Last updated 02/17/2026
Live Video
POLICY
Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication comprising both audio and video elements; or
The following activities that are asynchronous or do not have both audio and video elements:
- Telephone calls
- Remote patient monitoring
- Communication with a patient through secure electronic mail or a secure patient portal.
For services rendered by behavioral health providers as defined in rule 5160-27-01 of the Administrative Code, telehealth is defined in rule 5122-29-31 of the Administrative Code.
Conversations or electronic communication between practitioners regarding a patient without the patient present is not considered telehealth unless the service would allow billing for practitioner to practitioner communication in a non-telehealth setting.
SOURCE: OAC 5160-1-18. (Accessed Feb. 2026).
The department of Medicaid shall establish standards for Medicaid payments for health care services the department determines are appropriate to be covered by the Medicaid program when provided as telehealth services. The standards shall be established in rules adopted under section 5164.02 of the Revised Code.
In accordance with section 5162.021 of the Revised Code, the Medicaid director shall adopt rules authorizing the directors of other state agencies to adopt rules regarding the Medicaid coverage of telehealth services under programs administered by the other state agencies. Any such rules adopted by the medicaid director or the directors of other state agencies are not subject to the requirements of division (F) of section 121.95 of the Revised Code.
SOURCE: OH Revised Code, Sec. 5164.95.(B) (Accessed Feb. 2026).
The practitioner site may submit either a professional or institutional claim for health care services delivered through the use of telehealth. For any professional claim submitted for health care services utilizing telehealth to be paid, it is the responsibility of the provider to follow ODM billing guidelines found on the ODM website: www.medicaid.ohio.gov.
An institutional (facility) claim may be submitted by an outpatient hospital for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill when practicing in an outpatient hospital setting. Other telehealth services provided in a hospital setting may be billed in accordance with rule 5160-2-02 of the Administrative Code.
Medicaid-covered services may be provided through telehealth, as appropriate, if otherwise payable under the medicaid school program as defined in Chapter 5160-35 of the Administrative Code.
Except for services billed by behavioral health providers as defined in paragraphs (A)(1) and (A)(2) of rule 5160-27-01 of the Administrative Code and FQHC and RHC services defined in rule 5160-28-03 rules 5160-28-03.1 and 5160-28-03.3 of the Administrative Code, the payment amount for a health care service delivered through the use of telehealth is the lesser of the submitted charge or the maximum amount shown in appendix DD to rule 5160-1-60 of the Administrative Code for the date of service.
For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived and payment is made in accordance with Chapter 5160-28 of the Administrative Code.
Individuals who meet the definition of inmate in a penal facility or a public institution, with the exception of “eligible juvenile,” as defined in rule 5160:1-1-03 of the Administrative Code are not eligible for telehealth services under this rule.
For telehealth services billed by behavioral health providers as defined in paragraphs (A)(1) and (A)(2) of rule 5160-27-01 of the Administrative Code, payment is made in accordance with Chapter 5160-27 of the Administrative Code.
SOURCE: OH Admin Code 5160-1-18. (Accessed Feb. 2026).
Mental Health
No initial in person visit is necessary to initiate services using telehealth modalities. The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.
SOURCE: OH Admin Code 5122-29-31 (Accessed Feb. 2026).
Teledentistry
The department of medicaid shall establish standards for medicaid payments for services provided through teledentistry. The standards shall provide coverage for services to the same extent that those services would be covered by the medicaid program if the services were provided without the use of teledentistry.
SOURCE: OH Revised Code, Sec. 5164.951. (Accessed Feb. 2026).
Managed Care Entities
In accordance with the MCE provider agreements, MCEs shall cover telehealth services as specified in this document. Providers are directed to contact the MCEs directly with questions about telehealth claims. This document has been developed specifically for MCEs, and outlines requirements related to payment for telehealth services as well as information regarding the provider types allowed to deliver services through telehealth. The telehealth services included in this document reiterate the requirements outlined in Ohio Administrative Code (OAC) rule 5160-1-18, Telehealth Services, effective 07/15/2022.
SOURCE: Ohio Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, Applies to dates of service on or after July 15, 2022, Updated 1/2025, (Accessed Feb. 2026.
ELIGIBLE SERVICES/SPECIALTIES
The Managed Care Organizations (MCOs) and Managed Care Entities (MCEs) cover the same telehealth services as in fee-for-service but may have different billing requirements.
In most cases, the “GT” modifier is required to identify the service delivery through telehealth. If the description of a covered procedure code in an ODM fee schedule indicates a telehealth or electronic service, the GT modifier is not required. See instructions for your specific program area or provider type for further clarification.
- Example: CPT code 98000 New patient synchronous audio-video visit with straightforward medical decision making, if using time 15 minutes or more
See guidelines for eligible codes.
When a covered telehealth procedure code is deleted due to annual CPT and HCPCS updates, ODM will adopt the replacement procedure code if a replacement is identified.
Hospital providers are eligible to bill for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill a professional claim. Telehealth services are covered to the extent they appear with a telehealth note on the EAPG covered code list, located on our website: https://www.medicaid.ohio.gov/provider/feescheduleandrates.
To bill outpatient hospital telehealth services, please append modifier “GT” to the procedure code. Outpatient hospital telehealth services will pay according to the Enhanced Ambulatory Patient Grouping (EAPG) pricing methodology as described in OAC rule 5160-2-75.
FQHCs and RHCs
For a covered telehealth service that is also an FQHC or RHC prospective payment system (PPS) service, the face-to-face requirement is waived, and payment is made in accordance with Chapter 5160-28 of the Administrative Code.
Medical nutrition therapy and lactation services rendered by eligible FQHC and RHC practitioners will be paid under the PPS.
- When these services are rendered by a practitioner not listed in Chapter 5160-28 of the Administrative Code, these services shall be paid through FFS under the clinic provider type 50 (using ODM’s fee schedules).
Group therapy will continue to be paid through FFS as a covered non-PPS service under the clinic provider type 50 (using ODM’s fee schedules).
Services under the Specialized Recovery Services (SRS) program are not currently covered FQHC or RHC services.
When the FQHC or RHC is billing as the practitioner site:
- The T1015 encounter code must be reported in the first detail line of the claim with the appropriate U modifier indicating the type of visit.
- The next detail line reported on the claim must be the service (procedure code) provided via telehealth. Modifier “GT” must be reported with the procedure code in addition to any other required modifiers. If there is more than one modifier, the GT modifier should be reported first.
- The place of service code reported on the claim must reflect the physical location of the practitioner.
For more information regarding payment for covered pharmacist services in an FQHC or RHC, please refer to Medicaid Advisory Letter (MAL) number 653 found here: https://medicaid.ohio.gov/static/About+Us/PoliciesGuidelines/MAL/MAL-653.pdf
Dental
Dentists may provide a limited problem-focused oral exam (CDT D0140) or periodic oral evaluation (D0120) through telehealth under this rule.
When billing for the procedure on a professional claim, providers should use the GT modifier to indicate the service was provided through telehealth. There is no need to report D9995.
When billing for the procedure on a dental claim, providers should include procedure code D9995 to indicate the service was provided through telehealth.
Dental services furnished through telehealth at FQHCs are covered under 5160-1-18 and are paid as covered FQHC dental services.
- On the first service line of the claim, the provider should report T1015 with the appropriate modifier to identify the type of visit (in this case U2).
- The procedure code (D0140 or D0120) should be reported in the next detail line of the claim representing the service that was provided along with a GT modifier to identify the service as a telehealth service. There is no need to report D9995.
- The place of service code should reflect the practitioner’s physical location.
Home Health Services, RN Assessment and RN Consultation
Home health services, the RN assessment service and the RN consultation service can be provided using telehealth when clinically appropriate. These services should be billed using the procedure codes below. The value “02” should be used to indicate telehealth as the “Place of Service” on all claims for services provided using telehealth. See list of codes in guidelines.
Nursing Facilities
Nursing facilities (NF) are reimbursed for all telehealth related services through the NF per diem rate. Nursing Facilities do not bill for the telehealth related services they provide. Per the telehealth rule 5160-1-18, physicians and other eligible providers may bill for the services they provide to nursing facility residents from the practitioner’s site in accordance with the rule. When nursing facilities provide telehealth related services to their residents, they report the costs they incur for those services on the Medicaid NF cost report using certain cost codes (see guidelines).
No system changes, Administrative Code rules, or the Medicaid State Plan are necessary to implement telehealth in nursing facilities.
Pre-Admission Screening and Resident Review
Pre-admission Screenings and Resident Reviews (PASRR) should be completed via the electronic HENS system as they are today as these screenings are primarily via desk review. In instances where a face-to-face is required, a telephonic and/or desk review is permissible.
Level II evaluations can be provided either by telephone or desk review when appropriate. There is no system or reimbursement impact as these functions are supported by the level II entities and the applicable contractor.
Important Clarifications
All services identified in this document and the appendix to rule 5160-1-18 may be delivered through telehealth for dates of service on or after January 1, 2026. Other practitioners and services authorized in rules promulgated under agency 5160 of the Administrative Code may also be delivered through telehealth. This includes procedure codes with a telehealth description added to appendix DD of rule 5160-1-60 or another ODM Fee Schedule.
- Example: CPT code 98000 New patient synchronous audio-video visit with straightforward medical decision making, if using time 15 minutes or more.
When a covered telehealth procedure code is deleted due to annual CPT and HCPCS updates, ODM will adopt the replacement procedure code if a replacement is identified.
Providers should use professional judgment when delivering telehealth services and should select the appropriate procedure code that reflects the service provided.
Similar to what CMS allows for Medicare services provided during the public health emergency, ODM adopts the following workforce flexibility: For services requiring direct supervision by the physician or other practitioner, that physician supervision can be provided virtually using real-time audio/video technology.
SOURCE: OH Department of Medicaid, OH Billing Guidelines, Jan. 1, 2026, (Accessed Feb. 2026).
Payment may be made only for the following medically necessary health care services identified in appendix A to this rule when delivered through the use of telehealth from the practitioner site:
- When provided by a patient centered medical home as defined in rule 5160-19-01 of the Administrative Code or behavioral health provider as defined in rule 5160-27-01 of the Administrative Code, evaluation and management of a new patient described as “office or other outpatient visit” with medical decision making not to exceed moderate complexity.
- Evaluation and management of an established patient described as “office or other outpatient visit” with medical decision making not to exceed moderate complexity.
- Inpatient or office consultation for a new or established patient when providing the same quality and timeliness of care to the patient other than by telehealth is not possible, as documented in the medical record.
- Mental health or substance use disorder services described as “psychiatric diagnostic evaluation” or “psychotherapy.”
- Remote evaluation of recorded video or images submitted by an established patient.
- Virtual check-in by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient.
- Online digital evaluation and management service for an established patient.
- Remote patient monitoring.
- Audiology, speech-language pathology, physical therapy, and occupational therapy services, including services provided in the home health setting.
- Medical nutrition services.
- Lactation counseling consultation services.
- Psychological and neuropsychological testing.
- Smoking and tobacco use cessation counseling.
- Developmental test administration.
- Limited or periodic oral evaluation.
- Hospice services.
- Private duty nursing services.
- State plan home health services.
- Dialysis related services.
- Services under the specialized recovery services (SRS) program as defined in rule 5160-43-01 of the Administrative Code.
- Notwithstanding paragraph (D)(2) of this rule, behavioral health services covered under Chapter 5160-27 of the Administrative Code.
- Optometry services.
- Pregnancy education Group prenatal careservices.
- Diabetic self-management training (DSMT) services.
- Doula services as defined in rule 5160-8-43 of the Administrative Code.
- Nurse home visiting services as defined in rule 5160-21-05 of the Adminsitrative Code.
- Report of pregnancy submitted on either form ODM 10257, “Report of Pregnancy (ROP)” or its web-based equivalent.
- Pregnancy risk assessment submitted on either form ODM 10207, “Pregnancy Risk Assessment Form” or its web-based equivalent.
- Enhanced ambulatory patient group (EAPG) covered telehealth-eligible codes as identified on the ODM Website: www.medicaid.ohio.gov.
- Individual counseling for pre-exposure prophylaxis (PrEP).
- Services that have a code description including a telehealth component and are covered in an ODM fee schedule.
- Other services if specifically authorized in rule promulgated under agency 5160 of the Administrative Code.
SOURCE: OH Admin Code 5160-1-18. (Accessed Feb. 2026).
New telehealth service codes 98000-98016 were added. See letter for detailed list.
SOURCE: OH Department of Medicaid, Medicaid Advisory Letter No. 676, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Level II updates, Jan. 1, 2025, (Accessed Feb. 2026).
Mental Health
The following are the services that may be provided via telehealth:
- General services
- CPST service
- Therapeutic behavioral services and psychosocial rehabilitation service
- Peer recovery services
- SUD case management service
- Crisis intervention service
- Assertive community treatment service
- Intensive home-based treatment service
- Mobile response and stabilization service
Individuals receiving residential and withdrawal management substance use disorder services as defined in rule 5122-29-09 of the Administrative Code or mental health day treatment service as defined in rule 5122-29-06 of the Administrative Code may receive any of the component services listed in paragraph (E) of this rule through telehealth.
SOURCE: OAC 5122-29-31. (Accessed Feb. 2026).
Services are allowed to be provided through telehealth pursuant to agency 5122 of the Administrative Code pertaining to telehealth, and these services are to be documented in accordance with rules. Telehealth services including induction of any form of medication assisted treatment will only be allowed in accordance with federal and state standards.
SOURCE: OAC 5122-40-09(C). (Accessed Feb. 2026).
Medication units may also provide telecounseling services if they provide appropriate privacy and adequate space with appropriately credentialed staff in accordance with all federal and state regulation. Telecounseling services may include individual or group sessions. Medication units that choose to provide telecounseling will:
- Provide telecounseling services with appropriate application of clinical judgment to best meet patient treatment needs;
- Be in compliance with paragraphs (H)(3) and (H)(4) of rule 5122-40-09 of the Administrative Code; and
- Ensure that every patient has a designated program counselor, as described in 42 C.F.R. 8.12(f)(5)(i), who is the primary contact for behavioral health treatment and care coordination. While the patient may utilize other counselors for emergencies, all counseling, including telecounseling, will be handled by the program counselor. Opioid treatment programs will maintain clear and accurate caseload records for auditing purposes.
SOURCE: OAC 5122-40-15, (Accessed Feb. 2026).
Mobile Response and Stabilization Service
The community behavioral health services provider is to be able to provide all allowable services by telehealth as defined in agency 5122 of the Administrative Code pertaining to telehealth.
MRSS is intended to be delivered in-person where the young person or the young person’s family is located, such as their home or a community setting. There are instances where MRSS may be delivered using a telehealth modality when clinically appropriate. Common times that telehealth would be appropriate include, but are not limited to:
- When the young person or their family requests MRSS delivery using telehealth modalities;
- When there is a contagious medical condition present in the home;
- When there is inclement weather that prevents or makes it dangerous for the MRSS team to travel to the young person or their family; or
- When a mobile response has been requested but a clinician is not available to respond, in person, as part of the MRSS team.
If a clinician is unable to be present in person at the location described in paragraph (L)(2)(a) of this rule, the QBHS, certified family peer supporter, or certified youth peer supporter is to contact the MRSS team’s clinician before leaving the premises of the site of the response so that the clinician can participate in the initial response by telehealth. If a telehealth connection cannot be made and sustained at the site of the response, the clinician is to be available for telephone consultation or is to go to the site of the response.
SOURCE: OAC 5122-29-14 (Accessed Feb. 2026).
Managed Care
Many clinically appropriate services that can be delivered virtually will be eligible for telehealth coverage, including but not limited to: sick visits, well visits, prenatal and postpartum care, behavioral health, and monitoring of chronic conditions. This is especially important for Medicaid members who experience a variety of access related barriers to care and social determinants of health. All Telemedicine/Telehealth services must be medically necessary and documented and in the applicable medical record in order to be reimbursable. Documentation may be requested to support medical necessity reviews.
See guide for telehealth visit code set.
SOURCE: Managed Care Plan Provider Telehealth Resource Guide, pg. 3-7, (Accessed Feb. 2026).
Behavioral Health
See Behavioral Health manual for telehealth modifier and Place of Service allowed for the different types of services.
SOURCE: Ohio Department of Medicaid, Medicaid Behavioral Health State Plan Services, Provider Requirements and Reimbursement Manual, Version 1.25, Effective 8/18/25, (Accessed Feb. 2026).
Intensive Home Based Treatment (IHBT) Service
IHBT is an intensive service that consists of multiple in person contacts per week with the child/adolescent and family, which includes collateral contacts related to the behavioral health needs of the child/adolescent as documented in the individual client record (ICR) as required by Chapter 5122-27 of the Administrative Code. IHBT can be provided via telehealth in accordance with rule 5122-29-31 of the Administrative Code.
SOURCE: OH Administrative Code 5122-29-28. (Accessed Feb. 2026).
Payment may be made for IHBT services rendered face-to-face in person or via telehealth in accordance with rule 5122-29-31 of the Administrative Code.
SOURCE: OH Administrative Code 5160-59-03.3. (Accessed Feb. 2026).
Federally Qualified Health Center
A visit may be conducted through telehealth if the service is rendered in accordance with rule 5160-1-18 of the Administrative Code.
SOURCE: OH Administrative Code 5160-28-01. (Accessed Feb. 2026).
“Teledentistry” means the delivery of dental services through the use of synchronous, real-time communication and the delivery of services of a dental hygienist or expanded function dental auxiliary pursuant to a dentist’s authorization as defined in section 4715.43 of the Revised Code.
In order to qualify as teledentistry activities, both the originating site(s) (location of the patient) and the approved practice site(s) must be located in dental health resource shortage areas.
All teledentistry activities must be conducted at the practice site(s) specified in the dentist’s contract.
SOURCE: OAC 3701-56-03. (Accessed Feb. 2026).
The face-to-face encounter may be completed using telehealth.
SOURCE: Ohio Administrative Code 5160-12-01, (Accessed Feb. 2026).
In accordance with rule 5160-1-18 of the Administrative Code, physician visits may be provided via telehealth.
SOURCE: Ohio Administrative Code 5160-3-19(4). (Accessed Feb. 2026).
Home Health and Private Duty Nursing
Reimbursement of home health or private duty nursing (PDN) services in accordance with this chapter are on a per visit basis. A “visit” is the duration of time that a covered home health service or private duty nursing (PDN) service is provided during an in-person or telehealth encounter to one or more individuals receiving medicaid at the same residence on the same date during the same time period.
A visit begins with the provision of a covered service and ends when the in-person or telehealth encounter ends.
SOURCE: Ohio Administrative Code 5160-12-04, (Accessed Feb. 2026).
Registered Nurse Assessment and Registered Nurse Consultation Services
The RN assessment may be completed using telehealth.
SOURCE: Ohio Administrative Code 5160-12-08, (Accessed Feb. 2026).
Comprehensive Maternal Care (CMC) Program
It is the responsibility of the CMC entity to:
- Offer at least one alternative to traditional office visits to increase access to the patient care team and clinicians in ways that best meet the needs of the population. This may include e-visits, telehealth, phone visits, group visits, home visits, alternate location visits, or expanded hours in the early mornings, evenings, or weekends
SOURCE: OAC 5160-19-03. (Accessed Feb. 2026).
Enhanced Ambulatory Patient Groups (EAPG)
List of CPT and HCPCS codes covered for EAPG when telehealth is used.
SOURCE: OH Dept. of Medicaid, Revised 3/31/25. (Accessed Feb. 2026).
Nursing Facility-Based Level Care of Home and Community-Based Services: Home Care Attendant Services
All other RN home care attendant service visits may be conducted via telehealth, unless the individual’s needs necessitate an in-person visit.
“RN home care attendant service visit” means the visit every ninety days between the RN and the individual receiving home care attendant services as required by paragraph (G)(8) of this rule. The visit may be conducted by via telehealth, unless the individual’s needs necessitate in-person visit.
SOURCE: OAC 5160-44-27, (Accessed Feb. 2026).
Nursing facility-based level of care home and community-based services programs: waiver nursing services
Non-agency LPNs, at the direction of an RN will: Conduct a visit with the directing RN at least every sixty days after the initial visit to evaluate the provision of waiver nursing services and LPN performance, and to ensure that waiver nursing services are being provided in accordance with the approved plan of care and within the LPN’s scope of practice. The visit may be conducted via telehealth.
SOURCE: OAC 5160-44-22, (Accessed Feb. 2026).
Ohio home care waiver
At least twice per year, the RN will conduct RN assessment visits in- person. All other RN assessment service visits may be conducted via telehealth, unless the individual’s needs necessitate an in-person visit. When the RN performs an RN assessment visit, the RN will bill the state plan nursing assessment code set forth in appendix A to rule 5160-12-08 of the Administrative Code.
SOURCE: OAC 5160-46-04, (Accessed Feb. 2026).
Doula Services
During a coverage period, payment may be made for the following doula services: …
- Antepartum and postpartum support services, including consultation and telehealth visits, provided in fifteen-minute units up to a maximum of forty-eight units
SOURCE: OAC 5160-8-43, (Accessed Feb. 2026).
Managed Care Entities
The appendices to this document have identified the service codes that should allow Medicaid to pay as primary, as follows:
- Codes that are not covered for Medicare or primary insurance as telehealth have a ‘No’ in the Medicare Telehealth Coverage column.
- Codes that are covered for Medicare when rendered by telephone as telehealth have ‘Yes’ in the Audio-only interaction allowed by Medicare column.
ODM periodically reviews telehealth coding changes from Medicare to add/remove codes. The billing guidelines may not always have the most up-to-date coding changes and MCEs should note that providers can still provide these services to dually eligible individuals and if Medicare pays, MCEs should consider payment of cost sharing even if ODM does not cover that service in FFS.
See guidelines for list of codes.
Managed Care Organizations must allow Applied Behavioral Analysis (ABA) services to be available through telehealth under the current guidelines . If the provider is not enrolled with Medicaid, a single case agreement would be needed.
See manual for chart with modifiers depending if a professional services or FQHC/RHC.
All services identified in this document and the appendix to rule 5160-1-18 may be delivered through telehealth. Other practitioners and services authorized in rules promulgated under agency 5160 of the Administrative Code may also be delivered through telehealth. This includes procedure codes with a telehealth description added to appendix DD of rule 5160-1-60.
Providers should use professional judgment when delivering telehealth services and should select the appropriate procedure code that reflects the service provided.
SOURCE: Ohio Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, Applies to dates of service on or after July 15, 2022, Updated 1/2025, (Accessed Feb. 2026).
ELIGIBLE PROVIDERS
Rendering providers
- Physician, Psychiatrist, Ophthalmologist (20)
- Podiatrist (36)
- Psychologist (42)
- Physician Assistant (24)
- Dentist (30)
- Advanced Practice Registered Nurses:
- Clinical Nurse Specialist (65)
- Certified Nurse Midwife (71)
- Certified Nurse Practitioner (72)
- Licensed Independent Social Worker (37)
- Licensed Independent Chemical Dependency Counselor (54)
- Licensed Independent Marriage and Family Therapist (52)
- Licensed Professional Clinical Counselor (47)
- Dietitians (07)
- Audiologist (43)
- Occupational Therapist (41)
- Physical Therapist (39)
- Speech-language pathologist (40)
- Practitioners who are supervised or cannot practice independently:
- Supervised practitioners, trainees, residents, and interns as defined in OAC rules 5160-4-05 and 5160-8-05
- Occupational therapy assistant
- Physical therapist assistant
- Speech-language pathology aide
- Audiology Aide
- Individuals holding a conditional license as described in section 4753.071 of the Revised Code
- Registered Nurses (RN) and Licensed Practical Nurses (LPN) working in a home health setting.
- Non-Agency Nurses (38)
- Medicaid School Program (MSP) practitioners described in 5160-35 of the Administrative Code (28)
- Optometrists (35)
- Pharmacists (69)
- Chiropractors (27) effective 7/15/2022
- Doula (09) under OAC 5160-8-43 effective 10/3/2024 Practitioners enrolled with the International Board-Certified Lactation Consultant (IBCLC) specialty under OAC 5160-8-42
- Other practitioners if specifically authorized in rule under Agency 5160 of the Administrative Code
Billing (pay to) Providers
- Rendering practitioners listed above except:
- Supervised practitioners defined in 5160-4-05 and 5160-8-05
- Occupational therapy assistant
- Physical therapist assistant
- Speech-language pathology and audiology aides o Individuals holding a conditional license
- Registered Nurses (RN) and Licensed Practical Nurses (LPN) working in a home health setting
- Professional Medical Group (21)
- Professional Dental Group (31)
- Federally Qualified Health Center (12)
- Rural Health Clinic (05)
- Ambulatory Health Care Clinics (50)
- Outpatient Hospitals (01) on behalf of licensed psychologists and independent practitioners not eligible to separately bill in this setting
- Psychiatric Hospitals providing BH services (02)
- Medicaid School Program Provider (28)
- Private Duty or non-Agency Nurses (38)
- Pharmacies (70) (submitted on a professional claim)
- Chiropractors (27)
- Doula (09) under OAC 5160-8-43
- Independent practitioners enrolled with the International Board-Certified Lactation Consultant (IBCLC) specialty under OAC 5160-8-42
- Other practitioners if specifically authorized in rule promulgated under Agency 5160 of the Administrative Code
Claims Submission Process: Providers of Professional Services
- Claim Type: Professional (Submitted via PNM portal or EDI)
- Procedure Code: CPT code for service delivered via telehealth
- Telehealth Modifier:
- GT modifier
- Any other required modifiers based on provider contract
- Above-mentioned U modifier to identify patient location, if applicable
- Place of Service Code: Physical location of the practitioner when the service was delivered
Claims Submission Process: FQHC and RHC (FFS or claims for wraparound payments)
- Claim Type: Professional (Submitted via PNM portal or EDI)
- Procedure Code: First detail line: T1015 encounter code and the appropriate U modifier
- Second detail line: procedure code for service delivered via telehealth
- Telehealth Modifier: GT modifier with the procedure code
- Any other required modifiers based on provider contract
- Above-mentioned U modifier to identify patient location, if applicable
- Place of Service Code: Physical location of the practitioner when the service was delivered
Hospital providers are eligible to bill for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill a professional claim. Telehealth services are covered to the extent they appear with a telehealth note on the EAPG covered code list, located on our website: https://www.medicaid.ohio.gov/provider/feescheduleandrates.
FQHCs and RHCs
For a covered telehealth service that is also an FQHC or RHC prospective payment system (PPS) service, the face-to-face requirement is waived, and payment is made in accordance with Chapter 5160-28 of the Administrative Code.
Medical nutrition therapy and lactation services rendered by eligible FQHC and RHC practitioners will be paid under the PPS.
- When these services are rendered by a practitioner not listed in Chapter 5160-28 of the Administrative Code, these services shall be paid through FFS under the clinic provider type 50 (using ODM’s fee schedules).
Group therapy will continue to be paid through FFS as a covered non-PPS service under the clinic provider type 50 (using ODM’s fee schedules).
Services under the Specialized Recovery Services (SRS) program are not currently covered FQHC or RHC services.
When the FQHC or RHC is billing as the practitioner site:
- The T1015 encounter code must be reported in the first detail line of the claim with the appropriate U modifier indicating the type of visit.
- The next detail line reported on the claim must be the service (procedure code) provided via telehealth. Modifier “GT” must be reported with the procedure code in addition to any other required modifiers. If there is more than one modifier, the GT modifier should be reported first.
- The place of service code reported on the claim must reflect the physical location of the practitioner.
For more information regarding payment for covered pharmacist services in an FQHC or RHC, please refer to Medicaid Advisory Letter (MAL) number 653 found here: https://medicaid.ohio.gov/static/About+Us/PoliciesGuidelines/MAL/MAL-653.pdf
Dental
Dentists may provide a limited problem-focused oral exam (CDT D0140) or periodic oral evaluation (D0120) through telehealth under this rule.
When billing for the procedure on a professional claim, providers should use the GT modifier to indicate the service was provided through telehealth. There is no need to report D9995.
When billing for the procedure on a dental claim, providers should include procedure code D9995 to indicate the service was provided through telehealth.
Dental services furnished through telehealth at FQHCs are covered under 5160-1-18 and are paid as covered FQHC dental services.
- On the first service line of the claim, the provider should report T1015 with the appropriate modifier to identify the type of visit (in this case U2).
- The procedure code (D0140 or D0120) should be reported in the next detail line of the claim representing the service that was provided along with a GT modifier to identify the service as a telehealth service. There is no need to report D9995.
- The place of service code should reflect the practitioner’s physical location.
Nursing Facilities
Nursing facilities (NF) are reimbursed for all telehealth related services through the NF per diem rate. Nursing Facilities do not bill for the telehealth related services they provide. Per the telehealth rule 5160-1-18, physicians and other eligible providers may bill for the services they provide to nursing facility residents from the practitioner’s site in accordance with the rule. When nursing facilities provide telehealth related services to their residents, they report the costs they incur for those services on the Medicaid NF cost report using certain cost codes (see guidelines).
No system changes, Administrative Code rules, or the Medicaid State Plan are necessary to implement telehealth in nursing facilities.
Important Clarifications
If the practitioner site does not bill the Ohio Department of Medicaid (ODM) directly (i.e., holds a contractual agreement with the practice), the patient site or practice who holds the contractual agreement may instead bill for the service delivered using telehealth.
- If the physical location of the practitioner at the time of service is not known, the POS code reported on the claim should reflect the location of the billing provider.
In most cases, the “GT” modifier is required to identify the service delivery through telehealth. If the description of a covered procedure code in an ODM fee schedule indicates a telehealth or electronic service, the GT modifier is not required. See instructions for your specific program area or provider type for further clarification.
SOURCE: OH Department of Medicaid, OH Billing Guidelines, Jan. 1, 2026, (Accessed Feb. 2026).
The following practitioners are eligible to render services through the use of telehealth:
- Physicians as defined in Chapter 4731. of the Revised Code.
- Psychologists as defined in Chapter 4732. of the Revised Code.
- Physician assistants as defined in Chapter 4730. of the Revised Code.
- Clinical nurse specialists, certified nurse-midwives, or certified nurse practitioners as defined in Chapter 4723. of the Revised Code.
- Licensed independent social workers, licensed independent marriage and family therapists, or licensed professional clinical counselors as defined in Chapter 4757. of the Revised Code.
- Licensed independent chemical dependency counselors as defined in Chapter 4758. of the Revised Code.
- Supervised practitioners, trainees, residents, and interns as defined in rules 5160-4-02 and 5160-8-05 of the Administrative Code.
- Audiologists, speech-language pathologists, speech-language pathology aides, audiology aides, and individuals holding a conditional license as defined in Chapter 4753. of the Revised Code.
- Occupational and physical therapists and occupational and physical therapist assistants as defined in Chapter 4755. of the Revised Code.
- Home health and hospice aides.
- Private duty registered nurses or licensed practical nurses in a home healthor hospice setting.
- Dentists as defined in Chapter 4715. of the Revised Code.
- Medicaid school program (MSP) practitioners as described in Chapter 5160-35 of the Administrative Code.
- Dietitians as defined in Chapter 4759. of the Revised Code.
- Behavioral health practitioners as defined in rule 5160-27-01 of the Administrative Code.
- Optometrists as defined in Chapter 4725. of the Revised Code.
- Pharmacists as defined in Chapter 4729. of the Revised Code.
- Doulas as defined in rule 5160-8-43 of the Administrative Code.
- International board-certified lactation consultants (IBCLCs) as defined in rule 5160-8-42 of the Adminsitrative Code.
- Other practitioners if specifically authorized in rule promulgated under agency 5160 of the Administrative Code.
The following provider types are eligible to bill for services rendered through the use of telehealth.
- Any practitioner Practitioners identified in paragraph (B)(1) of this rule, except for the following dependent practitioners:
- Supervised practitioners, trainees, residents, and interns as defined in rules 5160-4-02 and 5160-8-05 of the Administrative Code, except as provided in rule 5160-4-02.3 of the Administrative Code;
- Occupational therapist assistants as defined in section 4755.04 of the Revised Code;
- Physical therapist assistants as defined in section 4755.40 of the Revised Code;
- Speech-language pathology aides, audiology aides, and individuals holding a conditional license as defined in Chapter 4753. of the Revised Code.
- A professional A professional medical group.
- A professional A professional dental group.
- A federally A federally qualified health center (FQHC) or rural health clinic (RHC) as defined in Chapter 5160-28 of the Administrative Code.
- Ambulatory health care clinics (AHCC) as defined in Chapter 5160-13 of the Administrative Code.
- Outpatient hospitals on behalf of licensed psychologists and independent practitioners not eligible to separately bill when practicing in an outpatient hospital setting.
- Medicaid school program (MSP) MSP providers as defined in Chapter 5160-35 of the Administrative Code.
- Private duty nurses.
- Home health and hospice agencies.
- Behavioral health providers as defined in paragraphs (A)(1) and (A)(2) of rule 5160-27-01 of the Administrative Code.
- Doulas as defined in rule 5160-8-43 of the Adminstrative Code.
- International board-certified lactation consultants (IBCLCs) as defined in rule 5160-8-42 of the Adminstrative Code.
- Hospitals operating an outpatient hospital behavioral health program in accordance with rule 5160-2-76 of the Administrative Code.
Provider responsibilities when providing services through telehealth.
- It is the responsibility of the practitioner to deliver telehealth services in accordance with all state and federal laws including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and any HIPAA related directives from the office for civil rights (OCR) at the department of health and human services (HHS)issued during the COVID-19 national public health emergency and 42 C.F.R. part 2 (January 1, 2020).
- It is the responsibility of the practitioner to deliver telehealth services in accordance with rules set forth by their respective licensing board and accepted standards of clinical practice.
- The practitioner site is responsible for maintaining documentation in accordance with paragraph (C)(1) of this rule for the health care service delivered through the use of telehealth and to document the specific telehealth modality used.
- For practitioners who render services to an individual through telehealth for a period longer than twelve consecutive months, the telehealth practice or practitioner is expected to conduct at least one in-person annual visit or refer the individual to a practitioner or their usual source of clinical care that is not an emergency department for an in-person annual visit.
SOURCE: OAC 5160-1-18. (Accessed Feb. 2026).
To the extent permitted under rules adopted under section 5164.02 of the Revised Code and applicable federal law, the following practitioners are eligible to provide telehealth services covered pursuant to this section:
- A physician licensed under Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery;
- A psychologist, independent school psychologist, or school psychologist licensed under Chapter 4732. of the Revised Code;
- A physician assistant licensed under Chapter 4730. of the Revised Code;
- A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner licensed under Chapter 4723. of the Revised Code;
- An independent social worker, independent marriage and family therapist, or professional clinical counselor licensed under Chapter 4757. of the Revised Code;
- An independent chemical dependency counselor licensed under Chapter 4758. of the Revised Code;
- A supervised practitioner or supervised trainee;
- An audiologist or speech-language pathologist licensed under Chapter 4753. of the Revised Code;
- An audiology aide or speech-language pathology aide, as defined in section 4753.072 of the Revised Code, or an individual holding a conditional license under section 4753.071 of the Revised Code;
- An occupational therapist or physical therapist licensed under Chapter 4755. of the Revised Code;
- An occupational therapy assistant or physical therapist assistant licensed under Chapter 4755. of the Revised Code.
- A dietitian licensed under Chapter 4759. of the Revised Code;
- A chiropractor licensed under Chapter 4734. of the Revised Code;
- A pharmacist licensed under Chapter 4729. of the Revised Code;
- A genetic counselor licensed under Chapter 4778. of the Revised Code;
- An optometrist licensed under Chapter 4725. of the Revised Code to practice optometry;
- A respiratory care professional licensed under Chapter 4761. of the Revised Code;
- A certified Ohio behavior analyst certified under Chapter 4783. of the Revised Code;
- A practitioner who provides services through a medicaid school program;
- Subject to section 5119.368 of the Revised Code, a practitioner authorized to provide services and supports certified under section 5119.36 of the Revised Code through a community mental health services provider or community addiction services provider;
- Any other practitioner the medicaid director considers eligible to provide telehealth services.
In accordance with division (B) of this section and to the extent permitted under rules adopted under section 5164.02 of the Revised Code and applicable federal law, the following provider types are eligible to submit claims for medicaid payments for providing telehealth services:
- Any practitioner described in division (C)(1) of this section, except for those described in divisions (C)(1)(g), (i), and (k) of this section;
- A professional medical group;
- A federally qualified health center or federally qualified health center look-alike, as defined in section 3701.047 of the Revised Code;
- A rural health clinic;
- An ambulatory health care clinic;
- An outpatient hospital;
- A medicaid school program;
- Subject to section 5119.368 of the Revised Code, a community mental health services provider or community addiction services provider that offers services and supports certified under section 5119.36 of the Revised Code;
- Any other provider type the medicaid director considers eligible to submit the claims for payment.
When providing telehealth services under this section, a practitioner shall comply with all requirements under state and federal law regarding the protection of patient information. A practitioner shall ensure that any username or password information and any electronic communications between the practitioner and a patient are securely transmitted and stored.
When providing telehealth services under this section, every practitioner site shall have access to the medical records of the patient at the time telehealth services are provided.
SOURCE: Ohio Revised Statue Sec. 5164.95, (Accessed Feb. 2026).
Teledentistry
“Teledentistry” means the delivery of dental services through the use of synchronous, real-time communication and the delivery of services of a dental hygienist or expanded function dental auxiliary pursuant to a dentist’s authorization as defined in section 4715.43 of the Revised Code.
All teledentistry activities must be conducted at the practice site(s) specified in the dentist’s contract.
SOURCE: OAC 3701-56-03. (Accessed Feb. 2026).
Managed Care Entities
See manul for chart of eligible rendering providers, their provider type number, and whether or not they are eligible for telehealth.
*Along with modifier GT. Modifiers GC and GE are to be used to indicate a resident performed a service under the direction of a teaching physician or that the resident has a primary care exception. These modifiers would be situational depending on who provided the service and are not specific to telehealth.
If the practitioner site does not bill the Ohio Department of Medicaid (ODM) directly (i.e., holds a contractual agreement with the practice), the patient site or practice who holds the contractual agreement may instead bill for the service delivered using telehealth.
- If the physical location of the practitioner at the time of service is not known, the POS code reported on the claim should reflect the location of the billing provider.
SOURCE: Ohio Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, Applies to dates of service on or after July 15, 2022, Updated 1/2025, (Accessed Feb. 2026).
An MSP provider may provide telehealth services. Telehealth services are to be delivered in accordance with an eligible child’s IEP, 504 plan, or school services plan of care and in accordance with the telehealth service delivery methods as identified in rule 5160-1-18 of the Administrative Code or as provided in written guidance, as set forth by ODM or the appointing authority, when not clarified in rule 5160-1-18 of the Administrative Code.
SOURCE: OH Admin Code 5160-35-05, (Accessed Feb. 2026).
ELIGIBLE SITES
Medicaid covered individuals can access telehealth services wherever they are located. Locations include, but are not limited to:
- Home
- School
- Temporary housing
- Homeless shelter
- Nursing Facility
- Hospital
- Group home
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)
Excluded place of service
- Penal facility or public institution such as jail or prison (09), per federal exclusion
- As of 1/1/2025, place of service code 09 may be used when services are delivered to youth under 21 prior to release in accordance with section 5122 of the Consolidated Appropriations Act (CAA).
- Place of service codes (02) and (10) will not be accepted on claims where Medicaid is the primary payer unless specified in provider specific billing guidelines.
If applicable, a modifier indicating the patient site location must be reported. See provider specific billing guidelines.
In most cases, the place of service code reported on the claim must be the location of the practitioner. See instructions for your specific program area or provider type for further clarification.
Telehealth place of service codes 02 and 10 will not be accepted on claims where Medicaid is the primary payer unless stated otherwise in provider specific billing guidelines.
If the patient is at one of the following locations, a specific modifier identifying the type of location is required:
- The patient’s home
- School
- Inpatient hospital
- Outpatient hospital
- Nursing facility
- Intermediate care facility for individuals with an intellectual disability
If the patient site is not one of these locations, a modifier identifying patient location is not required
- U1: Patient home or place of residence at the time of service (includes homeless shelter, residential facility other than a nursing facility, temporary housing, etc.)
- U2: School
- U3: Inpatient Hospital
- U4: Outpatient Hospital
- U5: Nursing Facility
- U6: Intermediate Care Facility for Individuals with Intellectual Disabilities
Important Clarifications
If the practitioner site does not bill the Ohio Department of Medicaid (ODM) directly (i.e., holds a contractual agreement with the practice), the patient site or practice who holds the contractual agreement may instead bill for the service delivered using telehealth.
- If the physical location of the practitioner at the time of service is not known, the POS code reported on the claim should reflect the location of the billing provider.
The place of service (POS) code reported on a professional claim must reflect the physical location of the practitioner. The POS code set is maintained by the Centers for Medicare and Medicaid Services (CMS) and can be found here: https://www.cms.gov/Medicare/Coding/place-of-servicecodes/Place_of_service_code_set
- Place of service code 02 (Telehealth not provided in patient’s home) and 10 (Telehealth provided in patient’s home) will not be accepted on claims where Medicaid is the primary payer, unless otherwise stated in these billing guidelines
SOURCE: OH Department of Medicaid, OH Billing Guidelines, Jan. 1, 2026, (Accessed Feb. 2026).
Unless stated otherwise in the billing guidelines, professional claims submitted for health care services provided through the use of telehealth have to include:
- A “GT” modifier;
- A place of service code that reflects the physical location of the treating practitioner at the time a health care service is provided through the use of telehealth.
- The rendering provider’s national provider identifier (NPI).
- A modifier as identified in appendix B to this rule if the physical location of the patient is one of the following locations:
- The patient’s home (including homeless shelter, assisted living facility, group home, and temporary lodging);
- School;
- Inpatient hospital;
- Outpatient hospital;
- Nursing facility;
- Intermediate care facility for individuals with an intellectual disability.
SOURCE: Ohio Administrative Code 5160-1-18.
“Patient site” is the physical location of the patient at the time a health care service is provided through the use of telehealth.
A modifier as identified in appendix B to this rule if the physical location of the patient is one of the following locations:
- The patient’s home (including homeless shelter, assisted living facility, group home, and temporary lodging);
- School;
- Inpatient hospital;
- Outpatient hospital;
- Nursing facility;
- Intermediate care facility for individuals with an intellectual disability.
SOURCE: Ohio Administrative Code 5160-1-18, (Accessed Feb. 2026).
Modifiers recognized by Ohio Medicaid:
- GT Identifies a service as telehealth
- U1 Used to identify the patient location of “home” when a telehealth service was delivered
- U2 Used to identify the patient location of “school” when a telehealth service was delivered
- U3 Used to identify the patient location of “inpatient hospital” when a telehealth service was delivered
- U4 Used to identify the patient location of “outpatient hospital” when a telehealth service was delivered
- U5 Used to identify the patient location of “nursing facility” when a telehealth service was delivered
- U6 Used to identify the patient location of “Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)” when a telehealth service was delivered
SOURCE: Ohio Department of Medicaid, Modifiers Recognized by Ohio Medicaid, Jan. 28, 2022, (Accessed Feb. 2026).
For services delivered via telehealth, providers may use either the place of service code that reflects the location of the practitioner or the location of the patient. The appendix to OAC 5160-27-03 includes a list of allowable places of service codes for each procedure code. Please note, place of service code 02 is not allowed. Providers should use the GT modifier to identify telehealth services.
SOURCE: Ohio Department of Medicaid, Medicaid Behavioral Health State Plan Services, Provider Requirements and Reimbursement Manual, Version 1.28, Effective 8/18/25, pg. 93 (Accessed Feb. 2026).
Teledentistry
All teledentistry activities must be conducted at the practice site(s) specified in the dentist’s contract.
SOURCE: OAC 3701-56-03. (Accessed Feb. 2026).
Managed Care Entities
There is no limitation on the patient or practitioner site except for penal facilities or public institutions in accordance with OAC rule 5160:1-1-03. In accordance with section 5121 of the Consolidated Appropriations Act of 2023, U.S.C. 1396a, screening and diagnostic services are covered for incarcerated individuals under the age of 21 in the 30 days prior to release from the public institution. The POS code set is maintained by the Centers for Medicare and Medicaid Services (CMS).
If the practitioner site does not bill the MCE directly (i.e., holds a contractual agreement with the practice), the patient site or practice who holds the contractual agreement may instead bill for the service delivered using telehealth.
- In such cases, ODM recommends the place of service (POS) code reported on the professional claim should reflect the location of the billing provider if the rendering practitioner’s location is unknown.
Place of service 02 (Telehealth) will not be accepted on FFS claims where Medicaid is the primary payer. While FFS does not accept POS 02 and POS 10, MCEs may choose to allow these codes to identify telehealth services.
See manual for patient location modifiers.
The place of service (POS) code reported on a professional claim must reflect the physical location of the practitioner. The POS code set is maintained by the Centers for Medicare and Medicaid Services (CMS) and can be found here: Place of Service Code Set | CMS. As of 1/1/2025, place of service code 09 may be used when services are delivered to youth under 21 prior to release in accordance with section 5122 of the Consolidated Appropriations Act (CAA).
SOURCE: Ohio Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, Applies to dates of service on or after July 15, 2022, Updated 1/2025, (Accessed Feb. 2026).
GEOGRAPHIC LIMITS
There is no limitation on patient site.
The patient site can be anywhere.
SOURCE: OH Department of Medicaid, OH Billing Guidelines, Jan. 1, 2026, (Accessed Feb. 2026).
FACILITY/TRANSMISSION FEE
No Reference Found
