate consent from the member must be obtained by the provider prior to delivering services.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Apr. 2022).

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, published Mar. 30, 2021, p. 3. (Accessed Apr. 2022).

A health care provider may not be required to obtain a separate additional written health care consent for the provision of telehealth services.

SOURCE: IN Code 16-36-1-15 (Accessed Apr. 2022)

Last updated 04/07/2022

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, published Mar. 30, 2021, p.1. (Accessed Apr. 2022).

Telehealth activities means the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across a distance.

Telehealth services has the same meaning as telehealth in IN Code 25-1-9.5-6.

SOURCE: IN Code, 12-15-5-11 .  (Accessed Apr. 2022).

“Telehealth” means the delivery of health care services using interactive electronic communications and information technology, in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), including:

(1) secure videoconferencing;

(2) store and forward technology; or

(3) remote patient monitoring technology;

between a provider in one (1) location and a patient in another location.

(b) The term does not include the use of the following unless the practitioner has an established relationship with the patient:

(1) Electronic mail.

(2) An instant messaging conversation.

(3) Facsimile.

(4) Internet questionnaire.

(5) Internet consultation.

(c) The term does not include a health care service provided by:

(1) an employee of a practitioner; or

(2) an individual who is employed by the same entity that employs the practitioner;

who is performing a health care service listed in section 2.5(2), 2.5(3), or 2.5(4) of this chapter under the direction and that is customarily within the specific area of practice of the practitioner.

SOURCE: IN Code 25-1-9.5-6. (Accessed Apr. 2022).

“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.

SOURCE: IN Admin Code Title 405, Sec. 5-2-27, (Accessed Apr. 2022).

Home Health Services

“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.

SOURCE: IN Admin Code Title 405 1-4.2-2, (Accessed Apr. 2022).

Last updated 04/07/2022

Email, Phone & Fax

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 Apr. 2022).

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 Apr. 2022).

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, Oct. 1, 2020, p. 4, (Accessed Apr. 2022).

Last updated 04/07/2022

Live Video

POLICY

Indiana Code requires reimbursement for medically necessary telehealth services for FQHCs, Rural Health Clinics, Community Mental Health Centers, Critical Access Hospitals, provider licensed as 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 Apr. 2022).

IN Medicaid will follow the rules laid out in Senate Enrolled Act 3.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Apr. 2022).

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 Apr. 2022).   

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, “Article 5,” Title 405, 5-38-3 & 4., p. 182&  IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p.1 & 2. (Accessed Apr. 2022).

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, p. 2 June 8, 2021, (Accessed Apr. 2022).

Use of Modifier 93 for synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunication system. Providers are encouraged to continue using the GT modifier when billing for telehealth services and to follow guidelines outlined in BT2020106. the use of the modifier will be expanded upon in future updates to the telehealth code set.

SOURCE: Indiana Health Coverage Programs ICHP Bulleting BT202227 (March 31, 2022), p. 8.  (Accessed Apr. 2022).

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 Apr. 2022).

For information on telemedicine services provided by FQHCs and RHCs, see the Telemedicine and Telehealth Services module.

SOURCE: Medicaid Federally Qualified Health Centers and Rural Health Clinics Module, Oct. 1, 2020, p. 3, (Accessed Apr. 2022).

The IHCP covers telehealth services provided by home health agencies. See the Telemedicine and Telehealth Services module for more information.

SOURCE: IN Medicaid Home Health Services Module, Apr. 22, 2021, p. 2, (Accessed Apr. 2022).

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(h) (Accessed Apr. 2022).

Recently Passed Legislation SB 284 (Effective July 1, 2022).

Under General Provisions for health care providers, “health care services” do not include case management services, care management services, service coordination services or care coordination services as defined in IC 12-7-2-25; provided to individuals under the Indiana Medicaid program or Medicaid waivers; or provided under other programs administered by the office of the secretary of family and social services or the Indiana department of health.

SOURCE: SB 284.  (Accessed Apr. 2022).

ELIGIBLE PROVIDERS

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 2. & IN Admin. Code, “Article 5” Title 405, 5-38-4(2), p. 182-183 (Accessed Dec. 2021).

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 Apr. 2022).

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 Apr. 2022).  

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, Oct. 1, 2020, p. 3, (Accessed Apr. 2022).

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. 183 ; IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 2. (Accessed Apr. 2022).

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 Apr. 2022).

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 Apr. 2022). 

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.  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 Apr. 2022).

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 & IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 2. (Accessed Apr. 2022).

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 Apr. 2022)

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 Apr. 2022).

Last updated 04/08/2022

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 Apr. 2022).

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 Apr. 2022). 

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 Apr. 2022).  

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 Apr. 2022).

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(g). (Accessed Apr. 2022).

Last updated 04/07/2022

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, published Mar. 30, 2021, p. 5. (Accessed Apr. 2022).

Prior Authorization for Out-of-State Services

All out-of-state services rendered to IHCP members require prior authorization (PA), with the following exceptions: …

• Telemedicine services if providers have the subtype “telemedicine” attached to their enrollment – See the Telemedicine and Telehealth Services module for more information

SOURCE: IN Medicaid Out-of-State Providers Module, Jan. 1, 2021, p. 1, (Accessed Apr. 2022).

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, Sec. 11, f (Accessed Apr. 2022)

Last updated 04/07/2022

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.

Changes that were made by recently passed Senate Bill 3 have not yet been transferred into the state’s Medicaid Telemedicine and Telehealth Reference Module, including prohibitions around restricting originating and distant sites.  However, Indiana Medicaid did announce changes to their policies in Bulletin 202142 and BT202145.  Both the Module and Bulletins are listed in the policy finder because both items are still publicly accessible on IN Medicaid’s website. However, it appears that the information in the Bulletins overrides the Module information in cases where it conflicts.

Last updated 04/07/2022

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 Apr. 2022).

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 (Apr 22, 2021), p. 2. (Accessed Apr. 2022).

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, “Article 5” Title 405, 5-16-3.1(d), p. 42, & IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 7. (Accessed Apr. 2022).

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. 43 (Accessed Apr. 2022).

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, “Article 5” Title 405, 5-16-3.1(e), p. 43 (Accessed Apr. 2022).

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 Apr. 2022).

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.

(b) 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.

(c) Rates for telehealth services shall not be adjusted annually

SOURCE: IN Admin Code, “Article 1” Title 405, 1-4.2-6, p. 38 (Accessed Apr. 2022).

Last updated 04/07/2022

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 Apr. 2022).  

“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, “Article 5” 5-38-2 & 4., p. 182-183 (Accessed Apr. 2022)

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found