Last updated 11/22/2022
Definitions
“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.
SOURCE: MI Compiled Law Services, Section 330.1100(d)(16), (Accessed Nov. 2022).
“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.”
SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) & MI Compiled Law Services Sec. 5501401k(2). (Accessed Nov. 2022).
“Telemedicine is the use of telecommunication technology to connect a patient with a health care professional in a different location. MDHHS requires a real time interactive system at both the originating and distant site, allowing instantaneous interaction between the patient and health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary or there is an imminent health risk justifying immediate medical need for services.”
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p.1886, Oct. 1, 2022 (Accessed Nov. 2022).
Assertive Community Treatment Program (ACT)
Telepractice is the use of telecommunications and information technologies for the provision of psychiatric services to ACT consumers and is subject to the same service provisions as psychiatric services provided in-person.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 352 Oct. 1, 2022 (Accessed Nov. 2022).
Behavioral Health Treatment Services (BHT)
Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services may be prohibitive). Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 484 Jul. 1, 2022 (Accessed Sept. 2022).
Telemedicine for BHT Services
Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services may be prohibitive). Telemedicine must be obtained through real-time interaction between the individual’s physical location (patient site) and the provider’s physical location (provider site). Telemedicine services are provided to patients through hardwire or internet connection.
SOURCE: MSA Bulletin 21-20, (Sept. 1, 2021), (Accessed Nov. 2022).
Telepractice for BHT Services
Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed medical services may be prohibitive). Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p.485, Oct. 1, 2022. (Accessed Nov. 2022).
Medication Therapy Management
Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services. Telepractice must be obtained through real-time interactions between the beneficiary’s physical location (origin site) and the pharmacist provider’s physical location (distant site). Telepractice services are provided to beneficiaries through hardwire or internet connection.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1806 Oct. 1, 2022 (Accessed Nov. 2022).
Speech, Language and Hearing Therapy, School-Based Services
“Telepractice is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of speech, language and hearing services. Telepractice must be obtained through real-time interaction between the patient’s physical location (patient site) and the provider’s physical location (provider site).” Services are provided to patients through hardwire or internet connection.
SOURCE: MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1988 & 1990 Oct. 1, 2022 (Accessed Nov. 2022).
Child Therapy
Telepractice/Telehealth is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed therapy services may be prohibitive). Telepractice/Telehealth must be obtained through real-time interaction between the child’s/family’s physical location and the provider’s physical location. Telepractice/Telehealth services are provided to patients through hardwire or internet connection.
SOURCE: MI Dept. of Health and Human Services Medicaid Provider Manual, p. 337, Oct. 1, 2022. (Accessed Nov. 2022).
Last updated 11/22/2022
Live Video
POLICY
MDHHS requires a real time interactive system at both the originating and distant site, allowing instantaneous interaction between the patient and health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary or there is an imminent health risk justifying immediate medical need for services.
Source: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1886. Oct. 1, 2022 (Accessed Nov. 2022).
Assertive Community Treatment Program
All telepractice interactions shall occur through real-time interactions between the ACT consumer and the physician/nurse practitioner/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. 353 Oct. 1, 2022 (Accessed Nov. 2022)
ELIGIBLE SERVICES/SPECIALTIES
The following services may be provided via telemedicine:
- ESRD-related services
- Behavior change intervention
- Behavioral Health and/or Substance Use Disorder Treatment
- Education Services, Telehealth
- Inpatient consultations
- Nursing facility subsequent care
- Office or other outpatient consultations
- Office or other outpatient services
- Psychiatric diagnostic procedures
- Subsequent hospital care
- Training service – Diabetes (see Diabetes Self-Management Education Training Program section in Hospital Chapter specific program requirements)
Where face-to-face visits are required (such as ESRD and nursing facility related services), the telemedicine service may be used in addition to the required face-to-face visit but cannot be used as a substitute. There must be at least one face-to-face 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. The initial visit for nursing facility services must be face-to-face.
Procedure codes and modifier information is contained in the MDHHS Telemedicine Services Database.
There is no prior authorization requirements when providing telemedicine services for fee-for-service beneficiaries.
Authorization requirements for beneficiaries enrolled in Medicaid Health Plans (MHPs) may vary. Providers must check with individual MHPs for any authorization or coverage requirements.
Providers at the distant site can only bill services listed in the Telemedicine Services database.
SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1886-7, Oct. 1, 2022 (Accessed Nov. 2022).
Listed below 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 Nov. 2022).
Speech-Language and Audiology Services
Speech, language and hearing services may be reimbursed. Requires an annual referral from a physician. In addition to the use of the appropriate billing code, billers use the “GT modifier to identify services provided by telepractice.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1988, Oct. 1, 2022 (Accessed Nov. 2022).
Assertive Community Treatment Program
The telepractice modifier, 95, must be used in conjunction with ACT encounter reporting code H0039 when telepractice is used.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 352 Oct. 1, 2022 (Accessed Nov. 2022).
Telepractice for BHT Services
Telepractice services must be prior authorized. Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection. It is the expectation that providers, facilitators, and staff involved in telepractice are trained in the use of equipment and software prior to servicing patients, and services provided via telepractice are provided as part of an array of comprehensive services that include in-person visits and assessments with the primary supervising BHT provider. Qualified providers of behavioral health services are able to arrange telepractice services for the purposes of teaching the parents/guardians to provide individualized interventions to their child and to engage in behavioral health clinical observation and direction (i.e. increase oversight of the provision of services to the beneficiary to support the outcomes of the behavioral plan of care developed by the primary supervising BHT provider).
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 485 Oct. 1, 2022 (Accessed Nov. 2022).
Telepractice for BHT Services
Refer to the Behavioral Health Telemedicine reporting requirements database for appropriate or allowed telemedicine services that may be covered by Medicaid. Certain qualifications and conditions will also need to be met. Use GT modifier in addition to appropriate procedure code.
It is the expectation that providers, facilitators, and staff involved in telepractice are trained in the use of equipment and software prior to servicing patients and services provided via telepractice are provided as part of an array of comprehensive services that include in-person visits and assessments with the primary supervising BHT provider. The provider of the telepractice service is only able to monitor one child/family at a time.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 485, Oct. 1, 2022 (Accessed Nov. 2022).
It is the expectation that providers, facilitators and staff involved in telepractice are trained in the use of equipment and software prior to servicing patients. Behavioral health services administered by telepractice are subject to the same provisions as services provided to a patient in person.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1990, Oct. 1, 2022 (Accessed Nov. 2022).
Child Therapy
A child mental health professional may provide child therapy on an individual or group basis with a family-driven, youth-guided approach. Telepractice/Telehealth is approved for Individual Therapy or Family Therapy using approved children’s evidence-based practices (i.e., Trauma Focused Cognitive Behavioral Therapy, Parent Management Training-Oregon, 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. 337 Oct. 1, 2022 (Accessed Nov. 2022).
Psychiatric Collaborative Care Model (CoCM) Services
Provider care management services provided by a Behavioral Health Care Manager can be provided in a non-face-to-face interaction. Weekly consults with the psychiatric consultant may also be non-face-to-face. Face-to-face or non-face-to-face weekly to monthly follow-up by the behavioral health care manager that must include monthly screening with validated rating scale, monitoring of goals and/or medication, and may include recommended evidence-based therapies.
SOURCE: MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1881 Oct. 1, 2022 (Accessed Nov. 2022).
Medication Therapy Management (MTM)
In the event that the beneficiary is unable to physically access a face-to-face setting, an eligible pharmacist may provide MTM services via telepractice. The arrangements for telepractice will be made by the pharmacist. The administration of telepractice services are subject to the same provision of services that are provided to a beneficiary in person. For services provided through telepractice each procedure code must include the modifier GT (professional claims).
SOURCE: MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1806 Oct. 1, 2022 (Accessed Nov. 2022).
Children’s Special Health Care Services (CSHCS)
CSHCS covers services that are medically necessary, related to the beneficiary’s qualifying diagnosis(es), and ordered by the beneficiary’s CSHCS authorized specialist(s) or subspecialist(s). Services are covered and reimbursed according to Medicaid policy unless otherwise stated in this chapter.
The primary CSHCS benefits may include:
SOURCE: MI Dept. of Health and Human Services Medicaid Provider Manual, p. 589 Oct. 1, 2022 (Accessed Nov. 2022).
ELIGIBLE PROVIDERS
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.
SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2122, Oct. 1, 2022 (Accessed Nov. 2022).
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. The physician or practitioner at the distant site who is licensed under State law to furnish a covered telemedicine services (as described in the Telemedicine Services subsection) may bill, and receive payment for, the service when it is delivered via a telecommunication system. In order to be reimbursed for services, distant site providers must be enrolled in Michigan Medicaid.
SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 1887-88, Oct. 1, 2022 (Accessed Nov. 2022).
Telepractice for BHT Services
Qualified providers include:
- Board certified behavior analysts
- Board certified assistant behavior analysts
- Licensed psychologists
- Limited licensed psychologists
- Qualified behavioral health professionals
Occupational, physical and speech therapists are not included in this policy.
A facilitator trained in telepractice technology must be physically present with the patient during the entire telepractice session.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 485-486 Oct. 1, 2022 (Accessed Nov. 2022).
Telemedicine for Behavioral Health Services
Behavioral health services may be provided by:
- Licensed physician or psychiatrist;
- LIcensed psychologist;
- Limited licensed master’s level psychologist under the supervision of a licensed psychologist;
- MDE-credentialed master’s level school psychologist;
- Licensed master’s level marriage and family therapist;
- Board-certified behavior analyst (BCBA);
- Board-certified assistant behavior analyst (BCaBA) under the supervision of a BCBA;
- Licensed master’s level professional counselor;
- LImited licensed master’s level professional counselor under the supervision of a licensed master’s level professional counselor;
- Licensed master’s level social worker;
- Licensed master’s level school social worker;
- LImited licensed master’s level social worker under the supervision of a licensed master’s level social worker; and
- Temporary limited licensed psychologist under the supervision of a fully licensed psychologist.
SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1990-1991, Oct. 1, 2022 (Accessed Nov. 2022).
Medication Therapy Management (MTM)
In the event that the beneficiary is unable to physically access a face-to-face care setting, an eligible pharmacist may provide MTM services via telepractice. Services must be provided through hardwire or internet connection.
SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1806, Oct. 1, 2022 (Accessed Nov. 2022).
Prepaid Inpatient Health Plans/Community Mental Health (PIHP/CMH) can be either originating or distant sites. 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. 343, Oct. 1, 2022 (Accessed Nov. 2022).
Speech-Language and Audiology Services
Eligible providers:
- A fully licensed speech-language pathologist
- Licensed Audiologist in Michigan
- Speech language pathologist and/or audiology candidate under the direction of a qualified SLP or audiologist. All documentation must be reviewed and signed by the appropriately licensed SLP or licensed audiologist.
- A limited licensed speech language pathologist under the direction of a fully licensed SLP or audiologist. All documentation must be reviewed and signed by the appropriately licensed supervising SLP or licensed audiologist.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1988, Oct. 1, 2022 (Accessed Nov. 2022).
Federally Qualified Health Centers, Hospital, Nursing Facility, Rural Health Centers, Tribal Health Centers
An FQHC, hospital, nursing facility, RHC or tribal health centers can be either an originating or distant site for telemedicine services.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 738, 1004, 1523, 1950 & 2126 Oct. 1, 2022 (Accessed Nov. 2022).
Child Therapy
A child mental health professional may provide child therapy on an individual or group basis with a family-driven, youth-guided approach. It is the expectation that providers involved in telepractice/telehealth are trained in the use of equipment and software prior to servicing children/families.
SOURCE: MI Dept. of Health and Human Services Medicaid Provider Manual, p. 337, Oct. 1, 2022 (Accessed Nov. 2022).
School-Based Services and Caring 4 Students Providers
Telepractice specifically applies to the SBS and C4S programs. See Medicaid manual for requirements.
SOURCE: MI Dept. of Health and Human Services. Bulletin 20-15, School Based Services, p 1991-1992. Oct. 1, 2022 (Accessed Nov. 2022).
ELIGIBLE SITES
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 Nov. 2022).
Tribal 638 Facilities
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 Nov. 2022)
Eligible originating sites:
- County mental health clinics or publicly funded mental health facilities;
- Federally Qualified Health Centers;
- Hospitals (inpatient, outpatient, or Critical Access Hospitals);
- Physician or other providers’ offices, including medical clinics;
- Hospital-based or CAH-based Renal Dialysis Centers (including satellites);
- Rural Health Clinics;
- Skilled nursing facilities;
- Tribal Health Centers
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1887. Oct. 1, 2022 (Accessed Nov. 2022).
Speech-Language and Audiology Services, Behavioral Health Therapy, School-Based Services & Caring 4 Students Provider
The patient site may be located:
- Within the school (for speech-language and audiology services & School-Based and Caring 4 Students Provider);
- The Center (Behavioral Health Therapy);
- Home;
- Any other established site deemed appropriate by the provider.
The room must be free from distractions so as not to interfere with the telepractice session. A facilitator must be trained in the use of the telepractice technology and physically present at the patient site during the entire telepractice session to assist the patient at the direction of the SLP or audiologist.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 486 (BHT), 1988 (SLP & Audiology), 1991 (BHT), 1991 (School-Based/Caring 4 Kids Providers) Oct. 1, 2022 (Accessed Nov. 2022).
Federally Qualified Health Centers, Hospital, Nursing Facility, Rural Health Centers, Tribal Health Centers
An FQHC, hospital, nursing facility, RHC or tribal health centers can be either an originating or distant site for telemedicine services.
SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 738, 1004, 1523, 1950 & 2126 Oct. 1, 2022 (Accessed Oct. 2022).
Telemedicine Coding Changes
MDHHS acknowledges the addition of POS 10-Telehealth provided in a patient’s home, the new definition of POS 02-Telehealth provided other than in a patient’s home, and the addition of modifier FQ-audio only service.
However, due to current systems processing restraints, MDHHS will continue to require POS 02 for all services provided via telemedicine. Per bulletin MSA 20-09, all telemedicine services, as allowable on the telemedicine database and submitted on the professional invoice, must be reported with POS 02-Telehealth and the GT-interactive telecommunication modifier. To distinguish patient’s home from other location, MDHHS is requesting that providers, as able, include the comment “patient’s home” in the remarks section.
MDHHS will require modifier FQ to be appended in addition to modifier GT. When a provider submits modifier FQ for an audio only service, the provider does not need to include a note in the remarks section stating that the service was provided via telephone (per bulletin MSA 20-13). Please note, modifier GT must be included for the claim to be processed correctly. For FQHCs/RHCs/THCs and Tribal FQHCs, please use modifier GT and modifier FQ as indicated above.
Further updates to telemedicine reporting will be provided in future bulletins.
SOURCE: MI Health and Aging Services Administration Bulletin HASA 22-03 (Feb. 8, 2022), (Accessed Nov. 2022).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
To be reimbursed for the originating site facility fee, the originating site provider must bill the appropriate telemedicine procedure code and modifier. MDHHS will reimburse the originating site provider the lesser of charge or the current Medicaid fee screen.
SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 268, Oct. 1, 2022 (Accessed Nov. 2022).
