Last updated 01/10/2022
Definitions
“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.
SOURCE: MO Revised Statute Title XII Public Health and Welfare Sec. 208.670 which references Title XII Sec. 191.1145. (Accessed Jan. 2022).
Telemedicine Services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.
SOURCE: MO HealthNet, Physician Manual,13-69 p. 286 (Oct. 13, 2021), (Accessed Jan. 2022).
Telemedicine Services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.
SOURCE: MO HealthNet, Provider Manual, Rural Health Clinics, Section 13, p. 165 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13.22, p. 211 (Sept. 9, 2021). (Accessed Jan. 2022).
Department of Health and Senior Services – Comprehensive Emergency Medical Services Systems
Telemedicine–the use of medical information exchanged from one (1) site to another via electronic communications to improve patient’s health status. A neurology specialist will assist the physician in the center in rendering a diagnosis. This may involve a patient “seeing” a specialist over a live, remote consult or the transmission of diagnostic images and/or video along with patient data to the specialist.
SOURCE: MO Code of State Regulation, Title 19, Sec. 30-40.710, (Accessed Jan. 2022).
Last updated 01/11/2022
Live Video
POLICY
Services provided through telemedicine [or telehealth, as referred to in Rural Health Clinics manual] must meet the standard of care that would otherwise be expected should such services be provided in person. Prior to the delivery of telehealth services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the school year.
SOURCE: MO HealthNet, Physician Manual, 13.69A p. 286 (Oct. 13, 2021), Provider Manual, Rural Health Clinics, Section 13, p. 165 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 211 (Sept. 9, 2021). (Accessed Jan. 2022).
The department of social services shall reimburse providers for services provided through telehealth if such providers can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in-person. Reimbursement for telehealth services shall be made in the same way as reimbursement for in-person contact; however, consideration shall also be made for reimbursement to the originating site.
SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Jan. 2022).
ELIGIBLE SERVICES/SPECIALTIES
Services provided through telemedicine must meet the standard of care that would otherwise be expected should such services be provided in person. Reimbursement to the health care provider delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided. Use the appropriate CPT code for the service along with place of service 02 (telehealth/telemedicine). Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
When a participant is located in a residential or inpatient place of service (Place of service codes 14, 21, 33, 51, 55, 56 or 61), providers delivering behavioral health services via telemedicine must bill with the GT modifier and with the place of service where the participant is physically located. In these instances, providers must not bill with place of service 02
SOURCE: MO HealthNet, Physician Manual,13-69A p. 287 (Oct. 13, 2021) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).
Services provided through telehealth must meet the standard of care that would otherwise be expected should such services be provided in person.
Prior to the delivery of telehealth services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the school year.
SOURCE: MO Statute Annotated, Title 12, Sec. 208.677 & MO HealthNet, Provider Manual, Rural Health Clinics, Section 13, p. 166 (Nov. 25, 2020), (Accessed Jan. 2022).
Comprehensive Substance Abuse Treatment & Rehabilitation (CSTAR) Program
Medication services may be provided via telehealth. See manual for code list.
SOURCE: MO HealthNet, CSTAR Manual, 13.14(K)(4) p. 201 (Sept. 6, 2019, (Accessed Jan. 2022).
Community Psych Rehab Program
Several services are covered if delivered via telehealth. See manual for specific services.
SOURCE: MO HealthNet, Community Psych Rehab Program Manual, p. 239. (Sept. 6, 2019), (Accessed Jan. 2022).
Home Health
The telehealth may be used in the “face-to-face” requirement of an encounter.
SOURCE: MO HealthNet, Home Health Manual, p. 170. (Nov. 20, 2021), (Accessed Jan. 2022).
Dentistry
Some teledentistry is covered. See manual for codes.
SOURCE: MO HealthNet, Dental Manual, p. 260. (Nov. 1, 2021). (Accessed Jan. 2022).
Opioid Treatment Programs
Services may be provided via telehealth to enhance accessibility for individuals served.
SOURCE: MO Code of State Regulation, Title 9, Sec. 30-3.132, (Accessed Jan. 2022).
ELIGIBLE PROVIDERS
Any licensed health care provider shall be authorized to provide telemedicine [or telehealth, as referred to in Rural Health Clinic manual] services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. To be reimbursed for telehealth/telemedicine services health care providers treating patients in this state, utilizing telehealth/telemedicine, must be fully licensed to practice in this state and be enrolled as a MO HealthNet/ MHD provider prior to rendering services.
SOURCE: MO HealthNet, Physician Manual, 13.69B p. 287 (Oct. 13, 2021), Provider Manual, Rural Health Clinics, Section 13, p. 165-166 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).
Reimbursement to the health care provider delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided. Use the appropriate CPT® code for the service along with place of service 02 (telemedicine). When a participant is located in a residential or inpatient place of service (14, 21, 33, 51, 55, 56 or 61), providers delivering behavioral health services via telemedicine must bill with the GT modifier and with the place of service where the participant is physically located. In these instances, providers must not bill with place of service 02. Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
SOURCE: MO HealthNet, Physician Manual, 13.69A p. 287 (Oct. 13, 2021) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).
RHCs must bill with their non-RHC provider number when they are the originating site to receive the facility fee. RHCs may bill with either their non-RHC provider number or their RHC provider number when they are the distant site. The provider will use the appropriate procedure code for the service along with place of service 02 (Telehealth). Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. To be reimbursed for telehealth services health care providers treating patients in this state, utilizing telehealth, must be fully licensed to practice in this state and be enrolled as a MHD provider prior to rendering services.
SOURCE: MO HealthNet, Rural Health Clinic, p. 166 (Nov. 25, 2020). (Accessed Jan. 2022).
Anesthesiologist monitoring telemetry in the operating room is a non-covered service.
SOURCE: MO HealthNet, Physician Manual, p. 208 (Oct 13, 2021). (Accessed Jan. 2022).
ELIGIBLE SITES
When a participant is located in a residential or inpatient place of service (Place of service codes 14, 21, 33, 51, 55, 56 or 61), providers delivering behavioral health services via telemedicine must bill with the GT modifier and with the place of service where the participant is physically located. In these instances, providers must not bill with place of service 02
SOURCE: MO HealthNet, Physician Manual,13-69A p. 287 (Oct. 13, 2021) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).
The department shall not restrict the originating site through rule or payment so long as the provider can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in-person.
SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Jan. 2022).
No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient’s medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in-person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.
SOURCE: MO Revised Statute Sec. 191.1145(6). (Accessed Jan. 2022).
RHCs must bill with their non-RHC provider number (or when the distant site, the RHC provider number can also be used) when they are the originating site to receive the facility fee.
Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
SOURCE: MO HealthNet, Rural Health Clinic, p. 165 (Nov. 25, 2020). (Accessed Jan. 2022).
The originating site is where the MO HealthNet participant receiving the telehealth service is physically located. The originating site and distant site can be billed by the same provider for the same date of service as long as the distant site is not located in the originating site facility.
SOURCE: MO Department of Social Services. Provider Bulletin. Vol. 40, No. 47. Feb. 2, 2018. (Accessed Jan. 2022).
GEOGRAPHIC LIMITS
Payment for services rendered via telehealth shall not depend on any minimum distance requirement between the originating and distant site.
SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Jan. 2022).
FACILITY/TRANSMISSION FEE
The originating site is only eligible to receive a facility fee for the telemedicine service. Claims should be submitted with HCPCS code Q3014 (telemedicine originating site facility fee). Procedure code Q3014 is used by the originating site to receive reimbursement for the use of the facility while Telehealth services are being rendered.
SOURCE: MO HealthNet, Physician Manual, 13.69A p. 287 (Oct. 13, 2021); & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021). (Accessed Jan. 2022).
RHCs must bill with their non-RHC provider number to receive reimbursement for a facility fee for the Telehealth services when operating as the originating site. Claims must be submitted with HCPCS code Q3014 (Telehealth originating site facility fee).
SOURCE: Provider Manual, Rural Health Clinics, Section 13, p. 166 (Nov. 25, 2020). (Accessed Jan. 2022).
FQHCs and RHCs are eligible for an originating site facility fee. Special billing instructions apply to FQHC providers.
SOURCE: MO Department of Social Services. Provider Bulletin. Vol 41, No. 44. Mar. 5, 2019. (Accessed Jan. 2022).
Hospitals
Costs and charges for the telehealth originating site fee reimbursed on a fee schedule shall be excluded when calculating the outpatient cost-to-charge ratios used to determine outpatient percentage rates starting with the calculation of the outpatient percentage rate for the SFY after the telehealth originating site fee is moved to a fee schedule.
SOURCE: MO Revised Statute Title 13, Sec. 70-15.160, (Accessed Jan. 2022).
Last updated 01/11/2022
Miscellaneous
No later than July 1, 2022, there shall be established within the department a statewide telehealth network for forensic examinations of victims of sexual offenses in order to provide access to sexual assault nurse examiners (SANE) or other similarly trained appropriate medical providers. A statewide coordinator for the telehealth network shall be selected by the director of the department of health and senior services and shall have oversight responsibilities and provide support for the training programs offered by the network, as well as the implementation and operation of the network.
SOURCE: MO Revised Statute Ch. 192.2520 (Accessed Aug. 2021).
Special documentation requirements apply.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021); MO HealthNet, Physician Manual, Telehealth Services, p. 287 (Oct. 13, 2021) & MO HealthNet, Rural Health Clinic, p. 166 (Nov. 24, 2020). (Accessed Jan. 2022).
Precertification and Utilization Review
All services are subject to utilization review for medical necessity and program compliance. Reviews can be performed before services are furnished, before payment is made, or after payment is made.
Certain procedures or services can require precertification from the MO HealthNet Division or its authorized agents. Services for which a precertification was obtained remain subject to utilization review at any point in the payment process. A service provided through Telemedicine is subject to the same precertification and utilization review requirements which exist for the service when not provided through Telemedicine.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 212 (Sept. 9, 2021), (Accessed Jan. 2022).
School-based Therapy Services
Place of service school (03) must be used for services provided in a school or on school grounds. If a school district is providing telehealth services on school grounds, the GT modifier must be used.
SOURCE: MO HealthNet, Therapy Manual, p. 174 (Oct. 12, 2021). (Accessed Jan. 2022).
Last updated 01/11/2022
Remote Patient Monitoring
POLICY
Subject to appropriations, the department shall establish a statewide program that permits reimbursement under the MO HealthNet program for home telemonitoring services.
“Home telemonitoring service” shall mean a health care service that requires scheduled remote monitoring of data related to a participant’s health and transmission of the data to a health call center accredited by the Utilization Review Accreditation Commission (URAC).
SOURCE: MO Revised Statute Sec. 208.686. (Accessed Jan. 2022).
CONDITIONS
Eligible conditions:
- Pregnancy
- Diabetes
- Heart disease
- Cancer
- Chronic obstructive pulmonary disease
- Hypertension
- Congestive heart failure
- Mental illness or serious emotional disturbance
- Asthma
- Myocardial infarction; or
- Stroke
The beneficiary must also exhibit two or more the following risk factors:
- Two or more hospitalizations in the prior twelve-month period;
- Frequent or recurrent emergency department admissions;
- A documented history of poor adherence to ordered medication regimens;
- A documented history of falls in the prior six-month period;
- Limited or absent informal support systems;
- Living alone or being home alone for extended periods of time;
- A documented history of care access challenges; or
- A documented history of consistently missed appointments with health care providers
SOURCE: MO Revised Statute Sec. 208.686.(Accessed Jan. 2022).
Personal Emergency Response Systems is available under the Developmental Disabilities Waiver. This service may also include electronic support systems using video, web-cameras, or other technology. However, use of such systems may be subject to due process review. Assistive technology shall not include household appliances or items that are intended for purely diversional or recreational purposes. Assistive technology should be evidenced based, and shall not be experimental. Electronic support systems using video, web-cameras, or other technology is only available on an individual, case-by-case basis when an individual requests the service and the planning team agrees it is appropriate and meets the health and safety needs of the individual. See manual for more details.
SOURCE: MO HealthNet, Provider Manual, Developmental Disabilities Waiver Manual, Section 13, p. 30-31 (Mar. 1, 2021). (Accessed Jan. 2022).
PROVIDER LIMITATIONS
The program must ensure the home health agency or hospital shares telemonitoring clinical information with participant’s physician.
SOURCE: MO Revised Statute Sec. 208.686. (Accessed Jan. 2022)
OTHER RESTRICTIONS
If, after implementation, the department determines that the program established under this section is not cost effective, the department may discontinue the program and stop providing reimbursement under the MO HealthNet program for home telemonitoring services. The department shall promulgate rules and regulations to implement the provisions of this section.
SOURCE: MO Revised Statute Sec. 208.686. (Accessed Jan. 2022).