Last updated 07/17/2023
Email, Phone & Fax
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.
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, June 1, 2023. (Accessed Jul. 2023).
Telephonic Claims: Modifier KX must be appended to the CPT or HCPCS code to indicate that a service has been provided via telephonic, audio-only communication.
Telehealth and telephonic claims should be filed with the provider’s usual place of service code(s).
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8F, Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD), Amended Apr. 1, 2023. (appears in multiple additional manuals), (Accessed Jul. 2023).
As outlined in Attachment A, select services within this clinical coverage policy can be provided via the telephonic, audio-only communication method. Telephonic services must be transmitted between a beneficiary 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:
- physical or behavioral health status prevent the beneficiary from participating in-person or telehealth services; or
- access issues (transportation, telehealth technology) prevent the beneficiary from participating in-person or telehealth services.
24-Hour Coverage for Behavioral Health Crises: This coverage must incorporate the ability for the beneficiary to speak with the licensed clinician on call either in-person, via telehealth, or telephonically.
Medicaid shall require prior approval for services provided via the telephonic, audio-only communication method.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, Apr. 1, 2023. (Accessed Jul. 2023).
FQHCs/RHCs
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 Jul. 2023).
Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD)
As outlined in Attachment A, select services within this clinical coverage policy may be provided via the telephonic, audio-only communication method. Telephonic services may be transmitted between a patient and provider in a manner that is consistent with the CPT code and definition for those services.
This service delivery method is reserved for circumstances when:
- the caregiver’s physical or behavioral health status prevents them from participating in in-person or telehealth services; or
- access issues (e.g., transportation, telehealth technology) prevent the caregiver from participating in in-person or telehealth services.
Refer to Subsection 3.2.5 for Telephonic-Specific Criteria; Subsections 5.1 and 5.2 for Prior Approval requirements; and Subsection 7.1 for Compliance requirements.
Telephonic-Specific Criteria
- Providers shall ensure that services can be safely and effectively delivered using telephonic, audio-only communication;
- Providers shall consider the caregiver’s abilities to participate in services provided using telephonic, audio-only communication;
- Delivery of services using telephonic, audio-only communication must conform to professional standards of care including but not limited to ethical practice, scope of practice, and other relevant federal, state and institutional policies and requirements including Practice Act and Licensing Board rules;
- Providers shall obtain and document verbal or written consent. In extenuating circumstances when consent is unable to be obtained, this should be documented;
- Providers shall verify the caregiver’s identity using two points of identification before initiating a telephonic, audio-only encounter; and
- Providers shall ensure that the beneficiary and caregivers’ privacy and confidentiality is protected.
Transition and discharge planning from a treatment program must document a written plan that specifies details for monitoring and follow-up as appropriate for the beneficiary and family or caregiver. The treatment plan is not to be used to provide respite, day care, or educational services and is not to be used to reimburse a parent for participating in a treatment program. The treatment or discharge plan must be available to a health plan upon request. A unit of service is defined according to the Current Procedural Terminology (CPT) approved code set unless otherwise specified.
See list of telephonic billable services on page 20-21.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8F, Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD), Amended Apr. 1, 2023, (Accessed Jul. 2023).
Peer Support Services
As outlined in Attachment A, select services within this clinical coverage policy may be provided via the telephonic, audio-only communication method. Telephonic services may be transmitted between a beneficiary and provider in a manner that is consistent with the CPT and HCPCS code definition for those services.
Refer to subsection 3.2.5.1 for Telephonic-Specific Criteria; and subsection 7.1 for Compliance requirements.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8G, Peer Support Services pgs. 5, 7 &17 & Attachment A, pgs. 20-21, Amended Aug. 15, 2022. (Accessed Jul. 2023).
Enhanced Mental Health and Substance Abuse Services
As outlined in Attachments A and D, select services within this clinical coverage policy may be provided via telehealth and telephonically. Services delivered via telehealth and telephonically must follow the requirements and guidance in clinical coverage Policy 1-H, Telehealth, Virtual Communications, and Remote Patient Monitoring, at https://medicaid.ncdhhs.gov/.
Certain services for mobile crisis management can be provided via telephonic consultation.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Enhanced Mental Health and Substance Abuse Services Amended Apr. 1, 2023, (Accessed Jul. 2023).
Community Alternatives Program
Providers can utilize telephony and other automated systems to document the provision of CAP/C services as subject to NC Medicaid guidelines on telephony, telehealth, and the CAP/DA policy guidance on electronic engagement.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Community Alternatives Program for Children, Amended Apr. 1, 2023, and Community Alternatives Program for Disabled Adults, Apr. 1, 2023, (Accessed Jul. 2023).
Last updated 07/17/2023
Live Video
POLICY
Medicaid shall cover the procedure, product, or service related to this policy when 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.
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.
General
- An eligible beneficiary shall be enrolled in the NC Medicaid Program (Medicaid is NC Medicaid program, unless context clearly indicates otherwise).
- Provider(s) shall verify each Medicaid 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.
Provider Provider(s) shall bill their usual and customary charges. For a schedule of rates, refer to: https://medicaid.ncdhhs.gov/
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, June 1, 2023. (Accessed Jul. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Medicaid shall cover services delivered via telehealth, virtual communications, and remote patient monitoring services when the all the following additional criteria are followed before rendering services via telehealth, virtual communications, or remote patient monitoring:
- Provider(s) shall ensure that services can be safely and effectively delivered using telehealth, virtual communications, or remote patient monitoring.
- Provider(s) shall consider a beneficiary’s behavioral, physical and cognitive abilities to participate in services provided using telehealth, virtual communications, or remote patient monitoring.
- The beneficiary’s safety must be carefully considered for the complexity of the services provided.
- In situations where a caregiver or facilitator is necessary to assist with the delivery of services via telehealth, virtual communications, or remote patient monitoring, their ability to assist and their safety must also be considered.
- Delivery of services using telehealth, virtual communications, or remote patient monitoring must conform to professional standards of care: ethical practice, scope of practice, and other relevant federal, state and institutional policies and requirements, such as Practice Act and Licensing Board rules;
- Provider(s) shall obtain and document verbal or written consent. In extenuating circumstances when consent is unable to be obtained, this must be documented.
- Beneficiaries are not required to seek services through telehealth, virtual communications, or remote patient monitoring, and shall be allowed access to in-person services, if the beneficiary requests;
- Provider(s) shall verify the beneficiary’s identity using two points of identification before initiating service delivery via telehealth, virtual communications, or remote patient monitoring.
- Provider(s) shall ensure that beneficiary privacy and confidentiality is protected to the best of their ability.
A range of services may be delivered via telehealth, virtual communication, and remote patient monitoring to Medicaid 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.
Each set of eligible services has its own set of eligible provider(s) as defined in Attachment A of this policy or Refer to https://medicaid.ncdhhs.gov/ for the related coverage policies.
Telehealth, including:
- office or other outpatient services and office and inpatient consultation codes; and
- hybrid telehealth visit with supporting home visit codes.
In addition to the eligible services and providers listed in Attachment A of this policy, the policies listed under “Related Clinical Coverage Policies” at the top of this document also include telehealth coverage information, such as telehealth-eligible services and providers. Please refer to those policies for program-specific telehealth guidance.
Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier should not be used for virtual patient communications (including telephonic evaluation and management services) or remote patient monitoring.
General Criteria Not Covered
- Medicaid shall not cover the procedure, product, or service related to this policy when:
- the beneficiary does not meet the eligibility requirements listed in Section 2.0;
- the beneficiary does not meet the criteria listed in Section 3.0;
- 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.
List of eligible Office or Other Outpatient Service and Office and Inpatient Consultation Codes and Hybrid Telehealth Visit with Supporting Home Visit Codes provided on page 12 of Attachment A of the Telehealth, Virtual Communications and Remote Patient Monitoring manual.
* Family Planning beneficiaries are not eligible for new patient visit via telehealth.
Guidance: Hybrid Telehealth with 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.
Providers shall choose the most appropriate code based on the complexity of the services provided and document accordingly. If time is used as a determining factor, providers shall choose the code that corresponds with the length of the telehealth visit provided by the eligible provider (not the duration of the home visit performed by the delegated staff person).
The delegated staff person may perform vaccinations in the home as long as they comply with applicable vaccination requirements (e.g., staff person’s scope of practice), and may conduct other tests or screenings, as appropriate.
- Any vaccinations, tests or screenings conducted in the home should be billed as if they were delivered within the office, without modifiers.
Local Health Departments may also utilize the hybrid model when the telehealth visit is rendered by an eligible provider and may bill the home visit codes listed in table C.1.
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, June 1, 2023. (Accessed Jul. 2023).
Triage and screening services provided to a beneficiary by a mobile crisis provider may be provided via telehealth or telephonically. Providers shall bill the MCM HCPCS with modifier GT for services provided via telehealth or modifier KX for services provided via telephonic, audio-only communication.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Policy Update for Behavioral Health Providers Effective Feb. 15, 2023, (Accessed Jul. 2023).
Telephonic Claims: Modifier KX must be appended to the CPT or HCPCS code to indicate that a service has been provided via telephonic, audio-only communication.
Telehealth and telephonic claims should be filed with the provider’s usual place of service code(s).
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8F, Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD), Amended Apr. 1, 2023. (appears in multiple additional manuals), (Accessed Jul. 2023).
Telehealth Claims: Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for services provided via telephonic, audio-only communication [or virtual patient communication or remote patient monitoring].
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, Apr. 1, 2023, (appears in multiple additional manuals), (Accessed Jul. 2023).
Telehealth eligible services may be provided to both new and established patients by the eligible providers listed within this policy.
SOURCE: NC Div. of Medical Assistance, Clinical Coverage Policies Dialysis Services Amended Dec. 1, 2020, pg. 17, (appears in multiple additional manuals), (Accessed Jul. 2023).
As outlined in Attachment A, select services within this clinical coverage policy may be provided via telehealth. Services delivered via telehealth must follow the requirements and guidance in clinical coverage Policy 1-H, Telehealth, Virtual Communications, and Remote Patient Monitoring, at https://medicaid.ncdhhs.gov/.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8A-2, Facility-Based Crisis Service for Children and Adolescents, amended Apr. 1, 2023. (appears in multiple additional manuals), (Accessed Jul. 2023).
Outpatient Behavioral Health
As outlined in Attachment A, select services within this clinical coverage policy can be provided via telehealth. Services delivered via telehealth must follow the requirements and guidance in clinical coverage Policy 1-H, Telehealth, Virtual Communications, and Remote Patient Monitoring, at https://medicaid.ncdhhs.gov/.
24-Hour Coverage for Behavioral Health Crises: This coverage must incorporate the ability for the beneficiary to speak with the licensed clinician on call either in-person, via telehealth, or telephonically.
See list of behavioral health codes provided in manual and whether or not its telehealth eligible on page 41.
Note: Please refer to Clinical Coverage Policy 1-H: Telehealth, Virtual Patient Communications, and Remote Patient Monitoring for utilization and billing guidance on virtual patient communication codes (e.g., online digital E&M, telephonic E&M, and interprofessional consultation) and remote patient monitoring codes (e.g., self-measured blood pressure and remote physiologic monitoring) billable by eligible psychiatric prescribers but which are not contained in Clinical Coverage Policy 8C.
Specific Criteria Not Covered by Medicaid – Outpatient Behavioral Health …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, Apr. 1, 2023. (Accessed Jul. 2023).
FQHCs/RHCs
Core Visit Services: Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) core service providers may deliver core services via telehealth if the service is:
- Defined as a core visit service in Section 5.3 of Clinical Coverage Policy 1D-4: Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics; and,
- Covered as a telehealth-eligible core visit service in Attachment A, Section C.1.
Non-Core Visit Services: FQHCs and RHCs may also deliver a select set of services via telehealth, virtual patient communications, and remote patient monitoring that are not defined as a core visit service in Section 5.3 of Clinical Coverage Policy 1D-4: Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics. FQHCs and RHCs would be reimbursed on a fee-for-service basis for delivering non-core visit services via telehealth, virtual patient communications, or remote patient monitoring. See Attachment A, Section C.1 of this policy for further guidance for billing virtual patient communications and remote patient monitoring codes.
In addition, FQHC and RHC core service providers may conduct telehealth visits with a supporting home visit by a delegated staff member (“hybrid model”) with new or established patients and bill using HCPCS code T1015 (or T1015-HI, T1015-SC), for a range of scenarios including (but not limited to) chronic disease management and perinatal visits.
Use modifier SC to bill non–behavioral health visits that occur after the first encounter in which the beneficiary appears with, presents with, or suffers illness or injury requiring additional diagnosis or treatment.
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. 8-9 & 19 Dec. 1, 2020. (Accessed Jul. 2023).
Office Based Opioid Treatment (OBOT)
Telehealth 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, Telehealth, Virtual Communications and Remote Patient Monitoring. If telehealth 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 telehealth visit.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1A-41, Office-Based Opioid Treatment, p. 12, Apr. 1, 2023. (Accessed Jul. 2023).
Independent Practitioners
A select set of speech and language evaluation and treatment interventions may be provided to a beneficiary using a telehealth delivery method as described in Clinical Coverage Policy 1-H. Telehealth delivery may be medically necessary when a beneficiary’s medical condition is such that exposure to others should be avoided, or if their location is remote or underserved such that access to appropriately qualified providers is limited.
To ensure a beneficiary receives high quality care aligned with best practices, the following criteria must be considered when making decisions about providing care using a telehealth delivery method:
- Unless in-person care is contraindicated or unavailable, telehealth must be used as an adjunct to in-person care and not as a replacement.
- Telehealth must be used in the best interest of the beneficiary and not as a convenience for the therapist.
- Telehealth must never be used solely to increase therapist productivity.
CPT codes that may be billed when service is furnished via telehealth are indicated in Attachment A, Section C: Codes.
See page 42 for list of eligible codes for telehealth services.
CPT codes that may be billed when service is furnished via telehealth are indicated in Attachment A, Section C: Codes.
SOURCE: NC Div. of Medical Assistance, Independent Practitioners, Clinical Coverage Policy No: 10B, Amended Apr. 1, 2023, (Accessed Jul. 2023).
Outpatient Specialized Therapies – Local Education Agencies
CPT codes that may be billed when service is furnished via telehealth are indicated in Attachment A, Section C: Codes.
A select set of psychological and counseling treatment interventions may be billed by LEAs when provided to student beneficiaries using a telehealth delivery method as
described in Clinical Coverage Policy 1-H. Telehealth delivery may be medically necessary when a student is medically homebound, experiencing an acute crisis, during an extended school closure, or if their school is remote or underserved such that access to appropriately qualified providers is limited.
Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate for virtual patient communications or remote patient monitoring.
SOURCE: NC Div. of Medical Assistance, Outpatient Specialized Therapies, Local Education Agencies, Clinical Coverage Policy, Amended Apr. 1, 2023, (Accessed Jul. 2023).
Family Planning Services
As outlined in Attachment A, select services within this clinical coverage policy may be provided via telehealth. Services delivered via telehealth must follow the requirements and guidance set forth in Clinical Coverage Policy 1-H: Telehealth, Virtual Communications, and Remote Patient Monitoring.
List of eligible telehealth service codes provided page page 23.
Family planning services must be billed with the appropriate code using the FP modifier. All providers, except ambulatory surgical centers, must append modifier FP to the procedure code for family planning services.
Six (6) inter-periodic visits are allowed per 365 calendar days. Each in-person or telehealth encounter will count as one of a beneficiary’s allotted six inter-periodic visits, per 365 days.
SOURCE: NC Div. of Medical Assistance, Family Planning Services, Clinical Coverage Policy, Amended Apr. 1, 2023, (Accessed Jul. 2023).
Home Health Services
Face to Face Encounter: The physician shall provide a written attestation statement that face-to-face contact (including the use of telehealth), was made with the beneficiary within the last 90 days in accordance with Section 6407 of the Patient Protection and Affordable Care Act.
Telehealth may be implemented in accordance with 42 CFR 440.70 and clinical coverage policy 1H, Telehealth, Virtual Patient Communications and Remote Monitoring at https://medicaid.ncdhhs.gov/.
SOURCE: NC Div. of Medical Assistance, Clinical Coverage Policies 3A Home Health Services, Amended Apr. 1, 2023, (Accessed Jul. 2023).
Dietary Evaluation and Counseling and Medical Lactation Services
Diabetes Outpatient Self-Management Education
See page 15 for eligible telehealth services.
SOURCE: NC Div. of Medical Assistance, Clinical Coverage Policies Diabetes Outpatient Self-Management Education Amended June 1, 2023, (Accessed Jul. 2023).
Independent Practitioners Respiratory Therapy Services
A select set of respiratory therapy treatment interventions may be provided to established patients using a telehealth delivery method as described in Clinical Coverage Policy 1-H. After necessary equipment and supplies have been delivered and assembled, delivery of treatment services via telehealth may be medically necessary when a beneficiary’s medical condition is such that exposure to others should be avoided, or if their location is remote or underserved such that access to appropriately qualified providers is limited.
Pregnancy Medical Home
See page 14 for list of telehealth eligible services.
TSOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1E-6, Pregnancy Management Program, Apr. 1, 2023. (Accessed Jul. 2023).
Enhanced Mental Health and Substance Abuse Services
List of telehealth eligible services provided on page 24.
As specified within this policy, components of certain service can be provided via telehealth by the physician. Due to this service containing other elements that are not permitted via telehealth, the GT modifier is not appended to the HCPCS code to indicate that a service component has been provided via telehealth.
Certain services for mobile crisis management can be provided via telehealth.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Enhanced Mental Health and Substance Abuse Services Amended Apr. 1, 2023, (Accessed Jul. 2023).
Facility-Based Crisis Service for Children and Adolescents
Under certain circumstances, a beneficiary shall be seen by the psychiatrist in-person or via telehealth within 24 hours of their admission to the Facility-Based Crisis Service.
See page 20 for list of eligible telehealth codes.
Note: As specified within this policy, components of this service may be provided via telehealth by the psychiatrist. Due to this service containing other elements that are not permitted via telehealth, the GT modifier is not appended to the HCPCS code to indicate that a service component has been provided via telehealth.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8A-2, Facility-Based Crisis Service for Children and Adolescents, amended Apr. 1, 2023. (Accessed Jul. 2023).
Diagnostic Assessment
A diagnostic assessment is a direct periodic service that can be provided in any location. This service may be provided to the beneficiary in-person or via telehealth.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8A-5, Diagnostic Assessment, Amended April 15, 2023, pg. 5, (Accessed Jul. 2023).
Children’s Developmental Service Agencies (CDSAs)
See page 21 for telehealth eligible services.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8-J, Children’s Developmental Service Agencies (CDSAs) Amended Apr.1, 2023, (Accessed Jul. 2023).
North Carolina Innovations
In addition to telehealth criteria specified in clinical coverage Policy 1-H, Telehealth, Virtual Patient Communications, and Remote Patient Monitoring, at https://medicaid.ncdhhs.gov/. The provision of NC Innovations waiver services using telehealth may only occur when it is clinically indicated for the beneficiary and the beneficiary needs only verbal cueing or prompting to complete tasks
See page 38 for list of telehealth billable services.
Note: Please refer to Clinical Coverage Policy 1-H: Telehealth, Virtual Patient Communications, and Remote Patient Monitoring for utilization and billing guidance on virtual patient communication codes (e.g., online digital E&M, telephonic E&M, and interprofessional consultation) and remote patient monitoring codes (e.g., self-measured blood pressure and remote physiologic monitoring) billable by eligible psychiatric prescribers but which are not contained in clinical coverage Policy 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers, https://medicaid.ncdhhs.gov/.
Specialized Consultation Services
Specialized Consultation Services provide expertise, training and technical assistance in a specialty area (psychology, behavior intervention, speech therapy, therapeutic recreation, augmentative communication, assistive technology equipment, occupational therapy, physical therapy, nutrition, nursing, and other licensed professionals who possess experience with individuals with Intellectual / Developmental Disabilities) to assist family members, support staff and other natural supports in assisting the beneficiary with developmental disabilities. Under this model, family members and other paid/unpaid caregivers are trained by a certified, licensed, and/or registered professional, or qualified assistive technology professional to carry out therapeutic interventions, consistent with the Individual Support Plan.
Activities covered include:
- Tele-consultation through use of two-way, real time-interactive audio and video to provide behavioral and psychological care when distance separates the care from the individual.
See manual for complete list of covered activities.
This service may be used for evaluations for adults when the State Plan limits have been exceeded.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 8-P, North Carolina Innovations Amended Apr. 1, 2023, (Accessed Jul. 2023).
Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD)
See list of telehealth billable services on page 20-21.
Note: Please refer to Clinical Coverage Policy 1-H: Telehealth, Virtual Patient Communications, and Remote Patient Monitoring for utilization and billing guidance on virtual patient communication codes (e.g., online digital E&M, telephonic E&M, and interprofessional consultation) and remote patient monitoring codes (e.g., self-measured blood pressure and remote physiologic monitoring) billable by eligible psychiatric prescribers but which are not contained in Clinical Coverage Policy 8F.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8F, Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD), Amended Apr. 1, 2023, (Accessed Jul. 2023).
Acute Inpatient Hospital Services
Refer to clinical coverage policy 1H, Telemedicine and Telepsychiatry, at https://medicaid.ncdhhs.gov/, for billing instructions and coverage criteria.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 2A-1, Acute Inpatient Hospital Services Amended Jun. 1, 2023, (Accessed Jul. 2023).
Childbirth Education
HCPCS Code S9442 is eligible for telehealth service.
Maximum beneficiaries (excluding partners) in both telehealth and non-telehealth group classes is limited to 10.
For telehealth group classes, the provider is responsible for making the beneficiary aware of the public nature of online classes.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 1M-2, Childbirth Education Amended Dec. 1, 2020, (Accessed Jul. 2023).\
Health and Behavior Intervention
CPT codes 96158 and 96159 are eligible for telehealth service.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 1M-3, Health and Behavior Intervention Amended May 15 2022, (Accessed Jul. 2023).
Obstetrical Services
Note: Prenatal and postpartum visits conducted via telehealth (interactive audio and video) shall count as a visit within a global or package service. Telephone calls or online communications do not replace a telehealth or in person visit for prenatal care and do not count towards global or package services.
Hybrid Telehealth Visit with Supporting Home Visit – Physicians, nurse practitioners, physician assistants and certified nurse midwives shall conduct antepartum or postpartum care via a telehealth visit with a supporting home visit made by an appropriately trained, delegated staff person when medically necessary. Reimbursement for this care model is open to both new and established patients. The supporting delegated staff person may perform vaccinations in the home, subject to compliance with all applicable requirements for vaccinations (it is within delegated staff person’s scope of practice to administer vaccinations) and may conduct other tests or screenings, as appropriate. Refer to Attachment B, Letter E for billing guidance.
Telehealth Claims:
Global/Package Billing- Append the GT modifier to the global or package code to indicate that one or more of the visits were conducted via telehealth under that package. This modifier is not appropriate for virtual patient communications or remote patient monitoring. Individual Visit Billing- When OB services are provided and billed per visit (refer to Section 3.2.2 for billing individual prenatal visits) append GT modifier to each visit conducted via telehealth. This modifier is not appropriate for virtual patient communications or remote patient monitoring.
See manual for list of eligible CPT codes
Billing Prenatal and Postpartum Services Via Telehealth – Eligible providers, including physicians, nurse practitioners, physician assistants, and certified nurse midwives may conduct antepartum and postpartum care visits via telehealth. These visits may not be conducted via virtual patient communication (e.g., telephone conversations). In order to promote early initiation of prenatal care, providers shall conduct the initial antepartum visit and pregnancy risk screen via telehealth or in-person in the office or clinic setting. When the initial visit is conducted via telehealth, a follow-up visit should be conducted in person within the first trimester of pregnancy.
Providers Billing Global OB or Package Codes:
- The following table of Global and Package CPT codes contains services that may be rendered via telehealth. A limited number of services may be offered via telehealth and billed for new and established patients.
- The code billed must be appended with the GT modifier to indicate that at least one visit was conducted via telehealth. This modifier is not appropriate for services performed telephonically or through patient portal. In addition, telephone calls or online communications do not replace a telehealth or in person visit for prenatal care and do not count towards global or package services.
Note: FQHCs, FQHC Look-Alikes and RHCs that bill T1015 for perinatal services may render some of these services via telehealth.
See manual for instructions on billing hybrid telehealth visit with a supporting home visit.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 1E-5, Obstetrical Services Amended Apr. 1, 2023, (Accessed Jul. 2023).
Office-Based Opioid Treatment: Use of Buprenorphine and Buprenorphine-Naloxone
Telehealth 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, Telehealth, Virtual Communications and Remote Patient Monitoring. If telehealth 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 telehealth visit.
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 1A-31, Office-Based Opioid Treatment: Use of Buprenorphine and Buprenorphine-Naloxone , Amended Apr. 1, 2023, (Accessed Jul. 2023).
ELIGIBLE PROVIDERS
The distant site is the location from which the provider furnishes 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 in Attachment A below.
A range of services may be delivered via telehealth, virtual communication, and remote patient monitoring to Medicaid 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.
Each set of eligible services has its own set of eligible provider(s) as defined in Attachment A of this policy or Refer to https://medicaid.ncdhhs.gov/ for the related coverage policies.
Up to three different consulting providers may be reimbursed for a separately identifiable telehealth service provided to a beneficiary per date of service.
To be eligible to bill for the procedure, product, or service related to this policy, the provider(s) shall:
- meet Medicaid qualifications for participation;
- have a current and signed Department of Health and Human Services (DHHS) Provider Administrative Participation Agreement; and
- bill only for procedures, products, and services that are within the scope of their clinical practice, as defined by the appropriate licensing entity.
The following HCPCS code can be billed for the Telehealth originating site facility fee by the originating site (the site at which the beneficiary is located): Q3014
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, June 1, 2023. (Accessed Jul. 2023).
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.
List of eligible Office or Other Outpatient Service and Office and Inpatient Consultation Codes and Hybrid Telehealth Visit with Supporting Home Visit Codes provided on page 12 of Attachment A of the Telehealth, Virtual Communications and Remote Patient Monitoring manual.
* Family Planning beneficiaries are not eligible for new patient visit via telehealth.
Guidance: Hybrid Telehealth with 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.
Providers shall choose the most appropriate code based on the complexity of the services provided and document accordingly. If time is used as a determining factor, providers shall choose the code that corresponds with the length of the telehealth visit provided by the eligible provider (not the duration of the home visit performed by the delegated staff person).
The delegated staff person may perform vaccinations in the home as long as they comply with applicable vaccination requirements (e.g., staff person’s scope of practice), and may conduct other tests or screenings, as appropriate.
- Any vaccinations, tests or screenings conducted in the home should be billed as if they were delivered within the office, without modifiers.
Local Health Departments may also utilize the hybrid model when the telehealth visit is rendered by an eligible provider and may bill the home visit codes listed in table C.1.
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).
Eligible providers listed on Telehealth Services code charts include:
- Physicians;
- Nurse practitioners;
- Psychiatric Nurse Practitioner
- Certified nurse midwives;
- Physician’s assistants; and
- 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, Attachment A, June 1, 2023. (Accessed Jul. 2023).
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.
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, June 1, 2023. (Accessed Jul. 2023).
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 Jul. 2023).
Independent Practitioners
Telehealth eligible services may be provided to beneficiaries by the eligible providers listed within this policy.
SOURCE: NC Div. of Medical Assistance, Independent Practitioners, Clinical Coverage Policy No: 10B, Amended Apr. 1, 2023, (Accessed Jul. 2023).
ELIGIBLE SITES
Telephonic Claims: Modifier KX must be appended to the CPT or HCPCS code to indicate that a service has been provided via telephonic, audio-only communication.
Telehealth and telephonic claims should be filed with the provider’s usual place of service code(s).
SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8F, Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD), Amended Apr. 1, 2023. (appears in multiple additional manuals), (Accessed Jul. 2023).
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.
Telehealth, virtual communication, and remote patient monitoring claims should be filed with the provider’s usual place of service code(s) and not place of service 02 (Telehealth). Exception: Hybrid telehealth with supporting home visits should be filed with Place of Service (POS) 12 (home).
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, June 1, 2023. (Accessed Jul. 2023).
Guidance: Hybrid Telehealth with Supporting Home Visit (“Hybrid Model”)
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).
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, Attachment A, June 1, 2023. (Accessed Jul. 2023).
Dietary Evaluation
Dietary evaluation and counseling is provided in hospital outpatient clinics; public agencies such as health departments, federally qualified health centers, and rural health clinics; private agencies; physician or medical diagnostic clinics; and physician offices.
SOURCE: NC Div. of Medical Assistance, Clinical Coverage Policies Dietary Evaluation and Counseling and Medical Lactation Services Amended Dec. 1, 2020, pg. 19, (Accessed Jul. 2023).
Lactation Consultation Services
Services must be provided in hospital outpatient clinics; public agencies such as health departments, federally qualified health centers, and rural health clinics; private agencies; physician or medical diagnostic clinics; and physician offices.
SOURCE: NC Div. of Medical Assistance, Clinical Coverage Policies Dietary Evaluation and Counseling and Medical Lactation Services Amended Dec. 1, 2020, pg. 19, (Accessed Jul. 2023).
FQHCs/RHCs
Core Services
Core visit services delivered via telehealth are billed under the FQHC and RHC provider number using the HCPCS code T1015 (clinic visit/encounter, all-inclusive), T1015-HI (for behavioral health services), or T1015-SC (subsequent sick visit) and appended with the GT modifier. Eligible providers include all core service providers as defined in Section 3.2.1 of this 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.
Hybrid Telehealth with Supporting Home Visit
In addition, FQHC and RHC core service providers may conduct telehealth visits with a supporting home visit by a delegated staff member (“hybrid model”) with new or established patients and bill using HCPCS code T1015 (or T1015-HI, T1015-SC), for a range of scenarios including (but not limited to) chronic disease management and perinatal visits.
See manual for additional guidance.
Telehealth claims, except for hybrid telehealth with supporting home visits, should be filed with the provider’s usual place of service code(s).
Hybrid telehealth with supporting home visits should be filed with Place of Service (POS) 12 (home).
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, pgs 19 & 20, Dec. 1, 2020. (Accessed Jul. 2023).
Respiratory Therapy Services
Respiratory Therapy treatment visits by the IPP must occur in the beneficiary’s primary private residence or via telehealth in accordance with Subsection 3.2.1 c., and focus on legal parent(s), legal guardian(s) or foster care provider(s) education. The IPP may provide two (2) respiratory therapy treatment visits of the allowed 15 treatment visits in either the school or other location (day care) during a six (6) consecutive month time frame to provide staff training.
SOURCE: NC Div. of Medical Assistance, Clinical Coverage Policies Independent Practitioners Respiratory Therapy Services Amended Jan. 1, 2023, (Accessed Jul. 2023).
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, June 1, 2023. (Accessed Jul. 2023).
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.
The following HCPCS code can be billed for the Telehealth originating site facility fee by the originating site (the site at which the beneficiary is located): Q3014.
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, June 1, 2023. (Accessed Jul. 2023).
Guidance: Hybrid Telehealth with Supporting Home Visit (“Hybrid Model”)
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, Attachment A, June 1, 2023. (Accessed Jul. 2023).
