Last updated 12/09/2022
Consent Requirements
The practitioner shall provide the member with basic information about the services that he/she will be receiving via telehealth and the member shall provide his/her consent to participate in services utilizing this technology. Telehealth sessions/services shall not be recorded without the member’s consent. Culturally competent translation and/or interpretation services must be provided when the member and distant practitioner do not speak the same language. If the member is receiving ongoing treatment via telehealth, the member must be informed of the following patient rights policies at the initial encounter. See guidance for patients rights policy.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 6-7. (Accessed Dec. 2022).
Mental Health
Telehealth services may be provided only where clinically appropriate and with informed consent by 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. The recipient may withdraw consent at any time. A provider may not deny services to an individual who has a preference to receive services in-person.
SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.1(b), as amended by Final Rule and Notice Of Adoption. (Accessed Dec. 2022).
Part of obtaining approval for telehealth services is obtaining informed consent and may be incorporated into the informed consent process for in-person care. See regulation for specific requirements.
SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.5(b)(c) & 596.6., as amended by Final Rule and Notice Of Adoption. (Accessed Dec. 2022).
Must obtain and document informed consent to utilize telemental health to deliver services. See guidance for details.
SOURCE: NY Office of Mental Health, Telemental Health Services Guidance, 2019, pg. 4, (Accessed Dec. 2022).
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
SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 85 (Accessed Dec. 2022).
Last updated 12/09/2022
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 Dec. 2022).
“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. Telephone conversations, e-mail or text messages, and facsimile transmissions between a practitioner and a Medicaid member or between two practitioners are not considered telehealth services and are not covered by Medicaid when provided as standalone services. Remote consultations between practitioners, without a Medicaid member present, including for the purposes of teaching or skill building, are not considered telehealth and are not reimbursable. The acquisition, installation and maintenance of telecommunication devices or systems is not reimbursable.
“Telemedicine” uses 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. The totality of the communication of information exchanged between the physician or other qualified health care practitioner and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.
SOURCE: NY Dept. of Health Medicaid Update Feb. 2019 Vol 35, Number 2, p. 1, 4. (Accessed Dec. 2022).
“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 Dec. 2022).
Telemental Health
Telemental Health Services means the use of two-way real-time interactive audio and video to provide and support clinical psychiatric care at a distance. Such services do not include a telephone conversation, electronic mail message, or facsimile transmission between a provider and a recipient or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support Telemental Health Services.
SOURCE: NY Office of Mental Health, Telemental Health Guidance, 2019, pg. 2. (Accessed Dec. 2022).
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 Dec. 2022).
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, 2022, page 85 (Accessed Dec. 2022).
Last updated 12/09/2022
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 Dec. 2022).
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 Dec. 2022).
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 Dec. 2022).
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 Dec. 2022).
Telephone conversations, e-mail or text messages, and facsimile transmissions between a practitioner and a Medicaid member or between two practitioners are not considered telehealth services and are not covered by Medicaid when provided as standalone services. Remote consultations between practitioners, without a Medicaid member present, including for the purposes of teaching or skill building, are not considered telehealth and are not reimbursable. The acquisition, installation and maintenance of telecommunication devices or systems is not reimbursable.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 2. (Dec. 2022).
Telephone conversations, e-mail or text messages, and facsimile transmissions between a dentist and a Medicaid member or between two dentists are not considered telehealth services and are not covered by Medicaid when provided as standalone services.
SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 86 (Accessed Dec. 2022).
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 Dec. 2022).
Telemental health services do not include a telephone conversation, electronic mail message or facsimile transmission between a provider and a recipient, or a consultation between two professionals or clinical staff.
SOURCE: NY State Office of Mental Health Telemental Guidance (Nov. 2019), p. 2. (Accessed Dec. 2022).
Last updated 12/09/2022
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. The totality of the communication of information exchanged between the physician or other qualified health care practitioner and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.
Telehealth should not be used by a provider if it may result in any reduction to the quality of care required to be provided to a Medicaid member or if such service could adversely impact the member.
NY Medicaid does not reimburse for telehealth used solely for the convenience of the practitioner when a face-to-face visit is more appropriate and/or preferred by the member.
New York Medicaid does not reimburse the acquisition, installation, and maintenance of telecommunication devices or systems.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019 (Special Edition), p. 1-4. (Accessed Dec. 2022).
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 proposed to be added by Final rule per Notice Of Adoption. (Accessed Dec. 2022).
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 Dec. 2022).
Mental Health
A program applying to utilize telemental health must complete a “Telemental Health Services Standards Compliance Attestation” form (Appendix 1) and attach it to the Administrative Action request, or to the email request for designated providers, for approval by OMH. The attestation assures OMH that the provider’s plan for the use of telemental health conforms to the technological and clinical standards. See guidance for further requirements.
SOURCE: NY Office of Mental Health, Telemental Health Guidance, 2019, pg. 2. (Accessed Dec. 2022).
ELIGIBLE SERVICES/SPECIALTIES
Federally Qualified Health Centers (FQHCs)
FQHCs that have “opted into” Ambulatory Patient Groups (APGs) should follow the billing guidance outlined for sites billing under APGs.
FQHCs that have not opted into APGs:
- When services are provided via telemedicine to a patient located at an FQHC originating site, the originating site may bill only the FQHC offsite services rate code (4012) to recoup administrative expenses associated with the telemedicine encounter.
- When a separate and distinct medical service, unrelated to the telemedicine encounter, is provided by a qualified practitioner at the FQHC originating site, the originating site may bill the Prospective Payment System (PPS) rate in addition to the FQHC offsite services rate code (4012).
- If a provider who is onsite at an FQHC is providing services via telemedicine to a member who is in their place of residence or other temporary location, the FQHC should bill the FQHC off-site services rate code (4012) and report the applicable modifier (95 or GT) on the procedure code line.
- If the FQHC is providing services as a distant site provider, the FQHC may bill their PPS rate.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 11. (Accessed Dec. 2022).
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, 2022, page 85-87 (Accessed Dec. 2022).
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 proposed to be added by Final rule per Notice Of Adoption. (Accessed Dec. 2022).
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 Dec. 2022).
As the final step in the approval process, though not required, 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 Telemental Health Services as part of the routine certification process. See guidance for details.
SOURCE: NY Office of Mental Health, Telemental Health Guidance, 2019, pg. 3 (Accessed Dec. 2022).
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 Dec. 2022).
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 Dec. 2022).
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 Dec. 2022)
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 proposed to be added by Final rule per Notice Of Adoption. (Accessed Dec. 2022).
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 & NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 5-6. (Accessed Dec. 2022).
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 Dec. 2022).
Recently Effective Regulations
Telehealth provider shall also include:
- 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.
- Providers licensed or certified by the New York State Department of Education to provide Applied Behavioral Analysis therapy.
- Radiologists licensed pursuant to Article 131 of the Education Law and credentialed by the site from which the radiologist practices;
- 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 proposed to be added by Final rule per Notice Of Adoption. (Accessed Dec. 2022).
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 Dec. 2022).
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 Dec. 2022).
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 Dec. 2022).
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.
SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 85 (Accessed Dec. 2022).
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 Dec. 2022).
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.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019 (Special Edition), p. 3; Dental Procedure Manual. 1/1/22. P. 85; (Accessed Dec. 2022).
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 Dec. 2022).
Teledentistry
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. 1/1/22. P. 85 (Accessed Dec. 2022).
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 Dec. 2022).
As the final step in the approval process, though not required, 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 Telemental Health Services as part of the routine certification process. See guidance for details.
SOURCE: NY Office of Mental Health, Telemental Health Guidance, 2019, pg. 3 (Accessed Dec. 2022).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
When services are provided via telemedicine to a member located at an Article 28 originating site (outpatient department/clinic, emergency room), the originating site may bill only CPT code Q3014 (telehealth originating-site facility fee) through APGs to recoup administrative expenses associated with the telemedicine encounter.
When a separate and distinct medical service, unrelated to the telemedicine encounter, is provided by a qualified practitioner at the originating site, the originating site may bill for the medical service provided in addition to Q3014. The CPT code billed for the separate and distinct service must be appended with the 25 modifier.
When a telemedicine service is being provided by a distant-site practitioner to a member located in a private practitioner’s office (originating site), the originating-site practitioner may bill CPT code Q3014 to recoup administrative expenses associated with the telemedicine encounter.
When a telemedicine service is being provided by a distant-site practitioner to a member located in a private practitioner’s office (originating site) and the originating-site practitioner provides a separate and distinct medical service unrelated to the telemedicine encounter, the originating- site practitioner may bill for the medical service provided in addition to Q3014. The CPT code billed for the separate and distinct medical service must be appended with the 25 modifier.
Only one clinic payment will be made when both the originating site and the distant site are part of the same provider billing entity. In such cases, only the originating site should bill Medicaid for the telemedicine encounter.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019 (Special Edition), p. 8-10. (Accessed Dec. 2022).
When services are provided via telemedicine to a member located at an Article 28 originating site (outpatient department/clinic, emergency room), the originating site may bill only CPT code Q3014 (telehealth originating-site facility fee) through APGs to recoup administrative expenses associated with the telemedicine encounter.
When a separate and distinct medical service, unrelated to the telemedicine encounter is provided by a qualified practitioner at the originating site, the originating site may bill for the medical service provided in addition to Q3014. The CPT code billed for the separate and distinct service must be appended with the 25 modifier.
SOURCE: NY Office of Mental Health, Telemental Health Guidance, 2019, pg. 8-9 (Accessed Dec. 2022).
Teledentistry
Procedure code Q3014 may be used by the provider at the originating site. Must be reported on claim line #1. Report all services rendered on subsequent lines.
SOURCE: Dental Procedure Manual. 1/1/22. P. 87; NY Dept. of Health, (Accessed Dec. 2022).
Last updated 12/09/2022
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 Dec. 2022).
Culturally competent translation and/or interpretation services must be provided when the member and distant practitioner do not speak the same language.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 6. (Accessed Dec. 2022).
Recently Effective Legislation
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 Dec. 2022).
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 Dec. 2022).
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 Dec. 2022).
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 Dec. 2022).
TeleMental Health
See clinical guidelines for tele-mental health services in guidance document. Also includes billing gudiance, managed care reimbursement, technology and telecommunications guidance, and guidance for contracting with telemedicine companies.
SOURCE: NY Office of Mental Health, Telemental Health Services Guidance, 2019, pg. 7-9, (Accessed Dec. 2022).
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 Dec. 2022).
Last updated 12/09/2022
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 Dec. 2022).
A distant site must be located within any of the fifty United States or United States’ territories where a telehealth provider is located when delivering health care services by means of telehealth.
The originating site must be located within the fifty United States or United States’ territories.
Practitioners providing services via telehealth must be licensed or certified, currently registered in accordance with NYS Education Law or other applicable law, and enrolled in NYS Medicaid.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 3 & 6. (Accessed Dec. 2022).
Telemental Health
The distant site must possess a current, valid license, permit, or limited permit to practice in New York State.
Psychiatrists and nurse practitioners in psychiatry may deliver services from a site located within the United States, including from a space in a place of residence approved by the Office of Mental Health; and
Mental health practitioners may deliver services from a site located within the State of New York, including from a space in a place of residence approved by the Office of Mental Health.
SOURCE: New York State Office of Mental Health, Telemental Health Guidance (Nov. 2019) p. 7. (Accessed Dec. 2022).
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 Dec. 2022).
Last updated 12/09/2022
Overview
New York Medicaid offers live video reimbursement and some reimbursement for store-and-forward and home health services. The New York State Department of Health released a Medicaid telehealth expansion in 2019 and the Office of Mental Health released Telemental health guidance in November 2019. 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.
Last updated 12/09/2022
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 Dec. 2022).
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.
Follow-up is included in the monthly time component.
Remote patient monitoring services are billed using CPT code “99091” and should not be billed more than once per member per month. Billing should occur on the last day of each month in which RPM is used. A fee of $48.00 per month will be paid for RPM for a minimum of 30 minutes per month spent collecting and interpreting a member’s RPM data.
FQHCs that have opted out of APGs are unable to bill for RPM services.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4 & 11-12. (Accessed Dec. 2022).
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. 35, Number 2, February 2019, p. 4. (Accessed Dec. 2022).
Maternal Care RPM Coverage
Effective October 1, 2022, for fee-for-service (FFS), andDecember 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 Dec. 2022)
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 Dec. 2022)
OTHER RESTRICTIONS
The following considerations apply to RPM:
- 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, and technology-dependent care such as continuous oxygen, ventilator care, total parenteral nutrition or enteral feeding.
- RPM must be ordered and billed by a physician, nurse practitioner or midwife, with whom the member has or has entered into a substantial and ongoing relationship. RPM can also be provided and billed by an Article-28 clinic, when ordered by one of the previously mentioned qualified practitioners.
- Members must be seen in-person by their practitioner, as needed, for follow-up care.
- RPM must be medically necessary and shall be discontinued when the member’s condition is determined to be stable/controlled.
- Payment for RPM while a member is receiving home health services through a Certified Home Health Agency (CHHA) is pursuant to PHL Section 3614 (3-c)(a) – (d) and will only be made to that same CHHA.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4-5. (Accessed Dec. 2022).
Last updated 12/09/2022
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.
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. 35, Number 2, February 2019 (Special Edition), p. 4. (Accessed Dec. 2022).
Reimbursement for store-and-forward is made to the consulting distant-site practitioner and is paid at 75 percent of the Medicaid fee for the service provided.
The consulting provider must provide the requesting originating-site practitioner with a written report of the consultation and use the GQ modifier in order for payment to be made.
SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019 (Special Edition), p. 11. (Accessed Dec. 2022).
“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 Dec. 2022).
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 proposed to be added by Final rule per Notice Of Adoption. (Accessed Dec. 2022).
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. Accompanying payable services will be reimbursed at 75% of the requested fee, not exceeding 75% of the current Medicaid fee.
SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 87 (Accessed Dec. 2022).
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 Dec. 2022).
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, 2022, page 87 (Accessed Dec. 2022).
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, 2022, page 87 (Accessed Dec. 2022).
