Last updated 07/05/2023
Consent Requirements
Signed member consent for telehealth home services is required.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health Agency, p. AIII-19 (Jul. 2023). (Accessed Jul. 2023).
Except when otherwise prohibited by any other provision of law, when the patient consents and has a primary care or other treating physician, the person providing telemedicine services will send within three business days a report to such primary care or other treating physician of the treatment and services rendered to the patient in the telemedicine encounter. A person licensed, registered, certified, or otherwise authorized to practice by the Behavioral Sciences Regulatory Board will not be required to comply with the provisions of this requirement.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31 (Jul. 2023). (Accessed Jul. 2023).
Last updated 07/06/2023
Definitions
Telemedicine is the use of communication equipment to link health care practitioners and patients in different locations. This technology is used by health care providers for many reasons, including increased cost efficiency, reduced transportation expenses, improved patient access to specialists and mental health providers, improved quality of care, and better communication among providers.
Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-30 (Jul. 2023); FQHC/RHC, p. 8-13 (Apr. 2023), (Accessed Jul. 2023).
‘‘Telemedicine,’’ including ‘‘telehealth,’’ means the delivery of healthcare services or consultations while the patient is at an originating site and the healthcare provider is at a distant site. Telemedicine shall be provided by means of real-time two-way interactive audio, visual, or audio-visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, that facilitate the assessment, diagnosis, consultation, treatment, education and care management of a patient’s healthcare.
‘‘Telemedicine’’ does not include communication between:
-
- Healthcare providers that consist solely of a telephone voice-only conversation, email or facsimile transmission; or
- A physician and a patient that consists solely of an email or facsimile transmission.
SOURCE: KS Statute Ann. § 40-2,211(5). & KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31 (Jul. 2023). (Accessed Jul. 2023).
Telemedicine is the use of communication equipment to link health care practitioners and patients in different locations. This technology is used by health care providers for many reasons, including increased cost efficiency, reduced transportation expenses, improved patient access to specialists and mental health providers, improved quality of care, and better communication among providers.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, p. 8-13 (Apr. 2023). (Accessed Jul. 2023).
Telemedicine is the use of communication equipment to link health care practitioners and individuals in different locations.
Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Certified Community Behavioral Health Clinic (CCBHC), p. 8-5 (May 2023). (Accessed Jul. 2023).
Last updated 07/05/2023
Email, Phone & Fax
Telemedicine does not include communication between:
- A healthcare provider that consists solely of a telephone voice-only conversation, email, or facsimile transmission.
- A physician and a patient that consists solely of an email or facsimile transmission.
Email, telephone, and facsimile transmissions are not covered as telemedicine services.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31 & 2-32 (Jul. 2023). (Accessed Jul. 2023).
Email, telephone, and facsimile transmissions are not covered as telemedicine services.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-13, (Apr. 2023). (Accessed Jul. 2023).
Hospital E&M
A “comprehensive exam” is considered a “hands on” specialist examination. Telephone consultation with a specialist is not the equivalent of comprehensive exam.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospital, p. 8-4 (May 2023). (Accessed Jul. 2023).
Hospice
Providers can submit claims for SIA end of life care if the following criteria are met: … The service is not covered if provided by a social worker via telephone.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospice, (Jan. 2023). (Accessed Jul. 2023).
Certified Community Behavioral Health Clinic (CCBHC) Services
Telephone evaluation and management service provided by a qualified healthcare professional to an established patient, parent, or guardian. National coding guidelines specify the criteria for appropriately billing these three codes.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Certified Community Behavioral Health Clinic (CCBHC) Services, (May 2023). (Accessed Jul. 2023).
Last updated 07/02/2023
Live Video
POLICY
Insurers (including Medicaid) cannot exclude from coverage a service solely because the service is provided through telemedicine, rather than in-person contact or based upon the lack of a commercial office for the practice of medicine, when such service is delivered by a healthcare provider.
SOURCE: KS Statute Ann. § 40-2,213(b). (Accessed Jul. 2023).
Services provided through telemedicine must be medically necessary and are subject to the terms and conditions of the individual’s health benefits plan.
Payment or reimbursement of covered healthcare services delivered through telemedicine is the payment or reimbursement for covered services that are delivered through personal contact.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31-2 (Jul. 2023). (Accessed Jul. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Eligible services:
- Office visits;
- Individual psychotherapy;
- Pharmacological management services.
The consulting or expert provider at the distant site must bill with the 02 place of service code and will be reimbursed at the same rate as face-to-face services. The GT modifier is not required when billing for telemedicine services.
See manual for list of acceptable CPT codes as well as codes KMAP does not recognize for payment.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-30 (Jul 2023) & FQHC/RHC, 8-13 (Apr. 2023), (Accessed Jul. 2023)
Mental health assessment can be delivered by a non-physician at a professional level and delivered either face-to-face or through telemedicine. Some specialized community-based rehabilitation services can be provided face-to-face or via telemedicine.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Mental Health, p. 8-15-16, 8-22-23 (Jul. 2023). (Accessed Jul. 2023).
The speech-language pathologist and audiologist may furnish appropriate and medically necessary services within their scope of practice via telemedicine. See manual for list of codes that are deemed appropriate to be furnished via telemedicine by the American Speech-Language and Hearing Association. Codes not appearing on the tables below are not covered via telemedicine.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-29 (Jul. 2023), & Rehabilitative Therapy Services, p. 8-4, (Nov. 2022). (Accessed Jul. 2023).
Kansas Medicaid does not authorize the use of telemedicine in the delivery of any abortion procedure.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-32 (Jul. 2023). (Accessed Jul. 2023).
Autism Service
Parent support and training as well as Family Adjustment Counseling can be provided via telemedicine, telehealth, or other modes of video distance monitoring methods that adhere to all required HIPPA guidelines and meet the state standards for telemedicine delivery methods. This service delivery model is subject to state program manager approval. A request submitted for this exception must include, at a minimum, three written statements from service providers in at least a 50-mile radius declining to provide services because the participant resides in a location that is so remote or far away that the provider does not have the staff to meet with the child on a continual and/or intermittent basis as needed.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Autism Services, p. 8-5 & 8-8 (Nov. 2021). (Accessed Jul. 2023).
Intellectual/Developmentally Disabled Services
All functional assessments must be conducted in-person at a location of the individual’s choosing, or, if available, through the use of real-time interactive telecommunications equipment that includes, at a minimum, audio and video equipment. Those responsible for conducting the assessment will be flexible in accommodating the individual’s preference for the meeting location and time of assessment.
SOURCE: KS Dept. of Health and Environment, Provider Manual, HCBS Intellectual/Developmentally Disabled, p. I-1 (Mar. 2023). (Accessed Jul. 2023).
Substance Use Disorder directs providers to General Benefits manual telemedicine section.
SOURCE: KS Dept. of Health and Environment, Provider Manual, Substance Use Disorder, p. 8-10, (Mar. 2023), (Accessed Jul. 2023).
Stand-alone vaccine counseling may also be covered when provided via telehealth.
The face-to-face encounter [for home health] may occur through telehealth, as implemented by the State.
Telehealth and transportation codes are covered codes for OTP services. Please refer to the Kansas Medicaid Telehealth and Non-Emergency Medical Transportation (NEMT) policies.
SOURCE: KS Dept. of Health and Environment, Provider Manual, Professional, (Jul. 2023). (Accessed Jul. 2023).
Stand-alone vaccine counseling may also be covered when provided via telehealth.
SOURCE: KS Dept. of Health and Environment, Provider Manual, KAN Be Health EPSDT, (Apr. 2023), (Accessed Jun. 2023).
Prenatal Care At Risk Enhanced Care Coordination
Effective with dates of service on and after May 1, 2023, procedure code H1002 will be covered for telemedicine for video and audio transmissions. Existing provisions for the delivery of this service will remain in effect. Place of service (POS) code 10 (telehealth services provided in patient’s home) will be covered for code H1002.
SOURCE: KS Department of Health and Environment, KMAP Bulletin 23051, Prenatal Care At Risk Enhanced Care Coordination, Mar. 2023, (Accessed Jul. 2023).
Lactation Counseling
Effective with dates of service on or after April 1, 2023, lactation counseling services (utilizing procedure code S9443) for nonphysician lactation counselors will be additionally covered via telemedicine. Both video and audio transmissions will be covered. The home setting is allowed for this service delivery. Existing provisions for the delivery of this service will remain in effect until specifically rescinded.
Telemedicine Place of Service (POS) codes include:
- 02 – Telehealth
- 10 – Telehealth in patient home
SOURCE: KS Department of Health and Environment, KMAP Bulletin 23042, Lactation Counseling Via Telemedicine, Feb. 2023 & KS Dept. of Health and Environment, Provider Manual, Professional, (Jul. 2023). (Accessed Jul. 2023).
ELIGIBLE PROVIDERS
Telemedicine and telehealth services may be delivered by a healthcare provider, which includes:
- Physicians
- Licensed Physician Assistants
- Licensed Advanced Practice Registered Nurses
- Other person licensed, registered, certified, or otherwise authorized to practice by the behavioral sciences regulatory board.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-30 (Jul. 2023). (Accessed Jul. 2023).
The speech-language pathologist and audiologist may furnish appropriate and medically necessary services within their scope of practice via telemedicine. As documented in related telemedicine policies, telemedicine claims at the distant site must contain place of service 02 (Telehealth distant site).
- Distant site means a site at which the healthcare provider is located while providing healthcare services by means of telemedicine.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-29-30 (Jul. 2023); Early Childhood Intervention Fee-for-Service Provider Manual, p. 8-5 (Feb. 2023); Local Education Agency Services, p. 8-7 (Feb 2023); & Rehabilitative Therapy Services, p. 8-4, (Nov. 2022). (Accessed Jul. 2023).
Providers who are not RHC or FQHC providers and are acting as the distant site will be reimbursed in accordance with a percentage of the Physician Fee Schedule and not an encounter rate.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-13, (Apr. 2023), (Accessed Jul. 2023).
ELIGIBLE SITES
The speech-language pathologist and audiologist may furnish appropriate and medically necessary services within their scope of practice via telemedicine. Providers at the originating site may submit claims using code Q3014 (Telehealth originating site facility fee).
- Originating site means a site at which a patient is located at the time healthcare services are provided by means of telemedicine. The facilitator at the originating site must have the appropriate skill set to safely assist the speech-language pathologist or audiologist to provide safe, effective, and medically necessary services via telemedicine.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-29 (Jul. 2023), & Rehabilitative Therapy Services, p. 8-5, (Nov. 2022). (Accessed Jul. 2023).
Adding Place of Service Code 10 to Home Telehealth Nursing Services
Effective with dates of processing on and after January 1, 2022, licensed practical nurses (LPNs) or registered nurses (RNs) that provide home telehealth services must use Place of Service (POS) code 10 for codes T1030 and T1031 on all claims.
SOURCE: KS Department of Health and Environment, KMAP Bulletin 23033, Adding Place of Service Code 10 to Home Telehealth Nursing Services, Feb. 2023, (Accessed Jul. 2023).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
The originating site, with the member present, may bill code Q3014 with the appropriate POS code. Providers at the originating site are required to submit claims using code Q3014 (Telehealth originating site facility fee).
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-30 & 32 (Jul. 2023), (Accessed Jul. 2023).
RHC/FQHC
The originating site, with the member present, may bill code Q3014 with POS code 50 or 72 under the originating site provider ID and location number.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, RHC/FQHC Fee-for-Service Provider Manual, Benefits & Limitations, p. 8-13 (Apr. 2023), (Accessed Jul. 2023).
Speech-Language Pathology
Providers at the originating site may submit claims using code Q3014 (Telehealth originating site facility fee). Originating site means a site at which a patient is located at the time healthcare services are provided by means of telemedicine. The facilitator at the originating site must have the appropriate skill set to safely assist the speech-language pathologist or audiologist to provide safe, effective, and medically necessary services via telemedicine.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-29 (Jul. 2023), (Accessed Jul. 2023).
Certified Community Behavioral Health Clinic (CCBHC) Services
The originating site, with the member present, may bill code Q3014 with the appropriate POS code. No payment will be made for Q3014 if the originating telemedicine site is place of service “home” (POS code 12) without the physical presence of a provider.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Certified Community Behavioral Health Clinic (CCBHC) Services, (May 2023). (Accessed Jul. 2023).
Last updated 07/05/2023
Miscellaneous
The same requirements for patient privacy and confidentiality under HIPAA of 1996 and 42 C.F.R. §2.13, as applicable, that apply to healthcare services delivered through in-person contact also apply to healthcare services delivered through telemedicine. Nothing in this section supersedes the provisions of any state law relating to the confidentiality, privacy, and security or privileged status of protected health information (PHI).
- Telemedicine may be used to establish a valid provider-patient relationship.
- The same standards of practice and conduct that apply to healthcare services delivered through personal contact also apply to healthcare services delivered through telemedicine.
- A person who is authorized by law to provide and provides telemedicine services to a patient must provide the patient with guidance on appropriate follow-up care.
- Except when otherwise prohibited by any other provision of law, when the patient consents and has a primary care or other treating physician, the person providing telemedicine services will send within three business days a report to such primary care or other treating physician of the treatment and services rendered to the patient in the telemedicine encounter.
- A person licensed, registered, certified, or otherwise authorized to practice by the Behavioral Sciences Regulatory Board will not be required to comply with the provisions of requirement #4 (above).
- The provisions of this section shall also apply to the Kansas Medical Assistance Program (KMAP).
- KMAP will not exclude an otherwise covered healthcare service from coverage solely because such service is provided through telemedicine, rather than through personal contact, or based upon the lack of a commercial office for the practice of medicine.
- The insured’s medical record will serve to satisfy all documentation for the reimbursement of all telemedicine healthcare services, and no additional documentation outside of the medical record will be required.
- Payment or reimbursement of covered healthcare services delivered through telemedicine is the payment or reimbursement for covered services that are delivered through personal contact.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31 (Jul. 2023). (Accessed Jul. 2023).
Home Health Agencies
The face-to-face encounter may occur through telehealth, as implemented by the State.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Home Health Agency, p. 8-7 (Jul. 2023). (Accessed Jul. 2023).
Hospice
Service Intensity Add-on (SIA) Payment for hospice care is not covered if provided by a social worker via telephone.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospice, p. 8-11 (Jan. 2023). (Accessed Jul. 2023).
Last updated 07/05/2023
Out of State Providers
No reference found. See Cross-State Licensing Section under Professional Requirements.
Last updated 07/05/2023
Overview
Kansas Medicaid covers live video telemedicine for certain services. Additionally, they also cover remote patient monitoring that is in real-time through home health agencies and with prior authorization.
Telephone evaluation and management services provided by a qualified healthcare professional to an established patient, parent, or guardian is reimbursed for certain codes.
All insurers (including Medicaid) must cover medically necessary services, subject to the terms and conditions of the contract. Medicaid specifically must provide reimbursement for speech language pathology services and audiology services.
Last updated 07/05/2023
Remote Patient Monitoring
POLICY
Kansas Medicaid will reimburse for home telehealth. The policy states:
“Home telehealth uses real-time, interactive, audio/video telecommunication equipment to monitor patients in the home setting, as opposed to a nurse visiting the home. This technology may be used to monitor the beneficiary for significant changes in health status, provide timely assessment of chronic conditions and provide other skilled nursing services.”
SOURCE: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health, p. 8-29 (Jul. 2023) (Accessed Jul. 2023).
Home and Community Based Services for the Frail Elderly
“Home Telehealth is a remote monitoring system that enables the participant to effectively manage one or more diseases and catch early signs of trouble so intervention can occur before the participant’s health declines. The provision of Home Telehealth involves participant education specific to one or more diseases (e.g. COPD, CHF, hypertension, and diabetes), counseling, and nursing supervision.
SOURCE: Kansas Medical Assistance Program, Provider Manual, HCBS Frail Elderly, p. 8-17. (Mar 2023) (Accessed Jul. 2023).
CONDITIONS
Providers use codes T1030 and T1031 for the provision of telehealth visits under the Long-Term Care Home Health Service Plan and to assist members in managing their diabetes. See specific provider requirements for the provision of telehealth services.
Place of service 02 is used for home telehealth skilled nursing visits. These codes are per visit.
SOURCE: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health, p. AIII-4-AIII-6 AIII-8. (Jul. 2023). (Accessed Jul. 2023).
Home and Community Based Services for the Frail Elderly
Telehealth services (including remote patient monitoring) are provided on an individualized basis for participants who have an identified need in their ISPOC. Participant options and information are provided and discussed during the development of the Integrated Service Plan of Care (ISPOC).
A participant can qualify if either of the following apply:
- The participant is in need of disease management consultation and education AND has had two or more hospitalizations, including emergency room (ER) visits, within the previous year related to one or more diseases.
- The participant is using MFP to move from a nursing facility back into the community.
SOURCE: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, HCBS Frail Elderly, p. 8-17 & 8-18, (Mar. 2023). (Accessed Jul. 2023).
PROVIDER LIMITATIONS
Home Telehealth services must be provided by a registered nurse or licensed practical nurse. Agencies may bill skilled nursing services on the same date of service as telehealth services.
SOURCE: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health, p. 8-29 (Jul. 2023). (Accessed Jul. 2023).
Home and Community Based Services for the Frail Elderly
Must be delivered by a registered nurse or licensed practical nurse with RN supervision. Providers can include home health agencies or county health departments with system equipment capable of monitoring participant vital signs daily. This includes (at a minimum) heart rate, blood pressure, mean arterial pressure, weight, oxygen saturation, and temperature. Also, the provider must have the capability to ask the participant questions which are tailored to his or her diagnosis. The provider and equipment must have needed language options such as English, Spanish, Russian, and Vietnamese.
SOURCE: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, HCBS Frail Elderly, p. 8-18-19, (Mar. 2023), (Accessed Jul. 2023).
OTHER RESTRICTIONS
Providers must submit literature to the fiscal agent’s Provider Enrollment team pertaining to the telecommunication equipment the agency has chosen that will allow thorough physical assessments such as: assessment of edema, rashes, bruising, skin conditions, and other significant changes in health status.
Providers must satisfy all the enrollment/demonstration requirements. See manual for specific demonstration criteria.
Providers are eligible for reimbursement of home telehealth services that meet the following criteria:
- Prescribed by a physician or allowed nonphysician practitioner;
- Considered medically necessary;
- Signed beneficiary consent for telehealth services;
- Skilled nursing service;
- Does not exceed program limitations (two visits per week for non-Home and Community Based Services beneficiaries)
Providers must obtain prior authorization (PA) for member participation in the demonstration process, as PA is required for all fee-for-service home health visits.
SOURCE: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health, p. AIII-18-19. (Jul. 2023). (Accessed Jul. 2023).
Home Telehealth Limitations
- Providers must bill T1030 and T1031 with place of service 02 for home telehealth skilled nursing visits. These codes are per visit.
- PAs are entered for no more than 60 days. Home telehealth services cannot be approved for durations of more than 60 days. Additional documentation may be required to support continuation of home telehealth service requests that exceed 60 days.
- Telehealth visits must be provided by a registered nurse or licensed practical nurse.
- Telehealth visits must use face-to-face, real-time, interactive video contact to monitor beneficiaries in the home setting as opposed to a nurse visiting the home. This technology can be used to monitor a beneficiary’s health status and to provide timely assessments of chronic conditions and other skilled nursing services.
- HCBS beneficiaries eligible for face-to-face skilled nursing visits provided by a home health agency may receive home telehealth visits with documentation of medical necessity and prior authorization (PA). The PA must include units to cover the duration and frequency of home telehealth visits. Oral medication administration or monitoring is not considered skilled care.
- Oral medication administration or monitoring is not considered skilled care.
SOURCE: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health, p. AIII-8. (Jul. 2023). (Accessed Jul. 2023).
Home and Community Based Services for the Frail Elderly
See HCBS Frail Elderly provider manual for documentation requirements.
SOURCE: Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, HCBS Frail Elderly, p. 8-19 & 8-20 (Mar. 2023), (Accessed Jul. 2023).
Last updated 07/05/2023
Store and Forward
POLICY
Kansas Medicaid requires the patient to be present at the originating site indicating store-and-forward will not be reimbursed, despite including store-and-forward in their definition of telemedicine.
SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31-32 (Jul. 2023). (Accessed Jul. 2023).
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
