Last updated 03/04/2023
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, p. 3. & OAC 5160-1-18. (Accessed Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
“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 Mar. 2023).
“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 Mar. 2023).
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. 2023).
“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 Mar. 2023).
Last updated 03/03/2023
Live Video
POLICY
Ohio Medicaid covers live video telehealth for certain eligible providers wherever the covered individual is located.
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, p. 3. & OAC 5160-1-18. (Accessed Mar. 2023).
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 Mar. 2023).
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)(6). (Accessed Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
Teledentistry
The department is required to establish standards for Medicaid payment for services provided through teledentistry.
SOURCE: OH Revised Code, Sec. 5164.951. (Accessed Mar. 2023).
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, p. 12. (Accessed Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
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(C). (Accessed Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
Outpatient Hospital
Hospital providers are eligible to bill for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill a professional claim. See guide for instructions.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 6. (Accessed Mar. 2023).
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, p. 7. (Accessed Mar. 2023).
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, 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.
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, p. 7. (Accessed Mar. 2023).
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 Mar. 2023).
Dental/Teledentistry
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, p. 8. (Accessed Mar. 2023).
“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 Mar. 2023).
Hospice
Hospice services can be provided using telehealth when clinically appropriate. See guide for codes.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 8-9. (Accessed Mar. 2023).
Home Health Services
Home health services, the RN assessment service and the RN consultation service can be provided using telehealth when clinically appropriate. See guide for codes.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 9. (Accessed Mar. 2023).
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. See guide for codes.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 9-10. (Accessed Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
Registered Nurse Assessment and Registered Nurse Consultation Services
The RN assessment may be completed using telehealth.
SOURCE: Ohio Administrative Code 5160-12-08, (Accessed Mar. 2023).
Home Health Services
The face-to-face encounter may be completed using telehealth.
SOURCE: Ohio Administrative Code 5160-12-01, (Accessed Mar. 2023).
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 Mar. 2023).
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, p. 3-4 & OH Administrative Code 5160-1-18, (Accessed Mar. 2023).
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, p. 6-9. (Accessed Mar. 2023).
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 Mar. 2023).
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 Mar. 2023).
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.
The place of service (POS) code reported on a professional claim must reflect the physical location of the practitioner. See billing guide for more information.
SOURCE: Ohio Administrative Code 5160-1-18. The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 11 (Accessed Mar. 2023).& Appendix B (Accessed Mar. 2023).
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, p. 3, 5. (Accessed Mar. 2023).
Teledentistry
All teledentistry activities must be conducted at the practice site(s) specified in the dentist’s contract.
SOURCE: OAC 3701-56-03. (Accessed Mar. 2023).
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, p. 3. (Accessed Mar. 2023)..
FACILITY/TRANSMISSION FEE
No Reference Found
