Ohio

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: ASLP-IC, CC, IMLC, NLC, OT, PSY, PTC
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: Ohio Medicaid
  2. Administrator: Ohio Department of Job and Family Services
  3. Regional Telehealth Resource Center: Upper Midwest Telehealth Resource Center

Last updated 09/07/2022

Audio-Only Delivery

Medicaid Managed Care: State of Emergency Provider Guide Statement on Telehealth

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Medicaid Managed Care: Telehealth Provider Guide

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Medicaid: Emergency Telehealth Rules

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Medicaid 1915(c) Waiver: Appendix K – Individual Options, Level One, and Self-Empowered Life Funding Waiver (SELF)

STATUS:  Active, until 6 months after the conclusion of the PHE (See extension)

Medicaid 1915(c) Waiver: Appendix K – Assisted Living, Ohio Home Care Waiver, My Care Ohio, PASSPORT

STATUS:  Active, until 6 months after the conclusion of the PHE (See extension)

Medicaid 1915(c) Waiver: Appendix K – Assisted Living, Ohio Home Care Waiver, My Care Ohio, PASSPORT

STATUS:  Active, until 6 months after the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K Addendum – Individual Options, Level One, and Self-Empowered Life Funding Waiver (SELF)

STATUS:  Active, until 6 months after the conclusion of the PHE

 

Last updated 09/07/2022

Cross-State Lincensing

Medical Board:  Telemedicine Guidance

STATUS:  Varies.  OH State of Emergency ended on June 18. Federal public health emergency is still active.

Last updated 09/07/2022

Easing Prescribing Requirements

Medical Board:  Telemedicine Guidance

STATUS:  Varies.  OH State of Emergency ended on June 18. Federal public health emergency is still active.

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Mental Health and Addiction Services: COVID-19 and Opioid Treatment Telehealth

STATUS:  Active, until document updated

Mental Health and Addiction Services: COVID-19 Guidance for the Field Office Based Opioid Treatment

STATUS:  Active, until document updated

Last updated 09/07/2022

Miscellaneous

No Reference Found

Last updated 09/07/2022

Originating Site

Medicaid Managed Care: State of Emergency Provider Guide Statement on Telehealth

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Medicaid: Emergency Telehealth Rules

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Medicaid 1915(c) Waiver: Appendix K Addendum – Individual Options, Level One, and Self-Empowered Life Funding Waiver (SELF)

STATUS:  Active, until 6 months after the conclusion of the PHE

Last updated 09/07/2022

Private Payer

HB 122: Private Payer Reimbursement

STATUS: Enacted

Last updated 09/07/2022

Provider Type

Medicaid Managed Care: State of Emergency Provider Guide Statement on Telehealth

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy.

Medicaid: Emergency Telehealth Rules

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy.

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Mental Health and Addiction Services: COVID-19 Guidance for the Field Office Based Opioid Treatment

STATUS:  Active, until document updated

Mental Health and Addiction Services: Guidance for Behavioral Health

STATUS:  Review of permanent policies

Last updated 09/07/2022

Service Expansion

Medicaid Managed Care: State of Emergency Provider Guide Statement on Telehealth

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Medicaid Managed Care: Telehealth Provider Guide

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Medicaid: Telehealth Billing Guidelines

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Medicaid: Emergency Telehealth Rules

STATUS: Still listed on state website, however policies may have been superseded by permanent telehealth policy).

Dept. of Mental Health & Addiction: COVID-19 Telehealth FAQs

STATUS:  Varies. Mix of temporary expired policies and permanent policies.

Mental Health and Addiction Services: COVID-19 and Opioid Treatment Telehealth

STATUS:  Active, until document updated

Mental Health and Addiction Services: Guidance for Behavioral Health

STATUS:  Review of permanent policies

Last updated 09/07/2022

Definitions

“Telehealth services” has the same meaning as in section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Annotated, 3902.30(A)(5).( Accessed Sept 2022)

“Telehealth services” means health care services provided through the use of information and communication technology by a health care professional, within the professional’s scope of practice, who is located at a site other than the site where either of the following is located:

  • The patient receiving the services;
  • Another health care professional with whom the provider of the services is consulting regarding the patient.

SOURCE: OH Revised Code Section 4743.09. (Accessed Sept. 2022).

Last updated 09/07/2022

Parity

SERVICE PARITY

A health benefit plan shall provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage for in-person health care services. Plans cannot exclude coverage for a service solely because it is provided as a telehealth service.

A health benefit plan shall not impose any annual or lifetime benefit maximum in relation to telehealth services other than such a benefit maximum imposed on all benefits offered under the plan. A health benefit plan shall not impose a cost-sharing requirement for telehealth services that exceeds the cost-sharing requirement for comparable in-person health care services.

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Sept. 2022).


PAYMENT PARITY

A health plan issuer shall reimburse a health care professional for a telehealth service that is covered under a patient’s health benefit plan. Division (B)(3) of this section shall not be construed to require a specific reimbursement amount.

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Sept. 2022).

Last updated 09/07/2022

Requirements

A health benefit plan shall provide coverage for telehealth services on the same basis and to the same extent that the plan provides coverage for the provision of in-person health care services.  A health benefit plan shall not exclude coverage for a service solely because it is provided as a telehealth service.

A health benefit plan shall not impose any annual or lifetime benefit maximum in relation to telehealth services other than such a benefit maximum imposed on all benefits offered under the plan.

A health benefit plan shall not impose a cost-sharing requirement for telehealth services that exceeds the cost-sharing requirement for comparable in-person health care services.

A health benefit plan shall not impose a cost-sharing requirement for a communication when all of the following apply:

  •  The communication was initiated by the health care professional.
  • The patient consented to receive a telehealth service from that provider on any prior occasion.
  • The communication is conducted for the purposes of preventive health care services only.

This section shall not be construed as doing any of the following:

  • Requiring a health plan issuer to reimburse a health care professional for any costs or fees associated with the provision of telehealth services that would be in addition to or greater than the standard reimbursement for comparable in-person health care services;
  • Requiring a health plan issuer to reimburse a telehealth provider for telehealth services at the same rate as in-person services;
  • Requiring a health plan issuer to provide coverage for asynchronous communication that differs from the coverage described in the applicable health benefit plan.

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Sept. 2022).

Last updated 09/07/2022

Definitions

“Telehealth” is the direct delivery of health care services to a patient related to the diagnosis, treatment, and management of a condition.

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes 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 further defined in rule 5122-29-31 of the Administrative Code.

*Please see Ohio Billing Guidelines Manual for Services prior to July 15, 2022.*

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022 & OAC 5160-1-18. (Accessed Sept. 2022).

Telehealth is the direct delivery of services to a patient via secure, synchronous, interactive, real-time electronic communication with both video and audio elements.

SOURCE: The Ohio Department of Medicaid. Office of Policy Hospital Billing Guidelines. pg. 49, Revised 7/26/2021. (Accessed Sept. 2022).

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 Sept. 2022).

Mental Health Services

Telehealth means the use of, real-time audiovisual communications of such quality as to permit accurate and meaningful interaction between at least two persons, one of which is a certified provider of the service being provided pursuant to Chapter 5122-25 of the Administrative Code. Asynchronous modalities that do not have both audio and video elements are considered telehealth.

SOURCE: OAC 5122-29-31. (Accessed Sept. 2022).

“Telemedicine” or “telemedical” as used in this chapter have the same meaning as telehealth as defined in rule 5122-29-31 of the Administrative Code.

SOURCE: OAC 5122-40-01. (Accessed Sept. 2022).

“Telehealth service” means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located.

SOURCE:  OH Revised Code, Sec. 5164.95. (Accessed Sept. 2022).

Managed Care

Telehealth, as defined in emergency rule 5160-1-21* of the Ohio Administrative Code (OAC), is the direct delivery of healthcare services to a patient via synchronous, interactive, real-time electronic communication comprising both audio and video elements; or activities that are asynchronous and do not have both audio and video elements such as telephone calls, images transmitted via facsimile machine, and electronic mail.

Telehealth is an umbrella term for remote care that may include healthcare education and administration as well as real-time clinical services. Telemedicine, a subset of telehealth, describes real-time clinical healthcare services provided through electronic technology when distance separates the patient and healthcare provider.

SOURCE: Managed Care Plan Provider Telehealth Resource Guide, pg. 3, (Accessed Mar. 2022).

“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.

SOURCE: OAC 3701-56-03. (Accessed Sept. 2022).

Last updated 09/07/2022

Email, Phone & Fax

“Telehealth” is the direct delivery of health care services to a patient related to diagnosis, treatment, and management of a condition.

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes 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 further defined in rule 5122-29-31 of the Administrative Code.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022 & OAC 5160-1-18.  (Accessed Sept. 2022).

Office of Mental Health and Addiction Services

Services must be provided using interactive, secure, real-time audiovisual communications of such quality to permit accurate and meaningful interaction between at least two persons, one of which is a certified provider of the service being provided pursuant to Chapter 5122-25 of the Administrative Code. This expressly excludes telephone calls, images transmitted via facsimile machine, and text messages with visualization of the other person. Services that may be provided by certified community behavioral health centers by telephone contact are CPST and SUD case management.

SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Sept. 2022).

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.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

Last updated 09/07/2022

Live Video

POLICY

Ohio Medicaid covers live video telehealth for certain eligible providers wherever the covered individual is located.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022. & OAC 5160-1-18.  (Accessed Sept. 2022).

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 Sept. 2022).

Inmates of a penal facility or a public institution are not eligible for reimbursement for telehealth services.

SOURCE: OH Admin Code 5160-1-18(E). (Accessed Sept. 2022).

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: OAR 5122-29-31 (Accessed Sept. 2022).

Office of Mental Health and Addiction Services

OhioMHAS-certified behavioral health centers are not subject to the Ohio Medicaid Telehealth rule 5160-1-18. However, if you are a behavioral health provider or other health care entity and are not certified by OhioMHAS, you are/or may be required to follow Ohio Medicaid rule 5160-1-18.

SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Sept. 2022).

Teledentistry

The department is required to establish standards for Medicaid payment for services provided through teledentistry.

SOURCE: OH Revised Code, Sec. 5164.951. (Accessed Sept. 2022).


ELIGIBLE SERVICES/SPECIALTIES

See Medicaid guidance document and appendix to new rule 5160-1-18 for eligible services for telehealth delivery on or after November 15, 2020.

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.

SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

The following services are eligible for payment when delivered through telehealth from the practitioner site:

  • When provided by a patient centered medical home, or behavioral health providers, 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
  • 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 provided by dietitians.
  • 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 services.
  • Diabetic self-management training (DSMT) services.
  • Other services if specifically authorized in rule promulgated under agency 5160 of the Administrative Code.

SOURCE: OH Admin Code 5160-1-18(D). (Accessed Sept. 2022).

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 Sept. 2022).

Services are allowed to be provided through telehealth pursuant to rule 5122-29-31 of the Administrative Code, and these services are to be documented in accordance with paragraph (G) of rule 5122-29-31 of the Administrative Code. 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. (Accessed Sept. 2022).

Mobile Response and Stabilization Service

MRSS is intended to be delivered in-person where the young person or family is located, such as their home or a community setting. There are instances where MRSS can be delivered using a telehealth modality. Common times that telehealth would be appropriate are:

  • When the young person or family requests MRSS service delivery using telehealth modalities,
  • There is a contagious medical condition present in the home, or
  • Inclement weather that prevents or makes it dangerous for the MRSS team to travel to the young person or family.

SOURCE: OAC 5122-29-14 (Accessed Sept. 2022).

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 Sept. 2022).

Office of Mental Health and Addiction Services

Services that may be provided using real-time, interactive videoconferencing as a certified community behavioral health center are:

  • Telehealth
  • General Services
  • Assessments
  • Counseling and therapy including groups up to 12
  • Medical Activities including prescribing as allowed by the State of Ohio Medical Board and practitioner’s
    licensure
  • CPST Services
  • Therapeutic behavioral services and psychosocial rehabilitation services

SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Sept. 2022).

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 Sept. 2022).

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 Sept. 2022).

Outpatient hospital behavioral health services (OPHBH)

Hospitals are eligible to provide outpatient behavioral health services via telehealth to the extent they appear on the OPHBH fee schedule.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

Federally Qualified Health Center and Rural Health Clinics

Medical nutrition therapy and lactation services rendered by eligible FQHC and RHC practitioners will be paid under the PPS.

Group therapy will continue to be paid through FFS as a covered non-FQHC/RHC service under the clinic provider type 50 (using ODM’s payment schedules).

Services under the Specialized Recovery Services (SRS) program are not currently covered FQHC or RHC services.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

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 Sept. 2022).

Dental

Dentists may provide a limited problem-focused oral exam (CDT D0140) or periodic oral evaluation (D0120) through telehealth during this state of emergency.  Dental services furnished through telehealth at FQHCs are covered under 5160-1-18 and are paid as covered FQHC dental services.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

Hospice

Hospice services can be provided using telehealth when clinically appropriate.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

Home Health Services

Home health services, the RN assessment service and the RN consultation service can be provided using telehealth when clinically appropriate.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

Nursing Facilities

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 Sept. 2022).

Hospice

Hospice providers that deliver any component of services via telehealth will add the GT modifier on those claims, in addition to the appropriate procedure code listed in the administrative code. Ohio Department of Medicaid will allow telehealth services to be provided where in-person visits are mandated. Services billed with T2044 and T2045 are not eligible to be provided via telehealth.

SOURCE: Ohio Administrative Code 5160-56-06. (Accessed Sept. 2022).

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 Sept. 2022).

Registered Nurse Assessment and Registered Nurse Consultation Services

The RN assessment may be completed using telehealth.

SOURCE: Ohio Administrative Code 5160-12-08, (Accessed Sept. 2022).

Home Health Services

The face-to-face encounter may be completed using telehealth.

SOURCE: Ohio Administrative Code 5160-12-01, (Accessed Sept. 2022).

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.

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 Sept. 2022).


ELIGIBLE PROVIDERS

Eligible providers:

  • Physicians, Psychiatrists
  • Ophthalmologist (in billing guide only)
  • Podiatrist (in billing guide only)
  • Psychologist
  • Physician Assistant
  • Dentist
  • Advanced Practice Registered Nurses:
    • Clinical Nurse Specialists
    • Certified Nurse Midwives
    • Certified Nurse Practitioners
  • Licensed Independent Social Workers
  • Licensed Independent Chemical Dependency Counselors, Supervised practitioners, trainees, residents, and interns
  • Licensed Independent Marriage and Family Therapists
  • Licensed Professional Clinical Counselors
  • Dietitians
  • Audiologist, speech-language pathologists, speech-language pathology aides, audiology aides, and individuals holding a conditional license
  • Occupational and physical therapists and occupational and physical therapist assistants
  • Speech-Language Pathologist
  • Home health aide and hospice aides (in admin code only)
  • Practitioners who are supervised or cannot practice independently (see billing guide for list but many are listed above as well (i.e. physical therapist assistant)
  • Non-Agency Nurses (in billing guide only)
  • Medicaid school program (MSP) practitioners
  • Behavioral health practitioners (in admin code only)
  • Optometrists
  • Pharmacists
  • Chiropractors (in billing guide only)
  • Other practitioners if specifically authorized in rule promulgated under Agency 5160 of the Administrative Code.

Types of providers able to bill: Rendering practitioners listed above, except:

  • Supervised practitioners
  • Occupational therapy assistant
  • Physical therapist assistant
  • Speech-language pathology and audiology aides
  • Individuals holding a conditional license
  • Registered Nurses (RN) and Licensed Practical Nurses (LPN) working in a hospice or home health setting (in billing guide only)

Other providers able to bill include:

  • Professional Medical or Dental Group
  • Federally Qualified Health Center
  • Rural Health Clinic
  • Ambulatory health care clinics
  • Outpatient hospitals on behalf of licensed psychologists and independent practitioners not eligible to separately bill when practicing in an outpatient hospital setting.
  • Psychiatric Hospitals providing OPHBH services
  • Medicaid school program (MSP)
  • Private duty  or non-Agency nurses
  • Pharmacies (submitted on a professional claim)
  • Chiropractors (in billing guide only)
  • Home health and hospice agencies (in admin code only)
  • Behavioral health providers (in admin code only)
  • Hospitals operating an outpatient hospital behavioral health program (in admin code only)

SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide.  Revised 7/15/2022 & OH Administrative Code 5160-1-18, (Accessed Sept. 2022).

Outpatient Hospitals

Hospital providers are eligible to bill for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill a professional claim. Ohio Medicaid will pay according to the Enhanced Ambulatory Patient Grouping (EAPG) pricing as described in OAC rule 5160-2-75.

Federally Qualified Health Center and Rural Health Clinics

For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived.

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.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

Hospice

Hospice providers that deliver any component of services via telehealth will add the GT modifier on those claims, in addition to the appropriate procedure code above. Ohio Department of Medicaid will allow telehealth services to be provided where in-person visits are mandated.

SOURCE: Ohio Administrative Code 5160-56-06. (Accessed Sept. 2022).

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.

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 Sept. 2022).


ELIGIBLE SITES

“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 of 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.

The “practitioner site” is the physical location of the treating practitioner at the time a health care service is provided through the use of telehealth.

SOURCE: Ohio Administrative Code 5160-1-18. &  Appendix B (Accessed Sept. 2022).

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

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)

Penal facility or public institution such as a jail or prison are excluded places of service.

In most cases, the “GT” modifier is required to identify the service delivery through telehealth. See instructions for your specific program area or provider type for further clarification.

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 unless stated otherwise in provider specific billing guidelines.

See billing guidance for appropriate modifiers depending on the place of service.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

Teledentistry

All teledentistry activities must be conducted at the practice site(s) specified in the dentist’s contract.

SOURCE: OAC 3701-56-03. (Accessed Sept. 2022).


GEOGRAPHIC LIMITS

There is no limitation on the practitioner or patient site.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022)..


FACILITY/TRANSMISSION FEE

No Reference Found

Last updated 09/07/2022

Miscellaneous

See administrative code for additional provider responsibilities related to HIPAA and other practice standards as well as information about submitting telehealth claims.

SOURCE: OAC 5160-1-18. (Accessed Sept. 2022).

Mental Health Services Provided by Agencies

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.

The provider must have a written policy and procedure describing how they ensure that staff assisting clients with telehealth services or providing telehealth services are adequately trained in equipment usage.

See rule for additional requirements of behavioral health providers utilizing telehealth.

SOURCE: OAC 5122-29-31. (Accessed Sept. 2022).

Opioid Treatment Programs

Telehealth meetings will only be conducted for stable patients.

SOURCE: OAC 5122-40-05, (Accessed Sept. 2022).

Recently Passed Legislation

The Appalachian Community Grant Program is hereby established. The Program shall be administered by the Department of Development, in consultation with local development districts, with the goal of investing in sustainable, transformational projects in the Appalachian region of Ohio. The Program shall award grants, in amounts determined by the Department, to applicants that operate exclusively within the thirty-two-county Appalachian region of Ohio.

Each application for an Appalachian Planning Grant shall include a formal proposal outlining the proposed project or projects. The Department may establish additional requirements to apply for Appalachian Planning Grants. Each application shall include an overview addressing how any of the following components will be incorporated in the project:

  • An infrastructure component, such as main street or downtown redevelopment, improvements to multi-community connecting trails, significant outdoor community space, links to community arts, history, and culture, or access to telemedicine services

SOURCE: OH Amended Substitute HB No. 377 ( 2022 Session). (Accessed Sept. 2022).

Last updated 09/07/2022

Out of State Providers

Mental Health Services Provided by Agencies

Provider must have a physical location in Ohio or have access to a physical location in Ohio where individuals may opt to receive in person services rather than telehealth services.

SOURCE: OAC 5122-29-31. (Accessed Sept. 2022).

Last updated 09/07/2022

Overview

Ohio Medicaid reimburses for live video telemedicine.  Store-and-forward and remote patient monitoring are only reimbursed for certain communication technology-based service codes.

Last updated 09/07/2022

Remote Patient Monitoring

POLICY

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes 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 further defined in rule 5122-29-31 of the Administrative Code.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022 & OAC 5160-1-18.  (Accessed Sept. 2022).

Remote physiologic monitoring codes 99453, 99454, 99457, and 99458 are listed as a covered telehealth service.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022. (Accessed Sept. 2022).

Federally Qualified Health Center and Rural Health Clinics

Remote patient monitoring will be paid through FFS as a covered non-FQHC/RHC service under the clinic provider type 50 (using ODM’s payment schedules).

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 09/07/2022

Store and Forward

POLICY

“Telehealth” is the direct delivery of health care services to a patient related to diagnosis, treatment, and management of a condition.

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes 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 further defined in rule 5122-29-31 of the Administrative Code.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022 & OAC 5160-1-18.  (Accessed Sept. 2022).

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 Sept. 2022).


ELIGIBLE SERVICES/SPECIALTIES

G2010, which is the remote evaluation of recorded video and/or images submitted by an established patient (e.g. store and forward) is listed as a covered telehealth service.

SOURCE:The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022. (Accessed Sept. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 09/07/2022

Cross State Licensing

Physical Therapy

If a physical therapy patient is located in Ohio, the physical therapist or physical therapist assistant providing physical therapy services via telehealth shall hold a valid license under sections 4755.40 to 4755.56 of the Revised Code.

SOURCE: OH Admin. Code 4755-27-01(10)(b). (Accessed Sept. 2022).

Optometry

A provider of telehealth services who practices in the state shall be licensed by the board.  A provider of telehealth services who resides out of state and who provides services for Ohio residents shall be licensed by the board.

SOURCE: Ohio Administrative Code 4725-25-01. (Accessed Sept. 2022).

Last updated 09/07/2022

Definitions

Physical Therapy Practice

“Telehealth” means the use of electronic communications to provide and deliver a host of health-related information and healthcare services, including, but not limited to physical therapy related information and services, over large and small distances.

SOURCE: OH Admin. Code 4755-27-01(10). (Accessed Sept. 2022).

“Telehealth” means health care services provided through the use of information and communication technology by a health care professional, within the professional’s scope of practice, who is located at a site other than the site where either of the following is located:

The patient receiving the services;

Another health care professional with whom the provider of the services is consulting regarding the patient.

SOURCE: OH Admin Code 4755-27-09. (Accessed Sept. 2022).

Speech Language Pathology

“Telehealth” means the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of audiology or speech-language pathology services to an individual from a provider through hardwire or internet connection.

“Telepractice” means the practice of telehealth.

SOURCE: OH Admin. Code 4753-2-01(A)(10) & (11). (Accessed Sept. 2022).

Counselor, Social Worker and Marriage and Family Therapists

Teletherapy means the use of real-time audio or audiovisual communications that permit accurate and meaningful interaction between at least two persons, one of whom is a licensee or registrant (“licensee”) as defined in Ohio Revised Code Chapter 4757. For the purposes of this rule, modalities, including but not limited to phone, video, text, email, instant messaging/chat, are considered teletherapy.

SOURCE: OH Admin. Code 4757-5-13  (Accessed Sept. 2022).

“Teletherapy” means counseling, social work or marriage and family therapy in any form offered, rendered, or supported by electronic or digitally-assisted approaches, to include when the counselor, social worker or marriage and family therapist and the client are not located in the same place during delivery of services or when electronic systems or digitally-assisted systems are used to support in-person face to face therapy.

SOURCE: OH Admin. Code 4757-3-01(GG). (Accessed Sept. 2022).

Optometry

“Telehealth” means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located.

SOURCE: Ohio Administrative Code 4725-25-01. (Accessed Sept. 2022).

Psychologist

Telepsychology” means the practice of psychology or school psychology by distance communication technology, including telephone, electronic mail, internet-based communications, and video conferencing.

SOURCE: OH Revised Code Section 4732.01. (Accessed Sept. 2022) .

“Telehealth services” means health care services provided through the use of information and communication technology by a health care professional, within the professional’s scope of practice, who is located at a site other than the site where either of the following is located:

  • The patient receiving the services;
  • Another health care professional with whom the provider of the services is consulting regarding the patient.

SOURCE: OH Revised Code Section 4743.09. (Accessed Sept. 2022).

Occupational Therapy

“Telehealth” means health care services provided through the use of information and communication technology by a health care professional, within the professional’s scope of practice, who is located at a site other than the site where either of the following is located:

  •  The patient receiving the services;
  • Another health care professional with whom the provider of the services is consulting regarding the patient.

SOURCE: OH Adminstrative Code 4755-7-05. (Accessed Sept. 2022).

Last updated 09/07/2022

Licensure Compact

Member of Occupational Therapy Licensure Compact.

SOURCE:  OT Compact Map. (Accessed Sept. 2022).

Member of the Psychology Interjurisdictional Compact.

SOURCE: PSYPACT, Compact Map, (Accessed Sept. 2022).

Member of Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact, Member States (Accessed Sept. 2022).

Member of Audiology and Speech Language Pathology Interstate Compact.

SOURCE: ASLP-IC, Compact Map, (Accessed Sept. 2022).

Member of Physical Therapy Compact.

SOURCE: PT Compact, Compact Map, (Accessed Sept. 2022).

Member of the Nurse Licensure Compact.

SOURCE: Nurse Licensure Compact (NLC) Map. (Accessed Sept. 2022.)

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Sept. 2022).

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

Last updated 09/07/2022

Miscellaneous

“Facility fee” means any fee charged or billed for telehealth services provided in a facility that is intended to compensate the facility for its operational expenses and is separate and distinct from a professional fee.

SOURCE:  OH Revised Code, Section 4743.09 (Accessed Sept. 2022). 

A physician may provide telehealth services in accordance with sections 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4731.741 (Accessed Sept. 2022).

An advanced practice registered nurse may provide telehealth services in accordance with section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4723.94 (Accessed Sept. 2022).

A school psychologist licensed by the department of education under rules adopted in accordance with sections 3301.07 and 3319.22 of the Revised Code may provide telehealth services in accordance with section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 3319.2212 (Accessed Sept. 2022).

Last updated 09/07/2022

Online Prescribing

A physician shall not prescribe, personally furnish or otherwise provide, or cause to be provided any controlled substance or non-controlled substance to a person on whom the physician has never conducted a physical examination, with the exceptions listed below.

Non-Controlled Substances Exceptions

Prescribing is allowed when a patient is remote from the physician by complying with the following:

  • Establish the patient’s identity and physical location;
  • Obtain the patient’s informed consent;
  • Forward medical record to patient’s primary care provider (upon consent);
  • Conduct an appropriate evaluation;
  • Establish or confirm a diagnosis and treatment plan;
  • Document information in patient’s medical record;
  • Provide or recommend appropriate follow-up care;
  • Make medical record of the visit available to patient; and
  • Use appropriate technology sufficient to conduct all steps.

Separate exceptions exist for prescribing controlled substances when the patient is remote from the physician.  See regulation.

SOURCE: OH Admin. Code 4731-11-09. (Accessed Sept. 2022).

A patient evaluation performed within the previous twenty-four months via telemedicine by a healthcare provider acting within the scope of their professional license is acceptable for satisfying the criteria to be an “active patient”.

SOURCE: OAC 4731-11-01(D). (Accessed Sept. 2022).

An optometrist who holds a therapeutic pharmaceutical agents certificate issued under this chapter may provide telehealth services in accordance with section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4725.35. (Accessed Sept. 2022).

A pharmacist may provide telehealth services in accordance with section 4743.09 of the Revised Code, except that in the case of dispensing a dangerous drug, a pharmacist shall not use telehealth mechanisms or other virtual means to perform any of the actions involved in dispensing the dangerous drug unless the action is authorized by the state board of pharmacy through rules it adopts under this chapter or section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4729.285.(Accessed Sept. 2022).

Certificate to recommend medical use of marijuana

For purposes of recommending use of marijuana, a physician who holds a certificate to recommend may recommend that a patient be treated with medical marijuana if all of the following conditions are met:

  • The patient has been diagnosed with a qualifying medical condition;
  • A bona fide physician-patient relationship has been established through all of the following:
    • An examination of the patient by the physician either in person or through the use of telehealth services in accordance with section 4743.09 of the Revised Code;
    • A review of the patient’s medical history by the physician;
    • An expectation of providing care and receiving care on an ongoing basis.

See Code for additional requirements.

SOURCE: OH Revised Code Section 4731.30, (Accessed Sept. 2022).

Last updated 09/07/2022

Professional Board Standards

Counselor, Social Worker and Marriage and Family Therapist Board

SOURCE: Admin Code 4757-5-13 – (Accessed Sept. 2022)

State Board of Speech Language Pathology and Audiology

STATUS: OH Admin. Code 4753-2-01. (Accessed Sept. 2022)

Ohio Vision Professionals Board

STATUS: OH Admin. Code 4725-25-01. (Accessed Sept. 2022).

Occupational Therapy

SOURCE: OH Adminstrative Code 4755-7-05. (Accessed Sept. 2022).

Physical Therapy Practice

SOURCE: OH Admin. Code 4755-27-09. (Accessed Sept. 2022).