Last updated 09/06/2023
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 Sept. 2023).
Telemedicine – the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face to face service.
SOURCE: MO HealthNet, Telemedicine Originating and Distant Site Reimbursement Scenarios, & MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
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 the patient is at the originating site and the health care provider is at the distant site.
SOURCE: MO HealthNet, Telemedicine Overview, (Accessed Sept. 2023).
Telemedicine [telehealth] 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, 2.67 p. 112 (9/1/23), & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 59 (9/1/23). (Accessed Sept. 2023).
Telemedicine shall mean the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.
SOURCE: MO Code of State Regulations 13 CSR 70-3.330(B)(5) (7/31/23), (Accessed Sept. 2023).
Telehealth 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.
Telehealth offers participants, particularly those in rural areas of the state, access to health care services without having to travel extensive miles for an appointment.
SOURCE: MO HealthNet, Rural Health Clinic, Provider Manual, 1.14, pg. 10 (9/1/23), (Accessed Sept. 2023).
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 Sept. 2023).
Mental Health
Telemedicine is the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.
SOURCE: MO 13 CSR 70-3.330, MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Sept. 2023)
What is Telemedicine?
Telemedicine is 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 HealthNet, Telemedicine, (Accessed Sept. 2023).
Last updated 09/05/2023
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, 2.67 p. 112 (9/1/23), Provider Manual, Rural Health Clinics, Section 1,14 p. 9 (9/1/23) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 59 (9/1/23). (Accessed Sept. 2023).
The MO HealthNet Division reimburses for eligible services provided via telemedicine when the service can be performed by a MO HealthNet provider with the same standard of care as a face to face service.
Reimbursement for the distant site provider is equal to the current fee schedule allowed amount for the service provided.
SOURCE: MO HealthNet, Telemedicine Overview, (Accessed Sept. 2023).
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 Sept. 2023).
Reimbursement to the health care provider delivering the telemedicine service at the distant site shall be made at the same amount as the current fee schedule for an in person service
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(5), (Accessed Sept. 2023).
The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023 MO HealthNet, will continue to allow any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.
Telehealth services may be provided to a MHD participant, while the participant is at an originating site, and the provider is at another location (the distant site.) The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.
There is not a separate telehealth fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.
SOURCE: MO HealthNet Provider Hot Tips, March 27, 2023, (Accessed Sept. 2023).
MO HealthNet reimburses for services provided via telemedicine when the service can be performed with the same standard of care as a face to face service.
SOURCE: MO HealthNet, Telemedicine, (Accessed Sept. 2023).
ELIGIBLE SERVICES/SPECIALTIES
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. This section shall not be construed to prohibit a health carrier, as defined in section 376.1350, from reimbursing nonclinical staff for services otherwise allowed by law.
Nothing in subsection 3 of this section shall apply to:
- Informal consultation performed by a health care provider licensed in another state, outside of the context of a contractual relationship, and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;
- Furnishing of health care services by a health care provider licensed and located in another state in case of an emergency or disaster; provided that, no charge is made for the medical assistance; or
- Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in this state
SOURCE: MO Revised Statute Sec. 191.1145(6). (Accessed Sept. 2023).
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, Sec. 2.67 p. 112 (9/1/23) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 60 (9/1/23). (Accessed Sept. 2023).
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 HealthNet, Physician Manual, 2.67 p. 112 (9/1/23), Provider Manual, Rural Health Clinics, Section 1,14 p. 9 (9/1/23) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 59 (9/1/23). (Accessed Sept. 2023).
There is not a separate telemedicine fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.
SOURCE: MO Medicaid Provider Tips, Telemedicine, July 18, 2022, (Accessed Sept. 2023).
Behavioral Health Services
Telemedicine is subject to the same precertification requirements. Claims submitted for behavioral health telemedicine services without a required precertification will be denied.
SOURCE: MO HealthNet Provider Tips (Nov. 22, 2022). (Accessed Sept. 2023).
Behavioral Health Crisis Centers
Direct services shall be provided by a licensed physician (includes psychiatrist) or licensed psychiatric mental health nurse practitioner (PMHNP), advanced practice registered nurse (APRN), physician assistant, resident physician (includes psychiatrist), and/or assistant physician in a written collaborative practice arrangement with a physician and with experience treating the target population. Services may be provided via telemedicine.
SOURCE: 9 CSR 30-7.010, (Accessed Sept. 2023).
Comprehensive Substance Abuse Treatment & Rehabilitation (CSTAR) Program
Communication with a collateral contact may be made face to face, by phone, or by telehealth platforms. See manual for code list.
SOURCE: MO HealthNet, CSTAR Manual, Sec. 2.9 K p. 44 (9/1/23). (Accessed Sept. 2023).
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, (9/1/23), (Accessed Sept. 2023).
Home Health
The face-to-face encounter may occur through telehealth, as allowed by State law.
SOURCE: MO HealthNet, Home Health Manual, Sec. 2.7, p. 12. (9/1/23), (Accessed Sept. 2023).
Teledentistry
MHD covers teledentistry services for participants under the age of 21, blind, pregnant or in a SNF. This benefit allows any licensed dental provider, enrolled with MO HealthNet, to provide teledentistry services if the services are within the scope of practice for which the dental provider is licensed. Teledentistry services must be performed with the same standard of care as an in-person, face-to-face service.
Prior to the delivery of teledentistry 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 teledentistry in the school for the remainder of the school year.
The MO HealthNet Dental Program allows reimbursement for CDT codes D9995 (Synchronous; real time encounter) and D9996 (Asynchronous; information stored and forwarded to dentist for subsequent review).
Teledentistry services must be billed by the distant site facility (physical location of the dentist or clinic providing the dental service to an eligible Medicaid participant through teledentistry). Dentists must bill either D9995 or D9996 and the CDT code(s) for services provided. Reimbursement to dental providers delivering the service at the distant site is equal to the current fee schedule amount for the service provided. There is not a separate teledentistry fee schedule. The originating site (physical location of the participant) is where diagnostic data is collected to be communicated to an off-site dentist for diagnosis or where a dental service is performed. The originating site cannot bill MHD for CDT codes D9995 or D9996. The originating site can bill procedure code Q3014 on the CMS-1500 claim form to receive reimbursement for use of the facility where teledentistry services were rendered. The distant site service must be billed on the 2019 ADA Dental Claim Form with the CDT code (D9995 or D9996) and any additional services provided, using place of service code 02 – Telehealth.
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 Sept. 2023).
A telemedicine service shall be covered only if it is medically necessary.
A telemedicine service must be performed with the same standard of care as an in-person, face-to-face service. If the same standard of care cannot be met, a telemedicine service shall not be provided.
School Services. Prior to the provision of telemedicine services in a school, the parent or guardian of the child shall provide authorization for the provision of such service. Such authorization shall include the ability for a parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(3), (4)(D), (Accessed Sept. 2023).
Health Assessment and Coordination Services (DD Waiver)
Health Assessment and Coordination (HAC) services are consultative telemedicine services designed for individuals with I/DD receiving HCBS Waiver services. The services are intended to coordinate care with local emergency departments, urgent cares, and primary care physicians to enable real time support, consultation, and coordination on health issues. HAC services assist individuals, families, and support providers in understanding the health symptoms with which individuals present in order to identify the most appropriate next steps. Services are available 24 hours a day, 7 days a week and include immediate evaluations, video-assisted examinations, treatment plans, and discussion and coordination with individuals and/or caregivers.
SOURCE: MO HealthNet, DD Waiver, Sec. 6.14, p. 80 (9/1/23). (Accessed Sept. 2023).
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, Sec. 2.67 p. 112 (9/1/23), Provider Manual, Rural Health Clinics, Section 1.14, p. 9 (9/1/23) & MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
Any licensed health care provider may provide telemedicine 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. Additionally, a health care entity may reimburse nonclinical staff for services otherwise allowed by law. This includes applied behavior analysis services rendered by a registered behavior technician under the supervision of a licensed behavior analyst or licensed psychologist or any individual provider delivering services within a Department of Mental Health (DMH) licensed, contracted, and/or certified organization (13 CSR 70-3.330(2)(A).
To be reimbursed for telemedicine services, health care providers treating patients in this state via telemedicine must be fully licensed to practice in this state and be enrolled as a MO HealthNet provider prior to rendering services.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 1.19 p. 59 (9/1/23), (Accessed Sept. 2023).
The originating site fee and distant site services 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 HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
MO HealthNet covers Telehealth services. MO HealthNet allows any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.
SOURCE: MO Medicaid Provider Tips, Telehealth services, Jan. 11, 2022, (Accessed Sept. 2023).
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).
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 (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, Sec. 2.67, p. 112 (9/1/23) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 60 (9/1/23). (Accessed Sept. 2023).
Distant site – a telemedicine site where the health care provider providing the telemedicine service is physically located.
See originating and distant site scenario examples in Reimbursement Scenarios document.
SOURCE: MO HealthNet, Telemedicine Originating and Distant Site Reimbursement Scenarios, & MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
Anesthesiologist monitoring telemetry in the operating room is a non-covered service.
SOURCE: MO HealthNet, Physician Manual, p. 44 (9/1/23). (Accessed Sept. 2023).
Health care professional shall mean a physician or other health care practitioner licensed, accredited, or certified by the state of Missouri to perform specified health services consistent with state law.
Health care provider or provider shall mean a health care professional or a health care facility.
Any licensed/enrolled health care professional shall be authorized to provide telemedicine services if such services to MHD participants 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. This shall not prohibit a health care entity from reimbursing nonclinical staff for services otherwise allowed by law. This includes applied behavior analysis services rendered by a registered behavior technician under the supervision of a licensed behavior analyst or licensed psychologist or any individual provider delivering services within a Department of Mental Health (DMH) licensed, contracted, and/or certified organization.
A health care provider utilizing telemedicine at either a distant site or an originating site shall be enrolled as a MO HealthNet provider pursuant to 13 CSR 65-2.020 and be fully licensed for practice in the state of Missouri. A health care provider utilizing telemedicine must do so in a manner that is consistent with the provisions of all laws governing the practice of the provider’s profession and shall be held to the same standard of care as a provider employing in-person behavioral health or medical health care.
For purposes of the provision of telemedicine services in the MO HealthNet Program, the provider-patient relationship may be established by the following:
- An in-person encounter through a medical interview and physical examination;
- Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the patient’s care; or
- A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Sept. 2023).
Most claims for services provided at the Distant Site (where the health care provider is located) are to billed with the appropriate Current Procedural Terminology (CPT) code for the service along with place of service 02. Exceptions to this include:
-
- Claims for Distant Site services provided on school grounds should be billed with the appropriate CPT code for the service along with place of service 03 and a GT modifier.
- Providers delivering behavioral health services via telemedicine, for participants located in a residential or inpatient place of service (Place of service codes 14, 21, 33, 51, 55, 56 or 61), must bill with the GT modifier and with the place of service where the participant is physically located.
SOURCE: MO HealthNet, Telemedicine, (Accessed Sept. 2023).
Distant Site on School Grounds
Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
The provider must get consent from the parent or guardian to provide telemedicine services. The parent or guardian may authorize services via telemedicine for a whole school year.
SOURCE: MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
Rural Health Clinics (RHC)
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
RHCs may bill with either their non-RHC provider number or their RHC provider number. 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.
SOURCE: MO HealthNet, Rural Health Clinic, Sec. 1.14, p. 9 (9/1/23). (Accessed Sept. 2023).
RHCs may use either their RHC provider number or their non-RHC provider number when operating as a distant site.
Use POS 02 when billing the distant site when you use your non-RHC provider number.
SOURCE: MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
Federally Qualified Healthcare Clinics (FQHC)
FQHC providers must remove originating site charges and payments for telemedicine services from their year-end cost reports.
FQHC providers must leave the Rendering Provider ID field (24j on CMS-1500) blank on their claims when billing the Q3014 originating site facility charge.
SOURCE: MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
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, Sec. 2.67, p. 112 (9/1/23) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19 p. 60 (9/1/23). (Accessed Sept. 2023).
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).
As the distant site, RHCs may bill with either their non-RHC provider number or their RHC provider number. 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.
SOURCE: MO HealthNet, Rural Health Clinic, Sec. 1.14, p. 9-10 (9/1/23). (Accessed Sept. 2023).
Originating site – a telemedicine site where the MO HealthNet participant receives the telemedicine service. Originating sites include, but are not necessarily limited to health care provider facilities, participants’ homes, and schools. For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location from which the referring provider transfers information to the distant site.
See originating and distant site scenario examples in Reimbursement Scenarios document.
SOURCE: MO HealthNet, Telemedicine Originating and Distant Site Reimbursement Scenarios, & MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
The originating site fee and distant site services 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.
Reimbursement to the health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided. Use the appropriate Current Procedural Terminology (CPT) code for the service along with place of service 02 when submitting telemedicine claims for the distant site.
Providers delivering behavioral health services via telemedicine, for participants located in a residential or inpatient place of service (POS codes 14, 21, 33, 51, 55, 56 or 61), must bill with the GT modifier and with the place of service where the participant is physically located.
SOURCE: MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
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. 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. Payment for services rendered via telehealth shall not depend on any minimum distance requirement between the originating and distant site. 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 Sept. 2023).
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 Sept. 2023).
Originating site shall mean a telemedicine site where the MO HealthNet participant receives the telemedicine service. Originating sites include, but are not necessarily limited to health care provider facilities, participants’ homes, and schools. For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location from which the referring provider transfers information to the distant site.
School Services. Prior to the provision of telemedicine services in a school, the parent or guardian of the child shall provide authorization for the provision of such service. Such authorization shall include the ability for a parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Sept. 20223).
Most claims for services provided at the Distant Site (where the health care provider is located) are to billed with the appropriate Current Procedural Terminology (CPT) code for the service along with place of service 02. Exceptions to this include:
-
- Claims for Distant Site services provided on school grounds should be billed with the appropriate CPT code for the service along with place of service 03 and a GT modifier.
- Providers delivering behavioral health services via telemedicine, for participants located in a residential or inpatient place of service (Place of service codes 14, 21, 33, 51, 55, 56 or 61), must bill with the GT modifier and with the place of service where the participant is physically located.
Claims for the Originating Site (where the patient is located) are billed with procedure code Q3014.
- Q3014 cannot be billed when participant is receiving services at home
SOURCE: MO HealthNet, Telemedicine, (Accessed Sept. 2023).
Rural Health Clinics (RHC)
RHCs, both provider-based and independent, must continue to bill telemedicine services using their non-RHC provider number when operating as an originating site.
RHCs may use either their RHC provider number or their non-RHC provider number when operating as a distant site.
Use POS 02 when billing the distant site when you use your non-RHC provider number.
SOURCE: MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
Originating site – Where the patient receiving telemedicine services is physically located.
Originating site fee and distant site services – Billable by same provider for the same date of service as long as the distant site provider is not located in the originating site facility.
Place of Service – Use the appropriate Current Procedural Terminology (CPT) code for the service with place of service (POS) 02 when submitting telemedicine claims for the distant site.
Exceptions to billing POS 02 –
- School Grounds: For distant site services provided on school grounds use POS 03 and GT modifier
- Residential/Inpatient: Behavioral health services at POS codes 14, 21, 33, 51, 55, 56 or 61 must bill with the GT modifier and the POS where the participant is physically located.
- Rural Health Clinics (RHCs): Bill with GT modifier for distant site services billed on the UB04 claim form.
PBRHC/UB04 – Rev code + CPT + GT + billed charge
IRHC/UB04 – Rev code + T1015 + GT
SOURCE: MO HealthNet, Telemedicine Overview, (Accessed Sept. 2023).
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 Sept. 2023).
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, 2.67 p. 114 (9/1/23); & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19 p. 60 (9/1/23). (Accessed Sept. 2023).
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 1,14, p. 9 (9/1/23). (Accessed Sept. 2023).
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 Sept. 2023).
Outpatient Hospital Facility Fee Billing
Hospitals may bill a facility fee for distant site services provided in their facilities.
The distant site service must be reported on the UB04 claim form with the procedure code and GT modifier.
The physician providing the service will bill for their distant site services on the medical claim form.
SOURCE: MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Sept. 2023).
The originating site is eligible to receive an originating site/facility fee.
Reimbursement of the originating site fee will be made according to the MO HealthNet Fee Schedule.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(5), (Accessed Sept. 2023).
The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.
SOURCE: MO Medicaid Provider Tips, Telemedicine, July 18, 2022, (Accessed Sept. 2023).
Originating site fee and distant site services – Billable by same provider for the same date of service as long as the distant site provider is not located in the originating site facility.
Q3014 – CPT code for originating site reimbursement for the use of the facility where telemedicine services are rendered. This code cannot be billed when the participant is receiving services at home.
SOURCE: MO HealthNet, Telemedicine Overview, (Accessed Sept. 2023).
