Last updated 02/21/2023
Definitions
“Telehealth” has the meaning ascribed to it in NRS 629.515.
“Telehealth” means the delivery of services from a provider of health care to a patient at a different location through the use of information and audio-visual communication technology, not including facsimile or electronic mail. The term includes, without limitation, the delivery of services from a provider of health care to a patient at a different location through the use of:(1) Synchronous interaction or an asynchronous system of storing and forw
SOURCE: NV Revised Statute 422.2721 & 629.515, (Accessed Feb. 2023).
Telehealth is the use of a telecommunications system to substitute for an in-person encounter for professional consultations, office visits, office psychiatry services, and a limited number of other medical services.
“Telehealth” is defined as the delivery of service from a provider of health care to a patient at a different location through the use of telecommunication technologies, not including facsimile or electronic mail.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3400 & 3403, p. 1 (Jun. 1, 2022), (Accessed Feb. 2023).
Telehealth is the use of a telecommunications system instead of an in-person recipient encounter for professional consultations, office visits, office psychiatry services and a limited number of other medical services.
The telecommunications system used must be an interactive audio and video system. Standard telephones, facsimile machines or electronic mail do not meet this criteria.
Telehealth is the use of a telecommunications system instead of an in-person recipient encounter for professional consultations, office visits, office psychiatry services and a limited number of other medical services.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (Nov. 18, 2020); School Health Services (2/17/23), pg. 76. (Accessed Nov. 2022).
Last updated 02/21/2023
Email, Phone & Fax
Per Nevada Senate Bill (SB) 5 passed during the 81st (2021) Nevada Legislative Session, telehealth visits may be performed using only audio outside of the COVID-19 Public Health Emergency. Effective on claims with dates of service on or after October 1, 2022, the telephone evaluation and management (E&M) codes listed below have been opened to allow audio-only telehealth services to be billed by the provider types (PT) listed below. No claims will be reprocessed automatically as these are go-forward changes.
SOURCE: NV Medicaid, Audio-Only Services Allowed. Web Announcement 3006. Feb. 13, 2023, (Accessed Feb. 2023).
Audio only telehealth for behavioral health delivery is limited to:
- Targeted Case Management
- Crisis Intervention Services
Non-Covered Services
- Images transmitted via facsimile machines (faxes)
- Text messages
- Electronic mail (email)
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.6, p. 3 (Jun. 1, 2022) (Accessed Feb. 2023).
Medicaid does not reimburse providers for telephone calls between providers and patients (including those in which the provider gives advice or instructions to or on behalf of a patient) except documented psychiatric treatment in crisis intervention (e.g. threatened suicide).
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Physician Services Chapter, Section 603, p. 5 (Oct. 25, 2022) (Accessed Feb. 2023).
For crisis intervention, modifier GT includes telephonic services.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Behavioral Health Outpatient Treatment, p. 17 (3/18/22), (Accessed Nov. 2022) & NV Dept. of Health and Human Svcs., Provider Type 82 Billing Guide, Behavioral Health Rehabilitative Treatment, p. 3. (2/1/19). (Accessed Nov. 2022). Special Clinics: Substance Abuse Agency Model (SAAM) p. 5 (2/16/22) (Accessed Nov. 2022), School Health Services (SHS), p. 41 (Feb. 17, 2023). (Accessed Feb. 2023).
Case management services are reimbursable when provided to Medicaid eligible recipients, on a one-to-one (telephone or face-to-face) basis.
Monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers. Monitoring may involve either face-to-face or telephone contact, at least annually.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Case Management Section 2500, pgs. 2 & 4 (Dec. 27, 2022) (Accessed Feb. 2023).
Last updated 02/21/2023
Live Video
POLICY
The State Plan for Medicaid must include:
- A requirement that the State, and, to the extent applicable, any of its political subdivisions, shall pay for the nonfederal share of expenses for services provided to a person through telehealth to the same extent and, except for services provided through audio-only interaction, in the same amount as though provided in person or by other means; and
- A provision prohibiting the State from:
- Requiring a person to obtain prior authorization that would not be required if a service were provided in person or through other means, establish a relationship with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to paying for services as described in paragraph (a). The State Plan for Medicaid may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or through other means.
- Requiring a provider of health care to demonstrate that it is necessary to provide services to a person through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to paying for services.
- Refusing to pay for services because of the distant site from which a provider of health care provides services through telehealth or the originating site at which a person who is covered by the State Plan for Medicaid receives services through telehealth; or the technology used to provide the services.
- Requiring services to be provided through telehealth as a condition to paying for such services.
- Categorizing a service provided through telehealth differently for purposes relating to coverage or reimbursement than if the service had been provided in person or through other means.
The provisions of this section do not:
- Require the Director to include in the State Plan for Medicaid coverage of any service that the Director is not otherwise required by law to include; or
- Require the State or any political subdivision thereof to:
- Ensure that covered services are available to a recipient of Medicaid through telehealth at a particular originating site; or
- Provide coverage for a service that is not included in the State Plan for Medicaid or provided by a provider of health care that does not participate in Medicaid.
Various other version of these provisions become effective under various circumstances, including:
- 1 year after the date on which the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, only if the Governor terminates that emergency before July 1, 2022.
- On July 1, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, before July 1, 2022.
- On June 30, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, on or after July 1, 2022.
See bill for alternate versions and accompanying effective dates.
SOURCE: NV Revised Statute 422.2721, (Accessed Feb. 2023).
Services provided via telehealth must be clinically appropriate and within the health care professional’s scope of practice as established by its licensing agency. Services provided via telehealth have parity with in-person health care services. Health care professionals must follow the appropriate Medicaid Services Manual (MSM) policy for the specific service they are providing.
- Photographs must be specific to the patient’s condition and adequate for rendering or confirming a diagnosis or a treatment plan. Dermatologic photographs (e.g., photographs of a skin lesion) may be considered to meet the requirement of a single media format under this instruction.
- Reimbursement for the DHCFP covered telehealth services must satisfy federal requirements of efficiency, economy and quality of care.
- All participating providers must adhere to requirements of the Health Insurance Portability and Accountability Act (HIPAA). The DHCFP may not participate in any medium not deemed appropriate for protected health information by the DHCFP’s HIPAA Security Officer.
Telehealth services follow the same prior authorization requirements as services provided in-person. Utilization of telehealth services does not require prior authorization. However, individual services may require prior authorization when delivered by telehealth.
ESRD visits must include at least one in-person visit to examine the vascular access site by a provider; however, an interactive audio/video telecommunications system may be used for providing additional visits.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403, p. 1; 3403.5, p. 3; & 3403.7, p. 4 (Jun. 1, 2022). (Accessed Feb. 2023).
Effective December 1, 2015, telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice to provide services that can be appropriately provided via telehealth. The telecommunications system used must be an interactive audio and video system. Standard telephones, facsimile machines or electronic mail do not meet this criteria.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (Nov. 18, 2020). (Accessed Feb. 2023).
Medicaid Managed Care plans must include coverage for services provided through telehealth to the same extent as through provided in-person or by other means.
Medicaid Managed Care plans shall not:
- Require an enrollee to establish an in-person relationship with a provider or provide any additional consent to or reason for obtaining services through telehealth as a condition to providing the coverage;
- Require a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license;
- Refuse to provide coverage for telehealth because of the type of the distant site or originating site in which the provider/enrollee provides/receives services via telehealth; or
- Require covered services to be provided through telehealth as a condition of providing coverage for such services.
A Medicaid Managed Care plan may not require an enrollee to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in-person.
Medicaid Managed Care plans are not required to:
- Ensure that covered services are available to an enrollee through telehealth at a particular originating site
- Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care; or
- Enter into a contract with any provider of health care or cover any service if the insurer is not otherwise required by law to do so.
SOURCE: NV Revised Statute Sec. 695G.162. (Accessed Feb. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Telehealth services are also covered by Nevada Medicaid. See MSM Chapter 3400, Telehealth Services for the complete coverage and limitations for Telehealth. Medical Nutrition Therapy may be provided through Telehealth services. See MSM Chapter 3400 for the Telehealth policy.
SOURCE: NV Dept. of Health and Human Svcs., Section 603, p. 4; Sec. 609, pg. 3 (Jul. 13, 2022) (Accessed Feb. 2023).
A licensed professional operating within the scope of their practice under state law may provide the following Telehealth services for Medicaid recipients:
- Annual wellness visits;
- Diabetic outpatient self-management;
- Documented psychiatric treatment in crisis intervention (e.g., threatened suicide); and
- Office or other outpatient visits
SOURCE: NV Dept. of Health and Human Svcs., Provider Type 20, 24, and 77 (Physician), (Osteopath) and (APRN) Billing Guide, pgs. 9 & 10 (1/17/23). (Accessed Feb. 2023).
Services NOT Covered:
- Basic Skills Training and Psychosocial Rehabilitation services, whether authorized, provided, and billed as stand-alone services or as components of Intensive Outpatient Program, Partial Hospitalization, and Day Treatment must be provided in person
- Personal care services provided by a Personal Care Attendant
- Home Health Services provided by a RN, occupational therapist, physical therapist, speech therapist, respiratory therapist, dietician or Home Health Aide
- Private Duty Nursing services provided by a RN
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403.6, p. 3 (Jun. 1, 2022). (Accessed Feb. 2023).
ELIGIBLE PROVIDERS
Telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p.1 (Nov. 18, 2020) (Accessed Feb. 2023).
Indian Health Services and Tribal Clinics should follow the guidelines in the Telehealth Chapter 3400.
SOURCE: Nevada Dept. of Health and Human Svcs., Medicaid Services Manual, Indian Health Services and Clinics, pg. 1, (5/1/20), (Accessed Feb. 2023).
Nurse Midwifes should follow guidelines in the Telehealth Chapter 3400.
SOURCE: Nevada Dept. of Health and Human Svcs., Medicaid Services Manual, Nurse Midwife, pg. 7, (11/14/22), (Accessed Feb. 2023).
A distant site provider must be an enrolled Medicaid provider.
Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating encounter site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 2, 3403.2, p. 1-2 (Jun. 1, 2022). (Accessed Feb. 2023).
Telehealth originating site services can be provided within a community paramedicine provider’s scope of practice as part of a community paramedicine visit when requested in plan of care.
SOURCE: NV Dept. of Health and Human Services, Medicaid Services Manual, Physician Services Chapter 600 Section 604.2, pg. 2 (Oct. 26, 2022), (Accessed Feb. 2023).
ELIGIBLE SITES
In order to receive coverage for a telehealth facility fee, the originating site must be an enrolled Medicaid provider.
A provider is not eligible for payment as both the originating and distant site for the same patient, same date of service.
If a patient is receiving telehealth services at an originating site not enrolled in Medicaid, the originating site is not eligible for a facility fee from the DHCFP. Examples of this include, but are not limited to, cellular devices, home computers, kiosks and tablets.
Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 1-2, (Jun. 1, 2022). (Accessed Feb. 2023).
Eligible sites:
- Office of provider
- Critical Access Hospital (CAH)
- Rural Health Clinic (RHC)
- Federally Qualified Health Center (FQHC)
- Hospital
- End Stage Renal Disease (ESRD) Facility
- Skilled Nursing Facility (SNF)
- Community Mental Health Centers (CMHC)
- Indian Health Services/Tribal Organization/Urban Indian Organization
- School-Based Health Centers
- Schools
- Family Planning Clinics
- Public Health Clinics
- ·Comprehensive Outpatient Rehabilitation Facilities
- Community Health Clinics (State Health Division)
- Special Children’s Clinics
- Human Immunodeficiency Virus (HIV) Clinics
- Therapy offices
- Chiropractic offices
- Emergency Medical Services (EMS) performing Community Paramedic Services
- Recipient’s smart phone (no facility fee)
- Recipient’s home computer (no facility fee)
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1-2 (Nov. 18, 2020) & Community Paramedicine, p. 1 (Nov. 4, 2019). (Accessed Feb. 2023).
Specific encounter service limits apply for distant site providers at Indian Health Service, Tribal clinics, or Tribal FQHCs. See billing guide for Nevada AI/AN providers.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines, Indian Health Services (IHS) and Tribal Clinics, p. 1. (05/01/2020) (Accessed Feb. 2023).
GEOGRAPHIC LIMITS
The originating site must be located in the state of Nevada.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 1, (Jun. 1, 2022). (Accessed Feb. 2023).
A Medicaid Managed Care Organization may not refuse to provide coverage of telehealth services because where the distant or originating site providing/receiving services via telehealth is located.
SOURCE: NV Revised Statute Sec. 695G.162. (Accessed Feb. 2023).
FACILITY/TRANSMISSION FEE
Originating site is qualified to receive a facility fee if they are an enrolled Medicaid provider. If a patient is receiving telehealth services at a site not enrolled in Medicaid, the originating site is not eligible to receive a facility fee.
Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1, pg. 1 & 2 (Jun. 2022). (Accessed Feb. 2023).
A facility fee is not billable if the telecommunication system used is a recipient’s smart phone or home computer.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 2 (Nov. 18, 2020) (Accessed Feb. 2023).
Some provider types that may bill for an originating site facility fee include:
- Some Special Clinic provider types
- Some Applied Behavior Analysis provider types
- Therapists
- Chiropractors
- Providers at End-Stage Renal Disease Facilities
SOURCE: NV Dept. of Health and Human Svcs. Announcement 1048 & 1202. (Accessed Feb. 2023).
Sites eligible for an originating site facility fee include:
- Office of provider
- Critical Access Hospital (CAH)
- Rural Health Clinic (RHC)
- Federally Qualified Health Center (FQHC)
- Hospital
- End Stage Renal Disease (ESRD) Facility
- Skilled Nursing Facility (SNF)
- Community Mental Health Centers (CMHC)
- Indian Health Services/Tribal Organization/Urban Indian Organization
- School-Based Health Centers
- Schools
- Family Planning Clinics
- Public Health Clinics
- Comprehensive Outpatient Rehabilitation Facilities
- Community Health Clinics (State Health Division)
- Special Children’s Clinics
- Human Immunodeficiency Virus (HIV) Clinics
- Therapy offices
- Chiropractic offices
- Emergency Medical Services (EMS) performing Community Paramedic Services
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1-2 (Nov. 18, 2020) (Accessed Feb. 2023).
If the originating site is enrolled as a Nevada Medicaid provider, they may bill HCPCS code Q3014. If the telecommunication system used is a recipient’s smart phone or home computer, the facility fee may not be billed.
SOURCE: Nevada Dept. of Health and Human Services, School Health Services, pg. 76 (2/17/23), (Accessed Feb. 2023).
