Last updated 06/06/2023
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All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable if the services:
- Are medically necessary and clinically appropriate for delivery via telemedicine/telehealth;
- Follow the guidelines set forth in the applicable Montana Healthcare Programs provider manual; and
- Are not a service specifically required to be face-to-face as defined in the applicable Montana Healthcare Programs provider manual.
There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.
Rates of payment for services delivered via telemedicine/telehealth will be the same as rates of payment for services delivered via traditional (e.g., in-person) methods set forth in the applicable regulations. Please refer to the fee schedules posted on the Provider Information website for current rates.
SOURCE: MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Jun. 2023).
Despite the above more recent guidance, the General Information for Providers Telemedicine Manual still seems to restrict audio-only coverage.
Telemedicine reimbursement does not include:
- Consultation by telephone
- Facsimile machine transmissions
- Crisis hotlines
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jun. 2023).
Telehealth services may be provided using secure portal messaging, secure instant messaging, telephone communication, or audiovisual communication.
SOURCE: Montana Code Annotated 53-6-122 (Accessed Jun. 2023)
Last updated 06/07/2023
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 Jun. 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 Jun. 2023).
ELIGIBLE SERVICES/SPECIALTIES
All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable if the services:
- Are medically necessary and clinically appropriate for delivery via telemedicine/telehealth;
- Follow the guidelines set forth in the applicable Montana Healthcare Programs provider manual; and
- Are not a service specifically required to be face-to-face as defined in the applicable Montana Healthcare Programs provider manual.
There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.
Rates of payment for services delivered via telemedicine/telehealth will be the same as rates of payment for services delivered via traditional (e.g., in-person) methods set forth in the applicable regulations. Please refer to the fee schedules posted on the Provider Information website for current rates.
SOURCE: MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Jun. 2023).
Applied Behavior Analysis Services
Telehealth delivery for ABA services, with approved Telehealth Exception Request form. Face-to-face service delivery is preferred. Telehealth may be substituted if clinically appropriate. Complete the Telehealth Exception Request Form available on the Applied Behavior Analysis Services page of the Provider Information website. You must read and accept the end user agreement at the link. Telehealth exception requests must be approved prior to the delivery of services via telehealth.
SOURCE: MT Medicaid, All Provider Notice, Comprehensive Waiver, Applied Behavior Analysis, and Targeted Case Management, Mar. 12, 2023, & Resumption of Face-to-Face Requirements for Selected Programs, Apr. 10, 2023, (Accessed Jun. 2023).
MT Developmental Disabilities Program and Targeted Case Management Providers: Comprehensive Waiver, Applied Behavior Analysis, and Targeted Case Management Updates
Telehealth delivery for some waiver services when clinically appropriate. Please see the applicable Montana Developmental Disabilities Program Service Manual for information on services that require face-to face-delivery and do not allow for telehealth.
SOURCE: MT Medicaid, All Provider Notice, Comprehensive Waiver, Applied Behavior Analysis, and Targeted Case Management, Mar. 12, 2023, (Accessed Jun. 2023).
Developmental Disabilities Program (DDP)
- 0208 Waiver Services
- Face-to-face service delivery is preferred. Telehealth may be substituted for some services when clinically appropriate. Please see the applicable Montana Developmental Disabilities Program Service Manual for information on services that require face-to-face delivery and do not allow for telehealth.
- Targeted Case Management Developmental Disabilities
- Returning to a minimum of 3 face-to-face contacts per year.
- Applied Behavior Analysis Services
- Face-to-face service delivery is preferred. Telehealth may be substituted if clinically appropriate. Complete the Telehealth Exception Request Form available on the Applied Behavior Analysis Services page of the Provider Information website. You must read and accept the end user agreement at the link. Telehealth exception requests must be approved prior to the delivery of services via telehealth.
SOURCE: MT Medicaid, All Provider Notice, Resumption of Face-to-Face Requirements for Selected Programs, Apr. 10, 2023, (Accessed Jun. 2023).
Permanent updates to face-to-face services are ‘proposed’ effective May 12, 2023 for Treatment Bureau, Children’s Mental Health Bureau, Health Resources Division, and Senior and Long-Term Care Division. See notice for details.
SOURCE: MT Medicaid, All Provider Notice, Resumption of Face-to-Face Requirements for Selected Programs, Apr. 10, 2023, (Accessed Jun. 2023).
Healthy Montana Kids
Outpatient medical and behavioral health services (non-surgical) include services provided via telehealth.
SOURCE: MT Children’s Health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Jan. 2023), p. 23 & 28-29. (Accessed Jun. 2023).
Physical, Occupational and Speech Therapy
Telehealth services are available for Physical, Occupational and Speech Therapy when ordered by a physician or mid-level practitioner. 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, Therapies Manual, Covered Services (Mar. 2020). (Accessed Jun. 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 Jun. 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 Jun. 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 (5/2/23). (Accessed Jun. 2023).
Diabetes Prevention Program (DPP) Information
Telehealth cohorts must provide live interaction, via technology, with the lifestyle coach following the same protocol as in-person cohorts.
SOURCE: MT Dept. of Public Health and Human Svcs. Diabetes Prevention Program (DPP) Information, MT Healthcare Programs Notice, May 8, 2023, (Accessed Jun 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 Jun. 2023).
Distance Provider – The enrolled provider delivering a medically necessary and clinically appropriate service from the distance site.
Distant Site – A site where the enrolled provider providing the service is located at the time the service is provided. While all applicable licensure and programmatic requirements apply to the delivery of the service, there are no additional geographic or facility restrictions on distant sites for services delivered via telehealth.
Enrolled Provider – A practitioner enrolled in the Montana Healthcare Programs.
SOURCE: MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Jun. 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 Jun. 2023).
Enrolled Originating Site Provider – 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 healthcare service. An enrollee’s residence is not reimbursable as an enrolled originating site provider.
Originating Site – A site where a patient is located at the time healthcare services are provided via a telecommunications system or where an asynchronous store-and-forward service originates.
SOURCE: MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Jun. 2023).
When performing a telemedicine consult, use the appropriate CPT E/M consult code. The place of service is the location of the provider providing the telemedicine service.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Billing Procedures (March 2021). (Accessed Jun. 2023).
Member’s residences do not qualify for originating provider reimbursement.
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 Jun. 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 Jun. 2023).
GEOGRAPHIC LIMITS
Distant Site – A site where the enrolled provider providing the service is located at the time the service is provided. While all applicable licensure and programmatic requirements apply to the delivery of the service, there are no additional geographic or facility restrictions on distant sites for services delivered via telehealth.
SOURCE: MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Jun. 2023).
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 Jun. 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 Jun. 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 Jun. 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 Jun. 2023).
Last updated 06/06/2023
Miscellaneous
Telemedicine/Telehealth Requirements
- To the extent possible, providers must ensure members have the same rights to confidentiality and security as provided during traditional office visits.
- Providers must follow consent and patient information protocol consistent with those followed during inperson visits.
- Telemedicine/telehealth does not alter the scope of practice of any healthcare provider; or authorize the delivery of healthcare services in a setting or manner not otherwise authorized by law.
- Record keeping must comply with Administrative Rules of Montana (ARM) 37.85.414.
- Enrolled providers delivering services via telemedicine/telehealth must submit claims using the appropriate CPT or HCPCS code, place of service, and modifier for the services rendered.
SOURCE: MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Jun. 2023).
Providers must also use the telehealth place of service of 02 for claims submitted on a CMS-1500 claim. 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 Jun. 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 Jun. 2023).
Telehealth is allowed for therapy in a youth facility under certain circumstances.
SOURCE: Montana Administrative Rules Sec. 37.97.906, (Accessed Jun. 2023).
Abortion
Supporting documentation for abortions must include a physical examination, including vital signs, heart, lungs, abdomen, extremities, and estimate of gestational age (if imaging is not available).
A lawsuit has been filed challenging the rule amendments adopted under Montana Administrative Register (MAR) Notice No. 37-1024, and seeking preliminary and permanent injunction against the rule amendments. A temporary restraining order has been entered, enjoining enforcement of the rule changes pending hearing on the request for a preliminary injunction. Accordingly, Montana Medicaid has postponed implementation of the rule amendments adopted under MAR 37-1024 until further notice. See: Medicaid Coverage of Abortion Services Notice.
SOURCE: MT Administrative Rules Sec. 37.86.104, (Accessed Jun. 2023).
Last updated 06/06/2023
Store and Forward
POLICY
Telehealth services may be provided using secure portal messaging, secure instant messaging, telephone communication, or audiovisual communication.
SOURCE: Montana Code Annotated 53-6-122 (Accessed Jun. 2023)
All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable if the services:
- Are medically necessary and clinically appropriate for delivery via telemedicine/telehealth;
- Follow the guidelines set forth in the applicable Montana Healthcare Programs provider manual; and
- Are not a service specifically required to be face-to-face as defined in the applicable Montana Healthcare Programs provider manual.
There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.
Rates of payment for services delivered via telemedicine/telehealth will be the same as rates of payment for services delivered via traditional (e.g., in-person) methods set forth in the applicable regulations. Please refer to the fee schedules posted on the Provider Information website for current rates.
SOURCE: MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Jun. 2023).
Despite the above more recent guidance, the General Information for Providers Telemedicine Manual still seems to restrict store-and-forward coverage based upon how it defines telehealth.
Distant site – Distance providers should submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with the GT modifier (interactive communication). Effective January 1, 2017, providers must also use the telehealth place of service of 02 for claims submitted on a CMS-1500 claim. 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.
SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jun. 2023).
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
