Last updated 09/05/2023
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POLICY
The Michigan Department of Health and Human Services (MDHHS) covers both synchronous (real-time interactions) and asynchronous (over separate periods of time) telemedicine services. MDHHS requires that all telemedicine policy provisions within this policy and other current policy are established and maintained within all telemedicine services.
Recognizing that telemedicine can never fully replace in-person care, MDHHS has established the following principles to be used by MDHHS-enrolled providers during the provision of telemedicine services:
- Effectual services – a service provided via telemedicine should be as effective as its in-person equivalent, ensuring convenient and high-quality care.
- Improved and appropriate access – the right visit, for the right beneficiary, at the right time by minimizing the impact of barriers to care, such as transportation needs or availability of specialty providers in rural areas.
- Appropriate beneficiary choice – the beneficiary is an active participant in the decision for telemedicine as a means for service delivery as appropriate (e.g., Does the beneficiary prefer telemedicine to an in-person visit? What is the optimal combination of ongoing service delivery for the individual? etc.).
- Appropriate utilization – ensure providers are utilizing telemedicine appropriately and that items listed above are taken into consideration when offering these services.
- Value considerations – telemedicine visits should yield the desired outcomes and quality measures; health outcomes should be improving and remain consistent with in-person care at a minimum.
- Privacy and security measures – providers must ensure the privacy of the beneficiary and the security of any information shared via telemedicine in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other privacy/security regulations as applicable.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2114-2115 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023. (Accessed Sept. 2023).
The reimbursement rate for allowable telemedicine services will be the same (also known as “at parity”) as in-person services. This means that all providers will be paid the equivalent amount, no matter the physical location of the beneficiary during the visit. To effectuate this policy, the provider must report the place of service as they would if they were providing the service in-person. See the “Telemedicine Billing Requirements” section of this policy for further details.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2120 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Targeted Case Management Services for Recently Incarcerated Beneficiaries
Accessing Services Via In-Reach – The in-reach visit is to be provided face-to-face. Face-to-face is defined as either in-person or via telehealth (i.e., simultaneous audio and visual technology).
SOURCE: MI Bulletin MMP 23-37, Targeted Case Management Services for Recently Incarcerated Beneficiaries, July 1, 2023, (Accessed Sept. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Telemedicine must only be utilized when there is a clinical benefit to the beneficiary. Examples of clinical benefit include:
- Ability to diagnose a medical condition in a beneficiary population without access to clinically appropriate in-person diagnostic services.
- Treatment option for a beneficiary population without access to clinically appropriate in-person treatment options.
- Decreased rate of subsequent diagnostic or therapeutic interventions (for example, due to reduced rate of recurrence of the disease process).
- Decreased number of future hospitalizations or physician visits.
- More rapid beneficial resolution of the disease process treatment.
- Decreased pain, bleeding, or another quantifiable symptom.
Furthermore, telemedicine must only be utilized when the beneficiary’s goals for the visit can be adequately accomplished, there exists reasonable certainty of the beneficiary’s ability to effectively utilize the technology, and the beneficiary’s comfort with the nature of the visit is ensured. Telemedicine must be used as appropriate regarding the best interests/preferences of the beneficiary and not merely for provider ease. Appropriate guidance must be provided to the beneficiary to ensure they are prepared and understand all steps to effectively utilize the technology prior to the first visit. Beneficiary consent must be obtained prior to service provision (see policy for “Consent for Telemedicine Services” for further information).
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2115 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Sept. 2023).
As standard practice, in-person visits are the preferred method of service delivery; however, in cases where this option is not available or in-person services are not ideal or are challenging for the beneficiary, telemedicine may be used as a complement to in-person services. Telemedicine services cannot be continued indefinitely for a given beneficiary without reasonably frequent and periodic in-person evaluations of the beneficiary by the provider to personally reassess and update the beneficiary’s medical treatment/history, effectiveness of treatment modalities, and current medical/behavioral condition and/or treatment plan. Applicable beneficiary records must contain documentation regarding the reason for the use of telemedicine and the steps taken to ensure the beneficiary was provided utilization guidance in an appropriate manner.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2115-2116 Jul. 1, 2023, (Accessed Sept. 2023).
In special situations, depending upon the needs of the beneficiary, providers may opt to deliver the majority of services via telemedicine. If this situation occurs, it must be documented in the beneficiary’s record or in their individual plan of service (IPOS). This situation should be the exception, not the norm. (Refer to the program-specific subsections of this policy for specific guidance regarding this benefit.)
All services provided via telemedicine must meet all the quality and specifications as would be if performed in-person. Furthermore, if while participating in the visit the desired goals of the beneficiary and/or the provider are not being accomplished, either party must be provided the opportunity to stop the visit and schedule an in-person visit instead (refer to the “Contingency Plan” section of bulletin MSA 20-09 for such instances). This follow-up visit must be provided within a reasonable time and be as easy as possible to schedule.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2116 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Sept. 2023).
When referenced within MDHHS Telemedicine Policy, face-to-face refers to either an in-person visit or a visit performed via simultaneous audio/visual technology.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2117 Jul. 1, 2023, (Accessed Sept. 2023).
All telemedicine visits are required to ascribe to correct coding requirements equivalent to in-person services, including ensuring that all aspects of the code billed are performed during the visit.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2116 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Sept. 2023)
Allowable telemedicine services for synchronous telemedicine are listed on the telemedicine fee schedules which can be accessed on the MDHHS website.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2120 Jul. 1, 2023, (Accessed Sept. 2023).
Where in-person visits are required (such as End Stage Renal Disease [ESRD] and nursing facility-related services), the telemedicine service may be used in addition to the required in-person visit but cannot be used as a substitute. There must be at least one in-person hands-on visit (i.e., not via telemedicine) by a physician, physician’s assistant, or advanced practice registered nurse per month to examine the vascular site for ESRD services.
For PIHP/CMHSP service providers, where in-person visits are required, the telemedicine service may be used in addition to the required in-person visit but cannot be used as a substitute. Refer to the MDHHS Bureau of Specialty Behavioral Health Services Telemedicine Database.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2120-2121 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Sept. 2023)
Listed are HCPCS codes being adopted by MDHHS for dates of service on and after April 1, 2022, and the provider groups allowed to bill these codes. These codes must not be reported with POS 02 nor the GT modifier and will be represented on the applicable provider fee schedules and not the telemedicine database. They are, by definition, technology enabled and do not need the telemedicine POS or modifier to identify them appropriately. See bulletin for code list.
SOURCE: MI Dept. of Health and Human Services, Medicaid Bulletin, 7/5/22, (Accessed Sept. 2023).
Professional Providers
Procedure code and modifier information for all telemedicine services is contained in the MDHHS Telemedicine Services Databases available on the MDHHS website. (Refer to the Directory Appendix for website information.)
Appropriate telemedicine modifiers must be used in conjunction with the appropriate CPT/HCPCS procedure code to identify the professional telemedicine services provided by the distant site provider.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 270 Jul. 1, 2023 (Accessed Sept. 2023).
Child Therapy
Telemedicine is approved for Individual Therapy or Family Therapy using approved children’s evidencebased practices (i.e., Trauma Focused Cognitive Behavioral Therapy, Parent Management TrainingOregon, Parenting Through Change) and utilizes the GT modifier when reporting the service. Qualified providers of children’s evidence-based practices have completed their training in the model, its implementation via telehealth, and are able to provide the practice with fidelity.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 339 Jul. 1, 2023 (Accessed Sept. 2023).
Behavioral Health
Behavioral health services may be delivered via telemedicine in accordance with current Medicaid policy. In compliance with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 548 Jul. 1, 2023 (Accessed Sept. 2023).
Brain Injury – Referral and Admission Process
When appropriate, the evaluation may occur through telecommunication technology (telemedicine). MDHHS requires a real-time interactive system at both the originating and distant sites, allowing instantaneous interaction between the patient and the health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary. Providers must ensure the privacy of the beneficiary and the security of any information shared via telemedicine.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 555 Jul. 1, 2023 (Accessed Sept. 2023).
Children’s Special Health Care Services
The primary CSHCS benefits may include: …
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 591 Jul. 1, 2023 (Accessed Sept. 2023).
Doula Services
It is the expectation that doula services be provided face-to-face with the beneficiary. Prenatal and postpartum services may be delivered via telehealth. Doula providers will be expected to adhere to current MDHHS telemedicine policy.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 687 Jul. 1, 2023 (Accessed Sept. 2023).
Home and Community Based Services
Independent assessment is a face-to-face assessment, conducted by a conflict-free individual or agency. The assessment is based on the individual’s needs and strengths and is part of the person-centered planning process. Telemedicine is an acceptable method of assessment.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 875 Jul. 1, 2023 (Accessed Sept. 2023).
Laboratory – Provider Evaluation
The consultation must be documented in the beneficiary’s medical record and, if performed via telemedicine, should follow all the requirements specified in Medicaid’s telemedicine policy.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1128 Jul. 1, 2023 (Accessed Sept. 2023).
Maternal Infant Health Program
MIHP agencies may conduct initial assessment visits and professional visits via telehealth. Agencies will be allowed to provide a maximum of up to 40 percent of their total caseload of visits as telehealth, while 60 percent of visits must remain as in-person visits. This percentage is applied to the agency and not per beneficiary to allow for telehealth visit flexibility dependent on beneficiary needs.
Telehealth visits must include a dual audio/visual platform. Providers must ensure the privacy of the beneficiary and the security of any information shared via telehealth. MDHHS requires either direct or indirect beneficiary consent for all services provided via telehealth. This consent must be properly documented in the beneficiary’s chart in accordance with applicable standards of practice. Telehealth visits must follow policy guidelines and program requirements for typical MIHP initial assessment and professional visits.
Appropriate use of telehealth will be determined by a combination of beneficiary preference and MIHP provider judgement. Examples of when telehealth is an appropriate option may include, but are not limited to, circumstances such as when a beneficiary:
- Refuses an in-person visit and would benefit from receiving MIHP services,
- Has an illness in their household, or
- Needs to share sensitive information that cannot be discussed in the home environment and a transportation barrier exists for an office visit.
Inappropriate use of telehealth may include, but is not limited to, circumstances such as when a beneficiary has no barrier for an in-person visit and does not request a telehealth visit.
Telehealth visits that occur via telephone-only are allowable only when a beneficiary barrier exists for use of an audio/visual platform (e.g., lack of smart phone or internet access). Documentation in the beneficiary’s chart must include the reason for a telephone-only visit.
MIHP providers are required to follow current Medicaid telemedicine policy requirements as applicable.
SOURCE: MI Medicaid Policy Bulletin, MMP 23-17, Apr. 10, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1161-1162 Jul. 1, 2023 (Accessed Sept. 2023).
Medical Supplier – Face-to-Face (F2F) Visit Requirement
Prior to the initial written order and delivery of selected durable medical equipment and medical supplies (some accessories), the beneficiary must have a face-to-face visit with a physician or NPP within six months prior to the initial written order. The visit must be related to the primary condition that supports the medical need for the equipment or supply. Telemedicine visits (refer to the Telemedicine Chapter) qualify as face-to-face visits.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1161-1162 Jul. 1, 2023 (Accessed Sept. 2023).
Practitioner – CoCM Services
CoCM services must include:
- Initial assessment: Visit occurring either in-person or via audio-visual telemedicine in which the beneficiary sets goals and is screened by a diagnosis-appropriate and consistent validated clinical rating scale, such as the PHQ-9 or GAD-7, which also must be done prior to subsequent CoCM services.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1913 Jul. 1, 2023 (Accessed Sept. 2023).
PIHP/CMHSP
The MDHHS Bureau of Specialty Behavioral Health Services requires all the requirements of Telemedicine policy are attained and maintained during all beneficiary visits. In addition to the Determination of Appropriateness/Documentation section of this policy, the Bureau of Specialty Behavioral Health Services would like to reiterate that services delivered to the beneficiary via telemedicine be done at the convenience of the beneficiary, not the convenience of the provider. In addition, these services must be a part of the person-centered plan of service and available as a choice, not a requirement, to the beneficiary.
If the individual (beneficiary) is not able to communicate effectively or independently, they must be provided appropriate on-site support from natural supports or staff. This includes the appropriate support necessary to participate in assessments, services, and treatment.
The PIHP/CMHSP must guarantee the individual is not being influenced or prompted by others when utilizing telemedicine.
Use of telemedicine should ensure and promote community integration and prevent isolation of the beneficiary. Evidence-based practice policies must be followed as appropriate for all services. For services within the community, in-person interactions must be prioritized.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2123 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Physical Therapy, Occupational Therapy and Speech Therapy Services
MDHHS will allow select therapy services to be provided via telemedicine when performed by Medicaid enrolled private practice and outpatient hospital physical therapy (PT), occupational therapy (OT) and speech therapy (ST) providers. PT, OT and ST services allowed via telemedicine will be represented by applicable CPT/HCPCS codes on the telemedicine fee schedule. Therapy services provided via telemedicine are intended to be an additional treatment tool and complement in-person services where clinically appropriate for the individual beneficiary.
Documentation re-evaluation, performance, and treatment elements that typically require hands-on contact for measurement or assessment must include a thorough description of how the assessment or performance findings were established via telemedicine. This includes, but is not limited to, such elements as standardized tests, strength, range of motion, and muscle tone.
Initial PT and OT evaluations and oral motor/swallowing services are not allowed via telemedicine and should be provided in-person.
Services that require utilization of equipment during treatment and/or physical hands-on interaction with the beneficiary cannot be provided via telemedicine.
Therapy re-evaluations performed via telemedicine must be provided by a therapist whose facility/clinic has previously evaluated and/or treated the beneficiary in-person.
Durable Medical Equipment (DME) re-assessments performed via telemedicine must be provided by a therapist who has previously evaluated and/or treated the beneficiary in-person, otherwise an in-person visit is required.
Modifier 95 should be used in addition to the required modifiers for therapy services as outlined in therapy policy.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2124 & 2125 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Audiology Services
MDHHS will allow speech therapy, auditory rehabilitation, select hearing device adjustments, programming, device performance evaluations, and education or counseling to be performed via telemedicine (simultaneous audio/visual). Remote device programming must be provided in compliance with current U.S. Food and Drug Administration (FDA) guidelines. Auditory brainstem response (ABR) and auditory evoked potential (AEP) testing may also be conducted via telemedicine when performed using remote technology located at a coordinating clinical site with appropriately trained staff (i.e., mobile unit, office/clinic, or hospital).
Reimbursable procedure codes are limited to the specific set of audiology codes listed in the telemedicine fee schedule. Audiology services provided via telemedicine are intended to be an additional treatment tool and complement in-person services where clinically appropriate.
Audiological diagnostic tests (other than those mentioned above), hearing aid examinations, surgical device candidacy evaluations, and other audiology and hearing aid services conducted via telemedicine are not reimbursable by Michigan Medicaid and should be provided in-person.
This policy supplements the existing audiology, hearing aid dealer and speech therapy services policies. All current referral, PA, documentation requirements, standards of care, and limitations remain in effect regardless of whether the service is provided through telemedicine. Providers should refer to the Hearing Services chapter of this Manual for complete information.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Dentistry
Services delivered to the beneficiary via telemedicine must be done for the convenience of the beneficiary, not the convenience of the provider. Services must be performed using simultaneous audio/visual capabilities. All services using telemedicine must be documented in the beneficiary’s record, including the date, time, and duration of the encounter, and any pertinent clinical documentation required per CDT code description. The provider is responsible for ensuring the safety and quality of services provided with telemedicine technologies.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
School Services Program (SSP)
Billing and reimbursement for telemedicine services are accomplished using the same methodology as other services; however, the service must be billed using POS 03—school and modifier 95 or modifier 93. Telemedicine claims for SSP are paid according to the Centers for Medicare & Medicaid Services (CMS) approved cost-based methodology used for other services provided within the program and not the information provided previously in this policy. SSP providers are not eligible for the facility fee as the facility is an integral part of the service provided and is covered under the service claim. A database of allowable telemedicine services for SSP can be found on the MDHHS website. (Refer to the Directory Appendix for website information.)
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2126 Jul. 1, 2023, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
School Services Program (SSP) PT and OT services, as outlined in this policy, will also be allowed via telemedicine. These services must meet all other telemedicine policies as outlined.
SOURCE: MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2124 & 2125 Jul. 1, 2023 (Accessed Sept. 2023).
FQHCs and RHCs
Claims for telemedicine services must be submitted using the ASC X 12N 837 5010 form using the appropriate telemedicine HCPCS or CPT code. All telemedicine claims must include the corresponding modifier 95- “Synchronous Telemedicine Service rendered via a real-time interactive audio and video telecommunications system” or 93 – “Synchronous Telemedicine Service rendered via telephone or other real-time interactive audio-only telecommunications system” and the appropriate revenue code.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127 Jul. 1, 2023 (Accessed Sept. 2023).
Clinics are also permitted to submit for reimbursement telemedicine services (using simultaneous audio/visual technologies) per bulletin MSA 20-09 if all other provisions of telemedicine policy are maintained. Simultaneous audio/visual telemedicine services, as indicated by CPT/HCPCS codes listed on the telemedicine fee schedule and considered qualifying visits, will also be considered face-to-face and will trigger the PPS/AIR if the service billed is listed as a qualifying visit.
Center (THC)/ Tribal Federally Qualified Health Centers (Tribal FQHC) Considerations – PT, OT and ST, when provided in accordance with this policy using both audio/visual modalities, will be considered face-to-face and will trigger the PPS AIR if the service billed is listed as a qualifying visit.
For FQHCs, RHCs, THCs and Tribal FQHCs, the appropriate CPT/HCPCS code, PPS/AIR payment code (if the service generates a Qualifying Visit), and modifier 95 – synchronous telemedicine must be used. Refer to www.michigan.gov/medicaidproviders >> Provider Specific Information for additional information.
SOURCE: MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Healthy Michigan Plan – Diabetes Prevention Program (MiDPP)
Sessions may take place in the following modalities and make-up sessions are encouraged:
- In-person
- Distance Learning (synchronous audio-visual or audio-only telemedicine): Lifestyle coaches deliver sessions where the coach is present in one location and participants are participating from another location. Claims for an audio-only session must include the appropriate procedure code, place of service code and modifier 93 and claims for an audio-visual session must include the appropriate
procedure code, place of service code and modifier 95.
- Online: An asynchronous mode of delivery where participants log into course sessions via a computer, tablet, or smart phone. Per CDC requirements, MiDPP lifestyle coach interaction (in person or via synchronous telemedicine) is required and must be no less than once per week during the first six months and once per month during the second six months.
When billing for a telemedicine session, synchronous or asynchronous, MiDPP providers are expected to adhere to current MDHHS telemedicine policy and modifiers. Refer to the Michigan Medicaid Telemedicine Fee schedule for the list of current codes acceptable for MiDPP telemedicine claims. Claims for an asynchronous session must include the appropriate procedure code and the following remark: “Service provided via an asynchronous telemedicine platform”.
SOURCE: MI Bulletin MMP 23-33, Michigan Diabetes Prevention Program (MiDPP), July 1, 2023, (Accessed Sept. 2023).
Psychiatric Residential Treatment Facilities (PRTF)
The Prepaid Inpatient Health Plan (PIHP) is responsible for managing Medicaid mental health services for all Medicaid beneficiaries residing within the service area covered by the PIHP. This includes the responsibility for timely screening, referral and certification of requests for admission to, PRTF services, defined as follows:
- Screening means the PIHP has been notified of the youth and has been provided enough information to support a referral to a PRTF based on the admission criteria established below. The screening may be provided on-site, face-to-face by PIHP personnel, the telephone or via a video conference platform.
- Certification means the PIHP has screened the youth and has documented that the services requested seem appropriate. Telephone screening must be followed by the written certification.
- All PRTC service authorizations will be made by MDHHS. The PIHP should make referrals when appropriate and will be actively involved in treatment planning/monitoring meetings, discharge planning and transition to the community.
SOURCE: MI Bulletin MMP 23-39, Psychiatric Residential Treatment Facilities (PRTF), July 1, 2023, (Accessed Sept. 2023).
ELIGIBLE PROVIDERS
In compliance with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a provider who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the beneficiary is located. The provider at the distant site who is licensed under State law to furnish a covered telemedicine service (as described in the Allowable Services subsection) may bill, and receive payment for, the service when it is delivered via a telecommunications system.
If providing services through the Prepaid Inpatient Health Plan (PIHP)/Community Mental Health Services Program (CMHSP), the provider must have a contract with or be authorized by the appropriate entity. To be reimbursed for services, providers must be enrolled in Michigan Medicaid.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2114 Jul. 1, 2023 (Accessed Sept. 2023).
Distant site is defined as the location of the provider providing the professional service at the time of the telemedicine visit. This definition encompasses the provider’s office, or any established site considered appropriate by the provider, so long as the privacy of the beneficiary and security of the information shared during the telemedicine visit are maintained.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2117, Jul. 1, 2023 (Accessed Sept. 2023).
A CMH/PIHP can be either an originating or distant site for telemedicine services. Practitioners must meet the provider qualifications for the covered service provided via telemedicine.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 354 Jul. 1, 2023 (Accessed Sept. 2023).
Assertive Community Treatment Program
Typically, although not exclusively, physician activities may include team meetings, beneficiary appointments during regular office hours, psychiatric evaluations, psychiatric meetings/consultations, medication reviews, home visits, telephone consultations and telemedicine.
Typically, although not exclusively, physician assistant activities may include team meetings, beneficiary appointments during regular office hours, evaluations, psychiatric meetings/consultations, medication reviews, home visits, telephone consultations and telemedicine.
Typically, although not exclusively, nurse practitioner/clinical nurse specialist activities may include team meetings, beneficiary appointments during regular office hours, evaluations, psychiatric meetings/consultations, medication reviews, home visits, telephone consultations and telemedicine.
All telemedicine interactions shall occur through real-time interactions between the ACT consumer and the physician/nurse practitioner/physician’s assistant/clinical nurse specialist from their respective physical location. Psychiatric services are the only ACT services that are approved to be provided in this manner.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 364 Jul. 1, 2023 (Accessed Sept. 2023).
Behavioral Health
Behavioral health services may be delivered via telemedicine in accordance with current Medicaid policy. In compliance with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 548 Jul. 1, 2023 (Accessed Sept. 2023).
Federally Qualified Health Centers
An FQHC can be either an originating or distant site for telemedicine services.
An allowable FQHC encounter means a face-to-face medical visit or an interaction using a qualifying telemedicine modality (audio/visual or audio-only) between a patient and the provider of health care services who exercises independent judgment in the provision of health care services. Encounters may be classified as medical, dental, or behavioral health.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 750 & 752, Jul. 1, 2023 (Accessed Sept. 2023).
Hospital
A hospital can be either an originating or distant site for telemedicine services. Refer to the Billing & Reimbursement for Institutional Providers Chapter for specific billing instructions.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1026, Jul. 1, 2023 (Accessed Sept. 2023).
Nursing Facility
A nursing facility can be either an originating or distant site for telemedicine. Refer to the Billing & Reimbursement for Institutional Providers Chapter for information regarding billing the originating site facility fee.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1557, Jul. 1, 2023 (Accessed Sept. 2023).
Rural Health Clinic
An RHC can be either an originating or distant site for telemedicine services. Refer to the Billing & Reimbursement for Institutional Providers Chapter for specific billing instructions.
An encounter is a face-to-face visit or an interaction using a qualifying telemedicine modality (audio/visual or audio-only) between a patient and the provider of health care services who exercises independent judgment in the provision of health care services. For a health service to be defined as an encounter, the provision of the health service must be recorded in the patient’s medical record. Encounters may be classified as medical or behavioral health.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1983-1984, Jul. 1, 2023 (Accessed Sept. 2023).
When the outpatient facility provides administrative support for a telemedicine service, the outpatient hospital facility may bill the hospital outpatient clinic visit on the institutional claim with modifier 95 or modifier 93 and the appropriate revenue code.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2123, Jul. 1, 2023, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
PIHP/CMHSP
PIHP/CMHSP providers must submit encounters for audio/visual telemedicine with POS 02 or 10 (as applicable) and for audio-only POS 02 or 10 (as applicable) and Modifier 93.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2121, Jul. 1, 2023 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Telemedicine is allowed for all services indicated in the Bureau of Specialty Behavioral Health Services Telemedicine Database. The features of what will be counted as a telemedicine visit need to align with the same standards of an in-person visit. Any phone call or web platform used to schedule, obtain basic information or miscellaneous work that would have been billed as a non-face-to-face and therefore non-billable contact, will remain non-billable. Telemedicine visits must include service provision as indicated in the IPOS and should reflect work towards or review of goals and objectives indicated forthwith.
Medicaid beneficiaries whose needs do not render them eligible for specialty services and supports through the PIHPs/CMHSPs may receive outpatient mental health services through Medicaid FFS or MHPs as applicable. These FFS/MHP enrolled non-physician behavioral health services may be provided via telemedicine when performed by Medicaid-enrolled psychologists, social workers, counselors, and marriage and family therapists. Services are covered when performed in a non-facility setting or outpatient hospital clinic. All applicable services are listed in the telemedicine audio/visual and audio-only fee schedules [databases].
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2123-2124 Jul. 1, 2023 (Accessed Sept. 2023) & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Physical Therapy, Occupational Therapy and Speech Therapy Services
This policy supplements existing PT, OT, and ST services policy. All current therapy referral, PA, documentation requirements, standards of care, and limitations remain in effect regardless of whether the service is provided through telemedicine. All telemedicine therapy services will count toward the beneficiary’s therapy service limits. (Refer to the Therapy Services chapter for additional information.)
Modifier 95 should be used in addition to the required modifiers for therapy services as outlined in therapy policy.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125 Jul. 1, 2023 (Accessed Sept. 2023).
Dentistry
MDHHS will allow dentists to provide the limited oral evaluation (Current Dental Terminology [CDT] code D0140) via telemedicine (simultaneous audio/visual) technology so long as all other telemedicine policy is followed. D9995 teledentistry – synchronous; real-time encounter, must be reported in addition to the applicable CDT code.
All requirements of the general telemedicine policy must be followed when providing the limited oral evaluation via telemedicine, including scope of practice requirements, contingency plan, and the use of both audio/visual service delivery unless otherwise indicated by federal guidance.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125 Jul. 1, 2023 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Billing instructions depend upon the claim format used:
- American Dental Association (ADA) Claim Format: Use POS 02 or POS 10; report D9995 with the procedure code.
- Institutional Claim Format: POS 02 and POS 10 are not required; Use modifier 95; report D9995 with the procedure code.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125 Jul. 1, 2023 (Accessed Sept. 2023).
Vision
Telemedicine vision services can be provided through a Medicaid-enrolled provider who can report E/M services as listed in the telemedicine fee schedules.
An intermediate ophthalmological exam can be provided via telemedicine for an established patient with a known diagnosis. The provider must have a previous in-person encounter with the beneficiary to ensure the provider is knowledgeable of the beneficiary’s current medical history and condition. For cases in which the provider must refer the beneficiary to another provider, a consulting provider is not required to have a pre-existing provider-patient relationship if the referring provider shares medical history, past eye examinations, and any related beneficiary diagnosis with the consulting provider. Intermediate ophthalmological exam codes should not be used to diagnose eye health conditions (an initial diagnosis). When medically necessary, providers must refer beneficiaries for an in-person encounter to receive a diagnosis and/or care. Telemedicine cannot act as a replacement for recommended in-person interactions.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2126 Jul. 1, 2023, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
School Services Program (SSP)
Because of the unique circumstances regarding the delivery of services within the School Services Program (SSP), telemedicine may be the primary delivery modality for some beneficiaries; however, the decision to use telemedicine should be based on the needs or convenience of the beneficiary, and not those of the provider.
In cases where the beneficiary is unable to use telemedicine equipment without assistance, an attendant must be provided by the provider. The attendant must be trained in the use of the telemedicine equipment to the point where they can provide adequate assistance. The attendant must also be available for the entire telemedicine session; however, they should also ensure the beneficiary’s privacy to the greatest extent possible. When the originating site for the service is the student’s home, any cost for an attendant is not reimbursable.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2126 Jul. 1, 2023, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
Durable Medical Equipment (DME) Providers
All DME providers must reference the Medical Supplier chapter of this Manual for specific requirements in the provision of services via telemedicine.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127 Jul. 1, 2023 (Accessed Sept. 2023).
FQHCs and RHCs
All current Medicaid policy for telemedicine services, including definitions, requirements and parameters of telemedicine, apply to FQHCs and RHCs. FQHCs and RHCs are responsible for ensuring compliance with all telemedicine policy.
Distant site services provided by qualified Medicaid enrolled providers may be covered when the qualified provider is employed by the clinic or working under the terms of a contractual agreement with the clinic. FQHCs and RHCs must maintain all practitioner contracts and provide them to MDHHS upon request.
During the Medicaid provider enrollment process, contracted providers must associate to the FQHC or RHC billing NPI. Refer to the Billing & Reimbursement for Institutional Providers chapter of this Manual for further information.
PPS is reimbursed according to the billing rules described below (See manual).
If both the originating and distant sites submit identical procedure code(s) for a telemedicine visit for the same beneficiary on the same date of service, it is considered duplicate billing. MDHHS will recover payment from the appropriate FQHC, RHC, or contracted provider. Recovery will be based on the terms specified in the contract.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127-2128 Jul. 1, 2023 (Accessed Sept. 2023).
Tribal FQHC
A Tribal facility may choose to enroll as a Tribal FQHC and be reimbursed for outpatient face-to-face visits within the FQHC scope of services provided to Medicaid beneficiaries, including telemedicine and services provided by contracted employees. Tribal FQHCs are eligible to receive the IHS outpatient AIR for eligible encounters.
A Tribal Health Clinic can be either an originating or distant site.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2171 & 2175 Jul. 1, 2023 (Accessed Sept. 2023).
ELIGIBLE SITES
Originating site is defined as the location of the eligible beneficiary at the time of the telemedicine service.
Authorized originating sites include:
- County mental health clinic or publicly funded mental health facility
- Federally Qualified Health Center (FQHC)
- Hospital (inpatient, outpatient, or critical access hospital)
- Office of a physician or other provider (including medical clinics)
- Hospital-based or Critical Access Hospital (CAH)-based Renal Dialysis Centers (including satellites)
- Rural Health Clinic (RHC)
- Skilled nursing facility
- Tribal Health Center (THC)
- Local Health Department (LHD) as defined in Sections 333.2413, 333.2415 and 333.2421 of the Michigan Public Health Code (PA 368 of 1978 as amended)
- Home, as defined as a location, other than a hospital or other facility, where the beneficiary receives care in a private residence
- Other established site considered appropriate by the provider (in accordance with clinical judgement)
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2117, Jul. 1, 2023, & MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Sept. 2023).
Effective March 1, 2020. The distant site is defined as the location of the practitioner, providing the professional service at the time of the telemedicine visit. The definition encompasses the providers office or any established site, considered appropriate by the provider so long as the privacy of the beneficiary and security of the information shared during the telemedicine visit are maintained.
Telemedicine services where “home” or another “establish site, considered appropriate by the provider” are utilized as the originating site or not eligible to receive the telehealth facility fee. Distant site providers in these situations are instructed to bill the appropriate current procedural term analogy HCPCS code for the services provided.
Neither the originating site or the distant side is permitted to bill both the telehealth facility and the code for the professional service for the same beneficiary at the same time.
SOURCE: MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Sept. 2023).
All audio/visual telemedicine services, as allowable on the telemedicine fee schedule and submitted on the professional invoice, must be reported with the Place of Service (POS) code that would be reported as if the beneficiary were in-person for the visit along with modifier 95—”Synchronous Telemedicine Service rendered via a real-time interactive audio and video telecommunications system”.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2121, Jul. 1, 2023 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
PIHP/CMHSP providers must submit encounters for audio/visual telemedicine with POS 02 or 10 (as applicable) and for audio-only POS 02 or 10 (as applicable) and Modifier 93.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2121, Jul. 1, 2023 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2023).
For PIHP/CMHSP service providers, refer to the MDHHS Bureau of Specialty Behavioral Health Services Telemedicine Database and the Audio-Only Telemedicine Database on the MDHHS website for services allowed via both audio/visual and audio-only telemedicine.
This information should be used in conjunction with the Billing & Reimbursement for Professionals and the Billing & Reimbursement for Institutional Providers Chapters as well as the Medicaid Code and Rate Reference tool and other related procedure databases/fee schedules located on the MDHHS website.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2122, Jul. 1, 2023, (Accessed Sept. 2023).
For services submitted on the institutional invoice, the appropriate National Uniform Billing Committee (NUBC) revenue code, along with the appropriate telemedicine CPT/HCPCS procedure code and modifier 95 or modifier 93, must be used.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2121, Jul. 1, 2023, (Accessed Sept. 2023).
Beginning October 1, 2020, telemedicine services are covered under the medical assistance program and Healthy Michigan program if the originating site is an in-home or in-school setting, in addition to any other originating site allowed in the Medicaid provider manual or any established site considered appropriate by the provider.
SOURCE: MI Compiled Laws Sec. 400.105h. (Accessed Sept. 2023).
Federally Qualified Health Centers
An FQHC can be either an originating or distant site for telemedicine services.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 750 Jul. 1, 2023 (Accessed Sept. 2023).
Hospital
A hospital can be either an originating or distant site for telemedicine services. Refer to the Billing & Reimbursement for Institutional Providers Chapter for specific billing instructions.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1026, Jul. 1, 2023. (Accessed Sept. 2023).
Nursing Facility
A nursing facility can be either an originating or distant site for telemedicine. Refer to the Billing & Reimbursement for Institutional Providers Chapter for information regarding billing the originating site facility fee.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1557, Jul. 1, 2023. (Accessed Sept. 2023).
Pharmacy
In the event that the beneficiary is unable to physically access an in-person (revised per bulletin MMP 23-20) care setting, an eligible pharmacist may provide MTM services via telemedicine. Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services. Telemedicine must be obtained through real-time interactions between the beneficiary’s physical location (originating site) and the pharmacist provider’s physical location (distant site). MTM telemedicine audio/visual services are provided to beneficiaries through hardwire or internet connection. It is the expectation that providers and facilitators involved in telemedicine are trained in the use of equipment and software prior to servicing beneficiaries. The arrangements for telemedicine will be made by the pharmacist. The administration of telemedicine services is subject to the same provision of services that are provided to a beneficiary in person. Providers must ensure the privacy of the beneficiary and secure any information shared via telemedicine. Refer to the Telemedicine chapter for additional information regarding telemedicine service provision.
For services provided through telemedicine, each procedure code must include the modifier 95.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1840, Jul. 1, 2023. (Accessed Sept. 2023).
Rural Health Clinic
An RHC can be either an originating or distant site for telemedicine services. Refer to the Billing & Reimbursement for Institutional Providers Chapter for specific billing instructions.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1983, Jul. 1, 2023. (Accessed Sept. 2023).
Dentistry
Billing instructions depend upon the claim format used:
- American Dental Association (ADA) Claim Format: Use POS 02 or POS 10; report D9995 with the procedure code.
- Institutional Claim Format: POS 02 and POS 10 are not required; Use modifier 95; report D9995 with the procedure code.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125 Jul. 1, 2023. (Accessed Sept. 2023).
FQHC/RHC
If both the originating and distant sites submit identical procedure code(s) for a telemedicine visit for the same beneficiary on the same date of service, it is considered duplicate billing. MDHHS will recover payment from the appropriate FQHC, RHC, or contracted provider. Recovery will be based on the terms specified in the contract.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127-2128 Jul. 1, 2023. (Accessed Sept. 2023).
Tribal Health Centers
A Tribal Health Clinic can be either an originating or distant site.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2175 Jul. 1, 2023. (Accessed Sept. 2023).
Tribal FQHCs are eligible to receive all-inclusive rate (AIR) reimbursement for clinic services provided outside of the four walls of the facility, including telemedicine and services provided by contracted employees.
SOURCE: MI Medical Services Administration Bulletin MSA 20-60, Sept. 1, 2020. (Accessed Sept. 2023).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Allowable originating sites are permitted to submit claims for the telehealth facility fee. This fee is intended to reimburse the provider for the expense of hosting the beneficiary at their location. To submit this code, the originating site must ensure the technology is functioning, the privacy of the beneficiary is secured, and that the information is shared confidentially.
Telemedicine services where “home” or another “established site considered appropriate by the provider” are utilized as the originating site are not eligible to receive the telehealth facility fee. Distant site providers in these situations are instructed to bill the appropriate Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code (as represented by the Telemedicine database) for the service(s) provided.
Neither the originating site nor the distant site is permitted to bill both the telehealth facility fee and the code for the professional service for the same beneficiary at the same time.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2121 Jul. 1, 2023, & MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Sept. 2023).
Institutional Providers
To be reimbursed for the originating site facility fee, the hospital must bill the appropriate telemedicine NUBC revenue code with the appropriate telemedicine facility fee code and modifier.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 189, 202, 215 Jul. 1, 2023. (Accessed Sept. 2023).
Professional Providers
To be reimbursed for the originating site facility fee, the originating site provider must bill the telehealth facility fee. MDHHS will reimburse the originating site provider the current Medicaid fee screen. Additional services provided at the originating site on the same date as the telemedicine service may be billed and reimbursed separately according to published policy.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 270 Jul. 1, 2023. (Accessed Sept. 2023).
FQHCs and RHCs
The telehealth facility fee does not qualify as a face-to-face visit and does not generate the PPS payment. Telemedicine service(s) provided at the distant site that qualify as a face-to-face visit may generate the PPS payment. All current PPS rules and encounter criteria apply to telemedicine visits. Refer to the Federally Qualified Health Centers and the Rural Health Clinics chapters of this Manual and the FQHC and RHC reimbursement lists on the MDHHS website for further information. (Refer to the Directory Appendix for website information.)
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127 Jul. 1, 2023. (Accessed Sept. 2023).
