Last updated 12/09/2022
Consent Requirements
Prior to the provision of telemedicine [or telehealth as its referred to in rural health clinic manual] 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 the parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.
SOURCE: MO Revised Statute. XII Public Health and Welfare. Ch. 208, Sec. 208.677; MO HealthNet, Rural Health Clinic, p. 165 (Sept. 8, 2022); MO HealthNet, Physician Manual, Telehealth Services, p. 286-287 (Oct. 12 2022) & MO HealthNet, Provider Manual, Behavioral Health Services, p. 209 (Sept. 8, 2022). (Accessed Dec. 2022).
Last updated 12/08/2022
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 Dec. 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 12, 2022), (Accessed Dec. 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. 164 (Sept. 8, 2022) & MO HealthNet, Provider Manual, Behavioral Services, Section 13.22, p. 209 (Sept. 8, 2022). (Accessed Dec. 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 Dec. 2022).
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 patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telemedicine shall also include the use of 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 Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Dec. 2022).
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 13 CSR 70-3.330, (Accessed Dec. 2022).
Last updated 12/08/2022
Email, Phone & Fax
MHD also allowed the use of telephone for telehealth services, and allowed quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number. MHD did not require additional CMS flexibility for these options, and they will continue.
SOURCE: MO Medicaid Provider Tips, Telehealth services, Jan. 11, 2022, (Accessed Dec. 2022).
Mental Health
Audio-only is real-time, interactive voice-only discussion between an individual and the service provider.
The CR Modifier will be ending on June 30, 2022, regardless of the PHE declaration end date.
Starting July 1, 2022, Audio-Only services shall utilize the FQ Modifier.
The GT modifier will continue to be utilized for Telemedicine, with the exception of CSTAR programs that have transitioned to American Society of Addiction Medicine (ASAM), as this billing structure no longer utilizes modifiers.
Starting July 1, 2022, CSTAR programs that have transitioned to ASAM, will use the 02 Place of Service, instead of the GT modifier.
See bulletin for audio-only service guidance.
SOURCE: MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Dec. 2022).
Last updated 12/08/2022
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. 12, 2022), Provider Manual, Rural Health Clinics, Section 13, p. 165 (Sept. 8, 2022) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 209 (Sept. 8, 2022). (Accessed Dec. 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 Dec. 2022).
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, (Accessed Dec. 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. 286-287 (Oct. 12, 2022) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 209-210 (Sept. 8, 2022). (Accessed Dec. 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, Physician Manual, 13-69A p. 286 (Oct. 12, 2022), MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 209 (Sept. 8, 2022). & MO HealthNet, Provider Manual, Rural Health Clinics, Section 13, p. 165 (Sept. 8, 2022), (Accessed Dec. 2022).
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 Dec. 2022).
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.
Medication services may be provided via telehealth. See manual for code list.
SOURCE: MO HealthNet, CSTAR Manual, 13.14(K)(1), 13.14(K)(5) pgs. 201 &202 & 13.14(L)(4) p. 203 (Sept. 8, 2022). (Accessed Dec. 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, (Nov. 7, 2022), (Accessed Dec. 2022).
Home Health
The face-to-face encounter may occur through telehealth, as allowed by State law.
SOURCE: MO HealthNet, Home Health Manual, p. 169. (Sept. 21, 2022), (Accessed Dec. 2022).
Teledentistry
MO HealthNet covers teledentistry services. MO HealthNet 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.
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 in order to communicate to the 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 American Dental Association (ADA) Dental Claim Form with the CDT code (D9995 or D9996) and any additional services provided, using place of service code 02 – Telehealth.
SOURCE: MO HealthNet, Dental Manual, pgs. 179 & 260. (Oct. 28, 2022). (Accessed Dec. 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 Aug. 2022).
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, (Accessed Dec. 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. 286 (Oct. 12, 2022), Provider Manual, Rural Health Clinics, Section 13, p. 165 (Sept. 8, 2022) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Sept. 8, 2022). (Accessed Dec. 2022).
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 Dec. 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, 13.69C p. 287 (Oct. 12, 2022) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Sept. 8, 2022). (Accessed Dec. 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. 165 (Sept. 8, 2022). (Accessed Dec. 2022).
Anesthesiologist monitoring telemetry in the operating room is a non-covered service.
SOURCE: MO HealthNet, Physician Manual, p. 208 (Oct 12, 2022). (Accessed Dec. 2022).
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 Dec. 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, 13-69C p. 287 (Oct. 12, 2022) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Sept. 8, 2022). (Accessed Dec. 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 Dec. 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 Dec. 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 (Sept. 8, 2022). (Accessed Dec. 2022).
Recently Adopted Rule
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 Dec. 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 Dec. 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, 13.69(C) p. 287 (Oct. 12, 2022); & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Sept. 8, 2022). (Accessed Dec. 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. 165 (Sept. 8, 2022). (Accessed Dec. 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 Dec. 2022).
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, (Accessed Dec. 2022).
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 Dec. 2022).
Last updated 12/08/2022
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. The statewide coordinator shall regularly consult with Missouri-based stakeholders and clinicians actively engaged in the collection of forensic evidence regarding 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 Dec. 2022).
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.
In order to establish a provider-patient relationship through telemedicine—
- The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
- Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.
See regulation for special documentation and confidentiality and data integrity requirements.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Dec. 2022).
Special documentation requirements apply.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Sept. 8, 2022); MO HealthNet, Physician Manual, Telehealth Services, p. 287 (Oct 12, 2022) & MO HealthNet, Rural Health Clinic, p. 165 (Sept. 8, 2022). (Accessed Dec. 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. 210 (Sept. 8, 2022), (Accessed Dec. 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 (Sept. 8, 2022). (Accessed Dec. 2022).
Last updated 12/08/2022
Out of State Providers
Payment cannot be made to any financial institutions, telemedicine providers, pharmacies, or other entities outside of the US, and US territories.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 58 (Sept 8, 2022); MO HealthNet, Physician Manual, Telehealth Services, p. 66 (Oct. 12, 2022) & MO HealthNet, Rural Health Clinic, p. 56 (Sept. 8, 2022). (Accessed Dec. 2022). (Language also appears in ALL Medicaid manuals).
In order to treat participants in this state through the use of telemedicine, health care providers shall be fully licensed to practice in this state and shall be subject to regulation by their respective professional boards. In addition, psychologists licensed in a Psychology Interjurisdictional Compact (PSYPACT) state may render telemedicine services under the Authority to Practice Interjurisdictional Telepsychology, according to the requirements in the PSYPACT.
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.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Dec. 2022).
Last updated 12/08/2022
Overview
Missouri Medicaid will reimburse for services delivered via live video. They will also reimburse for some tele-dentistry asynchronous services and remote patient monitoring for specific conditions.
Last updated 12/09/2022
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 Dec. 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 Dec. 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 (Feb. 15, 2022). (Accessed Dec. 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 Dec. 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 Dec. 2022).
Last updated 12/08/2022
Store and Forward
POLICY
Reimbursement for asynchronous store-and-forward may be capped at the reimbursement rate had the service been provided in-person.
SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Dec. 2022).
The telemedicine program shall be administered by the MO HealthNet Division (MHD). This rule is established pursuant to the authority granted to the Missouri Department of Social Services, MO HealthNet Division, to promulgate rules governing the practice of telemedicine in the MO HealthNet Program and to provide services under established, approved MO HealthNet benefits.
Asynchronous store-and-forward shall mean the transfer of a participant’s clinically important digital samples, such as still images, videos, audio, text files, and relevant data from an originating site through the use of a camera or similar recording device that stores digital samples that are forwarded via telecommunication to a distant site for consultation by a consulting provider without requiring the simultaneous presence of the participant and the participant’s treating provider.
- Asynchronous store-and-forward technology shall mean cameras or other recording devices that store images which may be forwarded via telecommunication devices at a later time.
- Asynchronous store-and-forward transfer shall mean the collection of a participant’s relevant health information and the subsequent transmission of that information from an originating site to a provider at a distant site without the participant being present.
Distant site shall mean a telemedicine site where the health care provider providing the telemedicine service is physically located.
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.
Licensed health care provider-patient relationship shall mean that a health care provider licensed under Chapter 334, RSMo, and/or other providers utilizing telemedicine, shall ensure that a properly established provider-patient relationship exists with the participant who receives telemedicine services.
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.
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.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Dec. 2022).
ELIGIBLE SERVICES/SPECIALTIES
Teledentistry
MO HealthNet covers teledentistry services. MO HealthNet 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.
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 in order to communicate to the 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 American Dental Association (ADA) Dental Claim Form with the CDT code (D9995 or D9996) and any additional services provided, using place of service code 02 – Telehealth. See manual for codes.
SOURCE: MO HealthNet, Dental Manual, p. 179 & 260 (Oct. 28, 2022). (Accessed Dec. 2022).
Health care service shall mean a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease, including but not limited to the provision of drugs or durable medical equipment.
A telemedicine service shall be covered only if it is medically necessary.
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found