Michigan

Disclaimer

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

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, PSYPACT
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: Yes
  • Allowed to collect PPS rate for telehealth: Yes

STATE RESOURCES

  1. Medicaid Program: Michigan Medicaid
  2. Administrator: Michigan Dept. of Health and Human Services (MDHHS)
  3. Regional Telehealth Resource Center: Upper Midwest Telehealth Resource Center
Disclaimer

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

Last updated 01/19/2024

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 HIPPA 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) (Accessed Jan. 2024).

Worker’s Compensation

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine, the health care professional must be able to examine the patient via a real-time, interactive audio and video telecommunications system, and the patient must be able to interact with the off-site health care professional at the time the services are provided. 

Source: Admin Rule Sec. 418.10109, (Accessed Jan. 2024).

Last updated 01/19/2024

Parity

SERVICE PARITY

An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer.

SOURCE: MI Compiled Law Services Sec. 500.3476, (Accessed Jan. 2024).

A group or nongroup health care corporation certificate must not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the health care corporation.

SOURCE:  Sec. 550.1401k. (Accessed Jan. 2024).


PAYMENT PARITY

No explicit payment parity.

Last updated 01/19/2024

Requirements

An insurer that delivers, issues for delivery, or renews in this state a health insurance policy or a group or nongroup health care corporation certificate shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer or health care corporation. 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. Telemedicine services are subject to all terms and conditions of the health insurance policy agreed upon between the policy holder and the insurer or the certificate agreed upon between the certificate holder and the health care corporation, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.

SOURCE: MI Compiled Law Services Sec. 500.3476(1), (Accessed Jan. 2024).

A group or nongroup health care corporation certificate must not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the health care corporation. 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. Telemedicine services are subject to all terms and conditions of the certificate agreed upon between the certificate holder and the health care corporation, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.

SOURCE: Sec. 550.1401k(1), (Accessed Jan. 2024).

Worker’s Compensation

A health care professional billing for telemedicine services shall utilize procedure codes  92507, 92521-92524, 97110, 97112, 97116, 97161-97168, 97530, 97535 or those listed in  Appendix P of the CPT codebook, as adopted by reference in R 418.10107, excluding CPT codes  99241-99245 and 99251-99255. The provider shall append modifier -95 to the procedure code to  indicate synchronous telemedicine services rendered via a real-time interactive audio and video  telecommunications system with place of service code -02. All other applicable modifiers shall  be appended in addition to modifier -95. 

When modifier -95 is used with procedure code 92507, 92521-92524, 97110, 97112, 97116, 97161-97168, 97530, 97535, or those listed in Appendix P of the CPT codebook, as adopted by reference in R 418.10107, excluding CPT codes 99241-99245 and 99251-99255, the telemedicine services must be reimbursed according to all of the following:

  • The carrier shall reimburse the procedure code at the non-facility maximum allowable payment, or the billed charge, whichever is less.
  • Supplies and costs for the telemedicine data collection, storage, or transmission must not be unbundled and reimbursed separately.
  • Originating site facility fees must not be separately reimbursed.

Source: Admin Rule Sec. 418.10901 & 418.101004, (Accessed Jan. 2024).

Last updated 01/16/2024

Definitions

Telemedicine is the use of telecommunication technology to connect a beneficiary with a Medicaid enrolled health care professional in a different location. 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 aligns the definition of telemedicine with Section 3476 of the Insurance Code of 1956, 1956 PA 218 MCL 500.3476, as updated on December 20, 2017. Therefore, “Telemedicine” means the use of an electronic media to link beneficiaries with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the beneficiary via a real-time, interactive audio or video (or both) telecommunications system, and the beneficiary must be able to interact with the off-site health care professional at the time the services are provided.

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. 2139 & 2142, Jan. 1, 2024 &  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 Jan. 2024).

“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 Jan. 2024).

“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 Jan. 2024).

Behavioral Health – Assertive Community Treatment Program

Telemedicine 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. The telemedicine modifier must be used in conjunction with the ACT encounter reporting code when telemedicine is used.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 364, Jan. 1, 2024. (Accessed Jan. 2024).

Telemedicine for MTM Services

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.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1840, Jan. 1, 2024, (Accessed Jan. 2024).

Behavioral Health – Child Therapy

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 therapy services may be prohibitive). Telemedicine must be obtained through real-time interaction between the child’s/family’s physical location and the provider’s physical location. Telemedicine services are provided to patients through hardwire or internet connection. It is the expectation that providers involved in telemedicine are trained in the use of equipment and software prior to servicing children/families.

The technology used must meet the requirements of audio and visual compliance in accordance with current regulations and industry standards. Refer to the General Information for Providers Chapter of this manual for the complete Health Insurance Portability and Accountability Act (HIPAA) compliance requirements

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 339 Jan. 1, 2023  (Accessed Jan. 2024).

Last updated 01/16/2024

Email, Phone & Fax

MDHHS supports the use of simultaneous audio/visual telemedicine service delivery, as a primary method of telemedicine service, but in situations where the beneficiary cannot access services via a simultaneous audio/visual platform, either due to technology constraints or other concerns, MDHHS will allow the provision of audio-only services for a specific set of procedure codes.

Additional guidelines for audio-only service include:

  1. Visits that include an assessment tool—the tool must be made available to the beneficiary and the provider must ensure the beneficiary can access the tool.
  2. When a treatment technique or evidence-based practice requires visualization of the beneficiary, it must be performed via simultaneous audio/visual technology.
  3. Audio-only must be performed at the preference of the beneficiary, not the provider’s convenience.
  4. Privacy and security of beneficiary information must always be established and maintained during an audio-only visit.

To effectuate this in perpetuity, MDHHS will publish audio-only databases that will include all codes MDHHS is permitting via audio-only. These databases will be created for both FFS/MHP providers and for those providers within the PIHP/CMHSP system and will be maintained on the MDHHS website. MDHHS will, on a regular and ongoing basis, assess the audio-only databases and will add/remove codes as needed. Some of the criteria used to determine addition/removal from the audio-only database include provider/stakeholder feedback, new coding guidelines, utilization data and quality reports.

All audio-only telemedicine services, as represented on the audio-only 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 93 – “Synchronous Telemedicine Service rendered via telephone or other real-time interactive audio-only telecommunications system”.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2142-2123 & 2146-2147 Jan. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Jan. 2024).

These procedure codes include the telephone only CPT/HCPCS codes (99441-99443 and 98955-98968) along with codes listed in the bulletin (see bulletin).

Providers should consult with MDHHS fee schedules for current allowable codes which can be accessed on the MDHHS website at www.michigan.gov/medicaidproviders >> Billing and Reimbursement >> Provider Specific Information. The Medicaid Code and Rate Reference Tool, located via the External Links menu in CHAMPS, may also be used to determine eligible reimbursement codes.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2147, Jan. 1, 2024, (Accessed Jan. 2024).

Behavioral Health – PIHP/CMHSP

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 CMHSP/PIHP 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., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2148, Jan. 1, 2024, (Accessed Jan. 2024).

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. 2147, Jan. 1, 2024, (Accessed Jan. 2024).

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.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, & Medicaid Provider Manual, p. 2148 Jan. 1, 2024  (Accessed Jan. 2024).

Interprofessional Telephone/Internet/Electronic Health Record Consultations

Asynchronous telemedicine services include the transmission of a beneficiary’s medical or other personally identifiable information through a secure, HIPAA-compliant, electronic communications system to a provider, often a specialist, at a distant site without the beneficiary present. Such communications, including store and forward services, interprofessional telephone/Internet/electronic health record consultations, and remote patient monitoring (RPM) services, involve contact between two parties (beneficiary to provider or provider to provider) in a way that does not require real-time interaction. Services must be medically necessary or essential for behavioral health and part of a provider-directed treatment plan.

Providers should not report interprofessional telephone/Internet/electronic health record consultations when the sole purpose of the communication is to arrange a transfer of care or other face-to-face service

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2143 & 2144, Jan. 1, 2024 &MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, (Accessed Jan. 2024).

Medication Therapy Management (MTM)

The following are not eligible to be covered as MTM services:

  • Services provided by telephone, email or US Postal Service Mail.

SOURCE: MI Medicaid Provider Manual, p. 1838 Jan. 1, 2024 (Accessed Jan. 2024).

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.

MDHHS will allow FQHCs and RHCs to be reimbursed for identified audio-only services (those represented on the audio-only database and that are identified as qualifying visits) to generate the PPS.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2152 & 2153 Jan. 1, 2024  (Accessed Jan. 2024).

Clinics will be permitted to submit for reimbursement allowable audio-only service codes, as indicated above, if appropriate for the interaction with the beneficiary. Medicaid clinic billing and reimbursement requirements apply. The provider must be employed by or contracted with the FQHC or RHC, and the procedure code billed must appear on the clinic reimbursement list as a qualifying visit. The clinic reimbursement list is located on the MDHHS website.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2153 Jan. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

The allowance for payment of the AIR for Indian Health Centers is contingent upon successful approval from the Centers for Medicare and Medicaid Services (CMS).

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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 Jan. 2024).

Last updated 01/16/2024

Live Video

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. 2139-2140 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023. (Accessed Jan. 2024).

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. 2145 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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 Jan. 2024).


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. 2140 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Jan. 2024).

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. 2141-2142 Jan. 1, 2024, (Accessed Jan. 2024).

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. 2141 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Jan. 2024).

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. 2142 Jan. 1, 2024, (Accessed Jan. 2024).

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. 2145 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Jan. 2024).

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. 2146 Jan. 1, 2024, (Accessed Jan. 2024).

For End Stage Renal Disease (ESRD), MDHHS aligns with Medicare policy regarding the delivery of telemedicine and frequency of in-person 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 for services allowed via telemedicine. (Refer to the Directory Appendix for website information.)

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2146 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Jan. 2024).

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 Jan. 2024).

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. 270-271, Jan. 1, 2024  (Accessed Jan. 2024).

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 Jan. 1, 2024  (Accessed Jan. 2024).

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. 545 Jan. 1, 2024 (Accessed Jan. 2024).

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. 552 Jan. 1, 2024 (Accessed Jan. 2024).

Children’s Special Health Care Services

The primary CSHCS benefits may include: …

  • Telemedicine

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 588 Jan. 1, 2024 (Accessed Jan. 2024).

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. 684 Jan. 1, 2024  (Accessed Jan. 2024).

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. 873 Jan. 1, 2024, (Accessed Jan. 2024).

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. 1125 Jan. 1, 2024  (Accessed Jan. 2024).

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. 1158-1158 Jan. 1, 2024  (Accessed Jan. 2024).

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. 1200 Jan. 1, 2024, (Accessed Jan. 2024).

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. 1923 Jan. 1, 2024, (Accessed Jan. 2024).

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. 2148 Jan. 1, 2023  & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2149 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2150 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2151-2152 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2151 Jan. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2150 Jan. 1, 2024  (Accessed Jan. 2024).

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. 2152 Jan. 1, 2024  (Accessed Jan. 2024).

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 Jan. 2024).

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 Jan. 2024).

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 Jan. 2024).

Dialysis

MDHHS follows the Medicare billing guidelines for hemodialysis and peritoneal dialysis for both in-person and telemedicine visits.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1000 Jan. 1, 2024, (Accessed Jan. 2024).


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. 2139 Jan. 1, 2024  (Accessed Jan. 2024).

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. 2142, Jan. 1, 2024  (Accessed Jan. 2024).

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 Jan. 1, 2024  (Accessed Jan. 2024).

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.

The telemedicine modifier must be used in conjunction with the ACT encounter reporting code when telemedicine is used.

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. 364-265 Jan. 1, 2024  (Accessed Jan. 2024).

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. 544 Jan. 1, 2024  (Accessed Jan. 2024).

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. 747 & 749, Jan. 1, 2024  (Accessed Jan. 2024).

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. 1023, Jan. 1, 2024  (Accessed Jan. 2024).

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, Jan. 1, 2024  (Accessed Jan. 2024).

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. 1992-1993, Jan. 1, 2024  (Accessed Jan. 2024).

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. 2148, Jan. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2147, Jan. 1, 2024 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2149 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2149 Jan. 1, 2024  (Accessed Jan. 2024).

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.

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. 2150 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

Billing instructions depend upon the claim format used:

  • American Dental Association (ADA) Claim Format: Use POS 02 or POS 10.
  • Institutional Claim Format: POS 02 and POS 10 are not required; Use modifier 95.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2151 Jan. 1, 2024  (Accessed Jan. 2024).

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. 2151 Jan. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2151 Jan. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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 Jan. 2024).

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. 2152-2153 Jan. 1, 2024  (Accessed Jan. 2024).

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. 2197 & 2201, Jan. 1, 2024  (Accessed Jan. 2024).


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. 2142, Jan. 1, 2024, & 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 Jan. 2024).

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 Jan. 2024).

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. 2146, Jan. 1, 2024 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2147, Jan. 1, 2024 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

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. 2147, Jan. 1, 2024, (Accessed Jan. 2024).

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. 2147, Jan. 1, 2024, (Accessed Jan. 2024).

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 Jan. 2024).

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. 747 Jan. 1, 2024  (Accessed Jan. 2024).

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. 1023, Jan. 1, 2024. (Accessed Jan. 2024).

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, Jan. 1, 2024. (Accessed Jan. 2024).

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, Jan. 1, 2024. (Accessed Jan. 2024).

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. 1992, Jan. 1, 2024. (Accessed Jan. 2024).

Dentistry

Billing instructions depend upon the claim format used:

  • American Dental Association (ADA) Claim Format: Use POS 02 or POS 10.
  • Institutional Claim Format: POS 02 and POS 10 are not required; Use modifier 95.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2151 Jan. 1, 2024. (Accessed Jan. 2024).

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. 2153 Jan. 1, 2024. (Accessed Jan. 2024).

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. 2201 Jan. 1, 2024. (Accessed Jan. 2024).

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 Jan. 2024).


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. 2146 Jan. 1, 2024, & 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 Jan. 2024).

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. 188 & 202 Jan. 1, 2024. (Accessed Jan. 2024).

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 Jan. 1, 2024. (Accessed Jan. 2024).

Nursing Facility

To be reimbursed for the originating site facility fee, the NF must bill the appropriate telemedicine NUBC revenue code with the appropriate telemedicine facility fee and modifier.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 215 Jan. 1, 2024. (Accessed Jan. 2024).

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. 2152 Jan. 1, 2024. (Accessed Jan. 2024).

Last updated 01/16/2024

Miscellaneous

Privacy and Security

MDHHS requires a HIPAA compliant real-time interactive system at both the originating and distant sites, allowing instantaneous interaction between the beneficiary and provider via the telecommunication system.

When providing services via telemedicine, sufficient privacy and security measures must be in place and documented to ensure confidentiality and integrity of beneficiary-identifiable information. This includes, but is not limited to, ensuring any tracking technologies used by websites, mobile applications, or any other technology used, comply with applicable law regarding use or disclosure of beneficiary-identifiable information. Transitions, including beneficiary email, prescriptions, and laboratory results, must be secure within existing technology (i.e., password protected, encrypted electronic prescriptions, or other reliable authentication, techniques). All beneficiary-physician email, as well as other beneficiary-related electronic communications, should be stored and filed in the beneficiary’s medical record, consistent with transitional recordkeeping policies and procedures.

Prior Authorization

There are no prior authorization (PA) requirements when providing services via telemedicine for Fee-for-Service (FFS) beneficiaries or for those accessing Behavioral Health Services through Prepaid Inpatient Health Plans (PIHPs)/Community Mental Health Services Programs (CMHSPs) unless the equivalent in-person service requires PA. Authorization requirements for beneficiaries enrolled in Medicaid Health Plans (MHPs) may vary. Providers must refer to individual MHPs for any authorization or coverage requirements.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2141-2142 Jan. 1, 2024, & 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 Jan. 2024).

The Michigan Department of Health and Human Services requires a health insurance, portability and accountability act of 1986 compliant real time interactive system at both the originating and distant sites, allowing simultaneous interaction between the beneficiary and practitioner via the telecommunication system. The technology used must meet the needs for audio and visual compliance in accordance with state and federal standards. Practitioners must ensure the privacy of the beneficiary and the security of any information shared via telemedicine.

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 Jan. 2024).

A contingency plan, including referral to an acute care facility or Emergency Room (ER) for treatment as necessary for the safety of the beneficiary, is required when utilizing telemedicine technologies. This plan must include a formal protocol appropriate to the services being rendered.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2141 Jan. 1, 2024, (Accessed Jan. 2024).

Covered services for community health workers includes health system navigation and resource coordination, including helping a beneficiary with a telehealth appointment and/or educating a beneficiary on the use of telehealth technology.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 23-74, Medicaid Coverage of Community Health Worker (CHW)/Community Health Representative (CHR) Services, Dec. 1, 2023, (Accessed Jan. 2024).

Last updated 01/16/2024

Out of State 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.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 2139,  Jan. 1, 2024 (Accessed Jan. 2024).

Asynchronous Interprofessional Consultations

In consultations that cross state lines, consulting providers must be an enrolled Medicaid provider in the state in which the beneficiary resides, though they need only be licensed/credentialed in the state in which they are practicing. Interprofessional consultations that occur across state lines require prior authorization. Refer to the MDHHS Medicaid Provider Manual for further information regarding out-of-state/beyond borderland providers and the prior authorization process.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2144, Jan. 1, 2024 (Accessed Jan. 2024).

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: Dept. of Health and Human Services, Medicaid Provider Manual, p. 545, Jan. 1, 2024 (Accessed Jan. 2024).

Assertive Community Treatment Programs (ACT)

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.

The physician (MD or DO) must possess a valid license to practice medicine in Michigan, a Michigan Controlled Substance License, and a Drug Enforcement Administration (DEA) registration.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 364, Jan. 1, 2024 (Accessed Jan. 2024).

Last updated 01/16/2024

Overview

Michigan Medicaid reimburses for live video telemedicine for certain healthcare professionals, for patients located at certain originating sites for specific services.  Medicaid reimburses for asynchronous telemedicine services, including store and forward services, interprofessional consultations and remote patient monitoring services under certain circumstances.

Last updated 01/16/2024

Remote Patient Monitoring

POLICY

“Remote patient monitoring means digital technology to collect medical and other forms of health data from an individual in 1 location and electronically transmit that information via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure system to a health care provider in a different location for assessment and recommendations.”

SOURCE: MI Compiled Laws Sec. 400.105g & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2145 Jan. 1, 2024, (Accessed Jan. 2024).

Remote Patient Monitoring (RPM) is a covered service under Michigan Compiled Law (MCL) 400.105g. RPM means using digital technology to collect medical and other forms of health data from an individual in one location and electronically transmit that information via a secure, HIPAA-compliant system to a health care provider in a different location for assessment and recommendations. RPM is covered for both acute and chronic conditions.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2145 Jan. 1, 2024, (Accessed Jan. 2024).

The Department of Health and Human Services must provide coverage for remote patient monitoring services through the medical assistance program and Healthy Michigan program.

SOURCE: MI Compiled Laws Sec. 400.105g (Accessed Jan. 2024).

Continuous Glucose Monitoring

CGMS may be non-adjunctive/therapeutic (CGMS can be used to make treatment decisions without the need to confirm test results using a blood glucose monitor [BGM]); or adjunctive/non-therapeutic (beneficiary must use a BGM to test the results displayed on the CGMS prior to making a treatment decision).

SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1238 Jan. 1, 2024, (Accessed Jan. 2024).


CONDITIONS

RPM is covered for both acute and chronic conditions.

SOURCE: Medicaid Provider Manual, p. 2145 Jan. 1, 2024, (Accessed Jan. 2024).

RPM devices include (1) non-invasive remote monitoring devices that measure or detect common physiological parameters, and (2) non-invasive monitoring devices that wirelessly transmit the beneficiary’s medical information to their health care provider or other monitoring entity. The device must be reliable and valid, and the beneficiary must be trained or sufficiently knowledgeable in the proper use/wearing of the device to ensure appropriate recording of medical information. Medical information may include, but is not limited to, blood pressure and heart rate and rhythm monitoring.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2145 Jan. 1, 2024, (Accessed Jan. 2024).

Continuous Glucose Monitoring

Personal use CGMS are covered for beneficiaries with diabetes under certain circumstances.

SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1238 Jan. 1, 2024, (Accessed Jan. 2024).


PROVIDER LIMITATIONS

Continuous Glucose Monitoring

Personal use CGMS are covered for beneficiaries with diabetes when all the following are met:

  • The beneficiary is under the care of one of the following:
    • An endocrinologist; or
    • A physician or non-physician practitioner (nurse practitioner, physician assistant or clinical nurse specialist) who is managing the beneficiary’s diabetes.
  • The beneficiary has diabetes requiring the administering of insulin or is currently using an insulin pump.
  • The beneficiary or their caregiver is educated on the use of the device and is willing and able to use the CGMS.

Although not required for coverage consideration, physicians/non-physician practitioners are encouraged to refer patients who are willing and able to attend a certified diabetes selfmanagement education training program.

SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1238 Jan. 1, 2024, (Accessed Jan. 2024).


OTHER RESTRICTIONS

All RPM devices, including mobile medical applications, must meet the U.S. Food & Drug Administration (FDA) definition of a medical device. Personal tablets, computers, cell phones, software intended for administrative support or support of healthy lifestyles/general wellness, and electronic health records are not medical devices or durable medical equipment and are not covered as part of RPM services.

Reimbursement for the device used for remote monitoring, and programming of the device, is generally included in the reimbursement of RPM services and not separately reimbursable. For items or devices separately reimbursed to a medical supplier, such as personal use continuous glucose monitoring systems (CGMs), refer to the Medical Supplier chapter of the MDHHS Medicaid Provider Manual.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2145 Jan. 1, 2024, (Accessed Jan. 2024).

See bulletin for documentation, prior authorization and eligible CGM codes.

SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1238 Jan. 1, 2024, (Accessed Jan. 2024).

Last updated 01/16/2024

Store and Forward

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.

Asynchronous telemedicine services include the transmission of a beneficiary’s medical or other personally identifiable information through a secure, Health Insurance Portability and Accountability Act (HIPAA)-compliant, electronic communications system to a provider, often a specialist, at a distant site without the beneficiary present. Such communications, including store and forward services, interprofessional telephone/Internet/electronic health record consultations, and RPM services, involve contact between two parties (beneficiary to provider or provider to provider) in a way that does not require real-time interaction. Services must be medically necessary or essential for behavioral health and part of a provider-directed treatment plan.

Asynchronous telemedicine services must be performed under the general or direct supervision of a Medicaid-enrolled physician or practitioner who has an active role in the management of the beneficiary’s physical and/or behavioral health. The analysis and interpretation of the beneficiary’s data must contribute to the development and/or monitoring of the beneficiary’s treatment plan. Asynchronous telemedicine services do not include telephone calls, images transmitted via facsimile machines, and text messages without visualization of the beneficiary. Photographs visualized by a telecommunications system must be specific to the beneficiary’s physical and/or behavioral health condition and adequate for furnishing or confirming a diagnosis and/or treatment plan.

Asynchronous telemedicine services generally may not be separately reported on the same day the beneficiary presents for an evaluation and management (E/M) or other related service to the same provider. These services are typically considered part of the E/M or other related service and are not separately reimbursed. Activities performed in the facility setting under the general or direct supervision of the provider are bundled with the facility services on the UB-04 claim form and cannot be reported on the CMS 1500 claim form or billed under the provider’s National Provider Identifier (NPI).

Store and forward services are asynchronous electronic transmissions of physical and/or behavioral health information from the beneficiary to a Medicaid-enrolled physician or practitioner at the distant site when video or face-to-face contact is not necessary. Information transmitted to the provider is analyzed and used in the diagnosis, development, or maintenance of an individualized treatment plan. Information may include, but is not limited to, digital images, documents, video clips, still images, x-rays, magnetic resonance images (MRIs), electrocardiograms (EKGs) and electroencephalograms (EEGs), and audio clips.

Store and forward services include interpretation and follow-up with the beneficiary. Services must not originate from or result in a related E/M service.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2139 & 2143-2144, Jan. 1, 2024 & Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 (Accessed Jan. 2024).

Asynchronous telemedicine service codes are listed on the corresponding provider specific fee schedules. Additional program-specific coverage will be represented on individual program fee schedules and will be indicated in the program-specific sections below as indicated.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2146 Jan. 1, 2024, (Accessed Jan. 2024).

In accordance with Section 16284 of Public Act No. 359 of 2016, telemedicine services, including asynchronous telemedicine, must be provided only with direct or indirect beneficiary consent and this consent must be properly documented in the beneficiary’s medical record in accordance with applicable standards of practice.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2144, Jan. 1, 2024 & Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Jan. 2024).

Interprofessional consultations (including eConsults), are defined as a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating provider (e.g., attending or primary) requests the opinion and/or treatment advice of a Medicaid-enrolled consulting provider with the specialty expertise to assist in the diagnosis and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consulting provider. The service must be for the direct benefit of the beneficiary, directly relevant to the individual beneficiary’s original evaluation, diagnosis, and/or treatment, and must conclude with a written report from the consulting provider to the treating provider.

The beneficiary for whom the service is requested may be either a new or established patient to the consulting provider. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology reports, is included in the service and should not be separately reported. The written or verbal request for the consultation must be documented in the beneficiary’s medical record by the treating provider. Additional documentation requirements (within the medical record of the beneficiary) include date of service; name of provider agency or person providing the service; nature, extent, or units of service; and the place of service, along with all record keeping requirements as outlined in the MDHHS Medicaid Provider Manual.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2144, Jan. 1, 2024 (Accessed Jan. 2024).


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 patient 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” in MSA 20-09 for further information).

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.

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. 2141-2142 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Jan. 2024).

Allowable telemedicine services for synchronous telemedicine are listed on the telemedicine fee schedules which can be accessed on the MDHHS website at www.michigan.gov/medicaidproviders >> Billing and Reimbursement >> Provider Specific Information. Asynchronous telemedicine service codes are listed on the corresponding provider specific fee schedules. Additional program-specific coverage will be represented on individual program fee schedules and will be indicated in the program-specific sections below as indicated.

Covered asynchronous telemedicine services (as defined above, represented on corresponding fee schedules, and outlined in bulletin MSA 21-24 – Asynchronous Telemedicine Services) should be billed with applicable POS and modifiers as standard practice.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

Covered asynchronous telemedicine services must be billed with applicable POS and modifiers as standard practice.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2147, Jan. 1, 2024, (Accessed Jan. 2024).

The beneficiary for whom the service is requested may be either a new or established patient to the consulting provider. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology reports, is included in the service and should not be separately reported. The written or verbal request for the consultation must be documented in the beneficiary’s medical record by the treating provider. Additional documentation requirements (within the medical record of the beneficiary) include date of service; name of provider agency or person providing the service; nature, extent, or units of service; and the place of service, along with all record keeping requirements as outlined in the MDHHS Medicaid Provider Manual. Providers must also consult with the American Medical Association (AMA) coding guidelines to ensure appropriate reporting of these services. Providers should not report interprofessional telephone/Internet/electronic health record consultations when the sole purpose of the communication is to arrange a transfer of care or other face-to-face service.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2144, Jan. 1, 2024 (Accessed Jan. 2024).

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 Jan. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 01/19/2024

Cross State Licensing

In limited circumstances, MI Public Health Code states that certain individuals are not required to have a license for practice of a health profession in MI, including the following:
  • A student who is in a health profession training program, that has been approved by the appropriate board, while performing the duties assigned in the course of training.
  • An individual who is practicing a health profession in the discharge of official duties while in the military service of the United States, the United States Public Health Service, the United States Department of Agriculture, or the United States Department of Veterans Affairs. The institution in which the individual practices shall report the name and address of the individual to the appropriate board within 30 days after the date of employment.
  •  An individual who by education, training, or experience substantially meets the requirements of this article for licensure while rendering medical care in a time of disaster or to an ill or injured individual at the scene of an emergency.
  • If the director of the department of health and human services determines that control of an epidemic is necessary to protect the public health under section 2253, an individual who is authorized to practice a health profession in another state, who would otherwise meet the requirements of this article for licensure, while rendering medical care during an epidemic-related staffing shortage to meet health professional staffing needs. As used in this subdivision, “epidemic-related staffing shortage” means a shortage of individuals who are licensed under this article during the epidemic. Epidemic-staffing shortage does not include a staffing shortage caused by a labor dispute as that term is defined in section 2 of 1939 PA 176, MCL 423.2.
  • An individual who provides nonmedical nursing or similar services in the care of the ill or suffering or an individual who in good faith ministers to the ill or suffering by spiritual means alone, through prayer, in the exercise of a religious freedom, and who does not hold himself or herself out to be a health professional.
  • An individual who resides in another state or country and is authorized to practice a health profession in that state or country who, in an exceptional circumstance, is called in for consultation or treatment by a health professional in this state.
  • An individual who resides in another state or country and is authorized to practice a health profession in that state or country, when attending meetings or conducting lectures, seminars, or demonstrations under the auspices of professional associations or training institutions in this state, if the individual does not maintain an office or designate a place to meet patients or receive calls in this state.
  • An individual who is authorized in another country to practice a health profession and who is employed by the United States Public Health Service or the government of another country for the exclusive use of members of its merchant marine and members of its consular and diplomatic corps, while caring for those members in the performance of his or her official duties.
  • An individual who resides adjacent to the land border between this state and an adjoining state and is authorized under the laws of that state to practice a health profession and whose practice may extend into this state, but who does not maintain an office or designate a place to meet patients or receive calls in this state.
  • An individual who is authorized to practice a health profession in another state and who is appointed by the United States Olympic Committee to provide health services exclusively to team personnel and athletes registered to train and compete at a training site in this state approved by the United States Olympic Committee or at an event conducted under the sanction of the United States Olympic Committee. An exemption granted under this subdivision applies to the individual while he or she is performing the duties assigned in the course of the sanctioned training program or event and for the time period specified by the United States Olympic Committee.
  • An individual who is currently authorized to practice a health profession in another state and is providing health services for an athletic team, if certain criteria are met. See statute.

SOURCE: MI Public Health Code 333.16171. License for practice of health profession; exemptions. (Accessed Jan. 2024).

Last updated 01/19/2024

Definitions

“Telehealth” means the use of electronic information and telecommunication technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, or health administration.

Telehealth may include, but is not limited to, telemedicine. As used in this subdivision, “telemedicine” means that term as defined in section 3476 of the insurance code of 1956, 1956 PA 218, MCL 500.3476.

SOURCE:  MI Compiled Laws Sec. 333.16283(c), (Accessed Jan. 2024).

“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 Insurance Code 500.3476 & MI Compiled Laws Sec. 330.1100d(16). (Accessed Jan. 2024).

Occupational Therapy

“Telehealth” means the use of electronic information and telecommunication  technologies to support or promote long-distance clinical healthcare, patient and professional health-related education, public health, or health administration. Telehealth may include, but is not limited to, telemedicine.

“Telehealth service” means a healthcare service that is provided through   telehealth. 

“Telemedicine” means the use of electronic media to link patients with  healthcare professionals in different locations. To be considered telemedicine, the  telemedicine services must be provided by a healthcare professional who is licensed, registered, or otherwise authorized to engage in his or her healthcare profession in the state where the patient is located.

SOURCE: MI Administrative Rule R 338.1241, (Accessed Jan. 2024).

Dentist

“Telehealth” means the use of electronic information and telecommunication technologies to support or promote long-distance clinical healthcare, patient and professional health-related education, public health, or health administration. Telehealth may include, but is not limited to, telemedicine. 

“Telehealth service” means a healthcare service that is provided through telehealth. The requirement in R 338.11401 to have an “in-person” contact with the dentist or dental therapist once every 24 months does not apply to telehealth services unless the dentist or dental therapist delegates or assigns duties, other than radiographic images, to allied dental personnel.

“Telemedicine” means the use of electronic media to link patients with healthcare professionals in different locations. To be considered telemedicine, the telemedicine services must be provided by a healthcare professional who is licensed, registered, or otherwise authorized to engage in the healthcare professional’s healthcare profession in the state where the patient is located. 

Last updated 01/19/2024

Licensure Compacts

Member of Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact, Compact Map. (Accessed Jan. 2024).

Member of Psychology Interjurisdictional Compact (PSYPACT).

SOURCE: PSYPACT Map, (Accessed Jan. 2024).

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

Last updated 01/19/2024

Miscellaneous

In a manner consistent with this part and in addition to the provisions set forth in this part, a disciplinary subcommittee may place restrictions or conditions on a health professional’s ability to provide a telehealth service if the disciplinary subcommittee finds that the health professional has violated section 16284 or 16285.

SOURCE: MI Compiled Law Section 333.16286 (Accessed Jan. 2024).

Last updated 01/19/2024

Online Prescribing

Before dispensing a drug or device pursuant to a prescription under this subsection, the pharmacist, in the exercise of his or her professional judgment, must determine all of the following:
  • Except as otherwise authorized under section 5110, 17744a, or 17744b, if the prescriber is not a veterinarian, that the prescription was issued pursuant to an existing prescriber-patient relationship.
  • That the prescription is authentic.
  • That the prescribed drug is appropriate and necessary for the treatment of an acute, chronic, or recurrent condition..

A pharmacist or a prescriber shall dispense a drug or device pursuant to a prescription only if the prescription falls within the scope of practice of the prescriber.

A pharmacist shall not knowingly dispense a drug or device pursuant to a prescription after the death of the prescriber or patient.

A pharmacist shall not dispense a drug or device pursuant to a prescription transmitted by facsimile or created in electronic format and printed out for use by the patient unless the document is manually signed by the prescriber.

See statute for additional requirements.

SOURCE: MI Compiled Laws Sec. 333.17751(2)(a).  (Accessed Jan. 2024).

A licensed prescriber shall not prescribe a controlled substance listed in schedules 2 to 5 unless the prescriber is in a bona fide prescriber-patient relationship with the patient for whom the controlled substance is being prescribed.

If a licensed prescriber prescribes a controlled substance under this subsection, the prescriber shall provide follow-up care to the patient to monitor the efficacy of the use of the controlled substance as a treatment of the patient’s medical condition. If the licensed prescriber is unable to provide follow-up care, he or she shall refer the patient to the patient’s primary care provider for follow-up care or, if the patient does not have a primary care provider, he or she shall refer the patient to another licensed prescriber who is geographically accessible to the patient for follow-up care.

SOURCE:  MI Compiled Laws Sec. 333.7303a. (Accessed Jan. 2024). 

A health professional providing telehealth service to a patient may prescribe the patient a drug if both the following are met:

  • The health professional is a prescriber who is acting within the scope of his or her practice; and
  • If the health professional is prescribing a controlled substance, the health professional must meet the requirements of this act applicable to that health professional for prescribing a controlled substance.

A health professional who prescribes a drug under subsection (1) shall comply with both of the following:

  • If the health professional considers it medically necessary, he or she shall provide the patient with a referral for other health care services that are geographically accessible to the patient, including, but not limited to, emergency services.
  • After providing a telehealth service, the health professional, or a health professional who is acting under the delegation of the delegating health professional, shall make himself or herself available to provide follow-up health care services to the patient or refer the patient to another health professional for follow-up health care services.

SOURCE:  MI Compiled Laws, Sec. 333.16285. (Accessed Jan. 2024).

Medicine, Podiatric Medicine & Surgery, Genetic Counseling, Osteopathic Medicine

A licensee [podiatrist] providing a telehealth service may prescribe a drug if the licensee [podiatrist] is a prescriber acting within the scope of his or her practice and in compliance with section 16285 of the code, MCL 333.16285, if he or she does both of the following:  

  • If medically necessary, refers the patient to a provider that is geographically  accessible to the patient.  
  • Makes himself or herself available to provide follow up care services to the   patient, or to refer the patient to another provider, for follow up care.  

A licensee [podiatrist] providing any telehealth service must do both of the following:  

  • Act within the scope of his or her practice.  
  • Exercise the same standard of care applicable to a traditional, in-person health care service. 

SOURCE: MI Administrative Code R 338.2407 & MI Administrative Code 338.8145, MI Administrative Code R. 338.2455, MI Administrative Code R 338.114, (Accessed Jan. 2024).

Counseling

A licensee providing any telehealth service shall do both of the following:

  • Act within the scope of the licensee’s practice.
  • Exercise the same standard of care applicable to a traditional, in-person healthcare service.

SOURCE: MI Administrative Code R 338.1758, (Accessed Jan. 2024).

Optometry

An optometrist providing a telehealth service may prescribe a drug if the optometrist is a prescriber acting within the scope of the optometrist’s practice and in compliance with section 16285 the code, MCL 333.16285, if the optometrist does both of the  following:  

  • If medically necessary, refers the patient to a provider that is geographically  accessible to the patient.
  • Makes himself or herself available to provide follow-up care services to the patient   or to refer the patient to another provider for follow-up care. 

An optometrist may provide a telehealth service only when the optometrist complies   with all of the following:  

  • Part 174 of the code, MCL 333.17401 to 333.17437.  
  • The eye care consumer protection law, part 55A of the code, MCL 333.5551 to  333.5571, including the duty to perform an examination and evaluation, under sections  5551 to 5559 of the code, MCL 333.5551 to 333.5559.

SOURCE: MI Administrative Code 338.306, (Accessed Jan. 2024).

Veterinary Medicine

A veterinarian providing a telehealth service may prescribe a drug if the veterinarian is a prescriber acting within the scope of his or her practice and in compliance with section 16285 of the code, MCL 333.16285. 

SOURCE: MI Administrative Code R 338.4901a, (Accessed Jan. 2024).

Dentist

A licensee who is authorized to prescribe may prescribe a drug during a telehealth service if the licensee complies with all of the following: 

  • Is licensed in this state and is a prescriber in this state.  
  • Is acting within the licensee’s scope of practice in prescribing the drug.  
  • Is acting in compliance with section 16285 of the code, MCL 333.16285.
  • If the licensee determines that it is medically necessary, the licensee shall refer the patient for other healthcare services or to another health professional that is geographically accessible to the patient.
  • After providing the telehealth service, the licensee or delegate shall provide follow-up care services to the patient or refer the patient to another health professional for follow-up care.

SOURCE: MI Administrative Code R 338.11615, (Accessed Jan. 2024).

Last updated 01/19/2024

Definition of Visit

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. Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, & Dept. of Health and Human Services Medicaid Provider Manual, p. 2142, Jan. 1, 2024 (Accessed Jan. 2024).

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.

An encounter occurs between a medical provider and a patient when medical services are provided for the prevention, diagnosis, treatment, or rehabilitation of an illness or injury. Included in this category are physician visits and mid-level practitioner visits. Family planning medical visits are a subset of medical visits.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 749, Jan. 1, 2024 (Accessed Jan. 2024).

Last updated 01/19/2024

Eligible Distant Site

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.

Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC)/Tribal Health 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 Jan. 2024).

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 within the Medicaid provider manual and any applicable supplemental Medicaid policy bulletins.

Distant site services, provided by qualified Medicaid enrolled practitioners, may be covered when the qualified practitioner 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 national provider identifier. Refer to the billing and reimbursement for institutional providers chapter of the Medicaid provider manual for further information.

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.

If both originating and distant sites submit identical procedure codes for a telemedicine visit for the same beneficiary on the same date of service it is considered a 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. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] & Dept. of Health and Human Services Medicaid Provider Manual, p. 2152-2153, Jan. 1, 2024 (Accessed Jan. 2023).

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: Dept. of Health and Human Services Medicaid Provider Manual, p. 2152, Jan. 1, 2024 (Accessed Jan. 2024).

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. 2197, Jan. 1, 2024 (Accessed Jan. 2024).

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. 747, Jan. 1, 2024 (Accessed Jan. 2024).

See: MI Medicaid Live Video Distant Site

Last updated 09/05/2023

Eligible Originating Site

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).

Authorized originating sites:

  • Federally Qualified Health Center (FQHC)

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2117, Jul. 1, 2023 (Accessed Sept. 2023).

See: MI Medicaid Live Video Eligible Sites.

Last updated 01/19/2024

Facility Fee

Allowable originating sites [includes FQHCs] 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

The telehealth facility fee does not qualify as a face-to-face visit and does not generate the PPS Payment.

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] & Dept. of Health and Human Services, Medicaid Provider Manual, p. 2146 & 2152, Jan 1, 2024 (Accessed Jan. 2024).

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: Dept. of Health and Human Services, Medicaid Provider Manual, p. 270, Jan. 1, 2024 (Accessed Jan. 2024).

See: MI Medicaid Live Video Facility/Transmission Fee

Last updated 01/19/2024

Home Eligible

Off-site services provided by employed practitioners of the FQHC to beneficiaries temporarily homebound or in any assisted living or skilled nursing facility because of a medical condition that prevents the beneficiary from traveling to the FQHC are also allowable for reimbursement under the PPS or the MOU.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 745-746, Jan. 1, 2024 (Accessed Jan. 2024).

Last updated 01/19/2024

Modalities Allowed

Live Video

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 within the Medicaid provider manual and any applicable supplemental Medicaid policy bulletins.

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] & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2152, Jan. 1, 2024 (Accessed Jan. 2024).

The provision of bulletin MSA 20-34 which allows providers to work from home, is also allowable per bulletin MSA 20-09, which defines the parameters for the distant site to include “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”.

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.

For services submitted on the Institutional invoice, the appropriate National Uniform Billing Committee (NUBC) revenue code, along with the appropriate telemedicine Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) procedure code and modifier 95 or Modifier 93, must be used.

Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC)/Tribal Health 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 Jan. 2024).

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. 747, Jan. 1, 2024 (Accessed Jan. 2024).

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.

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.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2152, Jan. 1, 2024 (Accessed Jan. 2024.

See: MI Medicaid Live Video.


Store and Forward

Asynchronous telemedicine services are allowed in specific situations, however, CCHP has not found an explicit reference stating whether or not FQHCs can be reimbursed in Medicaid manuals.

See: MI Medicaid Store and Forward.


Remote Patient Monitoring

According to the MI Medicaid provider manual, RPM is covered with restrictions, however there is no indication from Medicaid if FQHCs can bill for this.

See: MI Medicaid Remote Patient Monitoring.


Audio-Only

Clinics will be permitted to submit for reimbursement allowable audio-only service codes, as indicated above, if appropriate for the interaction with the beneficiary. Medicaid clinic billing and reimbursement requirements apply. The provider must be employed by or contracted with the FQHC, RHC, or THC and the procedure code billed must appear on the clinic qualifying visit list located on the MDHHS website.

For services submitted on the Institutional invoice, the appropriate National Uniform Billing Committee (NUBC) revenue code, along with the appropriate telemedicine Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) procedure code and modifier 95 or Modifier 93, must be used.

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. 2147 & 2153, Jan. 1, 2024 (Accessed Jan. 2024).

See: MI Medicaid Email, Phone and Fax.

Last updated 01/19/2024

Patient-Provider Relationship

No reference found

Last updated 01/19/2024

PPS Rate

Telemedicine services 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 FQHC/RHC telemedicine services billing chart for billing rules.

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] & Dept. of Health and Human Services Medicaid Provider Manual, p. 2152, Jan. 1, 2024 (Accessed Jan. 2024).

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. 2197, Jan. 1, 2024 (Accessed Jan. 2024).

Last updated 01/19/2024

Same Day Encounters

An FQHC may be credited with one encounter for each different type of visit provided to a beneficiary during a single day, regardless of the number of services provided at the visit. A maximum of three encounters are allowed per beneficiary per day (one medical, one dental, and one behavioral health). In cases where the beneficiary, after the first visit, suffers illness or injury requiring additional diagnosis or treatment, these visits may be classified as two encounters.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 750-751, Jan. 1, 2024 (Accessed Jan. 2024).