North Carolina

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

North Carolina Medicaid

Administrator

Dept. of Health and Human Services, Division of Medical Assistance

Regional Telehealth Resource Center

Mid-Atlantic Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: Yes, with limitations
Remote Patient Monitoring: Yes

Private Payer Law

Law Exists: No
Payment Parity: No

Professional Requirements

Licensure Compacts:
PTC, NLC, ASLP-IC, PSY
Consent Requirements: Yes

Last updated 02/28/2021

Audio-Only Delivery

Medicaid:  Bulletin on Telehealth and Virtual Patient Communication for Family Planning

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Hybrid Telemedicine with Supporting Home Visit

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Behavioral Health Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Innovations and TBI Appendix K and Developmental Disability Plans

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Postpartum Depression Screening

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Outpatient Behavioral Health Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Interim Perinatal Care

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Optometry Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Outpatient Specialized Therapies and Dental Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Telehealth Definitions, Eligible Providers, Services and Codes

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Guidance for Perinatal Care Providers

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Telehealth Billing Code Summary

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid 1915(c) Waiver: Appendix K – NC Innovations

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – NC Innovations

STATUS: Active, until six months following the end of the Public Health Emergency

Medicaid 1915(c) Waiver: Appendix K – CAP/DA

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – CAP/DA

STATUS: Active, until six months following the end of the Public Health Emergency

Medicaid 1915(c) Waiver: Appendix K – Community Alternatives for Children

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – Community Alternatives for Children

STATUS: Active, until six months following the end of the Public Health Emergency

Medicaid 1915(c) Waiver: Appendix K – NC TBI Waiver

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – NC TBI Waiver

STATUS: Active, until six months following the end of the Public Health Emergency

Last updated 02/28/2021

Cross-State Licensing

Medical Board: Telemedicine FAQs

STATUS: Active

Last updated 02/28/2021

Easing Prescribing Requirements

Medical Board: Use of Telemedicine Amid COVID-19

STATUS: Active, until end of national state of emergency

Medical Board: Telemedicine FAQs

STATUS: Active

Last updated 02/28/2021

Miscellaneous

State Resource: Guidelines for Health Care Providers for Accessibility for Deaf and Hard of Hearing Patients

STATUS: Active

HB 1038: Provides grants that could include telehealth

STATUS: Pending

SB 704/HB 1043: Involuntary Commitments

STATUS: Enacted

Last updated 02/28/2021

Originating Site

Medicaid: Bulletin on Telehealth for Maternal Support

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Hybrid Telemedicine with Supporting Home Visit

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for ESRD Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Outpatient Respiratory Therapy

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Interim Perinatal Care

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Enhanced Behavioral Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Telehealth Definitions, Eligible Providers, Services and Codes

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Guidance for Perinatal Care Providers

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Telehealth Billing Code Summary

STATUS: Active, until end of NC state of emergency or rescinded

Office of the Governor: Executive Order Regarding Telehealth and the Home

STATUS: Extended through duration of public health emergency

Medicaid 1915(c) Waiver: Appendix K – NC Innovations

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – NC Innovations

STATUS: Active, until six months following the end of the Public Health Emergency

Medicaid 1915(c) Waiver: Appendix K – CAP/DA

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – CAP/DA

STATUS: Active, until six months following the end of the Public Health Emergency

Medicaid 1915(c) Waiver: Appendix K – Community Alternatives for Children

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – Community Alternatives for Children

STATUS: Active, until six months following the end of the Public Health Emergency

Medicaid 1915(c) Waiver: Appendix K – NC TBI Waiver

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – NC TBI Waiver

STATUS: Active, until six months following the end of the Public Health Emergency

Last updated 02/28/2021

Private Payer

Department of Insurance:  Payer COVID-19 Telehealth Policies

STATUS: Active

 HB 1037: Health Plan Coverage

STATUS: Pending

Last updated 02/28/2021

Provider Type

Medicaid: Bulletin on Nursing Facility Care

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Skilled Nursing Facilities

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Outpatient Respiratory Therapy

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Well Child Visits

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Postpartum Depression Screening

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Health and Behavior Intervention Visits by Local Health Departments

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Interim Perinatal Care

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Physiologic Monitoring Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Outpatient Specialized Therapies and Dental Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Telehealth Definitions, Eligible Providers, Services and Codes

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Guidance for Perinatal Care Providers

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Telehealth Billing Code Summary

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid 1915(c) Waiver: Appendix K – NC Innovations

STATUS: Expired March 12, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – NC Innovations

STATUS: Active, until six months following the end of the Public Health Emergency

Last updated 02/28/2021

Service Expansion

Medicaid: Bulletin on Nursing Facility Care

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Smoking and Tobacco Cessation Counseling

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth and Virtual Patient Communication for Family Planning

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Maternal Support

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Hybrid Telemedicine with Supporting Home Visit

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for ESRD Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Behavioral Health Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Innovations and TBI Appendix K and Developmental Disability Plans

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Outpatient Respiratory Therapy

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Well Child Visits

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Postpartum Depression Screening

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Health and Behavior Intervention Visits by Local Health Departments

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Suspending copays

STATUS: Active, until end of calendar quarter of the federal PHE

Medicaid: Bulletin on Outpatient Behavioral Health Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Interim Perinatal Care

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Physiologic Monitoring Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Self-Measured Blood Pressure Monitoring

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Optometry Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Bulletin on Telehealth for Outpatient Specialized Therapies and Dental Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Bulletin on Telehealth for Enhanced Behavioral Services

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Telehealth Definitions, Eligible Providers, Services and Codes

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid: Guidance for Perinatal Care Providers

STATUS: Active, until end of NC state of emergency or rescinded

Medicaid:  Telehealth Billing Code Summary

STATUS: Active, until end of NC state of emergency or rescinded

Last updated 02/28/2021

Definitions

“Telehealth is the use of two-way real-time interactive audio and video to provide and support health care services when participants are in different physical locations.”

“Virtual communications is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a beneficiary or a provider and another provider.”

“Remote Patient Monitoring is the use of digital devices to measure and transmit personal health information from a beneficiary in one location to a provider in a different location. Remote patient monitoring enables providers to collect and analyze information such as vital signs (blood pressure, heart rate, weight, blood oxygen levels) in order to make treatment recommendations. There are two types of remote patient monitoring addressed within this policy:

  • Self-Measured and Reported Monitoring: When a beneficiary uses a digital device to measure and record their own vital signs, then transmits the data to a provider for evaluation.
  • Remote Physiologic Monitoring: When a beneficiary’s physiologic data is wirelessly synced from a beneficiary’s digital device where it can be evaluated immediately or at a later time by a provider.”

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, Nov. 15, 2020. (Accessed Feb. 2021).

Last updated 02/28/2021

Email, Phone & Fax

No reference found for email or fax.

Covered virtual communication services include: telephone conversations (audio only); virtual portal communications (secure messaging); and store and forward (transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Covered virtual communication services include telephone evaluation and management codes (audio only): 99441-99443 and G2012.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2 & 14, Nov. 15, 2020. (Accessed Feb. 2021).

Outpatient Behavioral Health

Telephonic services may be transmitted between a patient and provider in a manner that is consistent with the CPT code definition for those services. This service delivery method is reserved for circumstances when: a. the beneficiary’s physical or behavioral health status prevents them from participating in in-person or telehealth services; or b. access issues (e.g., transportation, telehealth technology) prevent the beneficiary from participating in in-person or telehealth services.

Excluding psychotherapy for crisis services, Medicaid and NCHC shall require prior approval for services provided via the telephonic, audio-only communication method.

See Outpatient Behavioral Health manual for telephone-specific criteria, eligible providers, and covered codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 4 & 10, Jan. 1, 2021. (Accessed Feb. 2021).

FQHCs/RHCs

Telephonic services may be transmitted between a patient and provider in a manner that is consistent with the CPT code definition for those services. This service delivery method is reserved for circumstances when: a. the beneficiary’s physical or behavioral health status prevents them from participating in in-person or telehealth services; or b. access issues (e.g., transportation, telehealth technology) prevent the beneficiary from participating in in-person or telehealth services.

See manual for specific requirements for telephonic services.

FQHCs and RHCs may conduct telephonic evaluation and management services using HCPCS code G0071. Eligible providers include physicians, nurse practitioners, psychiatric nurse practitioners, physician assistants, and certified nurse midwives.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, p. 19, Dec. 1, 2020. (Accessed Feb. 2021).

Last updated 02/28/2021

Live Video

POLICY

All telehealth services must be provided over a secure HIPAA compliant technology with live audio and video capabilities including (but not limited to) smart phones, tablets and computers.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 8, Nov. 15, 2020. (Accessed Feb. 2021).

The beneficiary must be enrolled in either the NC Medicaid program or the NC Health Choice Program.  Provider(s) shall verify each Medicaid or NCHC beneficiary’s eligibility each time a service is rendered.  The Medicaid beneficiary may have service restrictions due to their eligibility category that would make them ineligible for this service.  For example, to participate in the NC Health Choice Program, a beneficiary must be between 6 and 18 years old, although there is an exception if the child falls under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirement for Medicaid beneficiaries under 21 years of age.  See manual for details.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, Nov. 15, 2020. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

A range of services may be delivered via telehealth, virtual communication, and remote patient monitoring to Medicaid and NCHC beneficiaries. All telehealth, virtual communication, and remote monitoring services must be delivered in a manner that is consistent with the quality of care provided in-person.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 6, Nov. 15, 2020. (Accessed Feb. 2021).

Medicaid or NCHC shall cover procedures, products, and services related to this policy when they are medically necessary, and:

  • The procedure, product, or service is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the beneficiary’s needs;
  • The procedure, product, or service can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide; and
  • The procedure, product, or service is furnished in a manner not primarily intended for the convenience of the beneficiary, the beneficiary’s caretaker, or the provider.

Services NOT Covered

  • The beneficiary does not meet the eligibility requirements;
  • The beneficiary does not meet the criteria listed above;
  • The procedure, product, or service duplicates another provider’s procedure, product, or service; or
  • The procedure, product, or service is experimental, investigational, or part of a clinical trial.

See p. 5 of manual for specific criteria that must be met before a telehealth service can be rendered to a NC Medicaid beneficiary.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 5-7, Nov. 15, 2020. (Accessed Feb. 2021) & NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 7-8, Jan. 1, 2021. (Accessed Feb. 2021).

Additional Criteria not covered under NC Health Choice

Except as otherwise provided for eligibility, fees, deductibles, copayments, and other cost sharing charges, health benefits coverage provided to children eligible under the Program shall be equivalent to coverage provided for dependents under North Carolina Medicaid Program except for the following:

  • No services for long-term care.
  • No nonemergency medical transportation.
  • No EPSDT.
  • Dental services shall be provided on a restricted basis in accordance with criteria adopted by the Department to implement this subsection.

Unless otherwise required for a specific service, Medicaid and NCHC shall not require prior approval for 1H, Telehealth, Virtual Communications and Remote Patient Monitoring. Prior authorization or an initial in-person examination is not required in order to receive care via telehealth, virtual patient communication, or remote patient monitoring; however, when establishing a new relationship with a patient via these modalities, the provider shall meet the prevailing standard of care and complete all appropriate exam requirements and documentation dictated by relevant CPT or HCPCS coding guidelines.

Special provisions apply for the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program.  See manual.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 5-8, Nov. 15, 2020. (Accessed Feb. 2021).

Telehealth, including:

  • office or other outpatient services and office and inpatient consultation codes; and
  • hybrid telehealth visit with supporting home visit codes.

Virtual communication, including:

  • online digital evaluation and management codes;
  • telephonic evaluation and management;
  • telephonic evaluation and management and virtual communication codes; and
  • interprofessional assessment and management codes.

Virtual patient communications must be transmitted between a patient and provider, or between two providers, in a manner that is consistent with the CPT code definition for those services. Provider(s) shall follow all applicable HIPAA rules.

Hybrid Telehealth awith Supporting Home Visit (Hybrid Model)

Eligible providers may conduct telehealth visits with a supporting home visit by a delegated staff member (“hybrid model”) with new or established patients, for a range of scenarios including (but not limited to):

  • Chronic Disease Management: Providers shall use the home visit codes in this policy with appropriate modifiers.
  • Perinatal Care: Providers shall only use the home visit codes in this policy with appropriate modifiers if they are not billing the pregnancy global package codes. Providers billing the pregnancy global package codes shall refer to clinical coverage policy 1E-5, Obstetrical Services at https://medicaid.ncdhhs.gov/ for billing guidance for this model.

Well-child services are not eligible to be delivered via the hybrid model. See manual for additional requirements.

FQHCs, FQHC-Lookalikes, and RHCs may utilize this hybrid model but shall not bill the home visit codes in table C.1.; FQHCs, FQHC-Lookalikes and RHCs may bill their core service code (T1015) and an originating site facility fee (Q3014) for hybrid model visits to reflect the additional cost of the delegated staff person attending the beneficiary’s home. To be reimbursed for the originating site facility fee, all of the following requirements must be met for each home visit:

  • The assistance delivered in the home must be given by an appropriately trained delegated staff person.
  • The fee must be billed for the same day that the home visit is conducted.
  • HCPCS code Q3014 must be appended with the GT modifier and billed with a place of service ‘12’ to designate that the originating site was the home.
  • The core service code (T1015) must be billed separately from the originating site facility fee code (Q3014).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 13-14, Nov. 15, 2020. (Accessed Feb. 2021).

See Attachment A of manual for billable codes (p. 12).

When the GT modifier is appended to a code billed for professional services, the service is paid at the allowed amount of the fee schedule.

  • For hospitals, this is a covered service for both inpatient and outpatient and is part of the normal hospital reimbursement methodology.
  • Reimbursement for these services is subject to the same restrictions as face-to-face contacts (such as; place of service, allowable providers, multiple service limitations, prior authorization).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 6, 8 & 18, Nov. 15, 2020. (Accessed Feb. 2021).

Outpatient Behavioral Health

NC Medicaid covers a range of outpatient behavioral health services via audio-visual and audio-only modalities. See Outpatient Behavioral Health manual for criteria and covered services (p.

Medicaid and NCHC shall not cover Outpatient Behavioral Health Services for the following:

  • sleep therapy for psychiatric disorders;
  • when services are not provided in-person or in accordance with Attachment A.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 4-8, Jan. 1, 2021. (Accessed Feb. 2021).

FQHCs/RHCs

Certain FQHC or RHC providers may bill NC Medicaid for core services delivered via telehealth. Services must meet NC Medicaid’s definition of core services. See p.  NC Medicaid Clinical Coverage Policy No: 1D-4 for core visit services.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, p. 7, Dec. 1, 2020. (Accessed Feb. 2021).

Teledentistry

Synchronous real-time dentistry is covered through D9995.

SOURCE: NC Div. of Medical Assistance. Medicaid Bulletin. p. 22, Jan. 2018. (Accessed Feb. 2021).

Office Based Opioid Treatment (OBOT)

Telemedicine and telepsychiatry services may be used for the medical or counseling portions of OBOT services providing they are in accordance with NC Medicaid clinical coverage policy 1H, Telemedicine and Telepsychiatry. If telemedicine is utilized for the medical management portion of OBOT services, the beneficiary shall be located at a facility where a physical exam can be conducted by a nurse practitioner, physician assistant, or MD at the time of the telemedicine visit.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1A-41, Office-Based Opioid Treatment, p. 12, Dec. 12, 2019. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

To be eligible to bill for procedures, products, and services related to this policy, providers shall

  • Meet Medicaid or NCHC qualifications for participation;
  • Be currently Medicaid or NCHC enrolled; and
  • Bill only for procedures, products, and services that are within the scope of their clinical practice, as defined by the appropriate licensing entity.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 9, Nov. 15, 2020. (Accessed Feb. 2021) & NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 13, Jan. 1, 2021. (Accessed Feb. 2021).

The distant site is the location from which the provider furnishes the telehealth, virtual communications, or remote patient monitoring services. There are no restrictions on distant sites. Distant sites may be wherever the provider may be located. Provider(s) shall ensure that beneficiary privacy is protected (such as taking calls from private, secure spaces; using headsets).

Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes and Rural Health Centers (RHCs) are considered eligible distant sites and shall follow the coding and billing guidelines (see Attachment A in the manual).

Eligible providers that can bill for telehealth services:

  • Physicians;
  • Nurse practitioners;
  • Psychiatric Nurse Practitioner
  • Certified nurse midwives;
  • Physician’s assistants; and
  • Clinical pharmacist practitioners

NC Medicaid permits all of the above provider types to bill for virtual communication services and RPM except for clinical pharmacist practitioners.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, 13-16, Nov. 15, 2020. (Accessed Feb. 2021).

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Medically necessary services will be provided in the most economic mode, as long as the treatment made available is similarly efficacious to the service requested by the beneficiary’s physician, therapist, or other licensed practitioner; the determination process does not delay the delivery of the needed service; and the determination does not limit the beneficiary’s right to a free choice of providers.

EPSDT does not require the state Medicaid agency to provide any service, product or procedure:

  • that is unsafe, ineffective, or experimental or investigational.
  • that is not medical in nature or not generally recognized as an accepted method of medical practice or treatment.

Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may bill for telehealth, virtual communication, and remote patient monitoring services if the service follows core service billing requirements as outlined in clinical coverage policy 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 4 & 12, Nov. 15, 2020. (Accessed Feb. 2021).

In addition to physicians, the following provider types may bill NC Medicaid for outpatient behavioral health services via telehealth:

  • Licensed Psychologist
  • Licensed Psychological Associate (LPA)
  • Licensed Professional Counselor (LPC)
  • Licensed Clinical Mental Health Counselor (LCMHC)
  • Licensed Professional Counselor Associate (LPCA) or Licensed Clinical Mental Health Counselor Associate (LCMHCA)
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Clinical Social Worker Associate (LCSWA)
  • Licensed Marriage and Family Therapist (LMFT) h. Licensed Marriage and Family Therapist Associate
  • Licensed Clinical Addiction Specialist (LCAS)
  • Licensed Clinical Addiction Specialist – Associate (LCSA-A)
  • Licensed Physician Assistant (PA)

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 13, Jan. 1, 2021. (Accessed Feb. 2021).

FQHCs/RHCs

Eligible providers include all core service providers as defined in Section 3.2.1 of the FQHC/RHC clinical policy, which includes physicians, physician assistants, nurse practitioners, nurse midwives, clinical psychologists, clinical social workers, licensed psychological associates, licensed clinical mental health counselors, licensed marriage and family therapists, advance practice nurse specialists, clinical nurse specialists, and licensed clinical addiction specialists.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, p. 19, Dec. 1, 2020. (Accessed Feb. 2021).


ELIGIBLE SITES

The Originating Site is the location in which the beneficiary is located, which may be health care facilities, schools, community sites, the home, or wherever the beneficiary may be at the time they receive services via telehealth, virtual communications, or remote patient monitoring. There are no restrictions on originating sites.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, 13-16, Nov. 15, 2020. (Accessed Feb. 2021).

When the originating site is a hospital, the originating site facility fee must be billed with RC780 and Q3014.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 17, Nov. 15, 2020. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

There are no restrictions on the originating or distant sites.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, Nov. 15, 2020. (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

Any Medicaid enrolled provider who provides a beneficiary with access to audio and visual equipment in order to complete a telehealth encounter may bill for a facility fee when their office or facility is the site at which the beneficiary is located when the service is provided and the distant site provider is at a different physical location. Skilled nursing facilities (SNF) shall not bill an originating site facility fee when the SNF Medical Director or a beneficiary’s attending physician is conducting a telehealth visit.

Providers must bill Q3014 for the originating site facility fee.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 9 & 16, Nov. 15, 2020. (Accessed Feb. 2021).

FQHCs, FQHC-Lookalikes and RHCs may bill their core service code (T1015) and an originating site facility fee (Q3014) for hybrid model visits to reflect the additional cost of the delegated staff person attending the beneficiary’s home. To be reimbursed for the originating site facility fee, all of the following requirements must be met for each home visit:

1.       The assistance delivered in the home must be given by an appropriately trained delegated staff person.

2.       The fee must be billed for the same day that the home visit is conducted.

3.       HCPCS code Q3014 must be appended with the GT modifier and billed with a place of service ‘12’ to designate that the originating site was the home.

4.       The core service code (T1015) must be billed separately from the originating site facility fee code (Q3014).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 13-16, Nov. 15, 2020. (Accessed Feb. 2021) & NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, p. 19, Dec. 1, 2020. (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

Providers shall comply with the following in effect at the time the service was rendered:

  • All applicable agreements, federal, state and local laws and regulations including HIPAA and medical retention requirements.
  • All Medicaid’s clinical (medical) coverage policies, guidelines, policies, provider manuals, implementation updates and bulletins published by CMS, DHHS, its divisions or its fiscal contractor(s).

Since telehealth services are considered professional services, a beneficiary and provider relationship may be established via telehealth.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p.3 &  9, Nov. 15, 2020. (Accessed Feb. 2021).

Provider(s) shall comply with the following in effect at the time the service is rendered:

  • All applicable agreements, federal, state and local laws and regulations including the Health Insurance Portability and Accountability Act (HIPAA) and record retention requirements; and
  • All NC Medicaid’s clinical (medical) coverage policies, guidelines, policies, provider manuals, implementation updates, and bulletins published by the Centers for Medicare and Medicaid Services (CMS), DHHS, DHHS division(s) or fiscal contractor(s).

Provider(s) are expected to send documentation of any telehealth services rendered to a beneficiary’s identified primary care provider or medical home within 48 hours of the encounter for medical services (including behavioral health medication management), obtaining required consent when necessary (as per 42 CFR Part 2 for relevant substance use disorder related disclosures). Documentation can be sent by any HIPAA-compliant secure means.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 9-10, Nov. 15, 2020. (Accessed Feb. 2021).

Home Health Services

Telehealth may be implemented for the face-to-face encounter in accordance with 42 CFR 440.70 and clinical coverage policy 1H, Telemedicine and Telepsychiatry.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 3A, Home Health, p. 13, Jan 10, 2020. (Accessed Feb. 2021).

Other

Outpatient Specialized Therapies, Local Education Agencies: See p. 47 of LEA manual. NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 10C, Family Planning Services, p. 47, Jan. 1, 2021. (Accessed Feb. 2021). https://files.nc.gov/ncdma/documents/files/10C_4.pdf

SOURCE: Respiratory Therapy Services: See p. 23 of Respiratory Therapy Services manual. NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 10D, Respiratory Therapy Services, p. 23, Jan. 1, 2021. (Accessed Feb. 2021).

Last updated 02/28/2021

Out of State Providers

No Reference Found

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Overview

NC Medicaid reimburses for medically necessary telehealth services via live video, remote patient monitoring, audio-only and other virtual communications modalities outlined in its updated telehealth clinical coverage policies.

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

“Remote Patient Monitoring is the use of digital devices to measure and transmit personal health information from a beneficiary in one location to a provider in a different location. Remote patient monitoring enables providers to collect and analyze information such as vital signs (blood pressure, heart rate, weight, blood oxygen levels) in order to make treatment recommendations. There are two types of remote patient monitoring addressed within this policy:

  • Self-Measured and Reported Monitoring: When a beneficiary uses a digital device to measure and record their own vital signs, then transmits the data to a provider for evaluation.
  • Remote Physiologic Monitoring: When a beneficiary’s physiologic data is wirelessly synced from a beneficiary’s digital device where it can be evaluated immediately or at a later time by a provider.”

NC Medicaid reimburses for remote patient monitoring for self-measured blood pressure monitoring and remote physiologic monitoring. See manual for coverage criteria. See Appendix A of manual for covered remote monitoring codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, 5-7, Nov. 15, 2020. (Accessed Feb. 2021).

SMBPM is a beneficiary’s regular use of a personal blood pressure monitoring device to assess and record blood pressure across different points in time outside of a clinical setting, typically at home. This service is available for new or established patients.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 16, Nov. 15, 2020. (Accessed Feb. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

Providers that may bill NC Medicaid for remote patient monitoring include physicians, nurse practitioners; psychiatric nurse practitioner; certified nurse midwives; and physician’s assistants.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 15, Nov. 15, 2020. (Accessed Feb. 2021).


OTHER RESTRICTIONS

All remote patient monitoring must be conducted in a HIPAA compliant manner, particularly with respect to protecting transmission of patient health data.

Remote patient monitoring requires use of a device that is defined by the FDA as a medical device. Some forms of remote patient monitoring, such as remote physiologic monitoring (detailed below), require a device that is wirelessly synced where the provider can evaluate the data in real or near-real time. All remote patient monitoring must be conducted in a HIPAA compliant manner, particularly with respect to protecting transmission of patient health data.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 8, Nov. 15, 2020. (Accessed Feb. 2021).

Last updated 02/28/2021

Store and Forward

POLICY

Virtual communications is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a beneficiary or a provider and another provider. As outlined in Attachment A and program specific clinical coverage policies, covered virtual communication services include: telephone conversations (audio only); virtual portal communications (secure messaging); and store and forward (transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Virtual communication, including:

  • online digital evaluation and management codes;
  • telephonic evaluation and management;
  • telephonic evaluation and management and virtual communication codes; and
  • interprofessional assessment and management codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 6 & 2, Nov. 15, 2020. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Virtual patient communications must be transmitted between a patient and provider, or between two providers, in a manner that is consistent with the CPT code definition for those services. Provider(s) shall follow all applicable HIPAA rules.

Covered virtual communication services include: telephone conversations (audio only); virtual portal communications (secure messaging); and store and forward (transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Virtual communications include online digital evaluation and management codes and interprofessional assessment and management codes. See manual for covered codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, 8 & 14, Nov. 15, 2020. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

There are no site restrictions on the use of virtual communications for originating or distant sites.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, Nov. 15, 2020. (Accessed Feb. 2021).


TRANSMISSION FEE

Any Medicaid enrolled provider who provides a beneficiary with access to audio and visual equipment in order to complete a telehealth encounter may bill for a facility fee when their office or facility is the site at which the beneficiary is located when the service is provided and the distant site provider is at a different physical location.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 9, Nov. 15, 2020. (Accessed Feb. 2021).

Last updated 02/28/2021

Definitions

No Reference Found

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Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

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Requirements

No Reference Found

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Cross State Licensing

No Reference Found

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Definitions

Maternal and Child Health and Women’s Health

Telemedicine is the use of audio and video between places of lesser and greater medical capability or expertise to provide and

support health care when distance separates participants who are in different geographical locations.

SOURCE: NC General Statute 130A-125(b2)(1). (Accessed Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

Member of the Physical Therapy Compact.

SOURCE: PT Compact. Compact Map. HB 57 (2017). (Accessed Feb. 2021).

Member of the Nurses Licensure Compact.

SOURCE:  Current NLC States & Status.  Nurse Licensure Compact.  (Accessed Feb. 2021).

Member of Psychology Interjurisdictional Compact. (Effective 3/21/21)

SOURCE: PSYPACT. Compact Map. & NC SB 361 (2019 Session), (Accessed Feb. 2021).

Member of the Audiology and Speech-Language Pathology Interstate Compact (Effective when ten states join compact)

SOURCE: Audiology and Speech-Language Pathology Interstate Compact. Compact Map. & NC HB 1053 (2019 Session), (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

Telemedicine may be utilized for neonatal or infant echocardiograms.

SOURCE: 10A N.C.A.C. 43K.0102(c)(3). (Accessed Feb. 2021).

Telemedicine may be used to perform the initial examination required when an individual comes into custody of law enforcement.

SOURCE: N.C. Gen. Stat. § 122C-263(c). (Accessed Feb. 2021).

The Commission is required to address follow-up protocols to ensure early treatment for newborn infants diagnosed with congenital heart defects, including by means of telemedicine (live video).

SOURCE: NC General Statute 130A-125(b2)(1). (Accessed Feb. 2021).

Audiology Assistants may utilize telehealth to extend access to clinical care.

SOURCE: 21 NCAC 64 .1104(a)(8). (Accessed Feb. 2021).

Last updated 02/28/2021

Online Prescribing

No Reference Found

Last updated 02/28/2021

Professional Board Standards

No Reference Found