Last updated 01/16/2023
Definitions
“Telehealth” means the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance, including but not limited to the use of secure portal messaging, secure instant messaging, audiovisual communications, and audio-only communications.
The term includes both clinical and nonclinical services.”
SOURCE: MT Code Annotated Sec. 53-6-155, (Accessed Jan. 2023).
Telemedicine is the use of interactive audio-video equipment to link practitioners and patients located at different sites.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).
Healthy Montana Kids
Telemedicine is “the use of a secure interactive audio and video, or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located. Does not include audio only (phone call), e-mail, and/or facsimile transmission.”
SOURCE: MT Children’s health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Nov., 2017), p. 11. (Accessed Jan. 2023).
Last updated 01/16/2023
Live Video
POLICY
Providers enrolled in the Medicaid program may provide medically necessary services by means of telehealth if the service:
- is clinically appropriate for delivery by telehealth as specified by the department by rule or policy;
- comports with the guidelines of the applicable Medicaid provider manual; and
- is not specifically required in the applicable provider manual to be provided in a face-to-face manner
Telehealth services must be provided at same rate as services delivered in person.
Department directed to adopt rules for the provision of telehealth (see statute for further details).
SOURCE: MCA 53-6-122 (Accessed Jan. 2023).
MT Medicaid reimburses for medically necessary telemedicine services to eligible members. Providers must be enrolled as Montana Healthcare Programs providers and be licensed in the state of Montana.
Telemedicine should not be selected when face-to-face services are medically necessary. Members should establish relationships with primary care providers who are available on a face-to-face basis.
The originating and distant providers may not be within the same facility or community. The same provider may not be the “pay to” for both the originating and distance provider.
SOURCE: MT Dept. of Public Health and Human Svcs, Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Healthy Montana Kids
Services provided by telemedicine are allowed for non-surgical medical services and behavioral health outpatient services.
SOURCE: MT Children’s Health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Nov. 2017), p. 24 & 30. (Accessed Jan. 2023).
Telehealth services are available for Physical, Occupational and Speech Therapy when ordered by a physician or mid-level practitioner. The order is valid for 180 days. All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable so long as such services are medically necessary and clinically appropriate for delivery via telemedicine/telehealth.
The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services program (EPSDT) covers all medically necessary services for children age 20 and under. Therapy services for children are not restricted to a specific number of hours or units as long as the therapy services are restorative, not maintenance. All other applicable requirements apply.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Therapies Manual, Covered Services (Mar. 2020). (Accessed Jan. 2023).
School-Based Services
Telehealth services are allowed for Physical Therapy, Occupational Therapy and Speech Therapy. All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable so long as such services are medically necessary and clinically appropriate for delivery via telemedicine/telehealth.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, School-Based Services Manual, Covered Services (4/14/22). (Accessed Jan. 2023).
The availability of services through telemedicine in no way alters the scope of practice of any health care provider; or authorizes the delivery of health care services in a setting or manner not otherwise authorized by law.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Telemedicine (Feb. 2020). (Accessed Jan. 2023).
Durable Medical Equipment
Face-to-face assessments of the patient by the prescriber can be performed using telemedicine.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS) Manual, Covered Services (12/27/21). (Accessed Jan. 2023).
ELIGIBLE PROVIDERS
Providers must be enrolled as Montana Healthcare Programs providers and be licensed in the State of Montana in order to:
- Treat a Montana Healthcare Programs member; and
- Submit claims for payment to Montana Healthcare Programs
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).
ELIGIBLE SITES
Telemedicine can be provided in a member’s residence; the distance provider is responsible for the confidentiality requirements. See “Originating Provider Requirements” section for list of eligible originating sites for facility fee.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).
An enrollee’s residence is not reimbursable as an enrolled originating site provider.
SOURCE: MCA 53-6-122 & MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).
“Originating site provider” means an enrolled provider who is operating a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. 1320d, et seq., and assisting an enrollee with the technology necessary for a telehealth visit.
An originating site provider is not required to participate in the delivery of the health care service.
SOURCE: MCA 53-6-155, (Accessed Jan. 2023).
GEOGRAPHIC LIMITS
The originating and distant providers may not be within the same facility or community. The same provider may not be the pay to for both the originating and distance provider.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).
FACILITY/TRANSMISSION FEE
The department will reimburse for all Montana Medicaid covered services delivered via telemedicine/telehealth originating site fees as long as such services are medically necessary and clinically appropriate for delivery via telemedicine/telehealth, comply with the guidelines set forth in the applicable Montana Medicaid provider manual, and are not a service specifically required to be face-to-face.
SOURCE: Administrative Rules of Montana, Sec. 37.40.330, (Accessed Jan. 2023).
The following provider types can bill the originating site fee:
- Outpatient hospital
- Critical access hospital*
- Federally qualified health center*
- Rural health center*
- Indian health service*
- Physician
- Psychiatrist
- Mid-levels
- Dieticians
- Psychologists
- Licensed clinical social worker
- Licensed professional counselor
- Mental health center
- Chemical dependency clinic
- Group/clinic
- Public health clinic
- Family planning clinic
*Reimbursement for Q3014 is a set fee and is paid outside of both the cost to charge ratio and the all-inclusive rate.
Originating site providers must include a specific diagnosis code to indicate why a member is being seen by a distance provider and this code must be requested from the distance site prior to billing for the telemedicine appointment.
The originating site provider may also, as appropriate, bill for clinical services provided on-site the same day that a telemedicine originating site service is provided. The originating site may not bill for assisting the distant site provider with an examination, including for any services that would be normally included in a face-to-face visit.
FQHCs and RHCs can bill a telehealth originating site procedure code Q3014 if applicable.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).
No reimbursement for infrastructure or network use charges.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Billing Procedures (March 2021). (Accessed Jan. 2023).
Last updated 01/16/2023
Miscellaneous
Providers must also use the telehealth place of service of 02 for claims. By coding with the GT modifier and the 02 place of service, the provider is certifying that the service was a face-to-face visit provided via interactive audio-video telemedicine.
If a rendering provider’s number is required on the claim for a face-to-face visit, it is required on a telemedicine claim.
Confidentially requirements apply (see manual).
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).
A provider shall:
- ensure an enrollee receiving telehealth services has the same rights to confidentiality and security as provided for traditional office visits;
- follow consent and patient information protocols consistent with the protocols followed for in person visits; and
- comply with recordkeeping requirements established by the department by rule.
Telehealth services may be provided using secure portal messaging, secure instant messaging, telephone communication, or audiovisual communication.
The department shall adopt rules for the provision of telehealth services, including but not limited to:
- billing procedures for enrolled providers;
- the services considered clinically appropriate for telehealth purposes;
- recordkeeping requirements for providers, including originating site providers; and
- other requirements for originating site providers, including allowable provider types, reimbursement rates, and requirements for the secure technology to be used at originating sites.
SOURCE: Montana Code Annotated 53-6-122 (Accessed Jan. 2023).
Telehealth is allowed for therapy in a youth facility under certain circumstances.
SOURCE: Montana Administrative Rules Sec. 37.97.906, (Accessed Jan. 2023).
Last updated 01/16/2023
Overview
Montana Medicaid reimburses for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring based on the definition for telemedicine.
Telehealth services must be reimbursed at the same rate of payment as services delivered in person.
