Last updated 11/05/2025
Consent Requirements
Patients receiving telehealth services have the following rights:
- Patients are entitled to receive clear, comprehensive information about telehealth services, including their benefits, risks, and available alternatives, before agreeing to participate.
- Patients may refuse or withdraw consent for telehealth services at any time without affecting their access to in-person medical care by the provider.
- Patients must be informed of the identity, credentials, and affiliations of all healthcare providers involved in their telehealth care.
- Patients have the right to access and request corrections to their medical records, as permitted under state and federal law.
Before participating in telehealth, patients must acknowledge and understand the following:
- Participants must provide written or verbal consent to receive telehealth services in lieu of in-person healthcare services, consistent with all applicable state laws.
- By consenting to telehealth, patients agree to receive care via electronic communication and understand that they may choose in-person care if preferred or medically necessary.
- While telehealth offers convenience and accessibility, technological limitations may occur, including service disruptions or the need for an in-person evaluation for certain conditions.
- Reasonable measures will be taken to ensure the security of telehealth communications. However, as with any electronic communication, risks to data privacy may exist.
- Telehealth services are not a substitute for emergency medical care. If patients experience a medical emergency, they should call 911 or seek immediate in-person medical attention.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025).
Last updated 11/05/2025
Definitions
“Telemedicine” means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate assessment, diagnosis, counseling and prescribing treatment, and care management of a patient’s health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. “Telemedicine” does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
SOURCE: Rhode Island General Laws Sec. 27-81-3, (Accessed Nov. 2025).
Definitions for terms used in this guidance can be found at R.I. Gen. Laws § 27-81-3.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025).
Certified Community Behavioral Health Clinics (CCBHC)
Telehealth: An encounter provided via telephone or videoconference may only be considered a visit when such event is a minimum of 15 minutes, and otherwise meets the requirements for a billable outpatient visit under the RI Medicaid program (for example, in terms of clinical necessity, and relevance to the client’s treatment plan), and it is conducted directly with the client.
SOURCE: Rhode Island Department of Behavioral Healthcare, Certified Community Behavioral Health Clinics (CCBHC) Billing Manual, 5/21/24, (Accessed Nov. 2025).
Last updated 11/05/2025
Email, Phone & Fax
“Telemedicine” means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate assessment, diagnosis, counseling and prescribing treatment, and care management of a patient’s health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. “Telemedicine” does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
SOURCE: Rhode Island General Laws Sec. 27-81-3, (Accessed Nov. 2025).
Each audio-only encounter must include the following:
- Start and end time of the call;
- Provider verification of member iden3ty;
- Documentation of verbal consent;
- Clear rationale for audio-only use;
- Clinical content and outcomes of the encounter; and
- Follow-up plan (if any).
Providers must be willing to provide telephone records of services, if requested for an audit of services provided by audio-only telehealth. Phone records may be in the form of phone billing records or call records available from the telephone provider. Staff call logs, in and of themselves, are insufficient documentary evidence.
Failure to document these elements may result in denial or recoupment upon audit. While audio-only telehealth remains a valuable tool for expanding access, its use must reflect clinical judgment and align with Medicaid policy expectations.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025)
An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.
SOURCE: RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Nov. 2025).
Vision Services
The Medicaid Program does not pay for: …
- information provided over the telephone
SOURCE: RI Medicaid, Provider Reference Manual, Vision, pg. 7, Nov. 2024, & Vision Coverage Guidelines, (Accessed Nov 2025).
Are telephone calls Medicaid billable? Providers would have to check their contracts with the managed care organizations to see if telehealth is covered.
SOURCE: RI Medicaid, Peer Based Recover Support Services, FAQs, (Accessed May 2025).
Concurrent Reviews: Concurrent reviews are performed for all individuals who have been admitted to an acute care facility for the treatment of mental illness or substance abuse.
Concurrent review will be conducted on-site or by telephone for in-state facilities and by telephone for out-of-state facilities.
SOURCE: RI Medicaid, Provider Manual, Inpatient Services, (Accessed May 2025).
Recover Navigation Program (RNP)
All providers delivering RNP services must: …
- Ensure the on-site presence of all necessary practitioners to implement RNP services including a Registered Nurse, Case Manager and Peer Recovery Specialist. An On-call physician must be available to the RNP provider for telephonic consultation as needed.
SOURCE: RI Medicaid, RNP Certification Standards, (Accessed Nov. 2025).
Community Health Worker Program
Health Promotion and Coaching – Health Promotion and Coaching is interactive, one-on-one or group-based support to help a beneficiary understand, manage, or reduce the risks of a diagnosed chronic condition. Activities must involve direct coaching or motivational support linked to LPHA-documented goals.
This service must be delivered in person, face-to-face with the beneficiary. Telehealth, including audio or video communication, is not permitted for Health Promotion and Coaching unless explicitly approved in writing by EOHHS under extraordinary circumstances (e.g., public health emergencies or state-issued flexibilities)
Health Education and Training – Health Education and Training is standardized, evidence-based health education services provided one-on-one or in small groups to address a specific, LPHA documented health risk or chronic condition. These services must be directly tied to a beneficiary’s medically necessary condition or risk and aim to prevent disease, reduce disability, or promote health maintenance.
This service must be delivered in person, face-to-face with the Medicaid beneficiary. Telehealth, including telephone- or video-based communication, is not permitted for Health Education and Training unless explicitly authorized in writing by EOHHS for limited use cases (e.g., during declared public health emergencies).
Telehealth Requirements for Health System Navigation Services
Effective July 1, 2025, only Health System Navigation and Resource Coordination may be delivered either in person or via synchronous telehealth, including audio-only communication, as permitted under Rhode Island Medicaid policy and applicable federal law.
Effective July 1, 2025, Services must be delivered via synchronous, real-time interaction (e.g., phone or live video). Asynchronous formats (e.g., texting, pre-recorded content) are not reimbursable. Telehealth delivery is permitted only for Health System Navigation and Resource Coordination (H0038).
Telehealth is not allowed for Health Promotion and Coaching or Health Education and Training. Group-based CHW services may not be delivered or billed via telehealth.
Effective July 1, 2025, Telehealth is not permitted for Health Promotion and Coaching or Health Education and Training services.
SOURCE: RI Community Health Worker Manual, v 4.2, Aug. 2025, (Accessed Nov. 2025).
Certified Community Behavioral Health Clinics (CCBHC)
Telehealth: An encounter provided via telephone or videoconference may only be considered a visit when such event is a minimum of 15 minutes, and otherwise meets the requirements for a billable outpatient visit under the RI Medicaid program (for example, in terms of clinical necessity, and relevance to the client’s treatment plan), and it is conducted directly with the client.
SOURCE: Rhode Island Department of Behavioral Healthcare, Certified Community Behavioral Health Clinics (CCBHC) Billing Manual, 5/21/24, (Accessed Nov. 2025).
Conflict-Free Case Management (CFCM)
Meeting locations may include a face-to-face meeting, telephone call, or two-way audio and video communication (e.g., Microsoft Teams, FaceTime, Skype, Zoom, or similar technology). Meetings must be conducted in a method chosen by and accessible to the participant.
A monthly contact may include a face-to-face contact, telephone call, or two-way audio and video communication (e.g., Microsoft Teams, FaceTime, Skype, Zoom, or similar technology). Communication must be conducted in a method chosen by and accessible to the participant. If the participant’s health and/or safety requires monthly face-to-face contact, or if the participant wants all face-to-face meetings, the case manager must conduct the contacts face-to-face. Email, texting, or other methods of communication are not acceptable to meet the mandatory minimum monitoring requirements. However, email can be utilized to gather information prior to the monthly contact to streamline the process. Email must remain confidential and HIPAA compliant.
SOURCE: Rhode Island, Health and Human Services, Conflict-Free Case Management (CFCM) Program Manual, July 10, 2024, (Accessed Nov. 2025).
Last updated 11/05/2025
Live Video
POLICY
Each health insurer [includes Medicaid] that issues individual or group accident and sickness insurance policies for healthcare services and/or provides a healthcare plan for healthcare services shall provide coverage for the cost of such covered healthcare services provided through telemedicine services, as provided in this section.
SOURCE: Rhode Island General Laws Sec. 27-81-4. (Accessed Nov. 2025).
Coverage requirements
- The patient must be present at the time of service. Patient must be available in real time and participating in the encounter, whether by video or audio-only (if permitted). Services may not be billed
if the patient is not directly involved in the delivery of the service.
- Services must be medically necessary and clinically appropriate, as determined by the rendering provider, to be provided through telemedicine. Medically necessary and clinically appropriate services must meet the same quality of in-person care that is available to the patient. Care must be safe and effective when delivered via telehealth. Limitations of the modality must be considered when determining appropriateness.
- The communication of information exchanged between the provider and the patient must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.
- Services must be delivered via the most clinically appropriate modality. Remote patient monitoring and store-and-forward are not modalities for eligible for reimbursement unless specified elsewhere.
- Treatment must meet the same standard of care as, and be an appropriate substitute for, a face- to-face encounter.
- Services must be within the provider’s scope of license.
- Providers must have availability for both telehealth and in-person services.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025).
ELIGIBLE SERVICES/SPECIALTIES
A health insurer [includes Medicaid] shall not exclude a healthcare service for coverage solely because the healthcare service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such healthcare services are medically necessary and clinically appropriate to be provided through telemedicine services.
“Medically necessary” means medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health-related condition, including services necessary to prevent a decremental change in either medical or mental health status.
SOURCE: Rhode Island General Laws Sec. 27-81-3 & 27-81-4, (Accessed Nov. 2025).
Coverage Exclusions – The following services and activities are not reimbursable through telehealth:
- Services rendered through email, text message, fax, or social media platforms.
- Telehealth services provided on the same day as a face-to-face visit by the same provider.
- Incidental communications such as test result follow-up, educational material distribution, or general check-ins.
- Administrative tasks including appointment scheduling, reminders, medication refills, or test ordering.
- Use of automated computer programs to diagnose or treat conditions.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025)
The list of codes has been updated since published in July 2025. Procedure Code T1015 has been removed from the exclusion list for telehealth.
- Effective September 1, 2025, the codes in the table below can no longer be billed to RI Medicaid as a Telehealth Service. This includes all modifiers allowed for the codes.
- Claims billed after 9/1/2025, regardless of date of service, with a place of service of 02 – Telehealth provided other than patient’s home or 10 – Telehealth provided in the patient’s home will be denied.
See list of excluded services via source link below.
SOURCE: RI Medicaid Program Provider Update, Oct. 2025, (Accessed Nov. 2025).
Rhode Island Medicaid’s fee schedule lists several telehealth service CPT codes for outpatient visits and limited emergency department inpatient telehealth consultations under procedure/professional services. Reimbursement is available for initial inpatient telehealth consultation and follow-up inpatient telehealth consultation. See their fee schedule look-up tool and telehealth specific codes, including G0406, G0407, G0408, G0425, G0426, G0427.
SOURCE: RI Department of Health. Medicaid Fee Schedule Look-Up [search ‘telehealth’ in description area]. (Accessed Nov. 2025).
Community Health Worker Program
Health Promotion and Coaching – Health Promotion and Coaching is interactive, one-on-one or group-based support to help a beneficiary understand, manage, or reduce the risks of a diagnosed chronic condition. Activities must involve direct coaching or motivational support linked to LPHA-documented goals.
This service must be delivered in person, face-to-face with the beneficiary. Telehealth, including audio or video communication, is not permitted for Health Promotion and Coaching unless explicitly approved in writing by EOHHS under extraordinary circumstances (e.g., public health emergencies or state-issued flexibilities)
Health Education and Training – Health Education and Training is standardized, evidence-based health education services provided one-on-one or in small groups to address a specific, LPHA documented health risk or chronic condition. These services must be directly tied to a beneficiary’s medically necessary condition or risk and aim to prevent disease, reduce disability, or promote health maintenance.
This service must be delivered in person, face-to-face with the Medicaid beneficiary. Telehealth, including telephone- or video-based communication, is not permitted for Health Education and Training unless explicitly authorized in writing by EOHHS for limited use cases (e.g., during declared public health emergencies).
Health System Navigation and Resource Coordination – Navigation and Resource Coordination involves one-on-one support to help Medicaid beneficiaries access health services and community resources.
CHWs are not case managers, clinical providers, or eligibility workers, but instead assist beneficiaries in understanding and navigating systems of care.
Navigation and Resource Coordination may be delivered in-person or via telehealth options. See section 3.3.3. for additional information regarding appropriate use of telehealth for Navigation and Resource Coordination.
Allowable and Prohibited Activities for Health System Navigation and Resource Coordination
- Assisting with Telehealth Use and Technology Navigation: Helping the beneficiary understand how to use telehealth platforms (e.g., logging in to telehealth platform and basic telehealth information), and supporting participation in virtual care visits when appropriate. Note: CHWs are not allowed to bill Medicaid for general information technology or how to purchase information technology equipment for beneficiary to access telehealth.
Telehealth Requirements for Health System Navigation Services
Effective July 1, 2025, only Health System Navigation and Resource Coordination may be delivered either in person or via synchronous telehealth, including audio-only communication, as permitted under Rhode Island Medicaid policy and applicable federal law.
To ensure program integrity, HIPAA compliance, and adherence to state and federal Medicaid requirements, certain conditions must be met (see manual).
Effective July 1, 2025, Services must be delivered via synchronous, real-time interaction (e.g., phone or live video). Asynchronous formats (e.g., texting, pre-recorded content) are not reimbursable. Telehealth delivery is permitted only for Health System Navigation and Resource Coordination (H0038).
Telehealth is not allowed for Health Promotion and Coaching or Health Education and Training. Group-based CHW services may not be delivered or billed via telehealth.
Effective July 1, 2025, Telehealth is not permitted for Health Promotion and Coaching or Health Education and Training services.
Virtual Settings Without Documentation: CHW services delivered via phone or telehealth must meet strict documentation, medical necessity, and LPHA referral standards to be eligible for reimbursement. Telehealth is permitted only for Health System Navigation and Resource Coordination (H0038); Health Promotion and Coaching and Health Education and Training must be delivered in person. Anonymous, drop-in, or asynchronous telehealth (e.g., texting, video recordings) and group services via telehealth are not reimbursable.
SOURCE: RI Community Health Worker Manual, v 4.2, Aug. 2025, (Accessed Nov. 2025).
Effective May 19, 2025, Medicaid will only reimburse services with direct engagement and clear medical necessity documentation. Medicaid will discontinue reimbursement for CHW services not delivered directly to the Medicaid beneficiary. To ensure billing accuracy and compliance, EOHHS will implement additional safeguards, including enforcing HIPAA -compliant service delivery settings, preventing billing for overlapping or redundant services, appropriate use of telehealth, and strengthening documentation requirements to align with federal Medicaid rules. Please see below for a detailed timeline of these changes.
SOURCE: RI Medicaid Program Provider Update, Aug. 2025, (Accessed Nov. 2025).
Teledentistry Policy
Teledentistry is not a specific service but a mode of accomplishing a particular service. Teledentistry may include communication from one dental provider to another. Providers are asked to bill nonpaying codes D9995 (Synchronous teledentistry) and D9996 (Asynchronous teledentistry) for documentation but should use applicable D codes. Frequency limitations for service codes apply. Dentists billing for exams completed by dentistry acknowledge they have received and reviewed essential information to make a diagnosis, comparable to what would be used in an in-person visit.
SOURCE: RI Executive Office of Health and Human Services Medicaid Program, Dental Manual, pg. 11. (Oct. 2025). (Accessed Nov. 2025).
Certified Community Behavioral Health Clinics (CCBHC)
A visit is defined as qualifying “billable event,” when a client receives at least one face-to-face encounter or telehealth visit with a CCBHC qualifying staff person in a qualifying setting during which qualifying CCBHC services are provided and documented, consistent with the Attribution Guidance in section II of this manual.
A visit is defined as a “billable event” when a CCBHC enrolled client receives at least one face-to-face encounter or telehealth visit with a CCBHC qualifying staff person at a qualifying setting during which qualifying CCBHC services are provided and documented.
SOURCE: Rhode Island Department of Behavioral Healthcare, Certified Community Behavioral Health Clinics (CCBHC) Billing Manual, 5/21/24, (Accessed Nov. 2025).
ELIGIBLE PROVIDERS
All medically necessary and clinically appropriate telemedicine services delivered by in-network primary care providers, registered dietitian nutritionists, and behavioral health providers shall be reimbursed at rates not lower than services delivered by the same provider through in-person methods.
SOURCE: Rhode Island General Laws Sec. 27-81-4, (Accessed Nov. 2025).
All providers, including providers delivering services via telehealth, must be licensed and/or cer3fied and enrolled as a Medicaid provider. All provider requirements can be found at 210-RICR-20-00-1.
The following provider types do not qualify for reimbursement of services delivered through telehealth:
- Adult day care
- Anesthesiologists and nurse anesthetists
- Assisted living, nursing facilities, group homes, PRTF, MHPRR and all other residential placements
- Ambulance services
- Audiologists
- Chiropractors
- Dental specialties
- Durable medical equipment, including personal emergency response system suppliers
- Home delivered meals
- Home health and home care providers
- Home infusion providers
- Hospice
- Laboratories
- Non-emergency medical transporta3on
- Pathology services
- Pharmacies
- Radiologists
- Retail-based clinics
See Out of State Provider section for additional rules for providers located out-of-state.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025)
An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.
SOURCE: RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Nov. 2025).
Community Health Worker Program
Rhode Island CHW Medicaid services must be delivered within the geographic boundaries of Rhode Island, unless specifically authorized. Therefore, CHWs and Medicaid beneficiaries must both be physically located in Rhode Island at the time-of-service delivery.
Rhode Island Law (R.I. Gen. Laws § 27-81-3): Providers delivering telehealth services must be:
- Licensed (if a clinical provider) or certified (if a CHW) under Rhode Island law;
- Enrolled in the Rhode Island Medicaid Program;
- Delivering services to a beneficiary located in Rhode Island, unless otherwise authorized by EOHHS.
SOURCE: RI Community Health Worker Manual, v 4.0, Aug. 2025, (Accessed Nov. 2025).
ELIGIBLE SITES
“Originating site” means a site at which a patient is located at the time healthcare services are provided to them by means of telemedicine, which can include a patient’s home where medically necessary and clinically appropriate.
SOURCE: Rhode Island General Laws Sec. 27-81-3, (Accessed Nov. 2025).
New Place of Service Code
Due to recent changes made by Medicare, effective as of April 4, 2022 the Rhode Island Executive Office of Health & Human Services (EOHHS) is adding Place of Service Code 10 (Telehealth Provided in Patient’s Home) as a telehealth place of service for Fee-for-Service and Managed Care. Please submit telehealth claims with Place of Service Code 02 (Telehealth Provided Other than in Patient’s Home) or Place of Service Code 10 (Telehealth Provided in Patient’s Home) as applicable.
Fee-for-Service Providers should submit telehealth claims with the applicable Place of Service Code 10 for dates of service of April 4, 2022 forward.
SOURCE: Rhode Island Medicaid Program, Provider Update, Mar. 2023 . (Accessed Nov. 2025).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
Last updated 11/05/2025
Miscellaneous
Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, no health insurer [includes Medicaid] shall impose any specific requirements as to the technologies used to deliver medically necessary and clinically appropriate telemedicine services.
SOURCE: Rhode Island General Laws Sec. 27-81-4 (Accessed Nov. 2025).
Services provided by means of telehealth must be in compliance with HIPAA and all other relevant laws and regulations governing confidentiality, privacy, and consent, including, but not limited to 45 C.F.R. Parts 160 and 164; 42 C.F.R. Part 2; Confidentiality Rule (210-RICR-10-05-1); and R.I. Gen. Laws § 5-37.3-4. Providers must take steps to reasonably ensure privacy during all patient-practitioner interactions.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025).
Each health insurer shall collect and provide to the office of the health insurance commissioner (OHIC), in a form and frequency acceptable to OHIC, information and data reflecting its telemedicine policies, practices, and experience. OHIC shall provide this information and data to the general assembly on or before January 1, 2022, and on or before each January 1 thereafter.
SOURCE: Rhode Island General Laws Sec. 27-81-7 (Accessed Nov 2025).
Community Health Worker Program
See manual for documentation requirements.
SOURCE: RI Community Health Worker Manual, v 4.2, Aug 2025, (Accessed Nov. 2025).
Last updated 11/05/2025
Out of State Providers
Providers located outside of Rhode Island, including in a border community, may deliver telehealth services to Medicaid members only if they meet both of the following criteria:
The provider holds an active and unrestricted license in the state of Rhode Island that authorizes them to practice in the applicable discipline; and
The provider meets the state’s provider enrollment requirements and is enrolled as a participating provider in the Rhode Island Medicaid program at the time the service is rendered.
Out-of-state licensure alone does not confer eligibility to render services to Rhode Island Medicaid members via telehealth. All providers must comply with applicable state licensure laws, including any telehealth-specific requirements and must complete the full Medicaid enrollment process prior to billing for services. Services delivered via telehealth by out-of-state providers must also comply with state regulations for out-of-state providers as required in 210-RICR-20-00-3. Services rendered by out-of-state providers who are not licensed in Rhode Island or enrolled in Medicaid will not be reimbursed.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025)
Community Health Worker Program
Rhode Island CHW Medicaid services must be delivered within the geographic boundaries of Rhode Island, unless specifically authorized. Therefore, CHWs and Medicaid beneficiaries must both be physically located in Rhode Island at the time-of-service delivery.
SOURCE: RI Community Health Worker Manual, v 4.2, Aug. 2025, (Accessed Nov. 2025).
Last updated 11/05/2025
Overview
The Rhode Island Medical Assistance Program reimburses for some specific codes via live-video. A newly passed law requires Medicaid provide coverage of telemedicine, which includes live video, store-and-forward and remote patient monitoring. CCHP has only located policy indicating RI Medicaid is reimbursing store-and-forward through teledentistry.
An encounter for FQHCS includes a telemedicine visit (telephone-only and tele video services).
Last updated 11/05/2025
Remote Patient Monitoring
POLICY
“Telemedicine” means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate assessment, diagnosis, counseling and prescribing treatment, and care management of a patient’s health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. “Telemedicine” does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
SOURCE: Rhode Island General Laws Sec. 27-81-3, (Accessed Nov. 2025).
CONDITIONS
No Reference Found
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
No Reference Found
Last updated 11/05/2025
Store and Forward
POLICY
“Telemedicine” means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate assessment, diagnosis, counseling and prescribing treatment, and care management of a patient’s health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. “Telemedicine” does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
SOURCE: Rhode Island General Laws Sec. 27-81-3, (Accessed Nov. 2025).
Coverage Exclusions – The following services and activities are not reimbursable through telehealth:
- Services rendered through email, text message, fax, or social media platforms.
- Telehealth services provided on the same day as a face-to-face visit by the same provider.
- Incidental communications such as test result follow-up, educational material distribution, or general check-ins.
- Administrative tasks including appointment scheduling, reminders, medication refills, or test ordering.
- Use of automated computer programs to diagnose or treat conditions.
SOURCE: Rhode Island Executive Office of Health and Human Services, Telemedicine Billing Guidance, Effective Sept. 1, 2025, July 2025, (Accessed Nov. 2025)
Teledentistry Policy
Teledentistry is not a specific service but a mode of accomplishing a particular service. Teledentistry may include communication from one dental provider to another. Providers are asked to bill nonpaying codes D9995 (Synchronous teledentistry) and D9996 (Asynchronous teledentistry) for documentation but should use applicable D codes. Frequency limitations for service codes apply. Dentists billing for exams completed by dentistry acknowledge they have received and reviewed essential information to make a diagnosis, comparable to what would be used in an in-person visit.
SOURCE: RI Executive Office of Health and Human Services Medicaid Program, Dental Manual, pg. 11. (Oct. 2024). (Accessed Nov. 2025).
Community Health Worker Program
Effective July 1, 2025, Services must be delivered via synchronous, real-time interaction (e.g., phone or live video). Asynchronous formats (e.g., texting, pre-recorded content) are not reimbursable. Telehealth delivery is permitted only for Health System Navigation and Resource Coordination (H0038).
Telehealth is not allowed for Health Promotion and Coaching or Health Education and Training. Group-based CHW services may not be delivered or billed via telehealth.
Virtual Settings Without Documentation: CHW services delivered via phone or telehealth must meet strict documentation, medical necessity, and LPHA referral standards to be eligible for reimbursement. Telehealth is permitted only for Health System Navigation and Resource Coordination (H0038); Health Promotion and Coaching and Health Education and Training must be delivered in person. Anonymous, drop-in, or asynchronous telehealth (e.g., texting, video recordings) and group services via telehealth are not reimbursable.
SOURCE: RI Community Health Worker Manual, v 4.2, Aug. 2025, (Accessed Nov. 2025).
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
