Louisiana

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
1 / 4

MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: No
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, CC, EMS, IMLC, NLC, OT, PTC
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: Louisiana Medicaid
  2. Administrator: Louisiana Dept. of Health
  3. Regional Telehealth Resource Center: TexLa Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 02/15/2024

Definitions

“Telehealth” shall have the same meaning as defined in R.S. 40:1223.3 and may include audio-only conversations as provided for in R.S. 40:1223.3(5).

SOURCE: LA Revised Statute Sec. 22: 1841; as amended by Senate Bill 66 (2023 Session), (Accessed Feb. 2024).

“Telehealth” shall have the same meaning as that term defined in R.S. 40:1223.3.

SOURCE: LA Revised Statute Sec. 37:1262; as amended by Senate Bill 66 (2023 Session), (Accessed Feb. 2024).

“Telehealth” means healthcare services, including behavioral health services, provided by a healthcare provider, as defined in this Section, to a person through the use of electronic communications, information technology, asynchronous store-and-forward transfer technology, or synchronous interaction between a provider at a distant site and a patient at an originating site, including but not limited to assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient, and transfer of medical data. The term “telehealth” shall not include any of the following:

  • Electronic mail messages and text messages that are not compliant with applicable requirements of the Health Insurance Portability and Accountability Act of 1996, as amended, 42 U.S.C. 1320d et seq.
  • Facsimile transmissions.

NOTE: Subparagraph (6)(b) eff. until Jan. 1, 2024. See Acts 2023, No. 322.

SOURCE: LA Revised Statute Sec. 40:1223.3; as amended by Senate Bill 66 (2023 Session), (Accessed Feb. 2024).

Last updated 02/15/2024

Parity

SERVICE PARITY

Notwithstanding any provision of any policy or contract of insurance or health benefits issued, whenever the policy provides for payment, benefit, or reimbursement for any healthcare service, including but not limited to diagnostic testing, treatment, referral, or consultation, and the healthcare service is performed via transmitted electronic imaging or telehealth, the payment, benefit, or reimbursement under the policy or contract shall not be denied to a licensed physician conducting or participating in the transmission at the originating healthcare facility or terminus who is physically present with the individual who is the subject of the electronic imaging transmission and is contemporaneously communicating and interacting with a licensed physician at the receiving terminus of the transmission. The payment, benefit, or reimbursement to the licensed physician at the originating facility or terminus shall not be less than seventy-five percent of the reasonable and customary amount of payment, benefit, or reimbursement that the licensed physician receives for an intermediate office visit.

No reference found for distant-site physician reimbursement.

SOURCE: LA Revised Statutes 22:1821(F). (Accessed Feb. 2024).


PAYMENT PARITY

Physical Therapy

A health coverage plan shall pay for covered physical therapy services provided via telehealth to an insured person. Telehealth coverage and payment shall be equivalent to the coverage and payment for the same service provided in person unless the telehealth provider and the health coverage plan contractually agree to an alternative payment rate for telehealth services.

SOURCE: LA Revised Statute 22:1845.1, (Accessed Feb. 2024).

A health coverage plan shall pay for covered occupational therapy services provided via telehealth to an insured person. Telehealth coverage and payment shall be equivalent to the coverage and payment for the same service provided in person unless the telehealth provider and the health coverage plan contractually agree to an alternative payment rate for telehealth services.

SOURCE: LA Revised Statute 22:1845.2, (Accessed Feb. 2024).

Last updated 02/15/2024

Requirements

When the governor declares a state of emergency or a public health emergency, the commissioner may issue emergency rules or regulations that may remove restraints to telehealth and telemedicine, as well as other things. See statute for full details.

SOURCE: LA Revised Statute 22:11(C) (Accessed Feb. 2024).

Requirements in the event of a declared emergency

Health insurance issuers shall waive any coverage limitations restricting telemedicine access to providers included within a plan’s telemedicine network.

Health insurance issuers shall waive any requirement that the patient and provider have a prior relationship in order to have services delivered through telemedicine.

Health insurance issuers shall cover mental health services provided by telemedicine consultation to the same extent the services would be covered if provided through an in-person consultation. This shall not be interpreted to require coverage of telemedicine services that cannot be appropriately provided remotely.

Health insurance issuers shall waive any requirement limiting coverage to provider-to-provider consultations only and shall cover telemedicine consultations between a patient and a provider to the extent the same services would be covered if provided in person.

SOURCE: LA Admin Code, Sec. 37:XIII.17947, (Accessed Feb. 2024).

Each issuer of a health coverage plan shall display in a conspicuous manner on the health coverage plan issuer’s website information regarding how to receive covered telehealth healthcare services and remote patient monitoring services.

A link clearly identified on the health coverage plan’s issuer’s website to the information required pursuant to this Subsection shall be sufficient to meet the requirements of this Section.

This Section shall not require an issuer of a health coverage plan to display negotiated contract payment rates for healthcare providers who contract with the issuer to provide telemedicine medical services or telehealth healthcare services.

This Section shall not require an issuer of a health coverage plan to display negotiated contract payment rates for healthcare providers who contract with the issuer to provide telehealth healthcare services.

SOURCE: LA Revised Statute Sec. 22: 1842, as amended by Senate Bill 66 (2023 Session), (Accessed Feb. 2024).

Certain requirements apply in order to receive reimbursement for remote patient monitoring.  See text of statute.

 SOURCE: LA Revised Statute Sec. Sec. 22: 1843. (Accessed Feb. 2024).

Notwithstanding any provision of any policy or contract of insurance or health benefits issued, whenever the policy provides for payment, benefit, or reimbursement for any healthcare service, including but not limited to diagnostic testing, treatment, referral, or consultation, and the healthcare service is performed via transmitted electronic imaging or telehealth, the payment, benefit, or reimbursement under the policy or contract shall not be denied to a licensed physician conducting or participating in the transmission at the originating healthcare facility or terminus who is physically present with the individual who is the subject of the electronic imaging transmission and is contemporaneously communicating and interacting with a licensed physician at the receiving terminus of the transmission. The payment, benefit, or reimbursement to the licensed physician at the originating facility or terminus shall not be less than seventy-five percent of the reasonable and customary amount of payment, benefit, or reimbursement that the licensed physician receives for an intermediate office visit.

Any healthcare service proposed to be performed or performed via transmitted electronic imaging or telehealth pursuant to this Subsection shall be subject to the applicable utilization review criteria and requirements of the insurer. Terminology in a health and accident insurance policy or contract that either discriminates against or prohibits such a method of transmitted electronic imaging or telehealth shall be void as against public policy of providing the highest quality health care to the citizens of the state.

SOURCE: LA Revised Statutes 22:1821(F). (Accessed Feb. 2024).

Physical Therapy

A health coverage plan shall pay for covered physical therapy services provided via telehealth to an insured person.

A health coverage plan shall require a healthcare professional to be licensed or otherwise authorized to practice physical therapy in this state to be eligible to receive payment for telehealth services.

A health coverage plan shall not do any of the following:

  • Require a previously established in-person relationship or the provider to be physically present with a patient or client, unless the provider determines that it is necessary to perform that service in person.
  • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if that service were provided in person.
  • Require demonstration that it is necessary to provide services to a patient or client as telehealth.
  • Require a provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in person.
  • Restrict or deny coverage based solely on the communication technology or application used to provide the telehealth service; however, a health coverage plan may restrict physical therapy services via telehealth when the services are being provided solely by telephone.
  • Impose specific requirements or limitations on the technologies used to provide telehealth services; however, a health coverage plan may require the provider to demonstrate that the technology used to provide telehealth services is both safe and secure.
  • Impose additional certification, location, or training requirements as a condition of payment for telehealth services; however, this Paragraph does not prohibit a health coverage plan from providing additional reimbursement incentives  to providers with an enhanced certification, training, or accreditation.
  • Require a provider to be part of a telehealth network.

A health coverage plan is not required to provide coverage or reimbursement for any of the following procedures or services provided via telehealth:

  • A modality that is a type of electrical, thermal, or mechanical energy.
  • Manual therapy, massage, dry needling, or other invasive procedures

SOURCE: LA Revised Statute 22:1845.1, (Accessed Feb. 2024).

Occupational Therapy

Telehealth coverage and reimbursement for occupational therapy; prohibitions and limitations; exceptions; rulemaking

  • A health coverage plan shall pay for covered occupational therapy services provided via telehealth to an insured person. Telehealth coverage and payment shall be equivalent to the coverage and payment for the same service provided in person unless the telehealth provider and the health coverage plan contractually agree to an alternative payment rate for telehealth services.
  • Benefits for a service provided as telehealth may be subject to a deductible, copayment, or coinsurance. A deductible, copayment, or coinsurance applicable to a particular service provided through telecommunications technology shall not exceed the deductible, copayment, or coinsurance required by the health coverage plan for the same service when provided in person.
  • A health coverage plan shall not impose an annual dollar maximum on coverage for healthcare services covered under the health coverage plan that are provided as telehealth, other than an annual dollar maximum that applies to the same services when provided in person by the same provider.
  • A health coverage plan shall require a healthcare professional to be licensed or otherwise authorized to practice occupational therapy in this state to be eligible to receive payment for telehealth services.
  • Payment made pursuant to this Section shall be consistent with any provider network arrangements that have been established for the health coverage plan.
  • A health coverage plan shall not do any of the following:
    • Require a previously established in-person relationship or the provider to be physically present with a patient or client, unless the provider determines that it is necessary to perform that service in person.
    • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if that service were provided in person.
    • Require demonstration that it is necessary to provide services to a patient or client as telehealth.
    • Require a provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in person.
    • Restrict or deny coverage based solely on the communication technology or application used to provide the telehealth service; however, a health coverage plan may restrict occupational therapy services via telehealth when the services are being provided solely by telephone.
    • Impose specific requirements or limitations on the technologies used to provide telehealth services; however, a health coverage plan may require the provider to demonstrate that the technology used to provide telehealth services is both safe and secure.
    • Impose additional certification, location, or training requirements as a condition of payment for telehealth services; however, this Paragraph does not prohibit a health coverage plan from providing additional reimbursement incentives to providers with an enhanced certification, training, or accreditation.
    • Require a provider to be part of a telehealth network.
  • Nothing in this Section shall be construed to require a health coverage plan to do either of the following:
    • Provide coverage for telehealth services that are not medically necessary.
    • Reimburse any fees charged by a telehealth facility for transmission of a telehealth encounter.
  • A health coverage plan is not required to provide coverage or reimbursement for any of the following procedures or services provided via telehealth:
    • A modality that is a type of electrical, thermal, or mechanical energy.
    • Manual therapy, massage, dry needling, or other invasive procedures.

The department may take any action authorized in this Title to enforce the provisions of this Section and the commissioner may, in compliance with the Administrative Procedure Act, R.S. 49:950 et seq., promulgate and adopt rules as are necessary or advisable to effectuate the provisions of this Section.

This Act shall apply to any new health coverage plan issued on and after January 1, 2024. Any health coverage plan in effect prior to January 1, 2024, shall convert to conform to the provisions of this Act on or before the renewal date, but no later than January 1, 2025.

SOURCE: LA Revised Statute 22:1845.2, (Accessed Feb. 2024).

Last updated 02/15/2024

Definitions

“Telehealth” means healthcare services, including behavioral health services, provided by a healthcare provider, as defined in this Section, to a person through the use of electronic communications, information technology, asynchronous store-and-forward transfer technology, or synchronous interaction between a provider at a distant site and a patient at an originating site, including but not limited to assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient, and transfer of medical data. The term “telehealth” shall not include any of the following:

  • Electronic mail messages and text messages that are not compliant with applicable requirements of the Health Insurance Portability and Accountability Act of 1996, as amended, 42 U.S.C. 1320d et seq.
  • Facsimile transmissions.

SOURCE: LA Revised Statutes 40:1223.3, (Accessed Feb. 2024).

“Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or other licensed practitioner and a beneficiary are not in the same location. The telecommunications system shall include, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the beneficiary at the originating site and the physician or other licensed practitioner at the distant site. The telecommunications system must be secure, ensure patient confidentiality, and be compliant with the requirements of the Health Insurance Portability and Accountability Act.”

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 166. (As issued 6/27/22), & MCO Manual (updated 2/2/24), pg. 175, (Accessed Feb. 2024).

Outpatient Services, Outpatient Therapy by Licensed Practitioners:  Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or LMHP and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.

Rehabilitation: For dates of service on or after May 1, 2023, telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician, LMHP, or other qualified professional (see staff qualifications) and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.

Addiction Services: Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or LMHP and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.

SOURCE: LA Dept. of Health, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 112, 171 & 198 (As issued 1/12/24). (Accessed Feb. 2024).

Telecare is a delivery of care services to recipients in their home by means of telecommunications and/or computerized devices to improve outcomes and quality of life, increase independence and access to health care, and reduce health care costs. Telecare services include the following:

  • Activity and sensor monitoring;
  • Health status monitoring; and
  • Medication dispensing and monitoring.

See manual for description of monthly telecare services.

SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 23-24 (As issued 4/13/22). (Accessed Feb. 2024).

EPSDT Health and IDEA Related Services

Telemedicine/telehealth is not a covered service, but is a service delivery method. Louisiana Medicaid encourages the use of this delivery method, when appropriate, for any and all healthcare services (i.e., not just those related to COVID-19 symptoms). Louisiana Medicaid allows for the telemedicine/telehealth mode of delivery for many common healthcare services.

SOURCE: LA Dept. of Health, Provider Manual, Chapter Twenty of the Medicaid Svcs. Manual, Section 20.1, p. 13 (As issued 9/7/23). (Accessed Feb. 2024).

Last updated 02/15/2024

Email, Phone & Fax

Hospices may report some social worker calls as a visit. Hospices may not report any other types of phone calls.

SOURCE: LA Medicaid, Chapter 24: Hospice, Sec. 24.9, Medicaid Svcs. Manual, p. 62, (As issued on 1/11/23), (Accessed Feb. 2024).

Rural health clinics (RHC) and federally qualified health clinics (FQHC) are required to indicate the appropriate place of service, either 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of and append modifier 95 for the billing of telemedicine/telehealth services. Services delivered via an audio/video system and via an audio-only system are to be coded the same way.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

Early and Periodic Screening, Diagnostics and Treatment Health Services (EPSDT)

Permissible Telecommunications Systems: …

  • For use of an audio-only system, the same standard of care must be met, and the need and rationale for employing an audio-only system must be documented in the clinical record; and
  • Please note, some telemedicine/telehealth services require delivery through an audio/video system due to the clinical nature of these services. Where applicable, this requirement is noted explicitly.

SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on 9/7/23), (Accessed Feb. 2024).

Supports Waiver

Covered services include face-to-face support off the job site by provider staff that is necessary for the beneficiary to maintain gainful employment.  Examples of this kind of contact include, but are not limited to communications with the beneficiary by telephone, e-mail or fax that is necessary for the beneficiary to maintain gainful employment.

SOURCE: LA Dept. of Health, Support Services, Ch. 43.4, (As issued on 8/21/23), (Accessed Feb. 2024).

Last updated 02/15/2024

Live Video

POLICY

Louisiana Medicaid only reimburses the distant site for services provided via telemedicine. Reimbursement for services provided by telemedicine/telehealth is at the same level as services provided in person.

The beneficiary’s clinical record must include documentation that the service was provided through the use of telemedicine/telehealth. NOTE: The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid beneficiaries.

Medicaid covered services provided using telemedicine must be identified on claim submissions by appending the modifier “95” to the applicable procedure code and indicating the correct place of service, either POS 02 (other than home) or 10 (home). Both the correct POS and the -95 modifier must be present on the claim to receive reimbursement

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165-166 (as issued 6/27/22). (Accessed Feb. 2024).

Telemedicine/telehealth is the use of an interactive audio and video telecommunications system to permit real time communication between a distant site health care practitioner and the beneficiary. There is no restriction on the originating site (i.e., where the beneficiary is located) and it can include, but is not limited to, a healthcare facility,  school, or the beneficiary’s home.

Medicaid covered services provided via telehealth/telemedicine shall be identified on claim submissions by appending the Health Insurance Portability and Accountability Act (HIPAA) of 1996 compliant place of service (POS) or modifier to the appropriate procedure code, in line with current policy

SOURCE: LA Admin. Code 50: Sec. 501 & 503, p. 36 (Accessed Feb. 2024).

The MCO shall reimburse the distant site provider for services provided via telemedicine/telehealth. Reimbursement for services provided by telemedicine/telehealth is at the same level as services provided in person.

The MCO shall require the provider to include in the enrollee’s clinical record documentation that the service was provided through the use of telemedicine/telehealth.

The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid enrollees.

SOURCE: MCO Manual (updated 2/2/24), pg. 176, (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

The department shall periodically review policies regarding Medicaid reimbursement for telehealth services to identify variations between permissible reimbursement under that program and reimbursement available to healthcare providers under the Medicare program.

The department may modify its administrative rules, policies, and procedures applicable to Medicaid reimbursement for telehealth services as necessary to provide for a reimbursement system that is comparable to that of the Medicare program for those services.

SOURCE: LA Statute RS 40:1255.2 (Accessed Feb. 2024). 

When otherwise covered, services located in the Telemedicine appendix of the CPT manual, or its successor, may be reimbursed when provided by telemedicine/telehealth. In addition, other specified services may be reimbursed when provided by telemedicine/telehealth and these services are explicitly noted in this manual.

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (as issued 6/27/22). (Accessed Feb. 2024).

In the event that the federal or state government declares an emergency or disaster, the Medicaid Program may temporarily cover services provided through the use of an interactive audio telecommunications system, without the requirement of video, if such action is deemed necessary to ensure sufficient services are available to meet beneficiaries’ needs.

SOURCE: LA Admin Code, Sec. 50:I.505, (Accessed Feb. 2024).

When otherwise covered, the MCO shall cover services located in the Telemedicine appendix of the CPT manual, or its successor, when provided by telemedicine/telehealth. In addition, the MCO shall cover other services provided by telemedicine/telehealth when indicated as covered via telemedicine/telehealth in Medicaid program policy. The MCO shall ensure adequate availability of telemedicine/telehealth during declared emergencies, disasters, and pandemics. Physicians and other licensed practitioners must continue to adhere to all existing clinical policy for all services rendered. Providing services through telemedicine/telehealth does not remove or add any medical necessity requirements.

SOURCE: MCO Manual (revised 2/2/24, pg. 175, (Accessed Feb. 2024).

Treatment-in-place ambulance services

Effective for dates of service on or after May 12, 2023, the Louisiana Medicaid Program provides coverage for initiation and facilitation of telehealth services by qualified Louisiana Medicaid enrolled ambulance providers.

SOURCE:  LA Admin Code, Title 50, Part IX, Subpart 1, Ch. 13, Sec. 1301, p. 336 (Accessed Feb. 2024).

A physician directed treatment-in-place service is the facilitation of a telehealth visit by an ambulance provider.

Each paid treatment-in-place ambulance claim must have a separate and corresponding paid treatment-in-place telehealth claim, and each paid treatment-in-place telehealth claim must have a separate and corresponding paid treatment-in-place ambulance claim or a separate and corresponding paid ambulance transportation claim. Reimbursement for both an emergency transport to a hospital and an ambulance treatment-in-place service for the same incident is not permitted.

SOURCE: LA Dept. of Health, Medical Transportation, Sec. 10.8, (As issued on 9/25/23), (Accessed Feb. 2024).

Payment of treatment-in-place ambulance services is restricted to those identified on the Physician Directed Ambulance Treatment-in-Place Fee Schedule and edit claims for non-payable procedure codes as follows:

  • If a treatment-in-place ambulance claim is billed with mileage, the entire claim document shall be denied;
  • If an unpayable procedure code, that is not mileage, is billed on a treatment-in-place ambulance claim, only the line with the unpayable code will be denied;
  • Claims for allowable telehealth procedure codes must be billed with procedure code G2021. The G2021 code shall be accepted, paid at $0.00, and used by the transportation provider to identify treatment-in-place telehealth services; and
  • As with all telehealth claims, providers must include POS identifier “02” or “10” and modifier “95” with their claim to identify the claim as a telehealth service. Providers must follow CPT guidance relative to the definition of a new patient versus an established patient.

See valid treatment in place ambulance claim modifier list.

If an enrollee being treated-in-place has a real-time deterioration in their clinical condition necessitating immediate transport to an emergency department, as determined by the ambulance provider (i.e., EMT or paramedic), telehealth provider, or enrollee, the MCO may not reimburse for both the treatment-in-place ambulance service and the transport to the emergency department. In this situation, the MCO shall reimburse for the emergency department transport only. The MCO shall require ambulance providers to submit pre-hospital care summary reports when ambulance treatment-in-place and ambulance transportation claims are billed for the same enrollee with the same date of service.

If an enrollee is offered treatment-in-place services but declines the services, ambulance providers should include procedure code G2022 on claims for ambulance transportation to an emergency department. Use of this informational procedure code is optional and does not affect the establishment of medical necessity of the service or reimbursement of the ambulance transportation claim. The G2022 code shall be accepted, paid at $0.00, and used by the MCO to identify enrollee refusal of treatment-in-place services.

The MCO shall restrict payment of treatment-in-place telehealth services to those identified on the Treatment-in-Place Telehealth Services Fee Schedule.

SOURCE: MCO Manual (revised 2/2/24), pg. 88-89,LA Dept. of Health, Medical Transportation, Sec. 10.8, (As issued on 9/25/23), (Accessed Feb. 2024).

Behavioral Health Services

Assessments, evaluations, individual psychotherapy, family psychotherapy, and medication management services [CPST allowed in Rehabilitation Services section and services allowed within intensive outpatient or outpatient treatment may be provided in Addiction Services section] may be reimbursed when provided via telecommunication technology when the following criteria is met:

  1. The telecommunication system used by physicians and LMHPs must be secure, ensure member confidentiality, and be compliant with the requirements of the Health Insurance Portability and Accountability Act (HIPAA);
  2. The services provided are within the practitioner’s telehealth scope of practice as dictated by the respective professional licensing board and accepted standards of clinical practice;
  3. The member’s record includes informed consent for services provided through the use of telehealth;
  4. Services provided using telehealth must be identified on claims submission using by appending the modifier “95” to the applicable procedure code and indicating the correct place of service, either POS 02 (other than home) or 10 (home). Both the correct POS and the 95 modifier must be present on the claim to receive reimbursement;
  5. Assessments and evaluations conducted by an LMHP through telehealth should include synchronous, interactive, real-time electronic communication comprising both audio and visual elements unless clinically appropriate and based on member consent; and
  6. Providers must deliver in-person services when telehealth is not clinically appropriate or when the member requests in-person services.

LMHP’s providing assessments, evaluations, individual psychotherapy, family psychotherapy, and medication management services offered within Opioid treatment programs may be reimbursed when conducted via telecommunication technology. The LMHP is responsible for acting within the telehealth scope of practice as decided by the respective licensing board. The provider must bill the procedure code (CPT codes) with modifier “95”, as well as the correct place of service, either POS 02 (other than home) or 10 (home). Reimbursement will be at the same rate as a face-to-face service. Exclusions: Methadone admission visits conducted by the admitting physician within OTPs are not allowed via telecommunication technology.

SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 112, 198 & 269 (As issued 1/12/24). (Accessed Feb. 2024).

Parent-Child Interaction Therapy

Fidelity is then directly assessed via the following requirement: Applicants must have their treatment sessions observed by a certified PCIT Trainer. Observations may be conducted in real time (e.g., live or online/telehealth) or through video recording

Dialectical Behavioral Therapy

As an outpatient therapy service delivered by licensed practitioners, allowed modes of delivery include individual, family, group, on-site, off-site, and tele-video. Telehealth delivery is allowed if it includes synchronous, interactive, real-time electronic communication comprising both audio and visual elements.

A comprehensive DBT program is typically provided in an outpatient setting. Telehealth is an allowed modality, and use of telehealth for DBT skills training groups in particular may support continued and consistent client engagement, especially when travel or transportation is a barrier to client engagement.

Components of DBT may be delivered, with some adaptation, in a residential or inpatient setting; however, this would not be billed as a separate service, instead would be part of the active treatment plan reimbursed as part of the comprehensive inpatient or psychiatric residential treatment facility (PRTF) rate

SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, 460 (As issued 1/12/24). (Accessed Feb. 2024).

Ambulance Providers – Managed Care Organizations

Physician directed treatment-in-place service is the facilitation of a telehealth visit by an ambulance provider.  Each paid treatment-in-place ambulance claim must have a separate and corresponding paid treatment-in-place telehealth claim, and each paid treatment-in-place telehealth claim must have a separate and corresponding paid treatment-in-place ambulance claim or a separate and corresponding paid ambulance transportation claim. The MCO may not reimburse for both an emergency transport to a hospital and an ambulance treatment-in-place service for the same incident.

SOURCE: LA Medicaid Managed Care Organization (MCO) Manual, p. 88 (Updated 2/2/24), & LA Dept. of Health, Medical Transportation, Sec. 10.8, (As issued on 9/25/23), (Accessed Feb. 2024).

Early and Periodic Screening, Diagnostics and Treatment Health Services (EPSDT)

Permissible Telecommunications Systems:

  • All services eligible for telemedicine/telehealth may be delivered via an interactive audio/video telecommunications system;
  • A secure, HIPAA-compliant platform is preferred, if available. However, for the duration of the COVID-19 event, if a HIPAA-compliant system is not immediately available at the time it is needed, providers may use everyday communications technologies such as cellular phones with widely available audio/video communication platforms;
  • Providers should follow guidance from the Office for Civil Rights at the Department of Health and Human Services for software deemed appropriate for use during this event;
  • For the duration of the COVID-19 event, in cases where an interactive audio/video system is not immediately available at the time it is needed, an interactive audio-only system (e.g., telephone) without the requirement of video may be employed, unless noted otherwise;
  • For use of an audio-only system, the same standard of care must be met, and the need and rationale for employing an audio-only system must be documented in the clinical record; and
  • Please note, some telemedicine/telehealth services described below require delivery through an audio/video system due to the clinical nature of these services. Where applicable, this requirement is noted explicitly.

Reimbursement for services delivered through telemedicine/telehealth is at the same level as reimbursement for in-person services.

Providers must indicate place of service 02 and must append modifier -95.

SOURCE: LA Dept. of Health, Provider Manual, Chapter Twenty of the Medicaid Svcs. Manual, Section 20.1, p. 19-20 (As issued 9/7/23). (Accessed Feb. 2024).

Consultations are to be face-to-face contact in one-on-one sessions. These are services for which a parent would otherwise seek medical attention at a physician or health care provider’s office. Telemedicine/telehealth is not a covered service, but is an applicable service delivery method. When otherwise covered by Louisiana Medicaid, telemedicine/telehealth is allowed for all CPT codes located in Appendix P of the CPT manual. This service is available to all Medicaid individuals eligible for EPSDT.

SOURCE:  LA Admin Code, Title 50, Part XV, Subpart 5, Ch. 95, Sec. 9503, p. 390 (Accessed Feb. 2024).

The department shall include in its Medicaid policies and procedures all of the following information relating to telehealth:

  • An exhaustive listing of the covered healthcare services which may be furnished through telehealth.
  • Processes by which providers may submit claims for reimbursement for healthcare services furnished through telehealth.
  • The conditions under which a managed care organization may reimburse a provider or facility that is not physically located in this state for healthcare services furnished to an enrollee through telehealth.
For services rendered in the natural environment (home and community). “Community”: environment where children of same age with no disabilities or special needs participate such as childcare centers, agencies, libraries, and other community settings. Services can be provided via “teletherapy” specific POS/modifier combinations.

POS/modifier combination must be one of these two choices:

  • POS 12 (Home) and Procedure Modifier U8; or
  • POS 99 (Other Place of Service) and Procedure Modifier U8.
  • POS 02 (Teletherapy) and Procedure Modifiers 95 and U8.

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, EPSDT Health and IDEA, Part C- Early Steps, Section 47.5.1, p. 21 (As issued on 2/27/23), (Accessed Feb. 2024).

Supports Waiver

Virtual delivery of onsite day habilitation should be utilized during times that does not allow the beneficiary to attend in person (i.e. medical issues/surgery, an emergency where a provider agency may be closed) or when the beneficiary chooses to not attend in person. Virtual delivery is not the typical delivery method. In order to participate in virtual delivery of the service, the beneficiary should be independent or have natural supports, as this service cannot be billed at the same time as another service. The beneficiary should also have the technology necessary to participate in the virtual service (i.e., internet connection, laptop, smartphone, and/or tablet).

See manual for virtual delivery guidelines.

SOURCE: LA Dept. of Health, Support Services, Ch. 43.4, (As issued on 8/21/23), (Accessed Feb. 2024).


ELIGIBLE PROVIDERS

Distant site means the site at which the physician or other licensed practitioner is located at the time the services are provided.

The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services rendered to Louisiana Medicaid beneficiaries.

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on 6/27/22) (Accessed Feb. 2024).

Distant site means the site at which the physician or other licensed practitioner is located at the time the telehealth services are provided.

SOURCE:  Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 112, 171, & 198 (As issued 1/12/24). (Accessed Feb. 2024).

Rural health clinics (RHC) and federally qualified health clinics (FQHC): Reimbursement for these services will be at the all-inclusive prospective payment rate on file for the date of service (DOS).

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

FQHC manual refers to provider manual for billing instructions for telemedicine services.

SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.4, pg. 33, (As issued on Jun. 30, 2022) & Rural Health Clinic Manual, Chapter 40, Sec. 40.4, pg. 33 (As issued on Jun. 30, 2022). (Accessed Feb. 2024).

Distant Site: The distant site refers to where the provider is located. The preferred location of a distant site provider is in a healthcare facility. However, if there is disruption to a healthcare facility or a risk to the personal health and safety of a provider, there is no formal limitation as to where the distant site provider can be located, as long as the same standard of care can be met.

SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on 9/7/23), (Accessed Feb. 2024).

Treatment-in-place ambulance services

Ambulance providers interested in offering physician directed treatment-in-place telehealth services must complete the following:

  • enroll as a CMS ET3 model participant;
  • enter into a partnership with a qualified, Louisiana Medicaid enrolled healthcare provider to furnish treatment-in-place telehealth services to Louisiana Medicaid beneficiaries; and
  • notify the Department of Health of its partnerships with each telehealth provider.
  • Reimbursement for initiation and facilitation of telehealth services shall be made according to the established physician directed treatment-in-place telehealth service fee schedule or billed charges, whichever is the lesser amount.

Initiation and facilitation of physician directed treatment-in-place telehealth services are performed by Louisiana Medicaid enrolled ambulance providers on site, with no transport, using audio and video telecommunications systems that permit real-time communication between a qualified, Medicaid enrolled, licensed medical practitioner and the beneficiary.

All services provided by ambulance providers during the initiation and facilitation of the physician directed treatment-in-place intervention are covered by the associated BLS-E, emergency base rate, or the ALS1-E, Level 1 emergency base rate.

Ambulance providers are not eligible to submit a claim for reimbursement or receive payment for other services (except for supplies) at the scene.

If a beneficiary must be transported to an emergency department (ED) due to poor internet connection, which resulted in a failed physician directed treatment-in-place encounter, or the beneficiary’s condition deteriorates, the ambulance provider may submit a claim for reimbursement and receive compensation for the transport to the ED, but not for initiation and facilitation of the telehealth service.

The entity seeking reimbursement for the corresponding physician directed treatment-in-place telehealth service must be an enrolled Louisiana Medicaid provider.

Reimbursement to the ambulance providers for initiation and facilitation of the physician directed treatmentin-place telehealth service requires a corresponding treatment-in-place telehealth service. The corresponding treatment-in-place telehealth service is demonstrated via a Louisiana Medicaid paid treatment-in-place telehealth service claim.

SOURCE:  LA Admin Code, Title 50, Part IX, Subpart 1, Ch. 13, Sec. 1301-1305, p. 336 (AccessedFeb. 2024).

Valid rendering providers are licensed physicians, advanced practice registered nurses, and physician assistants.

SOURCE: MCO Manual (revised 2/2/24), pg. 89, & LA Dept. of Health and Hospitals, Medical Transportation, Sec. 10.8, (As issued on 9/25/23), (Accessed Feb. 2024).

School Based Health Centers provide convenient access to preventive and acute care services for students who might otherwise have limited or no access to health care. This care may be provided onsite or through telehealth.

SOURCE: LA Admin Code, Title 50, Park XV, Subpart 5, Ch. 91, pg. 388 (Accessed Feb. 2024).


ELIGIBLE SITES

Originating site means the location of the Medicaid beneficiary [enrollee] at the time the services are provided. There is no restriction on the originating site and it can include, but is not limited to, a healthcare facility, school, or the beneficiary’s [enrollee’s] home.

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165. (As issued 6/27/22), & MCO Manual (revised 2/2/24), pg. 175, & Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 171 (As issued 1/12/24). (Accessed Feb. 2024).

The Centers for Medicare and Medicaid Services (CMS) added a new place of service (POS) for telehealth services provided in the patient’s home effective for dates of service on and after January 1, 2022. Providers are required to use the appropriate POS, either 02 (other than home) or 10 (home) with modifier 95 for the billing of telemedicine/telehealth services based on the beneficiary’s location at the time of service.

SOURCE: LA Dept. of Health, Informational Bulletin 19-11. (May 18, 2022). (Accessed Feb. 2024).

Rural health clinics (RHC) and federally qualified health clinics (FQHC) are required to indicate the appropriate place of service, either 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of and append modifier 95 for the billing of telemedicine/telehealth services. Services delivered via an audio/video system and via an audio-only system are to be coded the same way.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

Originating Site: The originating site refers to where the patient is located. There is currently no formal limitation on the originating site and this can include, but is not limited to, the patient’s home.

SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on 9/7/23), (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

A BHS provider that is not a licensed mental health professional or a provisionally licensed mental health professional acting within his/her scope of practice may not provide telehealth services outside of its geographic service area.

SOURCE: LA Admin Code 48:I Sec. 5605, (Accessed Feb. 2024).


FACILITY/TRANSMISSION FEE

Louisiana Medicaid only reimburses the distant site provider.

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on 6/27/22). (Accessed Feb. 2024).

Last updated 02/15/2024

Miscellaneous

Supports Waiver

View virtual delivery guidelines in manual.

SOURCE: LA Dept. of Health, Support Services, Ch. 43.4, (As issued on 8/21/23), (Accessed Feb. 2024).

The department shall include in its Medicaid policies and procedures all of the following information relating to telehealth:

  1. An exhaustive listing of the covered healthcare services which may be furnished through telehealth.
  2. Processes by which providers may submit claims for reimbursement for healthcare services furnished through telehealth.
  3. The conditions under which a managed care organization may reimburse a provider or facility that is not physically located in this state for healthcare services furnished to an enrollee through telehealth.

SOURCE: LA Statute Sec. 46:460.54. (Accessed Feb. 2024).

The beneficiary’s clinical record must include documentation that the service was provided through the use of telemedicine/telehealth.

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 165, (As issued on 6/27/22), (Accessed Feb. 2024).

Last updated 02/15/2024

Out of State Providers

No reference found.

Last updated 02/15/2024

Overview

Live video telemedicine is covered for distant site providers enrolled in Louisiana Medicaid.  There is no reimbursement for the originating site.  Activity and sensor monitoring, health status monitoring and medication dispensing and monitoring are forms of remote patient monitoring that are covered by Louisiana Medicaid.  There is no reference to store-and-forward.

Last updated 02/15/2024

Remote Patient Monitoring

POLICY

Under the Community Choices Waiver, Louisiana Medicaid will reimburse for telecare, including:

  • Activity and Sensor Monitoring,
  • Health status monitoring, and
  • Medication dispensing and monitoring.

Monthly telecare services consist of:

  • Delivering, furnishing, maintaining and repairing/replacing equipment on an ongoing basis. This may be done remotely as long as all routine requests are resolved within three business days;
  • Monitoring of recipient-specific service activities by qualified staff;
  • Training the recipient and/or the recipient’s responsible representative in the use of the equipment;
  • Cleaning and storing equipment;
  • Providing remote teaching and coaching as necessary to the recipient and/or caregiver(s); and
  • Analyzing data, developing and documenting interventions by qualified staff based on information/data reported.

Personal Emergency Response System (PERS) is also reimbursed under Community Choices Waiver, which sends alerts when emergency services are needed by the recipient.

Activity and Sensor Monitoring

This service is a computerized system that monitors the recipient’s in-home movement and activity for health, welfare and safety purposes.  At a minimum the system must:

  • Monitor the home’s points of egress;
  • Detect falls;
  • Detect movement or lack of movement;
  • Detect whether doors are opened or closed; and
  • Provide a push button emergency alert system.

Some systems also monitor the home’s temperature.

Health Status Monitoring

This service collects health-related data to assist the health care provider in assessing the recipient’s health condition and in providing recipient education and consultation. Could be beneficial for patient with chronic conditions for monitoring weight, oxygen saturation measurements and vital signs.

Medication Dispensing and Monitoring

A remote monitoring system that is individually pre-programmed to dispense and monitor the recipient’s compliance with medication therapy.  The provider or caregiver is notified when there are missed doses or non-compliance with medication therapy.

SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 23-25 (as issued on 4/13/22). (Accessed Feb. 2024).

Standards

Assistive Devices and Medical Supplies Provided by a Durable Medical Equipment (DME) provider that:

  • Is enrolled to provide DME; and
  • Has enrolled in Medicaid as an Assistive Devices and Medical Supplies CCW provider (Provider Type 17);

OR

Provided by a home health agency provider that:

  • Is licensed to provide home health services;
  • Is Medicare certified; and
  • Has enrolled in Medicaid as an OAAS – Community Choices Waiver assistive devices provider (Provider Type 17).

For personal emergency response systems (PERS), these services are provided by a provider that:

  • Is enrolled in Medicaid as a PERS provider; and
  • Has furnished verification (copy of letter from the manufacturer written on the manufacturer’s letterhead stationary) that the provider is an authorized dealer, supplier or manufacturer of a PERS product.

The PERS provider must install and support PERS equipment in compliance with all of the applicable federal, state, parish and local laws and regulations, as well as meet manufacturer’s specifications, response requirements, maintenance records, and recipient education.

SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.6, p. 74 and 84 (As issued 4/13/22). (Accessed Feb. 2024).

Technology Supports with Remote Features:

  • Mobile Emergency Response System- an on-the-go mobile medical alert system, used in and outside the home. This system will cellular/GPS technology, two-way speakers and no base station required;
  • Medication Reminder System- an electronic device programmed to remind individual to take medications by a ring, automated recording or other alarm. The electronic device may dispense controlled dosages of mediation and may include a message back to the center if a medication
    has not been removed from the dispenser. Requires ability to self-administer medication with reminder; and

Other equipment used to support someone remotely may include but not limited to: electronic motion door sensor devices, door alarms, web-cams, telephones with modifications (large buttons, flashing lights), devices affixed to wheelchair or walker to send alert when fall occurs, text-to-speech software, intercom systems, tablets with features to promote communication or smart device speakers.

Remote Technology Service Delivery: covers monthly response center/remote support monitoring fee and tech upkeep (no internet cost coverage)

Remote Technology Consultation: evaluation of tech support needs for an individual, including functional evaluation of technology available to address the person’s assess needs and support person to achieve outcomes identified in the POC.

SOURCE: LA Dept. of Health, Residential Options Waiver, Section 38.1, p. 46-47 (As issued 3/27/23). (Accessed Feb. 2024).


CONDITIONS

Health status monitoring:

May be beneficial to beneficiaries with congestive heart failure, diabetes or pulmonary disease.

Services must be based on a verified need of the beneficiary and the service must have a direct or remedial benefit with specific goals and outcomes.

SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 35 (as issued on 4/13/22). (Accessed Feb. 2024).


PROVIDER LIMITATIONS

Telecare providers must meet the following requirements:

  • Be UL listed/certified or have 501(k) clearance;
  • Be web-based;
  • Be compliant with the requirements of the Health Insurance Portability and Accountability Act (HIPAA);
  • Have beneficiary specific reporting capabilities for tracking and trending;
  • Have a professional call center for technical support based in the United States; and
  • Have on-going provision of web-based data collection for each beneficiary, as appropriate. This includes response to beneficiary self-testing, manufacturer’s specific testing, self-auditing, and quality control.

SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.6, p. 84 (As issued 4/13/22). (Accessed Feb. 2024).


OTHER RESTRICTIONS

Limitations

  • Services must be based on verified need and have a direct or remedial benefit with specific goals and outcomes.
  • Benefit must be determined by an independent assessment on any item that costs over $500 and on all communication devices, mobility devices, and environmental controls.
  • Independent assessments must be performed by individuals who have no fiduciary relationship with the manufacturer, supplier, or vendor of the item.
  • All items must reduce reliance on other Medicaid State Plan or waiver services
  • All items must meet applicable standards of manufacture, design and installation
  • The items must be on the Plan of Care developed by the support coordinator and are subject to approval by OAAS Regional Office or its designee.
  • A beneficiary will not be able to simultaneously receive telecare activity and sensor monitoring services and traditional PERS services.

Where applicable, beneficiaries must use Medicaid state plan services, Medicare, or other available payers first. The beneficiary’s preference for a certain brand or supplier is not grounds for declining another payer in order to access waiver services.

SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 35 & 32 (As issued on 4/13/22). (Accessed Feb. 2024).

Last updated 02/15/2024

Store and Forward

POLICY

Louisiana Medicaid will not provide reimbursement for store-and-forward based upon the definition of “telemedicine/telehealth” which describes telemedicine as including “audio and video equipment permitting two-way, real time interactive communication” therefore excluding store-and-forward.

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 165 (As issued on 6/27/22). (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/15/2024

Cross State Licensing

Requirement for Permit/Qualifications. A physician who does not possess a Louisiana medical license shall not engage in the practice of medicine in this state via telemedicine, as defined in Chapter 75 of these rules, unless he or she holds a telemedicine permit issued by the board. A telemedicine permit is a limited license that provides lawful authority to a physician who does not hold a current, unrestricted Louisiana medical license to practice telemedicine with respect to patients located in this state. To be eligible for a telemedicine permit an applicant shall:

  • Possess the qualifications for licensing prescribed by § 311. of these rules;
  • Possess an unrestricted license to practice medicine issued by the medical licensing authority of a state other than Louisiana (whether allopathic or osteopathic);
  • Have completed a board-approved application and satisfied the applicable fee.

SOURCE: LA Admin Code Sec. 46:XLV.408, (Accessed Feb. 2024).

Board of Medicine

The practice of medicine is deemed to occur at the location of the patient. Therefore, no physician shall utilize telemedicine to provide medical services to patients located in this state unless the physician:

  • holds an unrestricted Louisiana medical license; or
  • holds a telemedicine permit as provided in §408 of these rules.

SOURCE: LA Admin. Code 46: XLV.7507. p. 250 (Accessed Feb. 2024).

A physician who practices telemedicine by virtue of a telemedicine permit issued by the board shall not:

  • Open an office in this state;
  • Meet with patients in this state;
  • Receive telephone calls in this state from patients; or
  • Engage in the practice of medicine in this state beyond the limited authority conferred by his or her telemedicine permit.

No physician shall supervise, collaborate or consult with an allied health care provider located in this state via telemedicine unless he or she possesses a full and unrestricted license to practice medicine in this state and satisfies and complies with the prerequisites and requirements specified by all applicable laws and rules.

No physician shall utilize telemedicine to provide care to a patient who is physically located outside of this state, unless the physician possesses lawful authority to do so by the licensing authority of the state in which the patient is located.

SOURCE: LA Admin. Code 46: XLV. 7513. , p. 227 (Accessed Feb. 2024).

Each state agency or professional or occupational licensing board or commission that regulates the practice of a healthcare provider, as defined in this Part, shall promulgate, in accordance with the Administrative Procedure Act, any rules necessary to provide for, promote, and regulate the use of telehealth in the delivery of healthcare services within the scope of practice regulated by the licensing entity.

  • The rules shall, at a minimum, provide for all of the following: …
    • Licensing or registration of out-of-state healthcare providers who seek to furnish healthcare services via telehealth to persons at originating sites in  Louisiana. The rules shall ensure that the healthcare provider possesses, at a minimum, an unrestricted and unencumbered license in good standing to perform the healthcare service in the state in which the healthcare provider is located, and that the license is comparable to its corresponding license in Louisiana as determined by the respective Louisiana licensing agency, board, or commission.
    • Each state agency and professional or occupational licensing board or commission may provide by rule for a reasonable fee for the license or registration provided for in this Subsection.

Licensing or registration of out-of-state healthcare providers who seek to furnish healthcare services via telehealth to persons at originating sites in Louisiana. The rules shall ensure that the healthcare provider possesses, at a minimum, an unrestricted and unencumbered license in good standing to perform the healthcare service in the state in which the healthcare provider is located, and that the license is comparable to its corresponding license in Louisiana as determined by the respective Louisiana licensing agency, board, or commission.

Each state agency and professional or occupational licensing board or commission may provide by rule for a reasonable fee for the license or registration provided for in this Subsection.

Exemption from the telehealth license or registration required by this Subsection for the consultation of a healthcare professional licensed by this state with an out-of-state peer professional.

SOURCE: LA Revised Statutes 40:1223.4, as amended by Senate Bill 66 (2023 Session), (Accessed Feb. 2024).

Licensed Professional Counselors

Licensees shall provide services consistent with the jurisdictional licensing laws and rules in both the jurisdiction in which licensee is physically located and where the client is physically located. Licensees providing teletherapy services to clients outside of Louisiana must comply with the regulations in the state in which the client is located at the time of service. The licensee shall contact the licensing board in the state where the client is located and document all relevant regulations regarding teletherapy. A nonresident of Louisiana who wishes to provide teletherapy health services in Louisiana must be licensed by the board. Teletherapy is a specialty area and requires board approval. Licensees who may provide teletherapy must meet the following requirements:

  1. The licensee must be licensed in Louisiana.
  2. The licensee must be licensed in the state where the client is located if licensing is required.
  3. The licensee must complete: a. professional training with a minimum of 3 asynchronous or synchronous clock hours in teletherapy. The training shall meet continuing education standards established by the board.  See rule for list of requirements.

SOUCE: LA Admin. Code 46: LX.505., p. 7 (Accessed Feb. 2024).

Teledentistry

  1. Treatment or diagnosis via teledentistry may be provided to patients in Louisiana only by a dentist who holds a license issued by the Board of Dentistry. The Louisiana licensed dentist need not be in Louisiana while providing the teledentistry
  2. An exception to the requirement that the provider of teledentistry services to a patient in Louisiana hold a Louisiana license is when a Louisiana licensed dentist with an in-person relationship with a patient consults an expert with a valid dental license in another United States jurisdiction for advice regarding the patient’s treatment or diagnosis; in this case the expert consulted need not have a Louisiana license.
  3. The standard of care applicable to a provider of teledentistry services, including obtaining informed consent and record documentation, is no different from the standard of care required in traditional dentistry.

SOURCE: Department of Health Board of Dentistry amendment to LAC 46:XXXIII.203 p. 12 (Accessed Feb. 2024).

Requirements listed under Title 37, Chapter 15, Part 1 do not apply  to a consultation without limitation between a practicing physician licensed in this state and a practicing physician licensed in another state or jurisdiction.

SOURCE: LA Revised Statute 37:1291 (Accessed Feb. 2024).

Speech-Language Pathology and Audiology

The use of telehealth in the delivery of speech-language pathology or audiology services, regardless of where the services are rendered or delivered, constitutes the practice of speech-language pathology or audiology and shall require Louisiana licensure for in-state practitioners and telehealth registration for out-of-state practitioners.

SOURCE: LA Revised Statute Title 37, Sec. 2660.1, (Accessed Feb. 2024).

Telehealth, regardless of where the service is rendered or delivered, constitutes the practice of audiology or speech-language pathology and shall require Louisiana licensure for in-state practitioners and telehealth registration for out-of-state licensed practitioners.

See admin code for registration requirements.

SOURCE: LA Admin Code LAC Title 46, Part LXXV, Sec. 135, (Accessed Feb. 2024).

Board of Optometry

The practice of optometry is deemed to occur both where the patient is located and where the optometrist providing professional services is located and is hereby declared to affect the public health, safety and welfare, and is subject to regulation and control in the public interest. It is further declared to be a matter of public interest and concern that the practice of optometry, as defined in this chapter, rendered to a person located in Louisiana or by an optometrist located in Louisiana be limited to qualified persons licensed to practice optometry in the state of Louisiana and registered as a telemedicine provider with the board.

An optometric telemedicine provider must hold an active Louisiana optometric license in good standing. Any optometric telemedicine license shall be renewed on an annual basis provided the licensee is in good standing and shall have the same renewal due dates as the basic optometric license.

SOURCE: LA Admin Code LAC 46:LI.509, (Accessed Feb. 2024).

Last updated 02/15/2024

Definitions

“Telehealth” shall have the same meaning as that term defined in R.S. 40:1223.3.

SOURCE: LA Revised Statute 37:1262(4) as amended by Senate Bill 66 (2023 Session) (Accessed Feb. 2024).

“Telehealth” means healthcare services, including behavioral health services, provided by a healthcare provider, as defined in this Section, to a person through the use of electronic communications, information technology, asynchronous store-and-forward transfer technology, or synchronous interaction between a provider at a distant site and a patient at an originating site, including but not limited to assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient, and transfer of medical data. The term “telehealth” shall not include any of the following:

  • Electronic mail messages and text messages that are not compliant with applicable requirements of the Health Insurance Portability and Accountability Act of 1996, as amended (42 U.S.C. 1320d et seq.).
  • Facsimile transmissions.

SOURCE: LA Revised Statute 40:1223.3 (Accessed Feb. 2024).

Speech-Language Pathology & Audiology

Telehealth, also known as telepractice, is a mode of delivering audiology and speech-language pathology services that utilizes information and communication technologies to enable the diagnosis, consultation, treatment, education care management, and self-management of clients at a distance from the audiologist or speech-language pathologist provider. Telehealth allows services to be accessed when providers are in a distant site and patients are in the originating site. Telehealth facilitates self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.

SOURCE: LA Admin. Code 46: LXXV.103., p. 4 (Accessed Feb. 2024).

Physician’s Use of Telemedicine in Practice

Telemedicine – the practice of health care delivery, diagnosis, consultation, treatment, and transfer of medical data by a physician using interactive telecommunication technology that enables a physician and a patient at two locations separated by distance to interact via two-way video and audio transmissions simultaneously. Neither an electronic mail message between a physician and a patient, or a true consultation constitutes telemedicine for the purposes of this Part. A physician practicing by telemedicine may utilize interactive audio without the requirement of video if, after access and review of the patient’s medical records, the physician determines that he or she is able to meet the same standard of care as if the healthcare services were provided in-person.

SOURCE: LA Admin. Code 46: XLV.7503., p. 225 (Accessed Feb. 2024).

Board of Optometry

Optometric Telemedicine — a health service interaction that is delivered by a licensed optometrist acting within the scope of his or her license between an optometrist in one physical location and a patient located in any different physical location, accomplished via audio-visual link, imaging, telephone, or other appropriate forms of electronic communication and/or technology used to allow or assist the optometrist in providing care to the patient and may require the use of advanced telecommunications technology, other than facsimile technology, including all of the following:

  • Compressed digital interactive video, audio, or data transmission;
  • Clinical data transmission using computer imaging by way of still image capture and store and forward;
  • Another technology that facilitates access to health care services or optometric specialty expertise.

SOURCE: LA Admin Code LAC 46:LI.509, (Accessed Feb. 2024).

Board of Psychology

Telecommunication—the preparation, transmission, communication, or related processing of information by electrical, electromagnetic, electromechanical, electrooptical, or electronic means (Committee on National Security Systems, 2010).

Telepsychology—the practice of psychology which includes assessment, diagnosis, intervention, consultation or information by psychologists using interactive telecommunication technology that enables a psychologist and a client, at two different locations separated by distance to interact via two-way audio/ or audio only transmissions simultaneously. Telepsychology is not a separate specialty. If the use of technology is for purely administrative purposes, it would not constitute telepsychology under this Chapter.

Telesupervision—a method of providing supervision to psychology trainees via two-way video and audio transmissions simultaneously or other telecommunication technologies.

SOURCE: LA Admin Code LAC Title 46:LXIII Sec. 1401-1409, (Accessed Feb. 2024).

Teledentistry

Teledentistry is defined as the use of medical or dental information exchanged from one site to another via electronic communications to provide dental treatment or diagnosis, but does not include email or telephone exchanges between a provider and a patient with whom an in-person provider-patient relationship has been established.

SOURCE: LA Admin. Code LAC 46:XXXIII.203 (Accessed Feb. 2024).

Professional Counselors

Teletherapy is defined as a method of delivering mental health counseling, psychotherapy, and marriage and family therapy services as prescribed by R.S. 37:1101 and R.S. 37:1116 using interactive technology-assisted media to facilitate prevention, assessment, diagnosis, and treatment of mental, emotional, behavioral, relational, and addiction disorders to individuals, groups, organizations, or the general public that enables a licensee and a client(s) separated by distance to interact via synchronous video and audio transmission.

SOURCE: LA Admin. Code LAC 46, Part LX, Subpart 1, Sec. 505 (Accessed Feb. 2024).

Last updated 02/15/2024

Licensure Compacts

Member of Physical Therapy Compact.

SOURCE:  PT Compact. Compact Map. (Accessed Feb. 2024).

Member of Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact.  Current NLC States and Status.  NCSBN.  (Accessed Feb. 2024).

Member of Audiology and Speech-Language Pathology Interstate Compact

SOURCE: ASLP, ASLP-IC Map, (Accessed Feb. 2024).

Member of Interstate Medical Licensure Compact

SOURCE: Interstate Medical Licensure Compact. U.S. State Participation in the Compact, (Accessed Feb. 2024).

Member of Emergency Medical Services (EMS) Compact.

SOURCE: Interstate Commission for EMS Personnel Practice, Compact Governance (Accessed Feb. 2024).

Member of Counseling Compact

SOURCE: Counseling Compact, Compact Map, (Accessed Feb. 2024).

Member of Occupational Therapy compact

SOURCE: Occupational Therapy Compact, Compact Map, (Accessed Feb. 2024).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 02/15/2024

Miscellaneous

Requires licensing standards be developed by the Department of Health on the delivery of behavioral health services through telehealth.

SOURCE: LA Revised Statute 40:2156 (Accessed Feb. 2024).

Teledentistry

A dental hygienist licensed in Louisiana may perform radiographs, oral prophylaxis, place sealants and place fluoride varnish without a Louisiana licensed dentist being physically present in the clinic if all of the following conditions are met:

A Louisiana licensed dentist is providing direct supervision via teledentistry and reviews exams being done by the hygienist and images of the patient’s oral cavity via the teledentistry connection. Unless restricted by bandwidth considerations, the teledentistry must be contemporaneous (synchronist). If bandwidth prohibits contemporaneous viewing by the dentist, non-contemporaneous (asynchronous) viewing of the patient may be employed, but the dentist must review the exam before the patient is dismissed from the clinic on the day of treatment.

See rule for complete requirements.

SOURCE: Louisiana Admin Code XXXIII, Ch. 7, Sec. 701, (Accessed Feb. 2024).

Venue in any suit filed involving care rendered via telehealth pursuant to the provisions of this Part shall be proper and instituted before the district court of the judicial district in which the patient resides or in the district court having jurisdiction in the parish where the patient was physically located during the provision of the telehealth service. The patient is considered physically located at the originating site as defined in R.S. 40:1223.3.

SOURCE: LA Statute Sec. 40, Sec. 1223.5, as amended by Senate Bill 66 (2023 Session), (Accessed Feb. 2024).

Last updated 02/08/2024

Online Prescribing

Physicians utilizing telemedicine shall establish a proper physician-patient relationship by:

  • Verify the identity of the patient.  Appropriate contact and identifying information shall be made part of the medical record;
  • Conduct an appropriate exam. The examination does not require an in-person visit if the technology is sufficient to provide the physician the pertinent clinical information reasonably necessary to practice at an acceptable level of skill and safety;
  • Establish a proper diagnosis through the use of accepted medical practices; e.g., history, mental status, appropriate diagnostic and laboratory testing;
  • Discuss the diagnosis and risks and benefits of various treatment options;
  • ·Ensure the availability of appropriate follow up care;
  • Create and/or maintain a medical record.

Telemedicine shall not be utilized by a physician with respect to any individual located in this state in the absence of a physician-patient relationship.

The practice of medicine by telemedicine, including the issuance of any prescription via electronic means shall be held to the same prevailing and usually accepted standards of medical practice as those in traditional (face-to-face) settings. An online, electronic or written mail message does not satisfy the standards of appropriate care.

A physician using telemedicine may be at any location at the time the services are provided. A patient receiving medical services by telemedicine may be in any location at the time that the services are received.

SOURCE: LA Admin. Code 46: XLV.7503-05. p. 249-250 (Accessed Feb. 2024).

No physician shall utilize telemedicine:

  1. for the treatment of non-cancer related chronic or intractable pain, as set forth in §§6915-6923 of the board’s rules;
  2. for the treatment of obesity, as set forth in §§6901-6913 of the board’s rules;
  3. to authorize or order the prescription, dispensation or administration of any controlled substance unless;
    1. the physician has had at least one in-person visit with the patient within the past year; provided, however, the requirement for an in-person visit shall not apply to a physician who holds an unrestricted license to practice medicine in LA and who practices telemedicine upon any patient being treated at a healthcare facility that is required to be licensed pursuant to the laws of LA and which holds a current registration with the U.S. Drug Enforcement Administration;
    2. the prescription is issued for a legitimate medical purpose;
    3. the prescription is in conformity with the standard of care applicable to an in-person visit; and
    4. the prescription is permitted by and in conformity with all applicable state and federal laws and regulations.

The Board may grant an exception if the physician submits a written application.

SOURCE: LA Admin. Code 46: XLV.7513. p. 251 (Accessed Feb. 2024).

All of the following restrictions and authorizations apply to a physician who holds an unrestricted license to practice medicine from the board and who utilizes telehealth for any patient who is being treated at a healthcare facility that is required to be licensed pursuant to the laws of this state and which holds a current registration with the United States Drug Enforcement Administration:

  • The physician shall use the same standard of care as if the healthcare services were provided in person.
  • The physician may prescribe any controlled dangerous substance without necessity of conducting an appropriate in-person patient history or physical examination of the patient as otherwise would be required by R.S. 40:1223.4.
  • The physician shall not be subject to any regulatory prohibition or restriction on the utilization of telehealth, including prohibitions or restrictions related to prescribing controlled dangerous substances, which are in any manner more restrictive than the prohibitions and restrictions that are otherwise applicable to the entire practice of medicine.

The physician may prescribe any controlled dangerous substance without necessity of conducting an appropriate in-person patient history or physical examination of the patient as otherwise would be required by R.S. 40:1223.4.

The physician shall not be subject to any regulatory prohibition or restriction on the utilization of telehealth, including prohibitions or restrictions related to prescribing controlled dangerous substances, which are in any manner more restrictive than the prohibitions and restrictions that are otherwise applicable to the entire practice of medicine.

SOURCE: LA Statute Sec. 37:1271.1, as amended by Senate Bill 66 (2023 Session). (Accessed Feb. 2024).

Except as otherwise provided in Paragraph (6) of this Subsection, a healthcare provider shall not be required to conduct an in-person patient history or physical examination of the patient before engaging in a telehealth encounter but shall provide a referral to a healthcare provider in this state or arrange for follow-up care in this state as necessary.

Except as authorized by R.S. 37:1271.1 or otherwise by rule promulgated by a state agency or professional or occupational licensing board or commission, no healthcare provider shall prescribe any controlled dangerous substance prior to conducting an appropriate in-person patient history or physical examination of the patient as determined by the appropriate state agency or professional or occupational licensing board or commission.

A healthcare provider may use interactive audio without the requirement of video if, after access and review of the patient’s medical records, the healthcare provider determines that he is able to meet the same standard of care as if the healthcare services were provided in person.

Creation of a record on each patient. The record shall be made available, upon request, to the state agency or professional or occupational licensing board or commission that regulates the practice of the healthcare provider.

SOURCE: LA Revised Statute 40:1223.4 as amended by Senate Bill 66 (2023 Session) (Accessed Feb. 2024).

Except as authorized by R.S. 37:1271.1 [see above] or otherwise by rule promulgated by the board, no physician practicing telemedicine pursuant to this Subsection shall prescribe any controlled dangerous substance prior to conducting an appropriate in-person patient history or physical examination of the patient as determined by the board.

SOURCE: LA Revised Statutes 37:1271(B)(3). (Accessed Feb. 2024).

Teledentistry

Controlled substances may not be prescribed via teledentistry except in emergency situations where the dentist determines:

  • That immediate administration of the controlled substance is necessary for proper treatment of the intended ultimate user, and
  • That no appropriate alternate treatment is available, including administration of a drug that is not a controlled substance.

In an emergency situation the prescription for a controlled substance must be limited to the amount adequate to treat the patient during the emergency period.

SOURCE: LA Admin. Code LAC 46:XXXIII.203 (Accessed Feb. 2024).

Board of Optometry

Evaluation, treatment, and consultation recommendations made in an optometric telemedicine setting, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

SOURCE: LA Admin Code LAC 46:LI.509, (Accessed Feb. 2024).

Last updated 02/15/2024

Professional Boards Standards

Louisiana Medical Board

SOUCE: LA Admin. Code 46: XLV.75 p. 225 (Accessed Feb. 2024).

Speech Language Pathology and Audiology

SOUCE: LA Admin. Code 46: LXXV. 135. p. 18 (Accessed Feb. 2024).

Licensed Professional Counselors

SOUCE: LA Admin. Code 46: LX.505., p. 6-7 (Accessed Feb. 2024).

Physical Therapy Board

SOUCE: LA Admin. Code 46: LIV.319. p. 24-25 (Accessed Feb. 2024).

Registered Dietitians/Nutritionists

SOUCE: LA Admin. Code 46: LXIX.101. p. 3-4 (Accessed Feb. 2024).

Board of Dentistry

SOURCE: LA Admin. Code LAC 46:XXXIII.203 (Accessed Feb. 2024).

Board of Optometry

SOURCE: LA Admin Code LAC 46:LI.509, (Accessed Feb. 2024).

Board of Psychology

SOURCE: LA Admin Code LAC Title 46:LXIII Sec. 1401-1409, (Accessed Feb. 2024).

Louisiana has specific standards for its telemedicine physicians.

SOURCE: LA Statute Sec. 37:1271 (Accessed Feb. 2024).

Hearing Aid Dealers – The Louisiana Board for Hearing Aid Dealers have the power to promulgate rules for the provision of telehealth services by licensed hearing aid dealers that, at a minimum, comply with the Louisiana Telehealth Access Act, R.S. 40:1223.1 et seq.

SOURCE: LA Revised Statute 37:2457(11) (Accessed Feb. 2024).

Each state agency or professional or occupational licensing board or commission that regulates the practice of a healthcare provider, as defined in this Part, shall promulgate, in accordance with the Administrative Procedure Act, any rules necessary to provide for, promote, and regulate the use of telehealth in the delivery of healthcare services within the scope of practice regulated by the licensing entity. See rule for requirements

SOURCE: LA Revised Statute Sec. 40:1223.4, as amended by Senate Bill 65 (2023 Session), (Accessed Feb. 2024).

Except as provided in Subparagraph (c) of this Paragraph, a coroner, who is a physician, or his deputy, who is a physician, may utilize telehealth to conduct the seventy-two-hour independent examination pursuant to this Paragraph.

SOURCE: LA Revised Statute Sec, 28:53(G)(7), & House Bill 181 (2023 Session), (Accessed Feb. 2024).

Last updated 02/15/2024

Definition of a Visit

Encounter – A face-to-face visit with a physician, physician assistant, nurse practitioner, nurse midwife, visiting nurse, clinical psychologist, clinical social worker, or any other State plan approved ambulatory provider during which an FQHC core or other ambulatory service is rendered. Multiple medical encounters with more than one health care practitioner or with the same health care practitioner, which take place on the same day at a single location, constitute a single visit, except for cases in which the beneficiary, subsequent to the first encounter, suffers illness or injury requiring additional diagnosis or treatment.

SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Glossary C, pg. 42, (As issued on 3/10/22) (Accessed Feb. 2024).

Medical (inclusive of DSMT services) encounters are defined as face-to-face visits with a physician, physician assistant, nurse practitioner, certified nurse mid-wife, or visiting nurse during which a FQHC service is rendered. Behavioral health encounters are defined as face-to-face visits with a physician with a psychiatric specialty, nurse practitioner with a psychiatric specialty, clinical nurse specialist with a psychiatric specialty, licensed clinical psychologist, licensed clinical social worker, licensed professional counselor, licensed marriage and family therapist, respectively, during which behavioral health service is rendered. A behavioral health specific service must be rendered in order to bill a behavioral health encounter.

A dental encounter is defined as a face-to-face visit with a dentist where dental services are rendered.

SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.1, pg. 15, (As issued on 6/30/22) (Accessed Feb. 2024).

Last updated 02/15/2024

Eligible Distant Site

Reimbursement for service codes appropriate to telemedicine/telehealth will be at the all-inclusive prospective payment rate on file for the date of service (DOS).

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

See: LA Medicaid Live Video Eligible Providers

Last updated 02/15/2024

Eligible Originating Site

LA Medicaid does not have an explicit list of eligible originating sites. They only state that a site should be coded either with POS 02 (places other than the home) or POS 10 (beneficiary’s home).  Note that they do not reimburse an originating site fee.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

See: LA Medicaid Live Video Eligible Sites

Last updated 02/15/2024

Home Eligible

Medicaid allows FQHCs to bill with POS code 10 indicating the patient is at their home.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

Last updated 02/15/2024

Modalities Allowed

Live Video

If a covered service is provided via an interactive audio and video telecommunications system (telemedicine), providers must refer to Chapter 5 of the Professional Services Provider Manual on www.lamedicaid.com for specific billing instructions.

SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.4, pg. 33, (As issued on 6/30/22) (Accessed Feb. 2024).

LA Medicaid reimburses for service codes that are appropriate for telemedicine/telehealth via live video, including for FQHCs.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

See: LA Medicaid Live Video


Store and Forward

Store-and-forward is not included in definition of telemedicine for LA Medicaid.  See: LA Medicaid Store and Forward


Remote Patient Monitoring

LA Medicaid provides reimbursement for ‘telecare’ which includes remote monitoring activities in the Community Choice Waiver program. However, there is no reference to whether or not FQHCs could be reimbursed for RPM.  See: LA Medicaid Remote Patient Monitoring


Audio-Only

Services delivered via an audio/video system and via an audio-only system are to be coded the same way (with the 02 or 10 POS and 95 modifier).

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

See: LA Medicaid Email, Phone and Fax

Last updated 02/15/2024

Patient-Provider Relationship

No reference found.

Last updated 02/15/2024

PPS Rate

Reimbursement for service codes appropriate to telemedicine/telehealth will be at the all-inclusive prospective payment rate on file for the date of service (DOS).

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

Last updated 02/15/2024

Same Day Encounters

Multiple medical and/or behavioral health encounters, however, with more than one health care practitioner or with the same health care practitioner, which take place on the same day at a single location, constitute a single visit, except for cases in which the beneficiary, subsequent to the first encounter, suffers illness or injury requiring additional diagnosis or treatment. When the beneficiary suffers illness or injury requiring additional diagnosis or treatment unrelated to the initial encounter visit an additional medical and/or behavioral health encounter may be billed.

Multiple dental encounters with more than one health care practitioner or with the same health care practitioner, which take place on the same day at a single location, constitute a single visit except for cases in which the beneficiary, subsequent to the first encounter, suffers illness or injury requiring additional diagnosis or treatment.

Only one medical encounter (inclusive DSMT encounters) per day per beneficiary, one behavioral health encounter per day per beneficiary, and one dental encounter per day per beneficiary may be billed except in cases in which the beneficiary, subsequent to the first encounter, suffers illness or injury requiring additional diagnosis or treatment. Services shall not be arbitrarily delayed or split in order to bill additional encounters.

SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.1, pg. 15, (As issued on 6/30/22) (Accessed Feb. 2024).

An FQHC provider can be reimbursed for only one medical, one behavioral health, and one dental encounter per day. Core service encounters with more than one health professional, and multiple encounters with the same health profession, that take place on the same date of service, at a single location, constitute a single visit, and are limited to one encounter per day except when one of the following conditions exists:

  1. After the first encounter, the beneficiary suffers illness or injury requiring additional diagnosis or treatment; and
  2. The beneficiary has a medical visit or dental visit on the same day. Behavioral health benefits are subject to the requirements outlined in Section 22:1 Covered Services, of this provider manual chapter.

SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.4, pg. 30-31, (As issued on 6/30/22) (Accessed Feb. 2024).