North Dakota

Disclaimer

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

At A Glance
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MEDICAID REIMBURSEMENT

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

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: CC, APRN, EMS, IMLC, NLC, PSY, PTC
  • Consent Requirements: Yes

FQHCs

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

STATE RESOURCES

  1. Medicaid Program: North Dakota Medicaid
  2. Administrator: North Dakota Dept. of Human Services
  3. Regional Telehealth Resource Center: Great Plains Telehealth Resource and Assistance Center
Disclaimer

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

COVID-19

Last updated 06/13/2023

Audio-Only Delivery

Human Services: Covid-19 Temporary Telehealth Policy for Right Track

STATUS: Expired. Was active until the end of the National PHE which ended May 11, 2023.

Medicaid: COVID-19 Temporary Telehealth Policy

STATUS: Expired. Was active until the end of the National PHE which ended May 11, 2023.

Medicaid 1915(c) Waiver: Appendix K – Developmental Disabilities Traditional IID/DD HCBS Waiver

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Medicaid Waiver for Home and Community Based Services

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Children’s Hospice

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Autism Spectrum Disorder (ASD) birth through thirteen

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Traditional IID/DD HCBS Waiver; Children’s Hospice; Medicaid Waiver for Home and Community Based Services; Autism Spectrum Disorder (ASD) birth through thirteen; Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE.

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Last updated 06/13/2023

Cross-State Licensing

Previous COVID-19 waivers expired.

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Last updated 06/13/2023

Easing Consent Requirements

Medicaid 1915(c) Waiver: Appendix K – Children’s Hospice

STATUS: Active, until 6 Months after the end of the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Traditional IID/DD HCBS Waiver; Children’s Hospice; Medicaid Waiver for Home and Community Based Services; Autism Spectrum Disorder (ASD) birth through thirteen; Medically Fragile Children

STATUS: Active, until 6 Months after the end of the Federal PHE

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Last updated 06/13/2023

Easing Prescribing Requirements

No Reference Found

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Last updated 06/13/2023

Miscellaneous

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Traditional IID/DD HCBS Waiver; Children’s Hospice; Medicaid Waiver for Home and Community Based Services; Autism Spectrum Disorder (ASD) birth through thirteen; Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Last updated 06/13/2023

Originating Site

Medicaid 1915(c) Waiver: Appendix K – Developmental Disabilities Traditional IID/DD HCBS Waiver

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Medicaid Waiver for Home and Community Based Services

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Children’s Hospice

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K – Autism Spectrum Disorder (ASD) birth through thirteen

STATUS: Active, until 6 Months after the Federal PHE. See extension below.

Medicaid 1915(c) Waiver: Appendix K Addendum – Developmental Disabilities Traditional IID/DD HCBS Waiver; Children’s Hospice; Medicaid Waiver for Home and Community Based Services; Autism Spectrum Disorder (ASD) birth through thirteen; Medically Fragile Children

STATUS: Active, until 6 Months after the Federal PHE

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Last updated 06/13/2023

Private Payer

Previous COVID-19 waivers expired.

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Last updated 06/13/2023

Provider Type

Medicaid: COVID-19 Temporary Telehealth Policy

STATUS: Expired. Was active until the end of the National PHE which ended May 11, 2023.

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Last updated 06/13/2023

Service Expansion

Medicaid: Teledentistry – COVID-19 Temporary Policy

STATUS: Expired. Was active until the end of the National PHE which ended May 11, 2023.

Medicaid: COVID-19 Temporary Telehealth Policy

STATUS: Expired. Was active until the end of the National PHE which ended May 11, 2023.

* This page was last updated in June 2023. Updates will no longer be made and this page will be removed from the Policy Finder at the end of the year.

Private Payer

Last updated 11/15/2023

Definitions

Telehealth:

  • Means the use of interactive audio, video or other telecommunications technology that is used by a health care provider or health care facility at a distant site to deliver health services at an originating site and that is delivered over a secure connection that complies with the requirements of state and federal laws.
  • Includes the use of electronic media for consultation relating to the health care diagnosis or treatment of a patient in real-time or through the use of store-and-forward technology.
  • Does not include the electronic mail, facsimile transmissions, or audio-only unless for the purpose of e-visits or a virtual check-in.

SOURCE: ND Century Code Sec. 26.1-36-09.15(1)(g). p. 20 (Accessed Nov. 2023).

Last updated 11/15/2023

Parity

SERVICE PARITY

An insurer may not deliver, issue, execute, or renew a policy that provides health benefits coverage unless that policy provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means.

Payment or reimbursement of expenses for covered health services delivered by means of telehealth under this section may be established through negotiations conducted by the insurer with the health services providers in the same manner as the insurer establishes payment or reimbursement of expenses for covered health services that are delivered by in-person means.

This section does not require:

    1. A policy to provide coverage for health services that are not medically necessary, subject to the terms and conditions of the policy;
    2. A policy to provide coverage for health services delivered by means of telehealth if the policy would not provide coverage for the health services if delivered by in-person means;
    3. A policy to reimburse a health care provider or health care facility for expenses for health services delivered by means of telehealth if the policy would not reimburse that health care provider or health care facility if the health services had been delivered by in-person means; or
    4. A health care provider to be physically present with a patient at the originating site unless the health care provider who is delivering health services by means of telehealth determines the presence of a health care provider is necessary.

SOURCE: ND Century Code Sec. 26.1-36-09.15(2)(3) & (5). p. 21 (Accessed Nov. 2023).

Insurance carriers must start or continue to provide covered services via telehealth visits. These services include, but are not limited to the following:

  • Office visits for patients
  • Physical therapy plan evaluation
  • Occupational therapy plan evaluation
  • Speech therapy plane valuation
  • Behavioral health and substance use disorder treatment
  • Diabetes Education
  • Nutrition Counseling.

In addition to traditional telehealth services carriers must expand telehealth under the CMS guidance and now offer coverage for e-visits and virtual check-ins. Insurance carriers shall establish reasonable requirements for the coverage of these virtual check-ins and e-visits in accordance with the guidance issued by CMS on March 17, 2020.  See bulletin for required codes.

SOURCE: ND Insurance Department. Bulletin 2021-1.  June 2, 2021, Expansion of Telehealth Services, (Accessed Nov. 2023).

PAYMENT PARITY

No explicit payment parity.  See above ‘coverage parity’ section for text regarding payment or reimbursement of expenses being negotiated by the insurer.

Last updated 11/15/2023

Requirements

An insurer may not deliver, issue, execute, or renew a policy that provides health benefits coverage unless that policy provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means.

A policy is not required to provide coverage for health services that are not medically necessary, subject to the terms and conditions of the policy.

SOURCE: ND Century Code Sec. 26.1-36-09.15. p. 21 (Accessed Nov. 2023).

Telehealth. The organization may pay for audio and video telecommunications instead of a face-to-face “hands on” appointment for CPT codes designated by the American medical association as telehealth codes. As a condition of payment, the patient must be present and participating in the telemedicine appointment. The professional fee payable is equal to the fee schedule amount for the service provided. The organization may pay the originating site a facility fee at the scheduled amount.

SOURCE: ND Admin. Code 92-01-02-34 (3d) p. 34 (Accessed Nov. 2023).

Insurance carriers must start or continue to provide covered services via telehealth visits. These services include, but are not limited to the following:

  • Office visits for patients
  • Physical therapy plan evaluation
  • Occupational therapy plan evaluation
  • Speech therapy plane valuation
  • Behavioral health and substance use disorder treatment
  • Diabetes Education
  • Nutrition Counseling.

In addition to traditional telehealth services carriers must expand telehealth under the CMS guidance and now offer coverage for e-visits and virtual check-ins. Insurance carriers shall establish reasonable requirements for the coverage of these virtual check-ins and e-visits in accordance with the guidance issued by CMS on March 17, 2020.  See bulletin for required codes.

SOURCE: ND Insurance Department. Bulletin 2021-1.  June 2, 2021, Expansion of Telehealth Services, (Accessed Nov. 2023).

Comprehensive medication management services may be provided via telehealth as defined in section 26.1 – 36 – 09.15 and may be delivered into an enrollee’s residence.

SOURCE: ND Statute Sec. 26.1.11-02 (Accessed Nov. 2023).

Medicaid

Last updated 11/15/2023

Consent Requirements

No Reference Found

Last updated 11/15/2023

Definitions

Telehealth is the use of telecommunications and information technology to provide access to physical, mental, and behavioral health care across distance.

Digital Health consists of online digital evaluation and management (E/M) services which are patient-initiated services with health care professionals. These are not real-time services. Patients initiate services through HIPAA-compliant secure platforms which allow digital communication with the health care professional. Online digital evaluation and management services are for established patients only. These services do not include nonevaluative electronic communications of test results, scheduling of appointments, or other communication that does not include evaluation and management.

Synchronous Telehealth is two-way, real-time interactive communication between a patient and their health care provider using technology such as interactive video/television, audio/visual secure online digital portals, and videoconferencing. Synchronous telehealth involves two collaborating sites: an “originating site” and a “distant site.” The patient is located at the originating site and the health care professional is located at the distant site.

Telehealth is an umbrella term which includes digital health and synchronous two-way real-time interactive audio/visual services. It does not include store and forward services.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 170, (Oct 2023), (Accessed Nov. 2023).

Synchronous teledentistry (D9995) is delivery of patient care and education where there is live, twoway 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. Synchronous teledentistry must use both audio and visual means. The totality of the communication of the information exchanged between the providers or others and the member during the synchronous teledentistry 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 an in-person interaction.

SOURCE: North Dakota Human Services Teledentistry Policy (July 2023), (Accessed Nov. 2023)

Last updated 11/15/2023

Email, Phone & Fax

Audio-Only Telephone Services can be delivered by using older-style “flip” phones or a traditional “land-line” phones that only support audio-based communication. Only certain services are covered using audio-only telephone services (see linked list of covered services below).

Audio Only Telephone E/M Services

Services must be initiated by an established patient or guardian of the established patient.

Do not report this service if:

  • It is decided that the patient will be seen within 24 hours or at the next available urgent visit appointment,
  • There is an E/M service for the same or a similar problem within the previous seven days
  • The patient is within a postoperative period and related to the surgical procedure.

Audio-only telephone services (CPT™ 99441-99443) are only available through December 31, 2024.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 171-172, (Oct. 2023), (Accessed Nov. 2023).

Home Health and Private Duty Nursing

Telephonic encounters are not covered by ND Medicaid.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 66, (Oct. 2023), (Accessed Nov. 2023).

Targeted Case Management

Telephone calls, in person and email contacts are allowable costs under transitional care management (TCM) for making collateral contacts.

SOURCE: North Dakota Department of Human Services: Targeted Case Management – Individuals with a serious mental illness or serious emotional disturbance. (Oct. 2023) P. 8, & Targeted Case Management Child Welfare, (Oct. 2023) p. 6 (Accessed Nov. 2023).

Teledentistry

Noncovered Services:

  • Examinations via online/email/electronic communication
  • Patient contact with dentist who provides the consultation using audio means only (no visual component)
  • Virtual check-in

SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023), & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 13 (Accessed Nov. 2023).

Pharmacy Manual

Medication Therapy Management (MTM) services are allowable with audio-only telephone.  See manual for codes.

SOURCE: ND Medicaid Pharmacy Medical Billing Manual, Jul. 2023, (Accessed Nov. 2023).

Last updated 11/15/2023

Live Video

POLICY

All qualified telehealth services must:

  • Meet the same standard of care as in-person care.
  • 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 as noted in the following tables. Health care professionals must follow CPT®/HCPCS coding guidelines.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 171, (Oct. 2023), (Accessed Nov. 2023).

ELIGIBLE SERVICES/SPECIALTIES

All qualified telehealth services must:

  • Meet the same standard of care as in-person care.
  • 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 as noted in the following tables. Health care professionals must follow CPT®/HCPCS coding guidelines.

Digital Health Evaluation and Management Services

Cumulative online digital evaluation and management (E/M) services occurring within a seven-day period beginning with the health care professional’s review of the patient-generated inquiry. Included services not separately billable:

  • For the same or a related problem within seven days of a previous E/M service,
  • Related to a surgical procedure occurring within the postoperative period of a previously completed procedure,
  • Any subsequent online communication that does not include a separately reported E/M service.
  • E/M services related to the patient’s inquiry provided by qualified health care professionals in the same group practice.

Separate reimbursement may be allowed for:

  • Online digital inquiries initiated for a new problem within seven days of a previous online digital E/M service.

Permanent documentation storage (electronic or hard copy) of the encounter is required.

See manual for coding instructions.

Noncovered Services:

  • Store and forward
  • Virtual check-in
  • Interprofessional Services
  • Digital Assessment and Management Services

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 171-173, (Oct. 2023), (Accessed Nov. 2023).

See excel document of Telehealth Covered Services in Telehealth Policies section on Manuals Webpage.

Indian Health Services

Coverage and payment of services provided through telehealth is on the same basis as those provided through face-to-face contact.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, p. 80, (Oct. 2023), (Accessed Nov. 2023).

Medicaid Services Rendered in Schools

Services rendered in schools may be delivered via telehealth. See the Telehealth chapter for additional information on services rendered via telehealth.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Schools, p. 107, (Oct. 2023), (Accessed Nov. 2023).

Home Health Services

Telemonitoring is a covered service. See remote patient monitoring section.

Teledentistry

Patient records must include the CDT© Code(s) that reflect the teledentistry encounter. The claim submission must include all applicable CDT© codes. ND Medicaid will reimburse CDT© code D9995 or D9996 once per date of service.

See Teledentistry policy for covered services and non-covered services.

SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023), & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 12 (Accessed Nov. 2023).

Medication Assisted Treatment

The member must require at least one face-to-face or telehealth check‐in per month for prescribing or dispensing OBOT/OTP medication.

Telehealth must be provided in accordance with applicable federal and state laws and policies and follow the Controlled Substances Act (CSA) (28 USC Part 802) for prescribing and administration of controlled substances.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, MAT, p. 94-95, (Oct. 2023), (Accessed Nov. 2023).

Behavioral Health

Remote service delivery is allowable as specified within each service. Remote support/telehealth limits, codes, and modifiers are available at https://www.hhs.nd.gov/sites/www/files/documents/1915i/1915i%20Codes.Rates_.Limits.pdf

SOURCE: ND Div. of Medical Assistance, Behavioral Health Provider Manual, p. 23, (Oct 2023), (Accessed Nov. 2023).

Pharmacy Manual

Medication Therapy Management (MTM) services are allowable with synchronous telehealth visits.  See manual for codes

SOURCE: ND Medicaid Pharmacy Medical Billing Manual, July 2023, (Accessed Jun. 2023).

ELIGIBLE PROVIDERS

Payment will be made only to the distant health care professional during the telehealth session. No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site.

Payment is made for services provided by licensed professionals enrolled with ND Medicaid within their licensed scope of practice only. All service limits set by ND Medicaid apply to telehealth services.

Telehealth 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 of whether the originating site is outside the “four walls” of the facility or clinic

Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing telehealth services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue codes listed in the FQHC and RHC portions of this manual along with the CPT® or HCPCS code for the service rendered appended with modifier GT or 95.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 172-173, (Oct. 2023), (Accessed Nov. 2023).

Indian Health Services

Coverage and payment of services provided through telehealth is on the same basis as those provided through face-to-face contact.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, p. 80, (Oct. 2023), (Accessed Nov. 2023).

ELIGIBLE SITES

POS 10 is allowed, which indicates telehealth provided in patient’s home.

No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site.

Payment will be made to the originating site as a facility fee only in the following places 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 telehealth service.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 172-173, (Oct. 2023), (Accessed Nov. 2023).

Health Services billed by schools can be delivered via telehealth; however, no originating site fee is allowed. See Telehealth chapter for additional information.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 83, (Oct. 2023), (Accessed Nov. 2023).

Teledentistry

Claim submissions must be billed using place of service (POS)/place of treatment codes:

  • 02 Teledentistry provided in a location other than the patient’s home.
  • 10 Telehealth provided in patient’s home.

Claims with any other place of service will be denied.

Place of Service code 02 or 10 is recorded in Box # 38 on the claim form or electronic equivalent.

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) – Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site.  When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.

Revenue Code 521: Clinic visit by member to RHC/FQHC.

One dental encounter is allowed per day. The encounter must be a face to face encounter to qualify for payment. Asynchronous teledentistry performed as a stand-alone service does not qualify for an encounter payment. At least one covered service must be performed as a face to face service to qualify for the dental encounter payment.

SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023) & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 12 (Accessed Nov. 2023).

Pharmacy Manual 

The business where services are provided (site of service) must:

  • Be located within the state of ND or the local trade area within 50 miles of the ND border (General Information for Providers outlines the requirements for out-of-state services)
  • Have appropriate size and accommodations for services provided
  • Be enclosed sufficiently to prevent:
    • Encounter from being heard and/or seen by others
    • Interference by distracting noise from other areas of the business

For services delivered via synchronous telehealth:

  • Both the origination site (where the member is located) and the distant site (where the provider is located) must meet the geographic location, privacy, and space requirements outlined above
  • Provider is responsible for supplying audio and video equipment permitting two-way, real-time interactive communication between the origination and distant sites.

SOURCE: ND Medicaid Pharmacy Medical Billing Manual, July 2023, p. 4, (Accessed Nov. 2023).

GEOGRAPHIC LIMITS

No Reference Found

FACILITY/TRANSMISSION FEE

Payment will be made to the originating site as a facility fee only in the following places 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 telehealth service.

Payment will be made only to the distant health care professional during the telehealth session. No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site.

Health Services billed by schools can be delivered via telehealth; however, no originating site fee is allowed.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 83 & 172, (Oct. 2023), (Accessed Nov. 2023).

Teledentistry

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) – Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site.  When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.

SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023) & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 13 (Accessed Nov. 2023).

Last updated 11/15/2023

Miscellaneous

Telepharmacy

For services delivered via telehealth:

  • Both the origination site (where the member is located) and the distant site (where the provider is located) must meet the geographic location, privacy, and space requirements outlined above
  • Provider is responsible for supplying audio and video equipment permitting two-way, real-time interactive communication between the origination and distant sites

SOURCE: ND Human Services, Provider Manual for Pharmacy Medical Billing, July 2023, pg. 4, (Accessed Nov. 2023).

Last updated 11/15/2023

Out of State Providers

No Reference Found

Last updated 11/15/2023

Overview

North Dakota reimburses for live video telemedicine for most services, with a few exceptions.

They provide reimbursement for store-and-forward through online digital evaluation and management services in specific circumstances.  Asynchronous teledentistry is required to be covered by a recently passed legislation, and recently incorporated into the dental provider manual.

Home health telemonitoring is covered though not much detail is provided.

Audio-only is allowed for established patients through Dec. 31, 2024.

Last updated 11/15/2023

Remote Patient Monitoring

POLICY

Home Health Services

All services are provided based on a licensed physician’s orders and a written plan of care. Other services include home health aide services, physical therapy, occupational therapy, speech pathology, audiology services, medical supplies, equipment, and appliances suitable for use in the home and telemonitoring.

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. 62 & 66, (Oct 2023), (Accessed Nov. 2023).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

No Reference Found

Last updated 11/15/2023

Store and Forward

POLICY

Digital Health consists of online digital evaluation and management (E/M) services which are patient-initiated services with health care professionals. These are not real-time services. Patients initiate services through HIPAA-compliant secure platforms which allow digital communication with the health care professional. Online digital evaluation and management services are for established patients only. These services do not include nonevaluative electronic communications of test results, scheduling of appointments, or other communication that does not include evaluation and management.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 170, (Oct. 2023), (Accessed Nov. 2023).

Noncovered Services:

  • Store and forward
  • Virtual check-in
  • Interprofessional Services
  • Digital Assessment and Management Services

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 173, (Oct. 2023), (Accessed Nov. 2023).

Teledentistry

Allowed Code:  D9996 – teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review.  Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.

Asynchronous (store-and-forward) teledentistry (D9996) is the transmission of recorded health information (i.e., radiographs, photographs, digital impressions) through a HIPAA-compliant electronic communications system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.

Noncovered Services:

  • Examinations via online/email/electronic communication
  • Patient contact with dentist who provides the consultation using audio means only (no visual component)
  • Virtual check-in

SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023) & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 13 (Accessed Nov. 2023).

Medical assistance coverage must include payment for the following services: …

  • Asynchronous teledentistry to reduce barriers to dental care through outreach programs and to integrate oral health into general health care settings to identify and refer treatment needs.

SOURCE: ND Statute Sec. 50-24.1-45 (Accessed Nov. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Digital Health Evaluation and Management Services

Cumulative online digital evaluation and management (E/M) services occurring within a seven-day period beginning with the health care professional’s review of the patient-generated inquiry. Included services not separately billable:

  • For the same or a related problem within seven days of a previous E/M service,
  • Related to a surgical procedure occurring within the postoperative period of a previously completed procedure,
  • Any subsequent online communication that does not include a separately reported E/M service.
  • E/M services related to the patient’s inquiry provided by qualified health care professionals in the same group practice.

Separate reimbursement may be allowed for:

  • Online digital inquiries initiated for a new problem within seven days of a previous online digital E/M service.

Permanent documentation storage (electronic or hard copy) of the encounter is required.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 171, (Oct. 2023), (Accessed Nov. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 11/17/2023

Consent Requirements

Physical Therapy:

“Consultation by telehealth” means that a physical therapist renders professional or expert opinion or advice to another physical therapist or professional health care provider via electronic communications or computer technology from a distant location. The patient’s written or verbal consent will be obtained and documented prior to such consultation. All records used or resulting from a consultation by means of telehealth are part of a patient’s record and are subject to applicable confidentiality requirements.

SOURCE: ND Admin. Code 61.5-01-02-01(3). (Accessed Nov. 2023).

Last updated 11/17/2023

Cross State Licensing

Medical Nutrition Therapy and Nutrition Care Services

An individual providing services regulated by this chapter via telehealth shall comply with, and is subject to, all licensing and disciplinary provisions of this chapter.

SOURCE: ND Century Code Ch. 43-44-19 p. 11 (Accessed Nov. 2023).

Last updated 11/17/2023

Definitions

“Telemedicine” means the practice of medicine using electronic communication, information technologies, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider. The term includes direct interactive patient encounters as well as asynchronous store-and-forward technologies and remote monitoring.

SOURCE: ND Admin Code Sec. 50-2-15-01 (Accessed Nov. 2023).

Stroke system of care task force

Telemedicine services means the use of interactive audio, video, and other electronic media used for the purpose of diagnosis, consultation, or treatment of acute stroke.  The stroke system of care task force shall recommend eligible essential health care services for acute stroke care provided through telemedicine services.

SOURCE: ND Century Code Sec. 23-43-05. (Accessed Nov. 2023).

North Dakota uses federal definitions for “internet” and “practice of telemedicine” set in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008.

SOURCE: ND Century Code Sec. 19-02.1-15.1(1)(d). (Accessed Nov. 2023).

The term ‘practice of telemedicine’ means, for purposes of this title, the practice of medicine in accordance with applicable Federal and State laws by a practitioner (other than a pharmacist) who is at a location remote from the patient and is communicating with the patient, or health care professional who is treating the patient, using a telecommunications system referred to in section 1834(m) of the Social Security Act.  See statute for additional requirements.

SOURCE: Ryan Haight Online Pharmacy Consumer Protection Act of 2008 [Pub. L. 110-425; 21 U.S.C. 802-803]. (Accessed Nov. 2023).

Physical Therapy:

“Telehealth” is the use of electronic communications to provide and deliver health-related information and health care services, including physical therapy-related information and services, over any distance. Telehealth encompasses health care and health promotion activities, including education, advice, reminders, interventions, and the monitoring of interventions.

SOURCE: ND Admin. Code 61.5-01-02-01. (Accessed Nov. 2023).

Chiropractic Examiners

“Telehealth” means the use of electronic communications to provide and deliver chiropractic related information and chiropractic services, including chiropractic-related information and services, over any distance. Telehealth encompasses chiropractic care and chiropractic promotion activities, including education, advice, reminders, interventions, and the monitoring of interventions.

SOURCE: ND Century Code 43-06-01, (Accessed Nov. 2023).

Physicians

“Telemedicine” means the practice of medicine using electronic communication, information technologies, or other means between a licensee in one location and a patient in another location, with or without an intervening health care provider. “Telemedicine” includes direct interactive patient encounters, asynchronous store-and-forward technologies, and remote monitoring.

SOURCE: ND Century Code 43-17-01, (Accessed Nov. 2023).

Medical Nutrition Therapy and Nutrition Care Services

“Telehealth” means the use of electronic information and telecommunications technologies to provide services under this chapter to support clinical health care, patient and professional health-related education, public health, and health administration between a licensee in one location and an individual in another location.

SOURCE: ND Century Code Ch. 43-44-01 (Accessed Nov. 2023).

Last updated 11/17/2023

Licensure Compacts

Member of the Physical Therapy Compact.

SOURCE:  PT Compact. Compact Map.  (Accessed Nov. 2023).

Member of the Nurses Licensure Compact.

SOURCE:  Current NLC States & Status.  Nurse Licensure Compact.  (Accessed Nov. 2023).

Member of the Interstate Medical Licensure Compact.

SOURCE: The IMLC. Interstate Medical Licensure Compact. (Accessed Nov. 2023).

Member of Emergency Medical Services Compact.

SOURCE: Interstate Commission for EMS Personnel Services, EMS Compact Member States, (Accessed Nov. 2023).

Member of Advanced Practice Registered Nurse (APRN) Compact

SOURCE: NCSBN, APRN Compact, (Accessed Nov. 2023).

Member of Counseling Compact

SOURCE: Counseling Compact, Compact Map, (Accessed Nov. 2023).

Member of Psychology Interjurisdictional Compact

SOURCE: PSYPACT, Compact Map, (Accessed Nov. 2023).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 11/17/2023

Miscellaneous

Under the Worker’s Compensation Act, the originating sites may receive a facility fee at the scheduled amount.

SOURCE: ND Admin. Code 92-01-02-34 (3d). p. 34 (Accessed Nov. 2023).

Dentistry

Each patient shall have access to health provider information as it pertains to their treating doctor or potential doctors. Any entity utilizing telehealth shall provide upon request of a patient the name of the dentist, telephone number, practice address, and state license number of any dentist who was involved with the provision of services to a patient before or during the rendering of dental services.

SORUCE: ND Admin. Code 20-02-01-9, (Accessed Nov. 2023).

Last updated 11/17/2023

Online Prescribing

“In-person medical evaluation” means a medical evaluation that is conducted with the patient in the physical presence of the practitioner, without regard to whether portions of the evaluation are conducted by other practitioners, and must include one of the following actions: … The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telemedicine.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a practitioner who has conducted an in-person medical evaluation of the patient.

SOURCE: ND Century Code Sec. 19-02.1-15.1.(c) & (f) (Accessed Nov. 2023).

A licensee practicing telemedicine shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient. A licensee practicing telemedicine shall verify the identity of the patient seeking care and shall disclose, and ensure the patient has the ability to verify, the identity and licensure status of any licensee providing medical services to the patient.

Before initially diagnosing or treating a patient for a specific illness or condition, an examination or evaluation must be performed. An examination or evaluation may be performed entirely through telemedicine, if the examination or evaluation is equivalent to an in-person examination.

  • An examination utilizing secure videoconferencing or store-and-forward technology for appropriate diagnostic testing and use of peripherals that would be deemed necessary in a like in-person examination or evaluation meets this standard, as does an examination conducted with an appropriately licensed intervening health care provider, practicing within the scope of the provider’s profession, providing necessary physical findings to the licensee. An examination or evaluation consisting only of a static online questionnaire or an audio conversation does not meet the standard of care.
  • Once a licensee conducts an acceptable examination or evaluation, whether in-person or by telemedicine, and establishes a patient-licensee relationship, subsequent followup care may be provided as deemed appropriate by the licensee, or by a provider designated by the licensee to act temporarily in the licensee’s absence. In certain types of telemedicine utilizing asynchronous store-and-forward technology or electronic monitoring, such as teleradiology or intensive care unit monitoring, it is not medically necessary for an independent examination of the patient to be performed.
A licensee practicing telemedicine is subject to all North Dakota laws governing the adequacy of medical records and the provision of medical records to the patient and other medical providers treating the patient.
A licensee must have the ability to make appropriate referrals of patients not amenable to diagnosis or complete treatment through a telemedicine encounter, including a patient in need of emergent care or complementary in-person care.

SOURCE: ND Century Code Sec. 43-17-44, (Accessed Nov. 2023).

A controlled substance that is a prescription drug may not be delivered, distributed, or dispensed by means of the internet without a valid prescription, but nothing in this subsection may be construed to imply that one in-person medical evaluation by itself demonstrates that a prescription has been validly issued for a legitimate medical purpose within the usual course of professional practice.

This section applies to the delivery, distribution, and dispensing of a controlled substance by means of the internet from a location whether within or outside this state to a person or an address in this state.

Nothing in this section applies to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the practice of telemedicine in accordance with applicable federal and state laws.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a:

  • Practitioner who has conducted at least one in-person medical evaluation of the patient; or
  • Covering practitioner.
“Covering practitioner” means, with respect to a patient, a practitioner who conducts a medical evaluation, other than an in-person medical evaluation, at the request of a practitioner who:
  • Has conducted at least one in-person medical evaluation of the patient or an evaluation of the patient through the practice of telemedicine, within the previous twenty-four months; and
  • Is temporarily unavailable to conduct the evaluation of the patient.

SOURCE: North Dakota Century Code, Sec. 19-03.1-22.4, (Accessed Nov. 2023).

A licensee who has performed a telemedicine examination or evaluation meeting the requirements of this chapter may prescribe medications according to the licensee’s professional discretion and judgment. Opioids may only be prescribed through telemedicine if done so as a federal food and drug administration-approved medication-assisted treatment for opioid use disorder. Opioids may not be prescribed through a telemedicine encounter for any other purpose.

Licensees who prescribe controlled substances, as defined by North Dakota law, in circumstances allowed under this rule, must comply with all state and federal laws regarding the prescribing of controlled substances, and must participate in the North Dakota prescription drug monitoring program.

SOURCE: ND Admin Code Sec. 50-02-15-02, (Accessed Nov. 2023).

Last updated 11/17/2023

Professional Board Standards

North Dakota statute outlines telehealth standard of care and professional ethics for dentists.

SOURCE: ND Century Code Ch. 43-28-11.3 (Accessed Nov. 2023).

North Dakota statute outlines telemedicine standard of care and professional ethics for physicians, resident physicians and physician assistants.

SOURCE: ND Century Code Sec. 43-17-44, (Accessed Nov. 2023).

North Dakota statute describes when use of telehealth for the provision of medical nutrition therapy and nutrition care services is allowed.

SOURCE: ND Century Code Ch. 43-44-19 (Accessed Nov. 2023).

Veterinary Board

Veterinary medicine includes telemedicine, laser therapy, chemotherapy, and rehabilitation services.

SOURCE: ND Admin Code Sec. 87-06-02, (Accessed Nov. 2023).

Federally Qualified Health Center (FQHC)

Last updated 11/15/2023

Definition of Visit

For FQHCs, the term “encounter” is defined as a face-to-face visit with the member during which a qualifying encounter service is rendered. FQHCs may furnish services that qualify as a medical, dental or behavior health encounter.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2023, pg. 48, (Accessed Nov. 2023).

Last updated 11/15/2023

Eligible Distant Site

FQHCs and RHCs

When providing telehealth services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue codes listed in the FQHC and RHC portions of this manual along with the CPT® or HCPCS code for the service rendered appended with modifier GT or 95.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2023, pg. 173, (Accessed Nov. 2023).

See: ND Medicaid Live Video Eligible Providers

Last updated 11/15/2023

Eligible Originating Site

FQHCs and RHCs

Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2023, pg. 173, (Accessed Nov. 2023).

See: ND Medicaid Live Video Eligible Sites.

Last updated 11/15/2023

Facility Fee

Facility fee only available to service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility.

Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2023, pg. 173, (Accessed Nov. 2023).

See: ND Medicaid Live Video Facility/Transmission Fee

Last updated 11/15/2023

Home Eligible

When providing telehealth services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue codes listed in the FQHC and RHC portions of this manual along with the CPT® or HCPCS code for the service rendered appended with modifier GT or 95.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2023, pg. 173, (Accessed Nov. 2023).

Last updated 11/15/2023

Modalities Allowed

Live Video

When providing telehealth services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue codes listed in the FQHC and RHC portions of this manual along with the CPT® or HCPCS code for the service rendered appended with modifier GT or 95.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2023, pg. 173, (Accessed Nov. 2023).

See: ND Medicaid Live Video

Store and Forward

Store-and-forward is reimbursed through digital health evaluation and management services but unclear if FQHCs can bill this service specifically.

See: ND Medicaid Store and Forward

Remote Patient Monitoring

Telemonitoring is a covered service under home health services for ND Medicaid but no reference was found to whether or not FQHCs can be reimbursed for remote patient monitoring.

See: ND Medicaid Remote Patient Monitoring

Audio-Only

Audio-only is covered in specific circumstances, but no direct reference to FQHCs, so unclear if FQHCs would be reimbursed.

See: ND Medicaid Audio-Only

Last updated 11/15/2023

Patient-Provider Relationship

No reference found.

Last updated 11/15/2023

PPS Rate

Refer to the FQHC and RHC portions of this manual for the revenue codes to bill for the various services

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2023, pg. 173, (Accessed Nov. 2023).

Last updated 11/15/2023

Same Day Encounters

If the only services rendered during a visit are “incident to” services, the visit does not qualify for claiming of an encounter. Services provided “incident to” are included in the encounter and cannot be billed separately (e.g. laboratory services, x-rays, and procedures performed during the visit).

Face-to-face services with more than one health professional and/or multiple services with the same health professionals on the same day and at a single location constitute a single encounter.

Payment is limited to one medical visit, one dental visit, and one mental health visit a day except when a member suffers an illness or injury requiring additional diagnosis or treatment after the member’s first encounter.

Medical nutritional therapy or a diabetes self-management training provided on the same day as a medical encounter is not eligible for a separate encounter. If medical nutritional therapy or diabetes self-management training is the only medical service provided, a medical encounter may be claimed. Diabetes self-management training may be provided by a credentialed registered nurse under supervision of a licensed practitioner. Bill diabetes self-management training rendered by a registered nurse under the supervising licensed practitioner’s NPI.

See the Telemedicine chapter for additional information on services rendered via telemedicine.

SOURCE: ND Medicaid General Information Provider Manual, Oct. 2023, pg. 50, (Accessed Nov. 2023).