Last updated 11/16/2023
Consent Requirements
Providers must document, in the participant’s medical record, the participant’s signed consent or the emergency situation that prevented obtaining consent from the participant prior to delivering services via telehealth.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 1-2, 4. Updated Aug. 2023. (Accessed Nov. 2023).
The provider shall obtain the participant’s consent to services via telehealth, unless there is an emergency that prevents obtaining consent, which shall be documented in the participant’s medical record.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.04. (Accessed Nov. 2023).
Consent may be given verbally by the participant.
SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 78. Updated Jan. 2023. (Accessed Nov. 2023).
Mental Health
An individual must voluntarily consent to telemental health services, which must be documented in the individual’s medical record.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05. (Accessed Nov. 2023).
Remote Patient Monitoring
The participant consents to remote patient monitoring services and has the capability to utilize the monitoring tools and take actions to improve self-management of the chronic disease.
SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.05(A)(2). (Accessed Nov. 2023).
Last updated 11/13/2023
Definitions
Recently Passed Legislation
“Telehealth” means the delivery of medically necessary somatic, dental, or behavioral health services to a patient at an originating site by a distant site provider through the use of technology–assisted communication.
“Telehealth” includes:
- Synchronous and asynchronous interactions;
- From July 1, 2021, to June 30, 2025, both inclusive, an audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service; and
- Remote patient monitoring services.
“Telehealth” does not include the provision of health care services solely through:
- Except as provided above, an audio–only telephone conversation;
- An e–mail message; or
- A facsimile transmission.
SOURCE: MD Health General Code 15-141.2(a)(7), as amended by HB 1148/SB 582/SB 534 (2023 Session). (Accessed Nov. 2023).
“Telehealth means the delivery of medically necessary somatic or behavioral health services to a patient at an originating site by distant site provider, through the use of technology-assisted communication.”
SOURCE: 2023 MD Medical Assistance Program Professional Services Provider Manual (Jan 2023)., p. 11. (Accessed Nov. 2023).
“Telehealth” means the synchronous delivery of medically necessary services to a patient at an originating site by distant site provider, through the use of technology-assisted communication.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.02. (Accessed Nov. 2023).
“Telehealth services means the delivery of health care services provided through the use of interactive audio, video, or other telecommunications or electronic technology by a health care provider at a hospital to a patient at a location other than at the hospital, or to a patient at the hospital where the provider is at a location other than the hospital, which enables the patient to interact with the health care provider at the time the health care services are provided.”
SOURCE: Code of Maryland Admin. Regs. Sec. 10.37.10.07-1. (Accessed Nov. 2023).
Hospitals
“Telemedicine” means the use of interactive audio, video, or other telecommunications or electronic technology by a physician in the practice of medicine outside the physical presence of the patient. “Telemedicine” does not include:
- An audio only telephone conversation between the physician and patient;
- An electronic mail message between a physician and a patient; or
- A facsimile transmission between a physician and a patient.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.07.01.01(B)(33). (Accessed Nov. 2023).
Individualized Education Program (IEP)/Individualized Family Service Plan (IFSP)
Telehealth – The delivery of medically necessary services to a patient at an originating site by distant site provider, through the use of technology-assisted communication.
SOURCE: MD Dept of Health, Medicaid Policy & Procedure Manual For Services Delivered through the IEP/IFSP (July 1, 2022). p. 6. (Accessed Nov. 2023).
Last updated 11/16/2023
Email, Phone & Fax
“Telehealth” includes, from July 1, 2021, to June 30, 2025, both inclusive, an audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service.
“Telehealth” does not include the provision of health care services solely through:
- Except as provided above, an audio–only telephone conversation;
- An e–mail message; or
- A facsimile transmission.
SOURCE: MD Health General Code 15-141.2, as amended by HB 1148/SB 582/SB 534 (2023 Session). (Accessed Nov. 2023).
Maryland Medicaid reimburses some covered services rendered via audio-only. Audio-only includes telephone conversations. Services rendered via audio-only are billed in the same manner as in-person services and must include the “UB” modifier. Reimbursement for services rendered via audio-only is program-specific. Please refer to specific program regulations or manuals for coverage of services rendered via audio-only.
For audio-only services, services rendered must be performed via technology that meets Technical Requirements of COMAR 10.09.49.05.
For services delivered via audio-only, providers may not bill:
- When technical difficulties prevent the delivery of all or part of the telehealth session;
- Services that require in-person evaluation or cannot be reasonably delivered via audio-only telehealth;
- Telecommunication between providers without the participant present;
- An electronic mail message between a provider and participant;
- A facsimile transmission between a provider and participant;
- A telephone conversation, electronic mail message, or facsimile transmission between the originating and distant site providers without direct interaction with the patient.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 1, 3-5. Updated Aug. 2023. (Accessed Nov. 2023).
To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service. Services delivered via telehealth using two-way audio-visual technology assisted communication should be billed using the “-GT” modifier. The use of audio-only telehealth services is permitted for services that can be fully and appropriately rendered with no video component. Any memorandum issued after the posting of this manual will supersede the guidance in this document.
SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 79-80. Updated Jan. 2023. (Accessed Nov. 2023).
A service delivered via telehealth does not include:
- An audio-only telephone conversation between a health care provider and a patient unless provided on dates of service between July 1, 2021, and June 30, 2025, inclusive;
- An electronic mail message between a health care provider and a patient;
- A facsimile transmission between a health care provider and a patient; or
- A telephone conversation, electronic mail message, or facsimile transmission between providers without direct interaction with the patient.
SOURCE: Code of Maryland Admin. Regs., Sec. 10.09.49.07, as proposed to be amended by Final Action (effective July 24 2023). (Accessed Nov. 2023).
Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) Services
MDH Will reimburse IEP and IFSP providers for certain procedure codes via telehealth. Providers must identify telehealth services on the child’s IEP/IFSP and bill using the appropriate modifier (GT or UB). Service coordination procedures (T1023, T1023-TG, T2022, W9322, W9323, and W9324) and individual psychotherapy services (90791, 90832 and 90834) may continue with an audio-only component. See Provider Transmittal for approved Maryland Medicaid Fee-for-Service approved IEP/IFSP Telehealth Services.
SOURCE: MD Medical Assistance Program. Early Intervention and School Health Service Providers Transmittal No. 3. Sept. 23, 2021. (Accessed Nov. 2023).
IEP Service Coordination may be rendered in person, in writing, by telephone or via telehealth.
SOURCE: MD Dept. of Health, Division of Children’s Services, Medicaid Policy & Procedure Manual, For Services Delivered Through the IEP/IFSP (July 1, 2022). p 13. (Accessed Nov. 2023).
Therapy Services (Physical Therapists, Occupational Therapists, Speech Therapists, Therapy Groups, EPSDT Providers, Managed Care Organizations)
MDH will reimburse providers for certain procedure codes when provided via audio-visual telehealth. MDH will not reimburse for services provided via an audio-only delivery model or for codes not included on the Provider Transmittal regarding approved therapy telehealth services when provided via any method of telehealth.
SOURCE: MD Medical Assistance Program. Guidance on the Continuation of Telehealth for Therapy Services. PT 09-22. Oct. 7, 2021. (Accessed Nov. 2023).
School-Based Health Centers (SBHCs)
When billing for services rendered via audio-video or audio-only modalities, SBHC sponsoring agencies must adhere to the following:
- Federal Rules (Clinic Services): SBHCs must adhere to federal Medicaid regulations governing clinics (42 CFR § 440.90 – Clinic Services). Medicaid may not reimburse SBHCs or other clinics if neither the practitioner nor patient is physically located within the clinic. This requirement applies to all freestanding clinics participating in the Maryland Medicaid program, regardless of whether they are community-based clinics or SBHCs.
- During the PHE, CMS granted MDH an 1135 waiver permitting services provided via telehealth from clinic practitioners’ homes (or another location) to be considered to be provided at the clinic for purposes of 42 C.F.R. § 440.90(a). Under this authority, SBHCs were permitted to receive Medicaid reimbursement for services rendered if both the practitioner and the patient are in their homes for the duration of the federal government’s declared public health emergency. The waiver has a retroactive effective date of March 1, 2020, and will terminate when the federal public health emergency ends on May 11, 2023
- Modifiers: When billing Medicaid or a HealthChoice MCO for an audio-video telehealth visit or an audio-only visit, sponsoring agencies should bill using the usual procedure code with the appropriate modifier.
- To bill for services delivered via two-way audio-visual telehealth technology assisted communication, providers must bill for the appropriate service code and use the “-GT” modifier.
- To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service.
- Place of Service (POS): SBHC sponsoring agencies should bill using the same POS code that would be appropriate for a non-telehealth claim.
- If conducting a telehealth visit with a student enrolled with a SBHC (or family member who is also enrolled) who would normally be eligible to receive in-person care at the SBHC, sponsoring agencies should use POS code 03 (School). Sponsoring agencies should use POS code 03 for such visits regardless of the physical location of the student.
- If a SBHC location adds or maintains telehealth services and wishes to use their telehealth service model to see patients they would not normally see (i.e., patients that are not associated with the student population), the sponsoring agency should not bill for the services as a SBHC. For such visits, sponsoring agencies should use POS code 11 (Office). Services to these recipients are not considered to be self-referred under COMAR 10.67.06.28. SBHCs should not use the 03 (School) POS when billing for services rendered to patients who would otherwise not be able to receive in-person care at the SBHC. MCOs also are not required to reimburse for such services if the sponsoring agency has not contracted with the MCO.
- SBHCs may NOT bill using the 02 (Telehealth) code in the POS field.
SOURCE: MD Medicaid Provider Transmittal 56-23 PHE Unwinding, May 30, 2023. (Accessed Nov. 2023).
Last updated 11/13/2023
Live Video
POLICY
Reimbursement for telehealth is required for services appropriately delivered through telehealth regardless of the location of the patient and may not exclude from coverage a health care service or behavioral health service solely because it is through telehealth.
SOURCE: MD Health General Code 15-141.2 (Accessed Nov. 2023).
Maryland Medicaid reimburses providers for services delivered via synchronous telehealth. Synchronous telehealth is defined as real-time interactive communication between the originating and distant sites via a secure, two-way audiovisual telecommunication system, and for some services audio-only, depending on the program.
The “distant site,” is the location of the provider who will perform the services. The “distant site provider” is the rendering practitioner that is not physically present at the originating site.
The “originating site” is where the participant/patient is located.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 1. Updated Aug. 2023. (Accessed Nov. 2023).
Mental Health
The Department shall grant approval to a telemental health provider to be eligible to receive State or federal funds for providing interactive telemental health services if the provider meets requirements of this chapter and for outpatient mental health centers; or if the telemental heath provider is an individual psychiatrist.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.03. (Accessed Nov. 2023).
Managed Care
MCOs shall provide coverage for medically necessary telemedicine services.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.67.06.31. (Accessed Nov. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Services provided through telehealth are subject to the same program restrictions, preauthorizations, limitations and coverage that exist for the service when provided in-person.
A provider may receive reimbursement for services delivered via telehealth if the participant:
- Consents to service rendered via telehealth (unless there is an emergency that prevents obtaining consent, which shall be documented in the participant’s medical record); and,
- Is authorized to receive services, except for services provided in a hospital emergency department
Providers must include the “GT” modifier with the billed procedure code to identify services rendered via audio-video telehealth.
Providers should use the place of service code that would be appropriate as if it were a non-telehealth claim. The billing provider should use the location of the rendering practitioner. If a distant site provider is rendering services at an off-site office, use the place of service office (11). Do not use place of service codes 02 (Telehealth-Other than home) and 10 (Telehealth-Home) for Medicaid-only FFS claims. Medicare Crossover Claims: For Medicare crossover claims, billing providers should use the same Place of Service Code as on the Medicare claim submission: 02 (Telehealth-Other than home) and 10 (Telehealth-Home) are permitted for use on crossover claims only.
For services delivered via audio-visual telehealth, a provider may not bill:
- When technical difficulties prevent the delivery of all or part of the telehealth session;
- Services that require in-person evaluation or cannot be reasonably delivered via telehealth;
-
Telecommunication between providers without the participant present
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 1-3. Updated Aug. 2023. (Accessed Nov. 2023).
Mental Health Eligible Services:
- Diagnostic interview;
- Individual therapy
- Family therapy
- Group therapy, up to 8 individuals
- Outpatient evaluation and management
- Outpatient office consultation
- Initial inpatient consultation
- Emergency department services
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.09. (Accessed Nov. 2023).
Services required to be provided shall include counseling and treatment for substance use disorders and mental health conditions. The Program may not exclude from coverage a behavioral health care service provided to a Program recipient in person solely because the service may also be provided through telehealth.
The Program may undertake utilization review, including preauthorization, to determine the appropriateness of any health care service whether the service is delivered through an in–person consultation or through telehealth if the appropriateness of the health care service is determined in the same manner.
For the purpose of reimbursement and any fidelity standards established by the Department, a health care service provided through telehealth is equivalent to the same health care service when provided through an in–person consultation.
SOURCE: MD General Health Code 15-141.2(c-e, h). (Accessed Nov. 2023).
Doula Services
Prenatal and postpartum services may be delivered in the home, at the provider’s office or doctor’s office and other community-based settings. Doula services for prenatal and postpartum visits may be delivered in-person or as a telehealth service. The labor and delivery service must be provided in-person and can only be delivered at a hospital or freestanding birthing center.
The Maryland Medical Assistance Program will not cover Doula services rendered during labor and delivery as a telehealth visit.
SOURCE: MD Medicaid Doula Services Program Manual, p. 3, 5. Updated Dec. 13, 2022. (Accessed Nov. 2023).
Effective January 1, 2022, the Program covers doula services as defined in Regulation .01 of this chapter when the services:
- Are medically necessary;
- Are rendered during a birthing parent’s prenatal period, labor and delivery, and postpartum period; and
- If rendered via telehealth, comply with the requirements established in COMAR 10.09.49 and any other subregulatory guidance.
B. The Program shall cover up to:
- Eight prenatal or postpartum visits; and
- One labor and delivery service.
SOURCE: Code of Maryland Admin Regs. 10.09.39.04 (Accessed Nov. 2023).
Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) Services
MDH Will reimburse IEP and IFSP providers for certain procedure codes via telehealth. Providers must identify telehealth services on the child’s IEP/IFSP and bill using the appropriate modifier (GT or UB). Service coordination procedures (T1023, T1023-TG, T2022, W9322, W9323, and W9324) and individual psychotherapy services (90791, 90832 and 90834) may continue with an audio-only component. In addition to IEP/IFSP services, MDH will continue to reimburse Autism Waiver service coordination when provided via telehealth. See Provider Transmittal for approved Maryland Medicaid Fee-for-Service approved IEP/IFSP Telehealth Services.
SOURCE: MD Medical Assistance Program. Early Intervention and School Health Service Providers Transmittal No. 3. Sept. 23, 2021. (Accessed Nov. 2023).
GT Modifier required for telehealth delivered services.
SOURCE: MD Dept of Health, Medicaid Policy & Procedure Manual For Services Delivered through the IEP/IFSP (July 1, 2022). p. 25. (Accessed Nov. 2023).
Therapy Services (Physical Therapists, Occupational Therapists, Speech Therapists, Therapy Groups, EPSDT Providers, Managed Care Organizations)
MDH will reimburse providers for certain procedure codes when provided via audio-visual telehealth. Services must be identified and billed using the GT modifier to indicate a telehealth delivery model. MDH will not reimburse for services provided via an audio-only delivery model or for codes not included on the Provider Transmittal regarding approved therapy telehealth services when provided via any method of telehealth.
SOURCE: MD Medical Assistance Program. Guidance on the Continuation of Telehealth for Therapy Services. PT 09-22. Oct. 7, 2021. MD Dept of Health, Audiology, Physical Therapy, and Early Periodic, Screening, Diagnosis, and Treatment (EPSDT) Provider Manual (Jan. 2023). (Accessed Nov. 2023).
Applied Behavior Analysis (ABA) Services
Maryland Medicaid reimburses for certain procedure codes via audio-visual telehealth for ABA providers. ABA providers may continue to render up to 100% of supervision services (97155) via telehealth. When billing for services that are rendered via two-way HIPAA compliant audio-visual telehealth, providers must bill using the GT modifier and Place of Service 11 to indicate a telehealth delivery model.
SOURCE: MD Medical Assistance Program. Guidance on the Continuation of Telehealth for ABA Services. PT 11-22. Oct. 26 2021. (Accessed Nov. 2023).
Dental Services
Coverage for teledentistry as described in previous guidance will continue to be permitted after the end of the PHE. See list of procedure codes in PT 56-23 PHE Unwinding for teledentistry. Services delivered via telehealth using two way audio- visual technology assisted communication should be billed using the Place of Service “02” to indicate use of telecommunication technology. For these services, audio-only or telephonic services are not reimbursable. This code does not require prior authorization from Maryland Medicaid.
SBHC Services
When billing for services rendered via audio-video or audio-only modalities, SBHC sponsoring agencies must adhere to the following:
- Federal Rules (Clinic Services): SBHCs must adhere to federal Medicaid regulations governing clinics (42 CFR § 440.90 – Clinic Services). Medicaid may not reimburse SBHCs or other clinics if neither the practitioner nor patient is physically located within the clinic. This requirement applies to all freestanding clinics participating in the Maryland Medicaid program, regardless of whether they are community-based clinics or SBHCs.
- During the PHE, CMS granted MDH an 1135 waiver permitting services provided via telehealth from clinic practitioners’ homes (or another location) to be considered to be provided at the clinic for purposes of 42 C.F.R. § 440.90(a). Under this authority, SBHCs were permitted to receive Medicaid reimbursement for services rendered if both the practitioner and the patient are in their homes for the duration of the federal government’s declared public health emergency. The waiver has a retroactive effective date of March 1, 2020, and will terminate when the federal public health emergency ends on May 11, 2023
- Modifiers: When billing Medicaid or a HealthChoice MCO for an audio-video telehealth visit or an audio-only visit, sponsoring agencies should bill using the usual procedure code with the appropriate modifier.
- To bill for services delivered via two-way audio-visual telehealth technology assisted communication, providers must bill for the appropriate service code and use the “-GT” modifier.
- To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service.
-
Place of Service (POS): SBHC sponsoring agencies should bill using the same POS code that would be appropriate for a non-telehealth claim.
- If conducting a telehealth visit with a student enrolled with a SBHC (or family member who is also enrolled) who would normally be eligible to receive in-person care at the SBHC, sponsoring agencies should use POS code 03 (School). Sponsoring agencies should use POS code 03 for such visits regardless of the physical location of the student.
- If a SBHC location adds or maintains telehealth services and wishes to use their telehealth service model to see patients they would not normally see (i.e., patients that are not associated with the student population), the sponsoring agency should not bill for the services as a SBHC. For such visits, sponsoring agencies should use POS code 11 (Office). Services to these recipients are not considered to be self-referred under COMAR 10.67.06.28. SBHCs should not use the 03 (School) POS when billing for services rendered to patients who would otherwise not be able to receive in-person care at the SBHC. MCOs also are not required to reimburse for such services if the sponsoring agency has not contracted with the MCO.
- SBHCs may NOT bill using the 02 (Telehealth) code in the POS field.
Well-Child Visits
Coverage for well-child visits delivered via telehealth as described in previous guidance will continue to be permitted after the end of the PHE. This guidance does not apply to sick visits or chronic care appointments. See PT 56-23 PHE Unwinding for additional information and eligible codes.
SOURCE: MD Medicaid Provider Transmittal 56-23 PHE Unwinding, May 30, 2023. (Accessed Nov. 2023).
Long Term Services and Supports
On December 22, 2021, via Provider Transmittal 27-22, the Maryland Department of Health (MDH), Medicaid Office of Long Term Services and Supports, authorized the continuation of reimbursement to providers for services determined to be clinically appropriate for delivery via telehealth. Effective July 1, 2023, the following services, which were previously authorized to be completed via telehealth, may no longer be provided in this manner and the MDH will not reimburse providers for these services delivered via telehealth:
- Registered Nurse Supervisory Visits (Staff training and supervision)
- Initial and significant change assessments (Private duty nursing)
- Personal Assistance Services
- Certain case management services
As previously discussed, effective July 1, 2023, the following services may continue to be provided via telehealth, MDH will reimburse providers for services delivered via telehealth below:
- Model Waiver Case Management (when authorized by the Division of Nursing Services (DONS))
- Psychological and psychiatric evaluations
- Participant and family consultation
- Certain case managment services and nurse monitoring
See PT 11-24 and 58-23 for additional details.
SOURCE: MD Medicaid Provider Transmittal 11-24 Discontinuation of Telehealth for Certain Services, Jul. 10, 2023 & MD Medicaid Provider Transmittal 58-23 Discontinuation of Telehealth for Certain Services, Jun. 7, 2023. (Accessed Nov. 2023).
ELIGIBLE PROVIDERS
“Health care provider” means:
- A person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program;
- A mental health and substance use disorder program licensed in accordance with § 7.5–401 of this article;
- A person licensed under Title 7, Subtitle 9 of this article to provide services to an individual with developmental disability or a recipient of individual support services; or
- A provider as defined under § 16–201.4 of this article to provide services to an individual receiving long–term care services.
SOURCE: MD General Health Code 15-141.2(a)(4). (Accessed Nov. 2023).
The Program shall reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth. This subsection does not require the Program to reimburse a health care provider for a health care service delivered in person or through telehealth that is:
- Not a covered health care service under the Program; or
- Delivered by an out–of–network provider unless the health care service is a self–referred service authorized under the Program.
From July 1, 2021, to June 30, 2025, both inclusive, when appropriately provided through telehealth, the Program shall provide reimbursement on the same basis and the same rate as if the health care service were delivered by the health care provider in person. Reimbursement does not include:
- Clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or
- Any room and board fees.
The Department may specify in regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this section. If the Department specifies by regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this subsection, the regulations shall include all types of health care providers that appropriately provide telehealth services.
The Program or a managed care organization that participates in the Program may not impose as a condition of reimbursement of a covered health care service delivered through telehealth that the health care service be provided by a third–party vendor designated by the Program.
The Department may adopt regulations to carry out this section. The Department shall obtain any federal authority necessary to implement the requirements of this section, including applying to the Centers for Medicare and Medicaid Services for an amendment to any of the State’s § 1115 waivers or the State plan. This section may not be construed to supersede the authority of the Health Services Cost Review Commission to set the appropriate rates for hospitals, including setting the hospital facility fee for hospital–provided telehealth.
SOURCE: MD General Health Code 15-141.2(g-l), as amended by HB 1148/SB 582/SB 534 (2023 Session). (Accessed Nov. 2023).
All distant site providers enrolled in Maryland Medicaid may provide services via telehealth if telehealth is a permitted delivery model within the rendering provider’s scope of practice.
For participants physically located in Maryland, Maryland Health Professional Licensing Boards set licensure requirements. Providers should consult licensing boards (in both originating and distant site states, if applicable) prior to rendering services via telehealth to verify governing authority over licensure, as well as for information about the permitted use of telehealth as a service modality.
Providers delivering services via telehealth must use technology that supports the standard level of care required to deliver the service rendered.
Providers delivering services via telehealth submit claims in the same manner the provider uses for in-person services.
For audio-visual telehealth, services rendered must be performed via technology that is HIPAA compliant and meets Technical Requirements of COMAR 10.09.49.05.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 2-3. Updated Aug. 2023. (Accessed Nov. 2023).
Distant Site Providers may render services via telehealth within the provider’s scope of practice.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.04(E). (Accessed Nov. 2023).
Mental Health
Eligible Providers:
- Outpatient mental health centers
- Telemental health providers who are individual psychiatrists.
Telemental health providers may be private practice, part of a hospital, academic, health or mental health care system. Public Mental Health System (PMHS) approved community-based providers or individual practitioners may engage in agreements with TMH providers for services. Fee-for-service reimbursement shall be at an enhanced rate, as stipulated by the Department, provided all applicable provisions of this chapter are met and funds are available.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.03 & Sec. 10.21.30.04. (Accessed Nov. 2023).
ELIGIBLE SITES
The Program shall provide health care services appropriately delivered through telehealth to Program recipients regardless of the location of the Program recipient at the time telehealth services are provided and allow a distant site provider to provide health care services to a Program recipient from any location at which the health care services may be appropriately delivered through telehealth.
SOURCE: MD General Health Code 15-141.2(b). (Accessed Nov. 2023).
The originating site may be any secure location, approved by the participant and the provider, for the delivery of services. All distant site providers enrolled in Maryland Medicaid may provide services via telehealth if telehealth is a permitted delivery model within the rendering provider’s scope of practice.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 2. Updated Aug. 2023. (Accessed Nov. 2023).
Mental Health
Eligible Originating Sites:
- County government offices appropriate for private clinical evaluation services;
- Critical Access Hospital;
- Federally Qualified Health Center;
- Hospital;
- Outpatient mental health center;
- Physician’s office;
- Rural Health Clinic;
- Elementary, middle, high, or technical school with a supported nursing, counseling or medical office; or
- College or university student health or counseling office.
Distant Site Location Eligibility – An approved distant TMH location shall be within the State.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05. (Accessed Nov. 2023).
Providers should use the place of service code that would be appropriate as if it were a non-telehealth claim. The distant site should use the location of the doctor. If a distant site provider is rendering services at an off-site office, use place of service office (11). Place of Service Code 02 (Telehealth) is not recognized for Maryland Medicaid participants except for use on Medicare crossover claims to specify services rendered through a telecommunication system for dual eligible participants. Allowable place of service codes should remain unchanged for Medicaid-only claims.
The Program recognizes specific modifiers for certain services rendered via telehealth delivery models; providers may bill using -GT and -UB. Providers should submit claims in the same manner as for in-person services and include the “-GT” modifier to identify that services were rendered via two-way audio-visual telehealth. To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service. Billing with these modifiers will not affect Medicaid reimbursement rates.
SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 24-25, 78. Updated Jan. 2023. (Accessed Nov. 2023).
GEOGRAPHIC LIMITS
The Program may not distinguish between Program recipients in rural or urban locations in providing coverage under the Program for health care services delivered through telehealth.
SOURCE: MD General Health Code 15-141.2(f). (Accessed Nov. 2023).
The telehealth care delivery model serves Medicaid participants regardless of geographic location.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 1. Updated Aug. 2023. (Accessed Nov. 2023).
Mental Health
To be eligible a beneficiary must reside in one of the designated rural geographic areas or whose situation makes person-to-person psychiatric services unavailable.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05(A)(3). (Accessed Nov. 2023).
FACILITY/TRANSMISSION FEE
From July 1, 2021, to June 30, 2025, when appropriately provided through telehealth, the Program shall provide reimbursement in accordance on the same basis and the same rate as if the health care service were delivered by the health care provider in person. Reimbursement does not include:
- Clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or
- Any room and board fees.
The Department may adopt regulations to carry out this section.
SOURCE: MD Health General Code 15-141.2 (g)(3),(h), as amended by HB 1148/SB 582/SB 534 (2023 Session). (Accessed Nov. 2023).
A provider eligible to bill a professional fee for a health care service shall bill a professional fee for the health care service instead of a clinic facility fee.
SOURCE: Code of Maryland Admin. 10.09.49.07 (Accessed Nov. 2023).
Hospital Billing Instructions
Facility charges related to the use of telemedicine services. This revenue code is listed as not payable.
SOURCE: Maryland Dept. of Health Medical Assistance, UB04 Hospital Billing Instructions, 6/2023, p. 96 (Accessed Nov. 2023).
Last updated 11/16/2023
Miscellaneous
Technical Requirements
Providers delivering services via telehealth must use technology that supports the standard level of care required to deliver the service rendered. A service delivered via synchronous audio-visual telehealth shall, at a minimum, meet the following technology requirements:
- Cameras at both the originating and distant sites that provide clear, synchronous video of the patient and provider, respectively, with the ability to meet the clinical requirements of the service;
- Have display monitor size sufficient to support diagnostic needs used in the service via telehealth;
- Network connectivity and bandwidth at both the originating and distant site sufficient to provide clear, synchronous two-way video and audio for the full duration of the service;
- Unless engaging in a telehealth communication with a participant who is deaf or hard of hearing, microphones and speakers at both the originating and distant sites, respectively, that provide clear, synchronous, two-way audio transmission;
- Utilize technology that meets the standards required by state and federal laws governing the privacy and security of protected health information (HIPAA compliant).
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 2-3. Updated Aug. 2023; COMAR 10.09.49.05. (Accessed Nov. 2023).
A dedicated connection that provides bandwidth only for telehealth communications is preferable for services delivered via telehealth.
All technical staff should be trained to use telehealth technology and in HIPAA Compliance.
Please review Maryland Medicaid’s FAQs for additional technological and HIPAA compliance questions.
For audio-visual telehealth, services rendered must be performed via technology that is HIPAA compliant and meets Technical Requirements of COMAR 10.09.49.05.
For audio-only services, services rendered must be performed via technology that meets Technical Requirements of COMAR 10.09.49.05.
Confidentiality
Providers must comply with the laws and regulations concerning the privacy and security of protected health information including but not limited to Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland and the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Particularly, providers:
- Shall ensure that all interactive video technology-assisted communication and audio-only communication comply with HIPAA patient privacy and security regulations throughout the transmission process;
- May not disseminate any participant images or information to other entities without the participant’s consent, unless there is an emergency that prevents obtaining consent; and,
- May not store the video images or audio portion of the service rendered via telehealth for future use.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 3-4. 8. Updated Aug. 2023, COMAR 10.09.49.06. (Accessed Nov. 2023).
Medical Records
Providers must maintain documentation in the same manner as during an in-person visit or consultation, using either electronic or paper medical records, per the Health-General Article, §4-403, Annotated Code of Maryland. Participants shall have access to all transmitted medical information. Providers may not store the video images or audio portion of the service delivered via telehealth for future use.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 4. Updated Aug. 2023. (Accessed Nov. 2023).
Medical Record Documentation
The provider shall:
- Maintain documentation in the same manner as during an in-person visit, using either electronic or paper medical records;
- Retain telehealth records according to the provisions of Health-General Article, §4-403, Annotated Code of Maryland; and
- Include the participant’s consent to participate in telehealth or an explanation as to why consent was not available.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.04. (Accessed Nov. 2023).
In consultation with interested stakeholders, the Director shall prepare an annual report on behavioral health services for children and young adults in the State. The report shall include: The number and the percentage of children and young adults who, during the reported year: … Used a public behavioral health service provided through telehealth.
SOURCE: MD Health General Code 7.5-209. (Accessed Nov. 2023).
The Maryland Health Services Cost Review Commission, the Maryland Department of Health, and the Maryland Insurance Administration, shall submit a report to the Senate Finance Committee and the House Health and Government Operations Committee on the impact of providing telehealth services. The Maryland Health Care Commission shall consider both audio–only and audio–visual technologies for purposes of reporting on the impact of providing telehealth services as required by this section.
Until and no later than June 30, 2023, while the Maryland Health Care Commission completes the study and submits the report for consideration by the General Assembly for the adoption of comprehensive telehealth policies by the State:
- The Maryland Medical Assistance Program is to continue to reimburse health care providers for covered health care services provided through audio–only and audio–visual technology in accordance with the requirements of Section 1 of this Act, and all applicable executive orders and waivers issued in accordance with Chapters 13 and 14 of the Acts of the General Assembly of 2020
- Insurers, nonprofit health service plans, and health maintenance organizations that are subject to § 15–139 of the Insurance Article as enacted by Section 1 of this Act continue to reimburse health care providers for covered health care services provided through audio–only and audio–visual technology in accordance with the requirements of Section 1 of this Act and all applicable accommodations made by the insurers, nonprofit health service plans, and health maintenance organizations during the Declaration of State of Emergency and Existence of Catastrophic Health Emergency – COVID–19 issued on March 5, 2020, and its renewals
The Maryland Health Care Commission should use the data collected from utilization and coverage of telehealth to complete the report.
The State is to use the report required to establish comprehensive telehealth policies for implementation after the Declaration of State of Emergency and Existence of Catastrophic Health Emergency – COVID–19 issued on March 5, 2020, and its renewals expire.
SOURCE: HB 123/SB 3 (2021 Session). (Accessed Nov. 2023).
The Maryland Health Care Commission shall study and make recommendations regarding the delivery of health care services through telehealth, including payment parity for the delivery of health care services through audiovisual and audio–only telehealth technologies. In conducting the study, the Maryland Health Care Commission shall:
- Determine whether it is more or less costly for health care providers to deliver health care services through telehealth;
- Determine whether the delivery of health care services through telehealth requires more or less clinical effort on the part of the health care provider;
- To help inform the debate on payment parity, identify the aspects of telehealth that are subject to overuse or underuse or yield greater or lower value;
- Assess the adequacy of reimbursement for behavioral health services delivered in person and by telehealth; and
- Address any other issues related to telehealth as determined necessary by the Commission.
On or before December 1, 2024, the Maryland Health Care Commission shall submit a report on its findings and recommendations to the General Assembly, in accordance with § 2–1257 of the State Government Article.
SOURCE: HB 1148/SB 582/SB 534 (2023 Session). (Accessed Nov. 2023).
Last updated 11/16/2023
Out of State Providers
Licensure requirements, including for telehealth practice, are determined by the state’s health care professional licensing boards. Maryland Medicaid does not further restrict telehealth practice or reimbursement beyond rules determined by the Health Occupations Code, and professional licensing board regulations.
For all scope of practice questions, including whether telehealth visits are permitted when a patient is outside the state where the practitioner is physically located, practitioners should contact their licensing board or credentialing authority to determine if rendering services via telehealth is a permitted modality of care and what limitations on telehealth may exist. Note that it may be necessary to consult the relevant licensing board of the foreign state.
Providers who are licensed, certified, or otherwise authorized and who are enrolled in Maryland Medicaid may provide services via telehealth as long as telehealth is a permitted delivery model within the rendering provider’s scope of practice. Providers should consult their licensing board prior to rendering services via telehealth.
A distant site may be any location where a licensed, certified, or otherwise authorized provider is located when rendering a service using technology-assisted communication.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 5-7. Updated Aug. 2023. (Accessed Nov. 2023).
To receive reimbursement for services delivered via telehealth, a provider shall:
- Be actively enrolled with Maryland Medical Assistance on the date the service is rendered; and
- Comply with payment procedures as set forth in COMAR 10.09.36.
Distant Site Reimbursement.
- The distant site provider shall be reimbursed as set forth in the COMAR chapter defining the covered service being rendered.
- Services delivered via telehealth shall be billed with the telehealth GT modifier.
- Services delivered via telehealth shall be within the provider’s scope of practice as determined by its governing licensure or credentialing board.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.08. (Accessed Nov. 2023).
“Health care provider” means a person who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care in the ordinary course of business or practice of a profession or in an approved education or training program.
SOURCE: MD Health General Code Sec. 15-141.2(a)(4)(i). (Accessed Nov. 2023).
Last updated 11/13/2023
Overview
Maryland Medicaid covers live video synchronous telehealth, asynchronous telehealth, and remote patient monitoring modalities. Until June 30, 2025, legislation also requires coverage of audio-only and telehealth reimbursement parity. See Provider Telehealth website for MD Medicaid overview.
Last updated 11/16/2023
Remote Patient Monitoring
POLICY
Remote patient monitoring services means the use of synchronous or asynchronous digital technologies that collect or monitor medical, patient–reported, and other forms of health care data for Program recipients at an originating site and electronically transmit that data to a distant site provider to enable the distant site provider to assess, diagnose, consult, treat, educate, provide care management, suggest self–management, or make recommendations regarding the Program recipient’s health care.
SOURCE: MD Health General Code 15-141.2; Code of Maryland Admin. Regs., Sec. 10.09.96.02(B)(14). (Accessed Nov. 2023).
RPM is a service which uses digital technologies to collect medical and other forms of health data from individuals and electronically transmits that information securely to health care providers for assessment, recommendations, and interventions.
Existing MD Medicaid guidance and regulation limits reimbursement for remote patient monitoring to certain chronic conditions. Preauthorization requirements also apply.
SOURCE: Remote Patient Monitoring. MD Department of Health. (Accessed Nov. 2023).
Effective January 1, 2018, Maryland Medicaid covers remote patient monitoring. Please refer to COMAR 10.09.96 Remote Patient Monitoring for more information and resources for Remote Patient Monitoring: https://health.maryland.gov/mmcp/Pages/RPM.aspx.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 5. Updated Aug. 2023. (Accessed Nov. 2023).
Covered Services
Remote patient monitoring services include:
- Installation;
- Education for the participant in the use of the equipment; and
- Daily monitoring of vital signs and other medical statistics.
The remote patient monitoring provider shall establish an intervention process to address abnormal data measurements in an effort to prevent avoidable hospital utilization.
Physician, nurse practitioner, and physician assistant providers who establish remote patient monitoring programs shall be responsible for:
- Establishing criteria for reporting abnormal measurements;
- Informing the participant of abnormal results; and
- Monitoring results and improvements in patient’s ability to self-manage chronic conditions.
Medical interventions by a physician, nurse practitioner, or physician assistant based on abnormal results shall be reimbursed according to COMAR 10.09.02.07.
A home health agency shall:
- Have an order by a physician, physician assistant, certified nurse midwife, or certified nurse practitioner who has examined the patient and with whom the patient has an established, documented and ongoing relationship;
- Report abnormal measurements to the participant and to the ordering provider; and
- Send the ordering provider a weekly summary of monitoring results, including improvement in patient’s ability to self-manage chronic conditions.
SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.06. (Accessed Nov. 2023).
CONDITIONS
Telehealth definition includes remote patient monitoring. The Program is required to reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth regardless of patient and provider location.
From July 1, 2021, to June 30, 2025, when appropriately provided through telehealth, the Program shall provide reimbursement in accordance on the same basis and the same rate as if the health care service were delivered by the health care provider in person. Reimbursement does not include:
- Clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or
- Any room and board fees.
The Department may adopt regulations to carry out this section.
SOURCE: MD Health General Code 15-141.2 (a-b, h), as amended by HB 1148/SB 582/SB 534 (2023 Session). (Accessed Nov. 2023).
Existing guidance states Medicaid recipients diagnosed with one of the following conditions qualify:
- Chronic Obstructive Pulmonary Disease
- Congestive Heart Failure
- Diabetes (Type 1 or 2)
The participant must be enrolled in Medicaid, consent to RPM, have an internet connection and capability to use monitoring tools and have one of the following scenarios within the most recent 12-month period:
- Two hospital admissions with the same qualifying medical condition as the primary diagnosis
- Two emergency room department visits with the same qualifying medical condition as the primary diagnosis
- One hospital admission and one emergency department visit with the same qualifying medical condition as the primary diagnosis.
SOURCE: MD Home Health Transmittal No. 64. Jan. 10, 2018. MD General Provider Transmittal No. 85. Feb. 12, 2018, MD Remote Patient Monitoring Transmittal No. 1, Jan 10, 2018. (Accessed Nov. 2023).
A participant is eligible to receive remote patient monitoring services if:
- The participant is enrolled in the Maryland Medical Assistance Program on the date the service is rendered;
- The participant consents to remote patient monitoring services and has the capability to utilize the monitoring tools and take actions to improve self-management of the chronic disease;
- The participant has the internet connections necessary to host the equipment in the home;
- The participant is at risk for avoidable hospital utilization due to a poorly controlled chronic disease capable of being monitored via remote patient monitoring; and
- The provision of remote patient monitoring may reduce the risk of preventable hospital utilization and promote improvement in control of the chronic condition.
SOURCE: Code of Maryland Admin Regs., Sec. 10.09.96.05. (Accessed Nov. 2023).
An MCO shall provide its enrollees medically necessary remote patient monitoring services as described in COMAR 10.09.96.
SOURCE: Code of Maryland Admin Regs., Sec. 10.67.06.26-5. (Accessed Nov. 2023).
PROVIDER LIMITATIONS
The Department may specify in regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients via telehealth. If the Department specifies by regulation the types of health care providers eligible to receive reimbursement for health care services provided to Program recipients under this subsection, the regulations shall include all types of health care providers that appropriately provide telehealth services.
The Program is not required to reimburse a health care provider for a health care service delivered in person or through telehealth that is:
- Not a covered health care service under the Program; or
- Delivered by an out–of–network provider unless the health care service is a self–referred service authorized under the Program.
SOURCE: MD General Health Code 15-141.2(g-h). (Accessed Nov. 2023).
Eligible Providers:
- Home Health Agencies
- Hospitals
- Clinics
- Federally Qualified Health Centers
- Managed Care Organizations
- Health Professionals (Physicians, Nurses, Physician Assistants)
SOURCE: Remote Patient Monitoring. MD Department of Health. (Accessed Nov. 2023).
Remote patient monitoring is not a substitute for delivery of care. Provider shall see patients in person periodically for follow-up care. To provide remote patient monitoring, the provider shall be enrolled with an active status as a Maryland Medical Assistance Program provider on the date the service is rendered and be a:
- Physician;
- Physician assistant;
- Certified nurse practitioner; or
- Home health agency when remote patient monitoring services are prescribed by a physician; and
- Meet the requirements for participation in the Medical Assistance Program as set forth in COMAR 10.09.36.03.
Medical Record Documentation. A remote patient monitoring provider shall:
- Maintain documentation using either electronic or paper medical records;
- Retain remote patient monitoring records according to the provisions of Health-General Article, §4-403, Annotated Code of Maryland;
- Submit the preauthorization on a form developed by the Department; and
- Include the participant’s consent to participate in remote patient monitoring.
SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.04. (Accessed Nov. 2023).
Home health agencies may only be reimbursed for remote patient monitoring when the service is ordered by a physician.
SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.07. (Accessed Nov. 2023).
OTHER RESTRICTIONS
The Department may preauthorize services when the provider submits to the Department adequate documentation demonstrating the:
- Participant’s condition meets the criteria listed in Regulation .05 of this chapter; and
- Participant has not already been preauthorized for two episodes during the past rolling calendar year.
The RPM reimbursement rate is an all-inclusive rate of $125 per 30 days of monitoring which covers equipment installation, participant education for using the equipment, and daily monitoring of the information transmitted for abnormal data measurements.
Reimbursement does not include RPM equipment, upgrades to RPM equipment or internet service for participants.
The Program does not cover more than:
- 2 months of remote patient monitoring services per episode; and
- Two episodes per year per participant.
SOURCE: MD Home Health Transmittal No. 64. Jan. 10, 2018., Code of Maryland Admin Regs, Sec. 10.09.96.06, Sec. 10.09.96.07, Sec. 10.09.96.08. (Accessed Nov. 2023).
Last updated 11/13/2023
Store and Forward
POLICY
Recently Passed Legislation
Telehealth definition includes both synchronous and asynchronous interactions. The Program is required to reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth regardless of patient and provider location.
From July 1, 2021, to June 30, 2025, when appropriately provided through telehealth, the Program shall provide reimbursement in accordance on the same basis and the same rate as if the health care service were delivered by the health care provider in person.
The Department may adopt regulations to carry out this section.
SOURCE: MD Health General Code 15-141.2 (a-b, g, j), as amended by HB 1148/SB 582/SB 534 (2023 Session). (Accessed Nov. 2023).
According to the Maryland Medicaid Synchronous Telehealth Policy Guide, store and forward technology means the transmission of medical images or other media captured by the originating site provider and sent electronically to a distant site provider, who does not physically interact with the patient located at the originating site. The Guide states that it is not billable as a synchronous telehealth service, but is covered for dermatology, ophthalmology, or radiology services under Physician Services in COMAR 10.09.02.07.
SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 3-4. Updated Aug. 2023. (Accessed Nov. 2023).
ELIGIBLE SERVICES/SPECIALTIES
MD regulations state store and forward technology does not meet the Maryland Medical Assistance Program’s definition of telehealth. However, dermatology, ophthalmology and radiology are excluded from definition of store-and-forward and they do reimburse for these services according to COMAR 10.09.02.07.
SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.02; 10.09.49.07 (Accessed Nov. 2023).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
