New York

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: None
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: Yes
  • Allowed to collect PPS rate for telehealth: Yes

STATE RESOURCES

  1. Medicaid Program: New York Medicaid
  2. Administrator: New York State Dept. of Health
  3. Regional Telehealth Resource Center: Northeast Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 11/18/2023

Definitions

Telehealth means the use of electronic information and communications technologies by a health care provider to deliver health services to an insured individual while such individual is located at a site that is different from the site where the health care provider is located.

SOURCE: NY Insurance Law Article 32 Section 3217-h & Article 43 Section 4306-g. (Accessed Nov. 2023).

Telehealth means the use of electronic information and communication technologies, including the telephone, by a health care provider to deliver health care services to an insured while such insured is located at a site that is different from the site where the health care provider is located, pursuant to Insurance Law sections 3217-h and 4306-g.

SOURCE: NY Codes, Rules, & Regs. Title 11, Sec. 52.16 (q)(3). (Accessed Nov. 2023).

Workers’ Compensation

Telehealth shall mean treatment by physicians, podiatrists, psychologists, nurse practitioners, physician assistants, and licensed clinical social workers authorized by the Chair to provide treatment and care under the Workers’ Compensation Law using two-way audio and visual electronic communication, or audio only.

SOURCE: Title 12 NYCRR Section. 325-1.26 as proposed to be added by Notice Of Adoption. (Accessed Nov. 2023).

Last updated 11/18/2023

Parity

SERVICE PARITY

An insurer or corporation shall not exclude from coverage a service that is otherwise covered under a policy or contract that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth; provided, however, that an insurer or corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the policy or contract.

SOURCE: NY Insurance Law Article 32 Section 3217-h  & NY Insurance Law Article 43 Section 4306-g. (Accessed Nov. 2023).


PAYMENT PARITY

Effective until April 1, 2024:

An insurer or corporation that provides comprehensive coverage for hospital, medical or surgical care shall reimburse covered services delivered by means of telehealth on the same basis, at the same rate, and to the same extent that such services are reimbursed when delivered in person; provided that reimbursement of covered services delivered via telehealth shall not require reimbursement of costs not actually incurred in the provision of the telehealth services, including charges related to the use of a clinic or other facility when neither the originating site nor distant site occur within the clinic or other facility.

SOURCE: NY Insurance Law Article 32 Section 3217-h  & NY Insurance Law Article 43 Section 4306-g, as amended by A 9007 (2022 Session). (Accessed Nov. 2023).

Last updated 11/18/2023

Requirements

An insurer or corporation shall not exclude from coverage a service that is otherwise covered under a policy or contract that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth.  Provided, however, that an insurer or corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the policy or contract.

An insurer or corporation may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth.

An insurer or corporation may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth.

Effective until April 1, 2024: 

An insurer or corporation that provides comprehensive coverage for hospital, medical, or surgical care with a network of health care providers shall ensure that such network is adequate to meet the telehealth needs of insured individuals for services covered under the policy when medically appropriate.

SOURCE: NY Insurance Law Article 32 Section 3217-h  & NY Insurance Law Article 43 Section 4306-g, as amended by A 9007 (2022 Session). (Accessed Nov. 2023).

No policy or contract delivered or issued for delivery in this State that provides comprehensive coverage for hospital, surgical, or medical care shall impose, and no insured shall be required to pay, copayments, coinsurance, or annual deductibles for in-network services delivered via telehealth when such service would have been covered under the policy if it had been delivered in person.

SOURCE: NY Codes, Rules, & Regs. Title 11, Sec. 52.16 (q). (Accessed Nov. 2023).

Workers’ Compensation

When rendering medical treatment or care via telehealth, an Authorized Medical Provider must be available for an in-person clinical encounter with the claimant should such in-person encounter be medically necessary. This means the Authorized Medical Provider must be able to meet the claimant at the Authorized Medical Provider’s office within a reasonable travel time and distance from the claimant’s residence. Telehealth must be used in accordance with this section and any applicable New York State Medical Treatment Guideline incorporated by reference under section 324.2 of this Title.

See regulations for billing and coding requirements.

SOURCE: Title 12 NYCRR Section. 325-1.26 as proposed to be added by Notice Of Adoption. (Accessed Nov. 2023).

Last updated 11/17/2023

Definitions

“Telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication, except that with respect to the medical assistance program established under section three hundred sixty-six of the social services law, and the child health insurance plan under title one-A of article twenty-five of this chapter, telehealth shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner. This subdivision shall not preclude the delivery of health care services by means of “home telehealth” as used in section thirty-six hundred fourteen of this chapter.

“Telemedicine” means the use of synchronous, two-way electronic audio visual communications to deliver clinical health care services, which shall include the assessment, diagnosis, and treatment of a patient, while such patient is at the originating site and a telehealth provider is at a distant site.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Nov. 2023).

Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance. Medicaid covered services provided via telehealth include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a Medicaid member. This definition includes audio-only services when audio-visual is unavailable, or a member chooses audio-only.

Telemedicine, or audio-visual telehealth, uses two-way synchronous electronic audio-visual communications to deliver clinical health care services to a patient at an originating site by a telehealth provider located at a distant site. Telemedicine includes teledentistry.

SOURCE: NY Dept. of Health Medicaid Update Feb. 2023 Vol 39, Number 3, p. 3, 4. (Accessed Nov. 2023).

“Telehealth” means the use of electronic information and communication technologies by a health care provider to deliver health care services to an enrollee while such enrollee is located at a site that is different from the site where the health care provider is located.

SOURCE: NY Public Health Law Article 44 – G Section 4406-g (2). (Accessed Nov. 2023).

Telemental Health 

Telehealth and telepsychiatry are both defined as the use of interactive audio and video technology to support interactive patient care and consultations between healthcare practitioners and patients at a distance.

SOURCE: Article 29-I VFCA Health Facilities License Guidelines, p. 49 (Dec 2022). (Accessed Nov. 2023).

Telehealth Services means the use of Telehealth Technologies by Telehealth Practitioners to provide mental health services at a distance. Such services do not currently include an electronic mail message, text message, or facsimile transmission between a practitioner and an individual receiving services, services provided where the originating and distant sites are the same location, or a consultation between two (2) physicians or nurse practitioners, or other staff, although these activities may support Telehealth Services. Telehealth Services must be synchronous. Where program regulations or guidance define an individual’s service provider as a collateral, a discussion or consultation between the Telehealth Practitioner and the individual’s other provider is considered a collateral contact, therefore is considered a Telehealth Service.

Telehealth Technologies means a dedicated, secure, and interactive Audio-only or Audiovisual linkage system approved by the Office to transmit data between an originating/spoke site and distant/hub site for purposes of providing Telehealth Services.

SOURCE: NY Office of Mental Health, Telehealth Services Guidance for OMH Providers, 2023, pg. 5. (Accessed Nov. 2023).

Telehealth Services means the use of telehealth technologies by telehealth practitioners to provide and support mental health services at a distance. Such services do not include an electronic mail message, text message, or facsimile transmission between a provider and a recipient, services provided where the originating and distant sites are the same location, or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support telehealth services.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.4(r), as amended by OMH final rule and Notice Of Adoption. (Accessed Nov. 2023).

Telehealth (formerly referred to as telepractice) as defined in 14 NYCRR Part 830 is the delivery of addiction treatment services via audio and video telecommunication, audioonly or video-only telecommunication.

SOURCE: OASAS Telehealth Standards for OASAS Designated Providers, p. 3, Aug. 2023. (Accessed Nov. 2023).

Teledentistry

Telehealth is defined as “the use of electronic information and communication technologies to deliver health care to patients at a distance, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient (Medicaid member)”.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2023, page 88 (Accessed Nov. 2023).

Caregiver Guide

Telehealth is the use of electronic technology to deliver health care to patients from a distance. Telehealth may take many forms including a video call with a doctor to discuss symptoms or treatment options; or the use of technology to remotely monitor and collect health data. Health and medical data collected remotely may include vital signs, blood pressure, heart rate, or blood oxygen levels.

SOURCE: NY State Caregiver Guide (2021), p. 36. (Accessed Nov. 2023).

Last updated 11/17/2023

Email, Phone & Fax

“Audio-only visits” means the use of telephone and other audio-only technologies to deliver services.

“eConsults” means the asynchronous or synchronous, consultative, provider-to-provider assessment and management services conducted through telephone, internet, or electronic health records.

“Virtual Check-in” means a brief communication via a secure, technology-based service initiated by the patient or patient’s guardian/caregiver, e.g., virtual check-in by a physician or other qualified healthcare professional.

Payment for telehealth services shall be made in accordance with section 538.3 of this Part only if the provision of such services appropriately reduces the need for on-site or in-office visits and the following standards are met:

  • An “audio-only visit” is reimbursable when the service can be effectively delivered without a visual or in-person component; and it is the only available modality or is the patient’s preferred method of service delivery; and the patient consents to an audio-only visit; and it is determined clinically appropriate by the ordering or furnishing provider; and the provider meets billing requirements, as determined and specified by the commissioner in administrative guidance. Services provided via audio-only visits shall contain all elements of the billable procedures or rate codes and must meet all documentation requirements as if provided in person or via an audio-visual visit.
  •  “eConsults” are intended to improve access to specialty expertise through consultations between consulting providers and treating providers. eConsults are reimbursable when the providers meet minimum time and billing requirements, as determined and specified by the commissioner in administrative guidance.
  • “Virtual Check-in” visits are intended to be used for brief medical discussions or electronic communications between a provider and a new or established patient, at the patient’s request. Virtual check-ins are reimbursable when the provider meets certain billing requirements, as determined and specified by the commissioner in administrative guidance.

As required by Social Services Law § 367-u and, except for services paid by State only funds, contingent upon federal financial participation, reimbursement shall be made in accordance with fees determined by the commissioner based on and benchmarked to in-person fees for equivalent or similar services.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538.1-3, as proposed by Final rule per Notice Of Adoption. (Accessed Nov. 2023).

Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication, except that with respect to the medical assistance program shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Nov. 2023).

The commissioner may specify in regulation additional acceptable modalities for the delivery of health care services via telehealth, including but not limited to audio-only or video-only telephone communications, online portals and survey applications, and may specify additional categories of originating sites at which a patient may be located at the time health care services are delivered to the extent such additional modalities and originating sites are deemed appropriate for the populations served.

SOURCE: NY Public Health Law Article 29 – G Section 2999-ee. (Accessed Nov. 2023).

Health care services delivered by means of telehealth shall be entitled to reimbursement under section three hundred sixty-seven-u of the social services law; provided however, reimbursement for additional modalities, provider categories and originating sites specified in accordance with section twenty-nine hundred ninety-nine-ee of this article, and audio-only telephone communication defined in regulations promulgated pursuant to subdivision four of section twenty-nine hundred ninety-nine-cc of this article, shall be contingent upon federal financial participation.

SOURCE: NY Public Health Law Article 29 – G Section 2999-dd. (Accessed Nov. 2023).

Telephonic service uses two-way electronic audio-only communications to deliver services to a patient at an originating site by a telehealth provider. Decisions on what type of visit the NYS Medicaid member receives should be based on their best interest, not that of the provider nor for the convenience of the provider. Providers must use professional judgment to determine whether audio-only services meet patient needs and whether a visit is eligible for audio-only based on criteria below.

NYS DOH anticipates only rare occasions when audio-only visits are appropriate for non-behavioral health (BH) services. For example, during weather emergencies when the patient is unable to use audiovisual technologies or when the visit could otherwise not occur unless provided via audio-only telehealth. NYS DOH will monitor audio-only billing and take steps to limit overuse and prevent misuse of audio-only services. This new policy will be monitored following the COVID-19 PHE to determine if additional guidance is necessary.

NYS Medicaid covers audio-only visits for NYS Medicaid members when all the following conditions are met:

  • audio-visual telehealth is not available to the patient due to lack of patient equipment or connectivity or audio-only is the preference of the patient;
  • the provider must make either audio-visual or in-person appointments available at the request of the patient;
  • the service can be effectively delivered without a visual or in-person component, unless otherwise stated in guidance issued by the NYS DOH (this is a clinical decision made by the provider); and
  • the service provided via audio-only visits contains all elements of the billable procedures or rate codes and meets all documentation requirements as if provided in person or via an audio-visual visit.

Providers must document in the chart of the NYS Medicaid member why audio-only services were used for each audio-only encounter.

Additional programmatic guidance may be published that specifically allows or prohibits the use of audio-only telehealth by type of service. For example, when specific Community Based Long Term Care Services and Supports will have allowable telephonic billing available, it will be defined in program-specific guidance. Additional agency-issued guidance outlines the appropriateness of audio-only visits for their specific populations.

All audio-only claims and encounters must include the 93 or FQ modifier unless modifiers are not allowable (e.g., teledentistry). The UA modifier should no longer be used to indicate the service as delivered via audio-only. Audio-only E&M procedure codes “99441” through “99443” are also billable.

Virtual Check-Ins

Virtual check-ins are brief medical interactions between a physician or other qualified health care professional and a patient. Virtual check-ins may be especially helpful for patients with ongoing chronic conditions that would benefit from recurring check-ins with their provider. A virtual check-in can be conducted via several technology-based modalities, including communication by telephone or by secure text-based messaging, such as electronic interactions via patient portal, secure email, or secure text messaging.

Communication must be Health Insurance Portability and Accountability Act (HIPAA)-compliant and don’t relate to an Evaluation and Management (E&M) visit the patient had within the past seven days, nor lead to a related E&M visit within 24 hours (see “VII. Billing Rules for Telehealth Services” on page 8 of this issue for specific information on code and modifiers).

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 4-5, 11. (Accessed Nov. 2023).

Telemental Health

Audio-only or audio-video communication is an acceptable option only when determined appropriate by the provider of service, in accordance with guidelines established by the Office, and with informed consent from the recipient. Where the recipient is a minor, consent shall also be provided by the parent/guardian or other person who has legal authority to consent to health care on behalf of the minor.

Audio-only or audio-video communication is covered by Medicaid and the Child Health Insurance Plan to the extent consistent with regulations promulgated by the New York State Commissioner of Health pursuant to Section 2999-cc of the Public Health Law.

Telehealth services do not include an electronic mail message, text message. or facsimile transmission between a provider and a recipient, services provided where the originating and distant sites are the same location, or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support teleealth services.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.1(d)(e)596.4(r)as amended by Final Rule and Notice Of Adoption. (Accessed Nov. 2023).

Telehealth Services means the use of Telehealth Technologies by Telehealth Practitioners to provide mental health services at a distance. Such services do not currently include an electronic mail message, text message, or facsimile transmission between a practitioner and an individual receiving services, services provided where the originating and distant sites are the same location, or a consultation between two (2) physicians or nurse practitioners, or other staff, although these activities may support Telehealth Services. Telehealth Services must be synchronous. Where program regulations or guidance define an individual’s service provider as a collateral, a discussion or consultation between the Telehealth Practitioner and the individual’s other provider is considered a collateral contact, therefore is considered a Telehealth Service.

OMH’s position is that in-person and Audio-visual telehealth are the preferred methods for service delivery, while recognizing that Audio-only service delivery, where appropriate, has an important role to play in increasing access to care. OMH expects providers to use their judgment and respect individual and, as applicable, family preference in deciding which services and in which circumstances to utilize the appropriate telehealth modality to best meet the individual’s needs.

Telehealth Services must include all elements of the billable procedure code or rate codes and all required documentation, and the provider must decide that services can be effective using Telehealth Technologies and without an in-person component. Additionally, for Audio-only Telehealth Services, pursuant to Department of Health (DOH) regulation 18 NYCRR § 538.2, providers must decide that services can be effectively delivered without a visual or in-person component.

For individuals without the developmental capacity to participate meaningfully telephonically, the Audio-only modality is not recommended.

  • Children 0-5 do not have the developmental capacity to participate meaningfully telephonically. Audio-only telehealth is not permissible for individual sessions with children 0-5 or dyadic sessions with a child 0-5 and parent. Audio-only telehealth is permissible for collateral sessions with parent/guardian of a child 0-5.

For all Telehealth Services including children/youth, Audio-visual is strongly encouraged.

  • All services for children/youth (up to age 18 or 21, based on regulation and program guidance) must include visualization of the individual (using Audio-visual Telehealth Services or in-person) in the initial assessment period and every 12 months thereafter at minimum. When this does not occur, reasons should be documented.
  • Audio-visual options should be fully explored with parents/guardians prior to considering Audio-only services.

For Audio-only Telehealth Services, DOH Medicaid guidance requires that providers document why Audio-only services were used for each encounter, i.e., Audio-only Telehealth Services are the individual’s preference or Audio-visual Telehealth Services are not available due to lack of equipment or connectivity.

See OMH Guidance for additional OMH program-specific audio-only considerations.

When clinically appropriate, prescribers may provide medication treatment services using Audio-only telehealth.

SOURCE: NY State Office of Mental Health Telehealth Services Guidance for OMH Providers (April 2023), p. 4-6, 8, 12. (Accessed Nov. 2023).

Teledentistry

Telephonic (audio only) services use two-way electronic audio only communications to deliver services to a patient at on originating site by a telehealth provider located at a distant site. This service is billed utilizing Current Dental Terminology (CDT) code “D9991”. When billing for teledentistry services, modifiers cannot be used by dentists.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 9. (Accessed Nov. 2023).

Last updated 11/17/2023

Live Video

POLICY

Reimbursement policy applies to fee-for-service and Medicaid Managed Care plans.

New York reimburses for two-way electronic audio-visual communications to deliver clinical health care services to a patient at an originating site by a telehealth provider located at a distant site, when appropriate, if such member chooses to receive telehealth services in lieu of an in-person visit. An audio-visual visit must contain all elements of the billable procedure codes or rate codes and all required documentation.

Decisions on what type of visit the NYS Medicaid member receives should be based on their best interest, not that of the provider nor for the convenience of the provider.

When services are provided via telehealth to a member located at an originating site, the servicing provider should bill for the telemedicine encounter as if the provider saw the member in-person using the appropriate billing rules for services rendered. The CPT or rate code for the encounter must be appended with the applicable modifier (see Medicaid Update Comprehensive Guidance for more information on billing rules by provider and modality, and modifiers to be used).

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023 (Special Edition), p. 1-4, 14. (Accessed Nov. 2023).

Recently Effective Regulations

Payment for telehealth services shall be made in accordance with section 538.3 of this Part only if the provision of such services appropriately reduces the need for on-site or in-office visits and certain modality-specific standards are met. As required by Social Services Law § 367-u and, except for services paid by State only funds, contingent upon federal financial participation, reimbursement shall be made in accordance with fees determined by the commissioner based on and benchmarked to in-person fees for equivalent or similar services. Reimbursement shall not be made for services that do not warrant separate reimbursement as identified by the department during fraud, waste and abuse detection efforts. The department reserves the right to request additional documentation and deny payment for services deemed duplicative or included in a primary service. Any potential fraud, waste, or abuse, identified through claims monitoring or any other source, will be referred to the Office of Medicaid Inspector General.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538, as added by Final rule per Notice Of Adoption. (Accessed Nov. 2023).

Recent Legislation Effective until April 1, 2024

Health care services delivered by means of telehealth shall be entitled to reimbursement on the same basis, at the same rate, and to the same extent the equivalent services, as may be defined in regulations promulgated by the commissioner, are reimbursed when delivered in person; provided, however, that health care services delivered by means of telehealth shall not require reimbursement to a telehealth provider for certain costs, including but not limited to facility fees or costs reimbursed through ambulatory patient groups or other clinic reimbursement methodologies, if such costs were not incurred in the provision of telehealth services due to neither the originating site nor the distant site occurring within a facility or other clinic setting.

For services licensed, certified or otherwise authorized, such services provided by telehealth, as deemed appropriate by the relevant commissioner, shall be reimbursed at the applicable in person rates or fees established by law, or otherwise established or certified by the office for people with developmental disabilities, office of mental health, or the office of addiction services and supports.

Both temporary and permanent statute state that while services delivered by means of telehealth shall be entitled to reimbursement, reimbursement for additional modalities, provider categories, originating sites and audio-only telephone communication defined in regulations shall be contingent upon federal financial participation.

SOURCE: NY Public Health Law Article 29 – G Section 2999-dd, as amended by A 9007 (2022 Session). (Accessed Nov. 2023).

Mental Health

A program applying for use of Telehealth Services must complete a “Telehealth Services Standards Compliance Attestation” form (AppendixA) and append it to the administrative action. The attestation assures OMH that the Provider’s plan for the use of telehealth conforms to the technological and clinical standards prescribed by 14 NYCRR Part 596 and applicable guidance. The “Technical Guidelines Checklist for Local Providers” (Appendix B) may be used as a guide to assist the program in purchasing equipment or choosing a telehealth platform.

SOURCE: NY Office of Mental Health, Telehealth Services Guidance for OMH Providers, 2023, pg. 44. (Accessed Nov. 2023).


ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

Services provided by means of telehealth must be in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and all other relevant laws and regulations governing confidentiality, privacy, and consent.

Reimbursement for teledentistry be made in accordance with existing Medicaid policy related to supervision and billing rules and requirements.  See manual for billing procedures.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2023, page 88-89 (Accessed Nov. 2023).

The types of teledental (audio-visual) encounters are synchronous (real time) encounters and asynchronous (Store and Forward) encounters. Synchronous (“D9995”) encounters are live, two-way encounters between a patient or caregiver and provider. These types of encounters may include urgent visits, follow-up visits or new patient screenings with the use of audio-visual technology. Additionally, synchronous teledental encounters may also occur between a patient or caregiver along with their dental provider and a specialist, such as an endodontist or oral surgeon. By contrast, asynchronous (“D9996”) encounters involve the transmission of recorded health information such as charting, radiographs, digital impressions and video to a dental provider who assesses the information for treatment needs at a later time.

When billing for teledentistry services, modifiers cannot be used by dentists. Both dental codes (“D9995” and “D9996”) are allowed to be used in place of modifiers.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 9. (Accessed Nov. 2023).

Teleradiology

Reimbursement for professional services delivered via teleradiology shall be made only for the final radiology read and must be billed separately from the technical and administrative component as specified by the commissioner in administrative guidance. (ii) Hospitals and physicians shall bill the professional and technical and administrative components separately in accordance with the relevant Radiology Fee Schedule set forth in subdivision (a) of section 533.6 of this Title.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538.3(c), as added by Final rule per Notice Of Adoption. (Accessed Nov. 2023).

Telemental Health

Telemental Health Services may be authorized by the office for licensed, designated or otherwise approved services provided by telehealth practitioners.

Under the Medicaid program, Telemental Health Services are covered when medically necessary and under the following circumstances:

  • The person receiving services is located at the originating/spoke site and the telehealth practitioner is located at the distant/hub site and is employed by or contracted with a program licensed or designated by the Office;
  • The person receiving services is present during the encounter;
  • The request for telehealth services and the rationale for the request are documented in the individual’s clinical record;
  • The clinical record includes documentation that the encounter occurred; and
  • The telehealth practitioner at the distant/hub site is (1) authorized in New York State; (2) practicing within his/her scope of specialty practice; and (3) if the originating/spoke site is a hospital, credentialed and privileged at the originating/spoke site facility.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.5 & 596.7, as proposed to be amended by Final Rule and Notice Of Adoption. (Accessed Nov. 2023).

Telehealth services may be used to satisfy specific statutory examination, evaluation, or assessment requirement necessary for the involuntary removal from the community, or involuntary retention in a hospital, pursuant to section 9.27 of the Mental Hygiene Law, and for the immediate observation, care and treatment in a hospital, pursuant to section 9.39 of the Mental Hygiene Law, if such services are utilized in compliance with regulations. See Final Rule for additional details.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.6(12-13), as proposed to be amended by Final Rule and Notice Of Adoption. (Accessed Nov. 2023).

Office of Alcoholism and Substance Abuse Services

Telepractice services, as defined in this Part, may be authorized by the office for the delivery of certain addiction services provided by practitioners employed by, or pursuant to a contract or memorandum of understanding (MOU) with a program certified by the office.

For purposes of billing for Medicaid reimbursement, both the practitioner and/or facility employing the practitioner, and the designated program must be Medicaid enrolled and in good standing. For Medicaid reimbursement the practitioner, as defined in this Part, must be defined as a telehealth provider in subdivision two of Public Health Law section 2999-cc.  For purposes of this subdivision, telepractice services shall be considered face-to-face contacts.

To be eligible for Medicaid reimbursement, telepractice services must meet all requirements applicable to assessment and treatment services of Part 841 and the part pursuant to which the designated program operating certificate is issued and must exercise the same standard of care as services delivered on-site or in-community.

Telepractice services will be reimbursed at the same rates for identical procedures provided by practitioners on-site or in-community; an additional administrative fee for transmission may be billed pursuant to applicable rules or directives issued by the NYS Department of Health.  The designated program is the primary billing entity; reimbursement for practitioners at a distant/hub site must be pursuant to a contract or MOU. Delivery of services via telepractice are covered when medically necessary and under the following circumstances:

  • the patient is located at an originating/spoke site and the practitioner is located at a distant/hub site;
  • the patient is located at another designated program, an additional location of a designated program or at an in-community location approved by the office; and the practitioner is located in another designated program;
  • the patient is present during the telepractice session;
  • the request for a telepractice session and the rationale for the request are documented in the patient’s case record; or
  • the case record includes documentation that the telepractice session occurred and the results and findings were communicated to the designated provider.

If the person receiving services is not present during the telepractice service, the service is not eligible for third party reimbursement and any incurred costs may remain the responsibility of the designated provider. Telepractice services may only be delivered via technological means approved by the Federal Center for Medicaid and Medicare Services (CMS), provided such means are compliant with Federal confidentiality requirements. If all or part of a telepractice service is undeliverable due to a failure of transmission or other technical difficulty, reimbursement shall not be provided.

SOURCE: NY Compilation of Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5(d). (Accessed Nov. 2023).

Gambling Disorder Treatment – Effective January 1, 2023

New York State (NYS) Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) Plans will begin covering Gambling Disorder treatment provided to individuals receiving services from the Office of Addiction Services and Supports (OASAS) certified programs. These services may be delivered face to face on-site at the certified location, via telehealth, and in the community. See Medicaid Update for billing guidance.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 38, Number 10, September 2022 (Accessed Nov. 2023)

Office for People with Developmental Disabilities (OPWDD) Services

OPWDD will continue to allow the use of Remote Technologies, where appropriate, to remotely deliver the following services authorized under OPWDD’s Comprehensive HCBS 1915(c) Waiver: Day Habilitation, Community Habilitation, Prevocational Services, Supported Employment, Pathway to Employment, Support Broker, and Respite Services. Remote technology cannot be an exclusive, long-term service delivery option. Additional requirements and information for the delivery of remote services is available in 21-ADM-03 Ability to use Technology to Remotely Deliver Home and Community-Based Services available at https://opwdd.ny.gov/system/files/documents/2021/07/21-adm-03-hcbs-remote-technology_final.pdf.

SOURCE: OPWDD Post-PHE Memo, Apr. 2023. (Accessed Nov. 2023).


ELIGIBLE PROVIDERS

For purposes of medical assistance reimbursement, all Medicaid providers authorized to provide in-person services are authorized to provide such services via telehealth, as long as such telehealth services are appropriate to meet a patient’s health care needs and are within a provider’s scope of practice.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538.1, as added by Final rule per Notice Of Adoption. (Accessed Nov. 2023).

To receive reimbursement from NYS Medicaid, providers submitting telehealth claims or encounters must be NYS-licensed and enrolled in NYS Medicaid. The enrollment requirement is applicable only to enrollable provider types, including pharmacies and most licensed practitioners.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 3. (Accessed Nov. 2023).

Providers who may deliver telemedicine services include:

  • Licensed physician
  • Licensed physician assistant
  • Licensed dentist
  • Licensed nurse practitioner
  • Licensed registered professional nurse (only when such nurse is receiving patient- specific health information or medical data at a distant site by means of RPM)
  • Licensed podiatrist
  • Licensed optometrist
  • Licensed psychologist
  • Licensed social worker
  • Licensed speech language pathologist or audiologist
  • Licensed midwife
  • Physical Therapists
  • Occupational Therapists
  • Certified diabetes educator
  • Certified asthma educator
  • Certified genetic counselor
  • Hospital (including residential health care facilities serving special needs populations)
  • Home care services agency
  • Hospice
  • Credentialed alcoholism and substance abuse counselor
  • Providers authorized to provide services and service coordination under the early intervention program
  • Clinics licensed or certified under Article 16 of the MHL
  • Certified and Non-certified day and residential programs funded or operated by the OPWDD
  • Care manager employed by or under contract to a health home program, patient centered medical home, office for people with developmental disabilities Care Coordination Organization (CCO), hospice or a voluntary foster care agency certified by the office of children and family services. (in Public Health Law only)
  • Certified peer recovery advocate services providers certified by the commissioner of addiction services and supports pursuant to section 19.18-b of the mental hygiene law, peer providers credentialed by the commissioner of addiction services and supports and peers certified or credentialed by the office of mental health (in Public Health Law only)
  • Or any other provider as determined by the Commissioner of Health pursuant to regulation or in consultation with the Commissioner, by the Commissioner of OMH, the Commissioner of OASAS, or the Commissioner of OPWDD pursuant to regulation.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Nov. 2023).

Effective until April 1, 2024

Additional providers who may deliver telemedicine services include mental health practitioners licensed pursuant to article one hundred sixty-three of the education law.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, as amended by A 9007 (2022 Session). (Accessed Nov. 2023).

Recently Effective Regulations

Telehealth provider shall also include:

  1. Voluntary foster care agencies certified by the New York State Office of Children and Family Services and licensed pursuant to article twenty-nine-I of Public Health Law, and providers employed by those agencies.
  2. Providers licensed or certified by the New York State Department of Education to provide Applied Behavioral Analysis therapy.
  3. Radiologists licensed pursuant to Article 131 of the Education Law and credentialed by the site from which the radiologist practices;
  4. All Medicaid providers and providers employed by Medicaid facilities or provider agencies who are authorized to provide in-person services are authorized to provide such services via telehealth as long as such telehealth services are appropriate to meet a patient’s needs and are within a provider’s scope of practice.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538.1, as added by Final rule per Notice Of AdoptionNY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 6. (Accessed Nov. 2023).

Telemental Health

Telehealth services may be authorized by the office for licensed, designated, or otherwise approved services provided by telehealth practitioners, as defined in section 596.4 of this Part, from a site distant from the location of a recipient, where the recipient is physically located at a provider site licensed by the office, or the recipient’s place of residence, other identified location, or other temporary location out-of-state. Services may be delivered via telehealth unless otherwise specified by guidelines established by the Office.

‘Telehealth practitioner’ means (i) a prescribing professional eligible to prescribe medications pursuant to federal regulations; or (ii) staff authorized by OMH to provide in-person services are authorized to provide behavioral health services via telehealth consistent with their scope of practice where applicable, and in accordance with guidelines established by the Office.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(i) & 596.5(a), as proposed to be amended by Final Rule and Notice Of Adoption. (Accessed Nov. 2023).

Distant or “hub” site means the distant secure location, as defined in Section 596.6(a)(1)(vi[i]) of this Part, at which the practitioner rendering the service using telehealth services is located. The distant/hub site telehealth practitioner must possess a current, valid license, permit, or limited permit to practice in New York State, or is designated or approved by the Office to provide services, amongst other requirements. Telehealth practitioners may deliver services from a site located within the United States or its territories, which may include the practitioner’s place of residence, office, or other identified space approved by the Office and in accordance with Office guidelines.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(b) & Sec. 596.6(a), as proposed to be amended by Final Rule and Notice Of Adoption. (Accessed Nov. 2023).

Home Telehealth

Subject to the approval of the state director of the budget, the commissioner may authorize the payment of medical assistance funds for demonstration rates or fees established for home telehealth services and subject to federal financial participation shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth as defined in Section 2999-cc.

SOURCE: NY Statute, Social Services Law SOS §367-u. (Accessed Nov. 2023).

Teledentistry

Dentists providing services via telehealth must be licensed and currently registered in accordance with NYS Education Law or other applicable law and enrolled in NYS Medicaid. Telehealth services must be delivered by dentists acting within their scope of practice.

Dentists providing services via telehealth must be licensed and currently registered in accordance with NYS Education Law or other applicable law and enrolled in NYS Medicaid. Telehealth services must be delivered by dentists acting within their scope of practice. Dental telehealth services shall adhere to the standards of appropriate patient care required in other dental health care settings. All dental telehealth providers shall identify themselves to patients, including providing the professional’s New York state license number.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2023, page 88. (Accessed Nov. 2023).

Federally Qualified Health Centers (FQHCs)

FQHCs can bill the Prospective Payment System (PPS) rate code “4012” or “4013”, depending on on-site presence as outlined in “VII. Billing Rules for Telehealth Services”, “M. FFS Billing for Telehealth by Site and Location” on page 14 of the Medicaid Comprehensive Guidance. Wrap payments are available for any telehealth services, including telephonic services reimbursed by an MMC Plan, under qualifying PPS and off-site rate codes.

FQHCs that have “opted into” Ambulatory Patient Groups (APGs) should follow the billing guidance outlined for sites billing under APGs.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 11, 14-15. (Accessed Nov. 2023).


ELIGIBLE SITES

“Originating site” means a site at which a patient is located at the time health care services are delivered to him or her by means of telehealth

“Distant site” means a site at which a telehealth provider is located while delivering health care services by means of telehealth. Any site within the United States or United States’ territories is eligible to be a distant site for delivery and payment purposes.

SOURCE: NY Public Health Law Article 29 – G Section 2999- cc, (Accessed Nov. 2023).

On professional claims, place of service (POS) “02”, “10”, or “11” must be coded to document the location of the NYS Medicaid member during the telehealth visit.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 3. (Accessed Nov. 2023).

The commissioner may specify in regulation acceptable modalities for the delivery of health care services via telehealth, including but not limited to audio-only or video-only telephone communications, online portals and survey applications, and may specify additional categories of originating sites at which a patient may be located at the time health care services are delivered to the extent such additional modalities and originating sites are deemed appropriate for the populations served.

SOURCE: NY Public Health Law Article 29 – G Section 2999-ee. (Accessed Nov. 2023).

Teledentistry

Originating and distant sites must be a secure location within the fifty United States or United States’ territories where the telehealth provider is located while delivering health care services by means of telehealth and may include:

  • Facilities licensed under Article 28 of the Public Health Law (PHL): hospitals, nursing homes and diagnostic and treatment centers;
  • Facilities licensed under Article 40 of the PHL: hospice programs;
  • Facilities as defined in subdivision 6 of Section 1.03 of the Mental Hygiene Law (MHL): clinics certified under Articles 16, 31 and 32;
  • Certified and non-certified day and residential programs funded or operated by the Office of People with Developmental Disabilities (OPWDD);
  • Private physician or dentist offices located within the State of New York;
  • Adult care facilities licensed under Title 2 of Article 7 of the Social Security Law (SSL);
  • Public, private and charter elementary and secondary schools located within the State of New York;
  • School-age child care programs located within the State of New York;
  • Child daycare centers located within the State of New York; and,
  • The member’s place of residence in New York State, or other temporary location in or out of state.

When services are provided by an Article 28 facility, the telehealth dentist must be credentialed and privileged at both the originating and distant sites in accordance with Section 2805-u of PHL.

SOURCE: Dental Procedure Manual. 1/1/23. P. 88-89 (Accessed Nov. 2023).

Telemental Health

The recipient can be physically located at a provider site licensed by the office, or the recipient’s place of residence, other identified location, or other temporary location out-of-state.

Originating or “spoke” site means a site where the recipient is physically located at the time mental health services are delivered to them by means of telehealth services, which may include the recipient’s place of residence, other identified location, or other temporary location out-of-state.

Distant or “hub” site means the distant secure location, as defined in Section 596.6(a)(1)(vi[i]) of this Part, at which the practitioner rendering the service using telehealth services is located. The distant/hub site telehealth practitioner must possess a current, valid license, permit, or limited permit to practice in New York State, or is designated or approved by the Office to provide services, amongst other requirements. Telehealth practitioners may deliver services from a site located within the United States or its territories, which may include the practitioner’s place of residence, office, or other identified space approved by the Office and in accordance with Office guidelines.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(b)(e), Sec. 596.5(a), & Sec. 596.6(a) as proposed to be amended by Final Rule and Notice Of Adoption. (Accessed Nov. 2023).

Upon receipt of the application for use of Telehealth Services, OMH Field Office licensing staff may conduct a remote readiness review to either or both the originating and/or distant sites to review the use of Telehealth Services as part of the routine certification process. This review may be achieved by having the Field Office licensing staff log on to the hub and/or spoke site’s telecommunication system to ascertain the quality of the transmission. See guidance for details.

SOURCE: NY Office of Mental Health, Telehealth Services Guidance for OMH Providers, 2023, pg. 44. (Accessed Nov. 2023).

Hospital Inpatient Billing for Audio-Visual Telehealth 

When a telehealth consult is being provided by a distant-site physician to a NYS Medicaid member who is an inpatient in the hospital, payment for the telehealth encounter may be billed by the distant-site physician. Other than physician services, all other practitioner services are included in the All Patient Revised – Diagnosis Related Group (APR-DRG) payment to the facility.

Skilled Nursing Facility Billing for Audio-Visual Telehealth 

When the services of the telehealth practitioner are included in the nursing home rate, the telehealth practitioner must bill the nursing home. If the services of the telehealth practitioner are not included in the nursing home rate, the telehealth practitioner should bill NYS Medicaid as if practitioner saw the NYS Medicaid member in-person. The CPT code billed should be appended with the applicable telehealth modifier. Practitioners providing services via telehealth should confirm with the nursing facility whether their services are in the nursing home rate.


GEOGRAPHIC LIMITS

Any secure site within the fifty United States (U.S.) or U.S. territories, is eligible to be a distant site for delivery and payment purposes, including Federally Qualified Health Centers (FQHCs) and providers homes, for NYS Medicaid-enrolled patients.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 3; Dental Procedure Manual. 1/1/23. P. 88; (Accessed Nov. 2023).


FACILITY/TRANSMISSION FEE

Exceptions to current telehealth payment parity requirements are in place for certain costs, including facility fees in instances when such costs were not incurred in the provision of telehealth services because neither the originating nor the distant site occurring within the facility or clinic setting for Article 28 licensed facilities.

When services are provided via telemedicine to a member located at a particular originating site (i.e. outpatient department/clinic, emergency room), the provider submits an APG claim for services provided. If the off-site provider delivering service is not employed or contracted by the facility, the provider submits APGs for CPT code “Q3014” as originating site fee. See Medicaid Comprehensive Guidance for further site and location billing scenarios.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 8, 15-16. (Accessed Nov. 2023).

Teledentistry

Procedure code Q3014 may be used by the provider at the originating site. Must be reported on claim line #1. Report any additional services rendered on subsequent lines.

SOURCE: Dental Procedure Manual. 1/1/23. P.90. (Accessed Nov. 2023).

Both dental codes (“D9995” and “D9996”) along with “Q3014” were added to the dental fee schedule.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 9. (Accessed Nov. 2023).

Last updated 11/18/2023

Miscellaneous

Subject to federal financial participation and the approval of the director of the budget, the commissioner shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth, as defined in section 2999-cc(4) of the public health law.

SOURCE: Social Services Law Article 367-u. (Accessed Nov. 2023).

The superintendent of financial services, in collaboration with the commissioner of health, shall report on the impact of reimbursement for telehealth services that, pursuant to the insurance law and public health law, will be reimbursed by an accident and health insurer and a corporation subject to article 43 of the insurance law, including a health maintenance organization, on the same basis, at the same rate, and to the same extent the equivalent services are reimbursed when delivered in person. The report shall, at a minimum, and to the extent possible, contain information regarding the use of telehealth services broken down by: social service district or county; age and gender of patients; procedure codes, diagnosis codes, and associated descriptions or modifiers; claims paid amount totals; claims information such as categories of services, specialty or type codes; and trends in the types of telehealth services used such as primary care, behavioral and mental health care, and the number of telehealth visits by provider type. The report shall include such utilization information dating from the effective date of this act and ending on the one-year anniversary of such effective date, and shall be submitted to the governor, the temporary president of the senate, and the speaker of the assembly by December 31, 2023.

SOURCE: A 9007 (2022 Session), part V, p. 28. (Accessed Nov. 2023).

Demonstration rates of payment or fees shall be established for telehealth services provided by a certified home health agency, a long term home health care program or AIDS home care program, or for telehealth services by a licensed home care services agency under contract with such an agency or program, in order to ensure the availability of technology-based patient monitoring, communication and health management. Reimbursement is provided only in connection with Federal Food and Drug Administration-approved and interoperable devices that are incorporated as part of the patient’s plan of care.

SOURCE: NY Public Health Law Article 36 Section 3614(3-c). (Accessed Nov. 2023).

Independent Practitioner Services for Individuals with Developmental Disabilities (IPSIDD) are prohibited from being delivered via telehealth.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 635-13.4(c). (Accessed Nov. 2023).

Each agency that operates a clinic treatment facility shall provide the Office for People with Developmental Disabilities (OPWDD) information it requests, including but not limited to the following: services provided by CPT/HCPCS and/or CDT codes, where such services were delivered, including the location of both the provider and the individual when services are delivered via telehealth, (i.e., on-site or at a certified satellite site, or, prior to April 1, 2016, off-site) and revenues by funding SOURCE or payee. These data shall correspond to the identical time period of the cost report.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 679.6(b). (Accessed Nov. 2023).

MMC Considerations

  1. MMC Plans are required to cover, at a minimum, services that are covered by NYS Medicaid FFS and included in the MMC benefit package, when determined medically necessary and must provide telehealth coverage as described in this guidance. To allow DOH to adequately track telehealth use, MMC Plans must ensure claims allow the use of the telehealth modifiers established in this guidance, and may establish additional claiming requirements beyond those set out in the FFS billing instructions in this guidance.
  2. MMC Plans must adhere to the payment parity requirements outlined in “VII. Billing Rules for Telehealth Services”, “A. Payment Parity with In-Person Services” on page 8 of this issue.
  3. MMC Plans may not limit enrollee access to telehealth/telephonic services to solely the MMC Plan telehealth vendors and must cover appropriate telehealth/telephonic services provided by other network providers.
  4. Questions regarding MMC reimbursement or documentation requirements should be directed to the MMC Plan of the enrollee.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 17. (Accessed Nov. 2023).

Credentialing and Privileging Physicians

NYS hospitals acting as originating sites are required to ensure that physicians who are providing consultations via telehealth at distant sites are appropriately credentialed and privileged. A hospital facility, including one that is acting as a telehealth originating site, may enter into a contract with an outside entity to carry out all or part of the professional application and verification process (physician credentialing). This includes activities associated with the collection and verification of information specific to credentials and prior affiliations/employment. A hospital originating site may therefore enter into a contract with the distant site to receive and collect credentialing information, perform all required verification activities, and act on behalf of the originating site hospital for such credentialing purposes regarding those physicians who will be providing patient consultations via telehealth. Such contracts must establish that the originating site hospital retains ultimate responsibility for the physician credentialing. Distant site hospitals may not delegate, through a contract, their responsibility for peer review, quality assurance/quality improvement activities and decision-making authority for granting medical staff membership or professional privileges (physician privileging).

Certified Asthma Educators (Verification Requirements)

The hospital, Diagnostic and Treatment Centers (D&TCs) or office serving as the originating site is responsible for ensuring that the Certified Asthma Educator (CAE) providing self-management training services via telehealth, is a NYS licensed, registered, or certified health care professional, who is also certified as an educator by the National Asthma Educator Certification Board (NAECB). NAECB and CBDCE educators are expected to practice within the scope of practice that is appropriate to their respective discipline, as defined by the NYSED Office of the Professions.

Certified Diabetes Educators

Certification through the Certification Board for Diabetes Educators (CBDCE) is no longer required. Registered dieticians can enroll as NYS Medicaid providers and deliver diabetes self-management training via telehealth.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 7. (Accessed Nov. 2023).

TeleMental Health

See clinical and program-specific guidance for telemental health services in guidance document.  Also includes billing guidelines, managed care reimbursement, technology and telecommunications guidance, and guidance for contracting with telemedicine companies.

SOURCE: NY Office of Mental Health, Telehealth Services Guidance for OMH Providers, 2023. (Accessed Nov. 2023).

Office of Alcoholism and Substance Abuse Services (OASAS)

Telepractice services, as defined in this Part, may be authorized by the office for the delivery of certain addiction services provided by practitioners employed by, or pursuant to a contract or memorandum of understanding (MOU) with a program certified by the office.  See regulation for details.

SOURCE: NY Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5. (Accessed Nov. 2023).

Recently Effective Legislation – Community-Based Paramedicine Demonstration Program

Legislation requires the Department to establish a community paramedicine demonstration program to evaluate the role of emergency medical services personnel in the delivery of health care services in the community in non-emergent settings. The program shall authorize mobile integrated and community paramedicine programs operating under COVID emergency policies to continue in the same manner and capacity as currently approved for a period of two years. The program shall include authorizing emergency medical service personnel to provide community paramedicine, use alternative destinations, telemedicine to facilitate treatment in place, and other services as approved by the Commissioner.

SOURCE: NY Public Health Law Sec. 3018 as added by S 6749 (2023 Session). (Accessed Nov. 2023).

Last updated 11/17/2023

Out of State Providers

“Distant site” means a site at which a telehealth provider is located while delivering health care services by means of telehealth. Any site within the United States or United States’ territories is eligible to be a distant site for delivery and payment purposes.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Nov. 2023).

Any secure site within the fifty United States (U.S.) or U.S. territories, is eligible to be a distant site for delivery and payment purposes, including Federally Qualified Health Centers (FQHCs) and providers homes, for NYS Medicaid-enrolled patients. To receive reimbursement from NYS Medicaid, providers submitting telehealth claims or encounters must be NYS-licensed and enrolled in NYS Medicaid. The enrollment requirement is applicable only to enrollable provider types, including pharmacies and most licensed practitioners.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 3. (Accessed Nov. 2023).

Telemental Health

Part 596 of Title 14 NYCRR permits the provision of Telehealth Services by the New York State (NYS) Office of Mental Health (OMH) programs licensed or designated pursuant to Article 31 of the NYS Mental Hygiene Law, if approved to do so by OMH. Approval shall be based upon review of policies and procedures that satisfactorily address a series of standards and procedures. For example, the policies and procedures must confirm that:

  • Telehealth Practitioners meet standards established in Part 596.6(a)(1)(i), including that they possess a current, valid license, permit, or limited permit to practice in New York State, or are designated or approved by the Office to provide services.

SOURCE: New York State Office of Mental Health, Telehealth Services Guidance for OMH Providers (Apr. 2023) p. 45. (Accessed Nov. 2023).

The recipient can be physically located at a provider site licensed by the office, or the recipient’s place of residence, other identified location, or other temporary location out-of-state.

Telehealth practitioners may deliver services from a site located within the United States or its territories, which may include the practitioner’s place of residence, office, or other identified space approved by the Office and in accordance with Office guidelines.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(b)(e), Sec. 596.5(a), & Sec. 596.6(a) as proposed to be amended by Final Rule and Notice Of Adoption. (Accessed Nov. 2023).

Last updated 11/17/2023

Overview

New York Medicaid offers live video, store-and-forward, and remote patient monitoring reimbursement. Both the Department of Health and Office of Mental Health have recently adopted final rules making many emergency Medicaid telehealth expansions permanent, including allowances for audio-only coverage. In addition, recently effective legislation requires telehealth reimbursement parity until April 1, 2024 and the Department of Health Announced Medicaid Telehealth Coverage Extended Beyond COVID-19 Public Health Emergency Through 2024. See NY Medicaid Telehealth website for overview of policies.

Last updated 11/17/2023

Remote Patient Monitoring

POLICY

“Remote patient monitoring” means the use of synchronous or asynchronous electronic information and communication technologies to collect personal health information and medical data from a patient at an originating site that is transmitted to a telehealth provider at a distant site for use in the treatment and management of medical conditions that require frequent monitoring. Such technologies may include additional interaction triggered by previous transmissions, such as interactive queries conducted through communication technologies or by telephone.

RPM included within definition of “telehealth” in statute requiring Medicaid Reimburse telehealth delivery of services.

Subject to the approval of the state director of the budget, the commissioner may authorize the payment of medical assistance funds for demonstration rates or fees established for home telehealth services provided pursuant to subdivision three-c of section thirty-six hundred fourteen of the public health law.

Subject to federal financial participation and the approval of the director of the budget, the commissioner shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth, as defined in subdivision four of section two thousand nine hundred ninety-nine-cc of the public health law.

SOURCE: Social Services Law Title 11, Article 367-u & NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Nov. 2023).

Remote patient monitoring (RPM) uses digital technologies to collect medical data and other personal health information from members in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. Monitoring programs can collect a wide range of health data from the point of care, such as vital signs, blood pressure, heart rate, weight, blood sugar, blood oxygen levels and electrocardiogram readings. RPM may include follow-up on previously transmitted data conducted through communication technologies or by telephone.

Telehealth services provided by means of RPM should be billed using CPT code “99091” [collection and interpretation of physiologic data (e.g., Electrocardiography (ECG), blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training and licensure/regulation (when applicable) requiring a minimum of 30 minutes of time].

A fee of $48.00 per month will be paid for RPM.

Providers are not to bill “99091” more than one time per member per month.

FQHCs that have opted out of Ambulatory Patient Groups (APGs) are unable to bill for RPM services at this time.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 4 & 12. (Accessed Nov. 2023).


CONDITIONS

Medical conditions that may be treated/monitored by means of RPM include, but are not limited to:

  • Congestive heart failure
  • Diabetes
  • Chronic obstructive pulmonary disease
  • Wound care
  • Polypharmacy
  • Mental or behavioral problems
  • Technology-dependent care, such as continuous oxygen, ventilator care, total parenteral nutrition, or enteral feeding.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. & NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 4. (Accessed Nov. 2023).

Maternal Care RPM Coverage

Effective October 1, 2022, for fee-for-service (FFS), and December 1, 2022, for Medicaid Managed Care (MMC) Plans, New York State (NYS) Medicaid is expanding coverage for remote patient monitoring (RPM) during pregnancy and up to 84 days postpartum to further improve and expand access to prenatal and postpartum care. This expansion of coverage includes an additional monthly fee to cover the cost of RPM devices/equipment. See Medicaid Update for additional billing guidance.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 38, Number 10, September 2022 (Accessed Nov. 2023)

The additional allowance that may be reimbursable for maternity RPM equipment provided by enrolled providers to pregnant and postpartum NYS Medicaid members calls for using CPT codes “99453” and “99454” with HD modifier. Please note: “99091” and “99454” are both intended to be billed once monthly but cannot be billed on the same day. This replaces the guidance for billing these codes that was included in the September 2022 issue of the Medicaid Update that stated, “CPT Code “99454” is billed along with CPT Code “99091”.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 12. (Accessed Nov. 2023).

Continuous Glucose Monitoring (CGM)

NYS Medicaid covers continous glucose monitoring for:

  1. Members with a diagnosis of gestational diabetes; or
  2. Members with a diagnosis of type 1 or type 2 diabetes, who meet all the following criteria:
    • Are under the care of an endocrinologist, or an enrolled Medicaid provider with experience in diabetes treatment, who orders the device.
    • Are compliant with regular visits to review CGM data with their provider.
    • Are on an insulin treatment plan or an insulin pump.
    • Are able, or have a caregiver who is able, to hear and view CGM alerts and respond appropriately

SOURCE: NY Dept. of Health, Provider Communication, Updated Continuous Glucose Monitoring Criteria, Oct. 2023. (Accessed Nov. 2023).


PROVIDER LIMITATIONS

Remote patient monitoring shall be ordered by a physician licensed pursuant to article one hundred thirty-one of the education law, a nurse practitioner licensed pursuant to article one hundred thirty-nine of the education law, or a midwife licensed pursuant to article one hundred forty of the education law, with which the patient has a substantial and ongoing relationship.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc.  (Accessed Nov. 2023)


OTHER RESTRICTIONS

No Reference Found

Last updated 11/17/2023

Store and Forward

POLICY

Store-and-forward technology involves the asynchronous, electronic transmission of a member’s health information in the form of patient-specific pre-recorded videos and/or digital images from a provider at an originating site to a telehealth provider at a distant site.

Store-and-forward technology aids in diagnoses when live video contact is not readily available or not necessary. Pre-recorded videos and/or static digital images (e.g., pictures), excluding radiology, must be specific to the member’s condition as well as be adequate for rendering or confirming a diagnosis or a plan of treatment.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023 (Special Edition), p. 4. (Accessed Nov. 2023).

Reimbursement will be made to the consulting distant-site practitioner when billed with an appropriate procedure code. The consulting distant-site practitioner must provide the requesting originating-site practitioner with a written report of the consultation in order for payment to be made. The consulting practitioner should bill the CPT code for the professional service appended with the telehealth GQ modifier.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023 (Special Edition), p. 11. (Accessed Nov. 2023).

“Store and forward technology” means the asynchronous, electronic transmission of a patient’s health information in the form of patient-specific digital images and/or pre-recorded videos from a provider at an originating site to a telehealth provider at a distant site.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Nov. 2023).

Reimbursement for consultations provided via store and forward technology will be paid at 75% of the Medicaid fee for the service provided.

SOURCE: NYS Medicaid Telehealth. Sept. 2023. (Accessed Nov. 2023).

Recently Effective Regulations

“eConsults” means the asynchronous or synchronous, consultative, provider-to-provider assessment and management services conducted through telephone, internet, or electronic health records.

“Virtual Check-in” means a brief communication via a secure, technology-based service initiated by the patient or patient’s guardian/caregiver, e.g., virtual check-in by a physician or other qualified healthcare professional.

“Virtual Patient Education” means education and training for patient self-management by a qualified health care professional via telehealth.

Payment for telehealth services shall be made in accordance with section 538.3 of this Part only if the provision of such services appropriately reduces the need for on-site or in-office visits and the following standards are met:

  •  “eConsults” are intended to improve access to specialty expertise through consultations between consulting providers and treating providers. eConsults are reimbursable when the providers meet minimum time and billing requirements, as determined and specified by the commissioner in administrative guidance.
  • “Virtual Check-in” visits are intended to be used for brief medical discussions or electronic communications between a provider and a new or established patient, at the patient’s request. Virtual check-ins are reimbursable when the provider meets certain billing requirements, as determined and specified by the commissioner in administrative guidance.
  • “Virtual Patient Education” delivers health education to patients, their families, or caregivers, and is reimbursable only for services that are otherwise reimbursable when delivered in person and when the provider meets certain billing requirements, as determined and specified by the commissioner in administrative guidance

As required by Social Services Law § 367-u and, except for services paid by State only funds, contingent upon federal financial participation, reimbursement shall be made in accordance with fees determined by the commissioner based on and benchmarked to in-person fees for equivalent or similar services. Reimbursement shall not be made for services that do not warrant separate reimbursement as identified by the department during fraud, waste and abuse detection efforts. The department reserves the right to request additional documentation and deny payment for services deemed duplicative or included in a primary service. Any potential fraud, waste, or abuse, identified through claims monitoring or any other source, will be referred to the Office of Medicaid Inspector General.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538, as added by Final rule per Notice Of Adoption. (Accessed Nov. 2023).

Virtual Check-In

Virtual check-ins are brief medical interactions between a physician or other qualified health care professional and a patient. Virtual check-ins may be especially helpful for patients with ongoing chronic conditions that would benefit from recurring check-ins with their provider. A virtual check-in can be conducted via several technology-based modalities, including communication by telephone or by secure text-based messaging, such as electronic interactions via patient portal, secure email, or secure text messaging. Communication must be Health Insurance Portability and Accountability Act (HIPAA)-compliant and don’t relate to an Evaluation and Management (E&M) visit the patient had within the past seven days, nor lead to a related E&M visit within 24 hours (see “VII. Billing Rules for Telehealth Services” on page 8 of this issue for specific information on code and modifiers).

Virtual Patient Education

Virtual patient education means education and training for patient self-management by a qualified health care professional via telehealth. Virtual patient education delivers health education to patients, their families, or caregivers, and is reimbursable only for services that are otherwise reimbursable when delivered in-person and when the provider meets certain billing requirements.

The National Diabetes Prevention Program (NDPP) is reimbursable when provided as a live/synchronous program (using code “0403T”) and is now also reimbursable when provided as an on-demand/asynchronous program (using code “0488T”). NDPPs must meet Centers for Disease Control and Prevention (CDC) requirements and adhere to previously published guidance.

Virtual eTriage

In accordance with The CMS Emergency Triage, Treat, and Transport Model with the Department of Health Parallel Model article published in the November 2021 issue of the Medicaid Update, authorized ambulance services responding to 911 calls may facilitate telehealth encounters where appropriate when providing “treatment in place”. The visit should be reported by both the ambulance service [as an Emergency Triage, Treat, and Transport (ET3) claim] and the telehealth provider (as a telehealth claim). This model mirrors the Centers for Medicare and Medicaid Services (CMS) ET3 Model and will only be allowable while the CMS program is active, and only to ambulance services participating in the national model. The CMS ET3 program is scheduled to end December 31, 2023. A future Medicaid Update issue regarding treatment in place and alternative destinations will provide additional guidance for ambulance providers.

eConsults (Interprofessional Consultations)

eConsults, or interprofessional consultations between a treating/requesting provider and a consulting provider, are intended to improve access to specialty expertise by assisting the treating practitioner with the care of the patient without patient contact with the consulting practitioner. NYS Medicaid intends to request approval of eConsult coverage from CMS and will release guidance outlining coverage policies once approved. eConsults are not currently a covered service in NYS Medicaid FFS.

eVisits

eVisits are patient-initiated communications with a medical provider through a text-based and HIPAA-compliant digital platform, such as a patient portal. eVisits are a type of Virtual Check-In which occur through asynchronous communication; the exchange is neither real-time nor face-to-face. They are intended to remotely assess non-urgent conditions and prevent unnecessary in-person visits. Coverage of eVisits reimburses providers for the problem-focused communication and medical decision-making conducted outside of their normal visits.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023 (Special Edition), p. 5-6. (Accessed Nov. 2023).

Effective October 1, 2023, the New York State (NYS) Medicaid Fee-for-Service (FFS) program will reimburse for eVisits. eVisits are a type of Virtual Check-In involving patient-initiated communications with a medical provider through a text-based and Health Insurance Portability and Accountability Act (HIPAA)-compliant digital platform, such as a patient portal. eVisits occur through asynchronous communication; the exchange is neither real-time nor face-to-face. Additional detail on telehealth modalities can be found in the February 2023 Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency Special Edition issue of the Medicaid Update. They are intended to remotely assess non-urgent conditions and prevent unnecessary in-person visits. Coverage of eVisits reimburses providers for the problem-focused communication and medical decision-making they do outside of normal visits.

eVisits may be provided to established patients only (though the presenting problem may be new). The patient must initiate the communication and the problem must require a physician or other qualified practitioner’s professional’s evaluation, assessment, and management. Claims for eVisits may not be submitted for contact initiated by the provider, whether individualized or as part of an outreach program. Communication of test results, scheduling appointments, medication refills, and any other communications outside the scope of evaluation and management are not considered eVisits.

Billing for eVisits is based on cumulative time spent with a single patient within a seven-day period. For example, if five to ten minutes are spent with a single patient for an eVisit over a seven-day period, procedure code “99421” may be billed (see table in Medicaid Update). For an encounter to qualify as an eVisit, the patient must not have been seen for the same clinical issue within the previous seven days.

See NY Medicaid Update for additional billing information, patient consent and documentation requirements and rates.

SOURCE: Medicaid Update Vol. 39, No. 13, Aug. 2023. (Accessed Nov. 2023).

Teledentistry

Store-and-Forward Technology – involves the asynchronous, electronic transmission of a member’s health information in the form of patient-specific pre-recorded videos and/or digital images from a provider at an originating site to a telehealth provider at a distant site.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2023, page 90 (Accessed Nov. 2023).


ELIGIBLE SERVICES/SPECIALTIES

Store-and-forward services may be reimbursed, based on the definition of telehealth.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Nov. 2023).

Teledentistry

Pre-recorded videos and/or static digital images (e.g., pictures), excluding radiology, must be specific to the member’s condition as well as be adequate for rendering or confirming a diagnosis or a plan of treatment.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2023, page 90 (Accessed Nov. 2023).

The types of teledental (audio-visual) encounters are synchronous (real time) encounters and asynchronous (Store and Forward) encounters. Synchronous (“D9995”) encounters are live, two-way encounters between a patient or caregiver and provider. By contrast, asynchronous (“D9996”) encounters involve the transmission of recorded health information such as charting, radiographs, digital impressions and video to a dental provider who assesses the information for treatment needs at a later time. For example, a hygienist who is employed by an Article 28 facility and has a collaboration arrangement with a dentist also employed by the same facility, can be in a remote location such as a School-Based Health Center (SBHC). From there the hygienist can perform dental hygiene services for the patient, including gathering information that will be sent to the dentist for further review. The dentist can then review the information at a later time, such as during last-minute cancellations or no-show appointments in their schedule.

When billing for teledentistry services, modifiers cannot be used by dentists. Both dental codes (“D9995” and “D9996”) are allowed to be used in place of modifiers.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 9. (Accessed Nov. 2023).

Telemental Health

The definition of telehealth services excludes store-and-forward since it states that telehealth services must be synchronous.

SOURCE: NY OMH Telehealth Services Guidance for OMH Providers. April 2023, page 5. (Accessed Nov. 2023).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

Teledentistry

Procedure code Q3014 may be used by the provider at the originating site.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2023, page 90 (Accessed Nov. 2023).

Last updated 11/18/2023

Cross State Licensing

Applied Behavioral Analysis, Mental Health Practitioners, Psychologists, Social Workers

In New York State, a practitioner must hold a New York license, or be otherwise authorized to practice, when providing professional services to a patient/client located in New York or when the practitioner is located in New York.

If you intend to provide telepractice services to a resident of New York State, you must hold a New York State license and be in compliance with the relevant law, rules and regulations.

New York State law permits a person from another state to perform speech-language pathology or audiology services in this State, as long as such services are performed for no more than thirty (30) days in any calendar year and provided that such services are performed in conjunction with and/or under the supervision of Speech-Language Pathologist or Audiologist licensed under Article 159 of the New York State Education Law.

SOURCE: NY Office of the Professions, Speech-Language Pathologists, Practice Guidelines, (Accessed Nov. 2023).

Last updated 11/18/2023

Definitions

Related to Credentialing and Privileging health care practitioners providing telemedicine

“Telemedicine means the delivery of clinical health care services by means of real time two-way electronic audio-visual communications 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 a distant site.”

SOURCE: NY Public Health Law Article 28 – Section 2805-u. (Accessed Nov. 2023).

Office of Addiction Services and Supports

Telehealth (formerly referred to as telepractice) as defined in 14 NYCRR Part 830 is the delivery of addiction treatment services via audio and video telecommunication, audioonly or video-only telecommunication.

SOURCE: OASAS Telehealth Standards for OASAS Designated Providers, p. 3, Aug. 2023. (Accessed Nov. 2023).

Applied Behavior Analysis, Mental Health Practitioners, Psychology Practice & Social Work

Telepractice includes the use of telecommunications and web-based applications to provide assessment, diagnosis, intervention, consultation, supervision, education and information across distance. It may include providing non-face-to-face applied behavior analysis (ABA), psychological, mental health, marriage and family, creative arts, psychoanalytic, psychotherapy and social work services via technology such as telephone, e-mail, chat and videoconferencing.

SOURCE: NY Office of the Professions, Applied Behavior Analysis, Practice Guidelines; Mental Health Practitioners, Telepractice; Psychology Practice, Telepractice Guidelines; Social Work, Telepractice Guidelines, (Accessed Nov. 2023).

Speech Language Pathology and Audiology

“Telepractice” is providing service that is not “in person” and is delivered through the use of technology. Such technology may include, but is not limited to: telephone, telefax, email, internet, or videoconference. It is considered a mode of practice and the same standards that apply to all forms of practice in the speech-language pathology and audiology professions would apply to telepractice. With reference to speech-language pathology and audiology, telepractice is the use of technology for the application of speech language pathology and audiology services over a distance by connecting a qualified and licensed clinician to a client or one clinician to another for assessment, treatment, and/or consultation.

SOURCE: NY Office of the Professions, Speech Language Pathology and Audiology, Practice Guidelines. (Accessed Nov. 2023).

Physical Therapy

“Telepractice” is providing service that is not “in person” and is facilitated through the use of technology. Such technology may include, but is not limited to, telephone, telefax, e-mail, internet, or videoconference.

SOURCE: NY Office of the Professions, Physical Therapy. Practice Guidelines, (Accessed Nov. 2023).

Last updated 11/18/2023

Licensure Compacts

No Reference Found

Last updated 11/18/2023

Miscellaneous

Services may be provided by OASAS certified, approved or otherwise authorized programs. OASAS programs must apply in accordance with these Telehealth Standards for OASAS Designated Providers (hereinafter Standards) for approval to deliver services via telehealth. OASAS certified programs are required to submit the Attestation for Telehealth (attached herein as Appendix B) requesting a designation be added to their operating certificate prior to service delivery via this method. The purpose of this document is to provide guidance to programs seeking to deliver services via telehealth.

OASAS has specific telepractice standards for its providers.  See regulation for details.

SOURCE: OASAS Telehealth Standards for OASAS Designated Providers, p. 3. Aug. 2023. (Accessed Nov. 2023).

Adverse action against legal reproductive health care

Every insurer that issues or renews medical malpractice insurance covering a health care provider licensed to practice in this state shall be prohibited from taking any adverse action against a health care provider solely on the basis that the health care provider performs an abortion or provides reproductive health care that is legal in this state on someone who is from out of the state. Such policy shall include health care providers who legally prescribe abortion medication to out-of-state patients by means of telehealth.

As used in this section, “adverse action” shall mean but not be limited to: (1) refusing to renew or execute a contract or agreement with a health care provider; (2) making a report or commenting to an appropriate private or governmental entity regarding practices of such provider which may violate abortion laws in other states; and (3) increasing in any charge for, or a reduction or other adverse or unfavorable change in the terms of coverage or amount for, any medical malpractice insurance contract or agreement with a health care provider.

SOURCE: NY Insurance Law Article 34 Section 3436*2-a, as added by S 9080 (2022 Session) and amended by S 4007 (2023 Session). (Accessed Nov. 2023).

Last updated 11/18/2023

Online Prescribing

Office of Alcoholism and Substance Abuse Services (OASAS)

Buprenorphine is a controlled substance and requires appropriate evaluation for use and ongoing monitoring. As such, buprenorphine initiation must include an evaluation by a practitioner with a valid DEA registration prior to issuance of a buprenorphine prescription; this visit may be done in person or via telehealth (an audio and video visit or an audio-only visit); all follow up visits may be done via telehealth.

SOURCE: OASAS Telehealth Standards for OASAS Designated Providers, p. 9. Aug. 2023. (Accessed Nov. 2023).

Induction and prescribing of addiction medications must be done in accordance any and all applicable Federal rules and regulations; guidance may be found in the Telepractice Standards for OASAS Designated Providers posted on the OASAS website.

SOURCE: NY Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5. (Accessed Nov. 2023).

Mental Health

OMH Telehealth Standards outline various considerations and program-specific requirements related to prescribing medications via telehealth.

SOURCE: NY Office of Mental Health. Telehealth Services Guidance for OMH Providers. (Apr. 2023). (Accessed Nov. 2023).

Workers’ Compensation

When rendering medical treatment or care via telehealth, an Authorized Medical Provider must be available for an in-person clinical encounter with the claimant should such in-person encounter be medically necessary. This means the Authorized Medical Provider must be able to meet the claimant at the Authorized Medical Provider’s office within a reasonable travel time and distance from the claimant’s residence. Telehealth must be used in accordance with this section and any applicable New York State Medical Treatment Guideline incorporated by reference under section 324.2 of this Title.

See regulations for additional rules related to when telehealth may be rendered following an initial in-person clinical encounter and related restrictions.

SOURCE: Title 12 NYCRR Section. 325-1.26 as proposed to be added by Notice Of Adoption. (Accessed Nov. 2023).

Last updated 11/18/2023

Professional Board Standards

Profession-Specific Telepractice Guidance is available for:

  • Applied Behavior Analysis
  • Audiology
  • Mental Health Practitioners
  • Physical Therapy
  • Psychology
  • Social Work
  • Speech-Language Pathology

SOURCE: NY Office of the Professions, Applied Behavioral Analysis, Practice Alerts – Telepractice; Audiology, Practice Alerts – Telepractice; Mental Health Practitioner, Practice Alerts – Telepractice; Physical Therapy, Practice Alerts – Telepractice; Psychology Practice Alerts – Telepractice; Social Work Practice Alerts – Telepractice; Speech Language Pathology Practice Alerts – Telepractice, (Accessed Nov. 2023).

Workers’ Compensation

See regulations for related provider practice requirements.

SOURCE: Title 12 NYCRR Section. 325-1.26 as proposed to be added by Notice Of Adoption. (Accessed Nov. 2023).

Last updated 11/18/2023

Definition of Visit

The unit of service used to establish rates of payment shall be the threshold visit, except for dialysis, abortion, sterilization services and free-standing ambulatory surgery, for which rates of payment shall be established for each procedure. A threshold visit, including all part-time clinic visits, shall occur each time a patient crosses the threshold of a facility to receive medical care without regard to the number of services provided during that visit.

SOURCE: NY Codes, Rules and Regulations, Title 10, Section 86-4.9. (Accessed Nov. 2023).

Last updated 11/18/2023

Eligible Distant Site

Any secure site within the fifty United States (U.S.) or U.S. territories, is eligible to be a distant site for delivery and payment purposes, including Federally Qualified Health Centers (FQHCs) and providers homes, for NYS Medicaid-enrolled patients. To receive reimbursement from NYS Medicaid, providers submitting telehealth claims or encounters must be NYS-licensed and enrolled in NYS Medicaid.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 4. (Accessed Nov. 2023).

Last updated 11/18/2023

Eligible Originating Site

When services are provided via telemedicine to a member located at a FQHC opting into APGs, the provider submits an APG claim for services provided. If the off-site provider delivering service is not employed or contracted by the facility, the provider submits APGs for CPT code “Q3014” as originating site fee. See Medicaid Comprehensive Guidance for further site and location billing scenarios.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 8, 15-17. (Accessed Nov. 2023).

Last updated 11/18/2023

Facility Fee

Exceptions to current telehealth payment parity requirements are in place for certain costs, including facility fees in instances when such costs were not incurred in the provision of telehealth services because neither the originating nor the distant site occurring within the facility or clinic setting for Article 28 licensed facilities.

When services are provided via telemedicine to a member located at a FQHC opting into APGs, the provider submits an APG claim for services provided. If the off-site provider delivering service is not employed or contracted by the facility, the provider submits APGs for CPT code “Q3014” as originating site fee. See Medicaid Comprehensive Guidance for further site and location billing scenarios.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 8, 15-17. (Accessed Nov. 2023).

Last updated 11/18/2023

Home Eligible

If a provider who is onsite at an FQHC is providing services via telemedicine to a member who is not onsite, the provider submits an APG claim for services provided – if the FQHC is opting into APGs. If only the provider is onsite and the FQHC has not opted into APGs, they bill the PPS rate. If the FQHC is opted into APGs and neither the provider or member is on-site, the physician can bill for professional component only. If neither the provider or member is on-site and the FQHC has not opted into APGs, they bill the off-site 4012 rate.

The originating site is where the NYS Medicaid member is located at the time health care services are delivered to the individual by means of telehealth. On professional claims, POS “02”, “10”, or “11” must be coded to document the location of the NYS Medicaid member during the telehealth visit.

Any secure site within the fifty United States (U.S.) or U.S. territories, is eligible to be a distant site for delivery and payment purposes, including Federally Qualified Health Centers (FQHCs) and providers homes, for NYS Medicaid-enrolled patients.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 3-4, 15. (Accessed Nov. 2023).

Last updated 11/18/2023

Modalities Allowed

Live Video

NY Medicaid reimburses for live video telemedicine services.

See: NY Medicaid Live Video


Store and Forward

Generally, reimbursement will be made to the consulting distant-site practitioner when billed with an appropriate procedure code. The consulting distant-site practitioner must provide the requesting originating-site practitioner with a written report of the consultation in order for payment to be made. The consulting practitioner should bill the CPT code for the professional service appended with the telehealth GQ modifier.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 11. (Accessed Nov. 2023).


Remote Patient Monitoring

FQHCs that have opted out of APGs are unable to bill for RPM services at this time.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 12. (Accessed Nov. 2023).


Audio-Only

Audio-only rate codes used during the COVID-19 PHE will be retired. FQHCs can bill the Prospective Payment System (PPS) rate code “4012” or “4013”, depending on on-site presence as outlined in “VII. Billing Rules for Telehealth Services”, “M. FFS Billing for Telehealth by Site and Location” on page 14 of this issue. Wrap payments are available for any telehealth services, including telephonic services reimbursed by an MMC Plan, under qualifying PPS and off-site rate codes.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 11. (Accessed Nov. 2023).

See: NY Medicaid Email, Phone, & Fax

Last updated 11/18/2023

Patient-Provider Relationship

Federally Qualified Health Centers will be reimbursed for the provision of offsite primary care services to existing FQHC patients in need of professional services available at the FQHC, but, due to the individual’s medical condition, is unable to receive the services on the premises of the center. FQHC offsite services must:

  • consist of services normally rendered at the FQHC site.
  • be rendered to an FQHC patient with a pre-existing relationship with the FQHC (i.e., the patient was previously registered as a patient with the FQHC) in order to allow the FQHC to render continuous care when their patient is too ill to receive on-site services, and only to patients expected to recover and return to become an on-site patient again. Off-site services may not be billed for patients whose health status is expected to permanently preclude return to on-site status.
  • be rendered only for the duration of the limiting illness, with the intent that the patient return to regular treatment as an on-site patient as soon as their medical condition allows.
  • be an individual medical service rendered to an FQHC patient by a physician, physician assistant, midwife or nurse practitioner.
  • not be rendered in a nursing facility or long term care facility, to any patient expected to remain a patient in that facility or at that level of care.
  • not be billed in conjunction with any other professional fee for that service, or on the same day as a threshold visit.

SOURCE: NY Codes, Rules and Regulations, Title 10, Section 86-4.9. (Accessed Nov. 2023).

Last updated 11/18/2023

PPS Rate

FQHCs can bill the Prospective Payment System (PPS) rate code “4012” or “4013”, depending on on-site presence as outlined in “VII. Billing Rules for Telehealth Services”, “M. FFS Billing for Telehealth by Site and Location” on page 14 of the Medicaid Comprehensive Guidance. Wrap payments are available for any telehealth services, including telephonic services reimbursed by an MMC Plan, under qualifying PPS and off-site rate codes.

FQHCs that have “opted into” Ambulatory Patient Groups (APGs) should follow the billing guidance outlined for sites billing under APGs.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 11, 14-15. (Accessed Nov. 2023).

Last updated 11/18/2023

Same Day Encounters

Only one threshold visit per patient per day shall be allowable for reimbursement purposes, except for transfusion services to hemophiliacs, in which case each transfusion visit shall constitute an allowable threshold visit.

SOURCE: NY Codes, Rules and Regulations, Title 10, Section 86-4.9. (Accessed Nov. 2023).