Last updated 06/19/2021
Definitions
“Telehealth” in this bulletin refers to the delivery of compensable behavioral health services at a distance using real-time, two-way interactive audio-video transmission. Telehealth does not include telephone conversations, electronic mail messaging or facsimile (fax) transmissions.
Source: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.2, Feb. 20, 2020, (Accessed Jun. 2021).
Telemedicine is the use of real-time interactive telecommunications technology that includes, at a minimum, audio and video equipment as a mode of delivering consultation services.
Source: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Jun. 2021).
Last updated 06/19/2021
Live Video
POLICY
For FQHCs & RHCs
Telepsychiatry Services – Only applicable to Behavioral Health Managed Care delivery system claims and not fee-for-service delivery. Mental health services are provided through the use of approved electronic communication and information technologies to provide or support clinical psychiatric care at a distance. Qualifying telepsych services utilize real-time, two-way interactive audio-video transmission, and do not include a telephone conversation, electronic mail message, or facsimile transmission between a health care practitioner and a service recipient, or a consultation between two healthcare practitioners, although these activities may support the delivery of telepsych services. Telepsych services require service providers to have a service description approved by the Office of Mental Health and Substance Abuse Services (OMHSAS) and deliverable through the managed care option.
SOURCE: PA PROMISe, 837 Professional/CMS-1500 Claim Form, Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Apr. 22, 2014). (Accessed Jun. 2021).
ELIGIBLE SERVICES/SPECIALTIES
See listing for reimbursable procedure codes when the service is provided via interactive telecommunication technology.
SOURCE: PA Department of Human Services, Medical Assistance Program Fee Schedule for Consultations Performed Using Interactive Telecommunication Technology, p. 3 (May 23, 2012), (Accessed Feb. 2021) & PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, Attachment A, Feb. 20, 2020, (Accessed Jun. 2021).
Psychiatric Outpatient Clinics, Psychiatric Partial Hospitalization Programs, and Drug & Alcohol Outpatient Clinics can bill for specified services provided by psychiatrists, licensed psychologists, CRNPs, PAs, LCSWs, LPCs, and LMFTs in the FFS delivery system. See Attachment A in cited bulletin for a list of procedure codes for services that may be provided using telehealth in the FFS delivery system. Providers must use the appropriate procedure codes and modifiers to identify that the service was delivered using telehealth.
Interpretive services, including sign language, must be provided as necessary.
SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.3-4, Feb. 20, 2020, (Accessed Jun. 2021).
PA Medical Assistance Program has a fee schedule that lists codes eligible to be performed using interactive telecommunication technology.
SOURCE: PA Department of Public Welfare, Fee Schedule for Consultations Performed Using Interactive Telecommunication Technology. May 23, 2012, (Accessed Jun. 2021).
ELIGIBLE PROVIDERS
In the FFS delivery system, psychiatrists, psychologists, CRNPs and PAs certified in mental health, LCSWs, LPCs, and LMFTs can provide services using telehealth in Psychiatric Outpatient Clinics, Psychiatric Partial Hospitalization Programs, and Drug & Alcohol Outpatient Clinics.
Psychiatric Outpatient Clinics, Psychiatric Partial Hospitalization Programs, and Drug & Alcohol Outpatient Clinics can bill for specified services provided by psychiatrists, licensed psychologists, CRNPs, PAs, LCSWs, LPCs, and LMFTs in the FFS delivery system. See Attachment A in cited bulletin for a list of procedure codes for services that may be provided using telehealth in the FFS delivery system. Providers must use the appropriate procedure codes and modifiers to identify that the service was delivered using telehealth.
SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.2 & 4, Feb. 20, 2020, (Accessed Jun. 2021).
Pennsylvania Medicaid will provide reimbursement for live video to all Medicaid enrolled physician specialists.
Eligible Providers (fee for service):
- Physicians
- Certified registered nurse practitioners
- Certified nurse midwives
Providers under a managed care system should contact the appropriate managed care organization.
SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Jun. 2021).
Telepsych services delivered in FQHCs and RHCs require providers to have a service description approved by the Office of Mental Health and Substance Abuse Services and the service must be deliverable through the managed care option. Telepsych services are limited to psychologists and psychiatrists.
SOURCE: PA PROMISe, 837 Professional/CMS-1500 Claim Form, Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Apr. 22, 2014). (Accessed Jun. 2021).
ELIGIBLE SITES
Telehealth cannot be utilized to deliver services to individuals in their homes, unless services are being delivered as part of Assertive Community Treatment (ACT), Dual Diagnosis Treatment Team (DDTT), or Mobile Mental Health Treatment (MMHT) services and only if staff trained in the use of the telehealth equipment and protocols to provide operating support and staff trained to provide in-person clinical intervention are present.
In the FFS delivery system, psychiatrists, psychologists, CRNPs and PAs certified in mental health, LCSWs, LPCs, and LMFTs can provide services using telehealth in Psychiatric Outpatient Clinics, Psychiatric Partial Hospitalization Programs, and Drug & Alcohol Outpatient Clinics. BH-MCOs may allow additional provider settings to utilize telehealth.
Originating site must have staff trained in telehealth equipment and protocols to provide operating support and staff trained and available to provide in-person clinical intervention, if needed. If ACT, DDTT, or MMHT services are being provided in the home, staff trained in the use of the telehealth equipment and protocols to provide operating support and staff trained to provide in-person clinical intervention if needed must be present.
SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.2-3, Feb. 20, 2020, (Accessed Jun. 2021).
A patient is allowed to access a telemedicine consultation at any enrolled office of the referring provider as well as any other participating physicians, certified registered nurse practitioner, or certified nurse midwife (i.e. other than the referring provider).
SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Jun. 2021).
GEOGRAPHIC LIMITS
Providers are reminded that services should be rendered face-to-face whenever practical and appropriate. Some situations providers may consider when determining if the use of telecommunication technology to provide a consultation is practical and appropriate include, but are not limited to, the recipient’s medical condition would make it dangerous to travel, the recipient must travel more than 60 minutes in a rural area or 30 minutes in an urban area, or there are no available openings with an appropriate physician specialist located within the travel limits within a timeframe appropriate to treat the recipient’s condition.
SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Jun. 2021).
FACILITY/TRANSMISSION FEE
No Reference Found
Last updated 06/19/2021
Miscellaneous
Technology Requirements:
Technology used for telehealth, whether fixed or mobile, should be capable of presenting sound and image in real-time and without delay. The telehealth equipment should clearly display the participants’ full bodies and their environments. The telehealth equipment must meet any state or federal requirements for the transmission or security of health information.
Providers are responsible to ensure confidentiality and security in the transmission and storage of health information, and to conduct regular reviews, at least annually, of systems used for the delivery of telehealth. Providers must maintain annual and comparative reports of these reviews to be examined by OMHSAS and BH-MCOs upon request. The reports must be retained in a retrievable record, identified by date of review, and include the following information:
- Technology provider certification(s).
- Manifest files of the software being utilized.
- Attestation of systems security checks performed with corresponding results logged on a regular basis.
Confidentiality:
Providers must assure the privacy of the individual receiving services and comply with the Health Insurance Portability and Accountability Act (HIPAA) and other federal and state privacy and confidentiality requirements.
Delivery of Services:
The participant’s medical record must indicate when a service is provided using telehealth including, the start and end time of service.
Quality of Service:
- The provider using telehealth must maintain written quality protocols for the operation and use of telehealth equipment including the provision of periodic training to ensure that telehealth is provided in accordance with the requirements in this bulletin as well as the provider’s established patient care standards.
- The providers must maintain a written procedure detailing a contingency plan for transmission failure or other technical difficulties that render the behavioral health service undeliverable.
- The provider must periodically review, at least annually, its quality protocol and delivery of services through telehealth. The provider must maintain annual and comparative reports of these reviews to be examined by OMHSAS and by the responsible BH-MCOs upon request.
SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.2-4, Feb. 20, 2020, (Accessed Jun. 2021).
