Last updated 01/25/2023
Definitions
Telemedicine is the use of interactive audio-video equipment to link practitioners and patients at different sites. Telemedicine involves two collaborating provider sites: an “originating site” and a “distant site”. The client/patient is located at the originating site and the practitioner is located at the distant site and provides those professional services allowed/reimbursed by ND Medicaid.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 157, (Oct. 2022), (Accessed Jan. 2023).
Synchronous teledentistry (D9995) is delivery of patient care and education where there is live, two-way interaction between the patient and at least one dental, medical or health caregiver at one physical location, and an overseeing supervising or consulting dentist or dental provider at another location. The communication is real-time and continuous between all participants who are working together as a group. Use of audiovisual telecommunications technology means that all involved persons can see what is happening and talk about in a natural manner.
SOURCE: North Dakota Human Services Teledentistry Policy (July 2019), (Accessed Jan. 2023)
Last updated 01/25/2023
Live Video
POLICY
The totality of the communication of the information exchanged between the physician or other qualified healthcare professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 157, (Oct. 2022), (Accessed Jan. 2023).
Teledentistry
Synchronous teledentistry is reimbursable and reported in addition to other ND Medicaid-covered procedures provided to the patient, when applicable. Dentists and dental offices must report the appropriate CDT Code for these procedures.
The patient record must include the CDT codes that reflect the teledentistry encounter. ND Medicaid reimburses for CDT code D9995 once per date of service. Submissions must be billed using place of service code 02. Service authorization is not required for CDT code D9995.
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2019). (Accessed Jan. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Qualified services for telemedicine must:
- Maintain actual visual contact (face-to-face) between the practitioner and patient.
- Be medically appropriate and necessary with supporting documentation included in the patient’s clinical medical record.
- Be provided via secure and appropriate equipment to ensure confidentiality and quality in the delivery of the service.
- The service must be provided using a HIPAA compliant platform.
- Use appropriate coding. See manual for appropriate coding.
All service limits set by ND Medicaid apply to telemedicine services.
Except for non-covered services noted below, telemedicine can be used for services covered by Medicaid, and otherwise allowed, per CPT, to be rendered via telemedicine.
Noncovered Services:
- Therapies provided in a group setting
- Store and Forward
- Targeted Case Management for High Risk Pregnant Women and Infants
- Targeted Case Management for Individuals in need of Long-Term Care Services
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 157-158, (Oct. 2022), (Accessed Jan. 2023).
Indian Health Services and Tribally Operated 638 Facilities
Coverage and payment of services provided through telemedicine is on the same basis as those provided through face-to-face contact.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, IHS, p. 78, (Oct. 2022), (Accessed Jan. 2023).
Medicaid Services Rendered in Schools
Services rendered in schools may be delivered via telemedicine. See the Telemedicine chapter for additional information on services rendered via telemedicine.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Schools, p. 91, (Oct. 2022), (Accessed Jan. 2023).
Home Health Services
Telemonitoring is a covered service. See remote patient monitoring section.
Dentistry
See manual for service codes that can be delivered utilizing synchronous real-time teledentistry.
SOURCE: ND Div. of Medical Assistance, Dental Services Provider Manual, p. 38, (Jul. 2022), (Accessed Jan. 2023).
Medication Assisted Treatment
The member must require at least one face to face or by telemedicine check‐in per month for prescribing or dispensing of OBOT/OTP medication.
Telemedicine must be provided in accordance with applicable federal and state laws and policies and follow the Controlled Substances Act (CSA)(28 USC 802) for prescribing and administration of controlled substances.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, MAT, p. 95 & 97, (Oct. 2022), (Accessed Jan. 2023).
ELIGIBLE PROVIDERS
Payment will be made only to the distant practitioner during the telemedicine session. No payment is allowed to a practitioner at the originating site if his/her sole purpose is the presentation of the patient to the practitioner at the distant site.
Payment is made for services provided by licensed professionals enrolled with ND Medicaid and within the scope of practice per their licensure only.
Telemedicine services provided by an Indian Health Service (IHS) facility or a Tribal 638 Clinic functioning as the distant site, are reimbursed at the All-Inclusive Rate (AIR), regardless whether the originating site is outside the “four walls” of the facility or clinic.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Oct. 2022), (Accessed Jan. 2023).
Rural Health Clinics
Coverage and payment of services provided through telemedicine is on the same basis as those provided through face-to-face contact. See Telemedicine chapter for additional information on services rendered via telemedicine.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, RHCs, p.78, (Oct. 2022), (Accessed Jan. 2023).
ELIGIBLE SITES
Payment will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Oct. 2022), (Accessed Jan. 2023).
Health Services billed by schools can be delivered via telemedicine; however, no originating site fee is allowed. See Services Rendered via Telemedicine chapter for additional information.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 81, (Oct. 2022), (Accessed Jan. 2023).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Payment will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service.
Payment will be made only to the distant practitioner during the telemedicine session. No payment is allowed to a practitioner at the originating site if his/her sole purpose is the presentation of the patient to the practitioner at the distant site.
Health Services billed by schools can be delivered via telemedicine; however, no originating site fee is allowed.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 81 & 158, (Oct. 2022), (Accessed Jan. 2023).
Last updated 01/25/2023
Remote Patient Monitoring
POLICY
Home Health Services
Telemonitoring is a covered service. Medical necessity for the home health services must be supported in the medical record. The visit may be performed via telehealth or in person; telephone encounter is not sufficient.
Home Health Telemonitoring will be covered within the same limits noted above. Home Telemonitoring is not allowed for the initial Home Health evaluation visit or for the discharge visit. In addition, Home Health Telemonitoring is limited to no more than forty percent (40%) of the total visits during each certification period.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 65 (Oct. 2022), (Accessed Jan. 2023).
CONDITIONS
No Reference Found
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
No Reference Found