Last updated 01/29/2024
Definitions
Telemedicine is the use of medical information exchange from one site to another via electronic communications to improve patient’s health status. It is the use of two-way, real time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video communications equipment.
Closely associated with telemedicine is the term “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Telehealth is the use of telecommunication technologies for clinical care (telemedicine), patient teachings and home health, health professional education (distance learning), administrative and program planning, and other diverse aspects of a health care delivery system.
SOURCE: GA Dept. of Community Health, Physician Services Manual, p. R-1/170 (Jan. 2024). (Accessed Jan 2024).
Telehealth is the use of medical information exchange from one site to another via electronic communications to improve patient’s health status. It is the use of two-way, real time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video communications equipment. Closely associated with telehealth is the term “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. (CCHP NOTE: We believe the previous sentence contains a typo and that the first use of the term “telehealth” was meant to be “telemedicine”.) Telehealth is the use of telecommunications technologies for clinical care (telehealth), patient teachings and home health, health professional education (distance learning), administrative and program planning, and other diverse aspects of a health care delivery system.
Telehealth is a broad definition of remote healthcare that does not always involve clinical services. Telehealth can be used in telecommunications technologies for patient education, home health, professional health education and training, administrative and program planning, and other diverse aspects of a health care delivery system.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 6, 8, (Jan 1, 2024). GA Community Behavioral Health Rehabilitation Services Manual p. 99 (Jan. 1, 2024) (Accessed Jan. 2024).
Telehealth involves the use of two-way, real time interactive communication equipment to exchange medical/clinical information between a healthcare practitioner and the member from one site to another via a secure electronic communication system. This includes audio and video communications equipment designed to facilitate delivery of healthcare services in a face-to-face interactive, though distant, engagement.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 6, 8, (Jan 1, 2024). (Accessed Jan. 2024).
Telemedicine involves the use of two-way, real time interactive communication equipment to exchange medical/clinical information between a healthcare practitioner and the member from one site to another via a secure electronic communication system. This includes audio and video communications equipment designed to facilitate delivery of healthcare services in a face-to-face interactive, though distant, engagement.
SOURCE: GA Community Behavioral Health Rehabilitation Services Manual p. 98 (Jan. 1, 2024) (Accessed Jan. 2024).
TeleMental Health is a term defined by Ga. Comp. R. & Regs. R. 135-11-01. and is applicable only to Licensed Social Workers, Professional Counselors and Marriage & Family Therapists when either 1) practicing telehealth as defined above, or 2) providing telephonic intervention when allowable via DCH/DBHDD guidelines). Per this rule and regulation, there are specific practice guidelines and mandatory training pertaining to what is identified as TeleMental Health. Providers shall adhere to these rules and regulations when TeleMental Health is provided by one of these named practitioners.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 9, (Jan 1, 2024) (Accessed Jan. 2024).
Telemedicine is the use of medical information exchanged from one secured site to another via electronic communications to improve a patient’s health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site (defined in the DBHDD Behavioral Health Provider Manual, Glossary).
SOURCE: GA Department of Behavioral Health & Developmental Disabilities, Provider Manual for Community Behavioral Health Providers (Dec 2023), p. 395 (Accessed Jan. 2024).
Last updated 01/29/2024
Live Video
POLICY
The use of a telecommunications system may substitute for an in-person encounter for professional office visits, pharmacologic management, limited office psychiatric services, limited radiological services and a limited number of other physician fee schedule services. See the telehealth guidelines for program specific policies.
SOURCE: GA Dept. of Community Health, Physician Services Manual, p. 170 (Jan. 1, 2024). (Accessed Jan. 2024).
Medicaid covered services are provided via telehealth for eligible members when the service is medically necessary, the procedure is individualized, specific, and consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 7 (Jan. 1, 2024). (Accessed Jan 2024).
ELIGIBLE SERVICES/SPECIALTIES
An interactive telecommunications system is required as a condition of payment. The originating site’s system, at a minimum, must have the capability of allowing the distant site provider to visually examine the patient’s entire body including body orifices (such as ear canals, nose and throat). The distant site provider should also have the capability to hear heart tones and lung sounds clearly (using a stethoscope) if medically necessary and currently within the provider’s scope of practice. The telecommunication system must be secure and adequate to protect the confidentiality and integrity of the information transmitted.
SOURCE: GA Dept. of Community Health, Physician Services Manual, p. 170 (Jan. 1, 2024). (Accessed Jan. 2024).
Claims for telehealth services must use the appropriate CPT or HCPCS code for the professional service. The GT modifier is required as applicable, and/or the use of either POS 02 or POS 10. POS 02 will indicate Telehealth services that were utilized at a location other than at the patient’s home. The GQ modifier is still required as applicable. By coding and billing with the covered telehealth procedure code, providers are certifying that the member was present at an eligible originating site when you furnished the telehealth service. CPT modifier ‘‘93’’ can be appended to claim lines, as appropriate, for services furnished using audio only communications technology. Interactive audio and video telecommunications must be used, permitting real time communications between the distant site provider or practitioner and the member.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 12, 16 (Jan. 1, 2024). (Accessed Jan. 2024).
The service must be medically necessary and the procedure individualized, specific, and consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.
Physician Services: When an enrolled provider determines that medical care can be provided via electronic communication with no loss in the quality or efficacy of the member’s care, telehealth services can be performed.
See telehealth manual for list of eligible telehealth services and codes for specific programs.
An interactive telecommunications system is required as a condition of payment. The originating site’s system, at a minimum, must have the capability of allowing the distant site provider to visually examine the patient’s entire body including body orifices (such as ear canals, nose, and throat). Depending upon an enrolled provider’s specialty and scope of practice, the distant provider should also have the capability to hear heart tones and lung sounds clearly (using stethoscope) if medically necessary and currently within the provider’s scope of practice. The telecommunication system must be secure and adequate to protect the confidentiality and integrity of the information transmitted.
Non-Covered Service Modalities:
- Telephone conversations.
- Electronic mail messages.
- Facsimile.
- Services rendered via a webcam or internet-based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance.
- Video cell phone interactions.
- The cost of telehealth equipment and transmission.
- Failed or unsuccessful transmissions.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance, p. 6-7 & 17 (Jan. 1, 2024). (Accessed Jan 2024).
Nursing Facilities
Those residents whose interest is best served by receiving mental health services in the nursing facility or in a nearby telemedicine site can receive services in either of those locations, with the practitioner using out-of-clinic or telehealth/telemedicine procedure codes. See manual for codes.
Though not available in all areas of the State, Medicare-funded mental health services are currently provided to nursing home residents via telemedicine, face-to-face visits by providers Rev. 04/12 in the nursing home, and nursing home resident visits to psychiatric/mental health clinics/offices for those individuals able to travel outside the nursing facility.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 45-46 (Jan. 1, 2024) & GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facility Services, p. H-1 , H-8 (p. 217, 223). (Jan. 1, 2024). (Accessed Jan 2024).
Teledentistry
See dental services manual for teledentistry codes.
SOURCE: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Dental Services, IX-21-22, p. 60-61 (Oct. 2023). GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 36 (Jan. 1, 2024). (Accessed Jan 2024).
Autism Spectrum Disorder Services
Practitioners of Autism Spectrum Disorder (ASD) services can use telehealth to assess, diagnose and provide therapies to patients. Prior authorization is required for all Medicaid-covered adaptive behavior services, behavioral assessment and treatment services (not telehealth specific). See manual for eligible codes.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 24-29 (Jan. 1, 2024). (Accessed Jan 2024).
Community Behavioral Health and Rehabilitation Services (CBHRS)
The Departments of Community Health and Behavioral Health and Developmental Disabilities have authorized telehealth to be used to provide some services in the CBHRS program. See Behavioral Health and Development Disabilities manual for more detailed information.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 31-34 (Jan. 1, 2024). GA Department of Community Health for CBHRS, p. 98-99 (Jan. 1, 2024). GA Dept. of Behavioral Health & Developmental Disabilties, Provider Manual for Community Behavioral Health Providers (Dec. 2023). (Accessed Jan 2024).
Those residents whose interest is best served by receiving mental health services in the nursing facility or in a nearby telemedicine site can receive services in either of those locations, with the practitioner using out-of-clinic or telehealth/telemedicine procedure codes.
SOURCE: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Community Behavioral Health Rehabilitation Services, p. 67, (Jan. 1, 2024). (Accessed Jan 2024).
Dialysis Services
The Centers for Medicaid and Medicare Services (CMS) has added Dialysis Services to the list of services that can be provided under Telehealth. See manual for list of eligible CPT codes.
SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 40-43 (Jan. 1, 2024). (Accessed Jan. 2024).
School Based Services
Telehealth benefits are allowed if all the following criteria are met:
- The provider is an authorized health-care provider enrolled in Georgia Medicaid
- The client is a child who is receiving the service in a primary or secondary school-based setting
- The parent or legal guardian of the client provides consent before the service is provided.
Certain speech language pathology, speech and audiology, and physical therapy services are reimbursable via telehealth in the school-based setting. This includes time spent assisting the student with learning to use adaptive equipment and assistive technology.
See manual for eligible CPT/HCPCS speech, audiology and physical therapy codes.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 49-53 (Jan. 1, 2024). (Accessed Jan. 2024).
Durable Medical Equipment Services
A face-to-face encounter may be made through the use of telehealth technology by reporting the appropriate E&M code.
SOURCE: GA Dept. of Community Health, GA Medicaid Durable Medical Equipment Services Manual, p. 34 (Jan. 1, 2024). (Accessed Jan 2024).
Elderly and Disabled Waiver EDWP Traditional/Enhanced Case Management
Members must be seen by their PCP annually, either in the office of the PCP or via Telehealth with the SNS provider RN performing the call.
SOURCE: GA Dept of Community Health, Division of Medicaid, Policies and Procedures for Elderly and Disabled Waiver EDWP – (CCSP) Traditional/Enhanced Case Management (Jan. 1, 2024), p. 23. (Accessed Jan 2024).
EDWP (CCSP and Source) Skilled Nursing Services by Private Home Care Providers
Registered Nurse Responsibilities include facilitating telehealth visits with the member and the member’s PCP.
SOURCE: GA Dept of Community Health, Division of Medicaid, Policies and Procedures for EDWP (CCSP and SOURCE): General Services (Jan.1, 2024), p. 212-213; Skilled Nursing Services by Private Home Care Providers (Jan. 1, 2024), p. 7, 11-12.; (Accessed Jan 2024).
Department of Community Health
The Department of Community Health (DCH) will allow medically necessary services to be rendered via telehealth. Each billed procedure code must be submitted with the usual program modifier(s). Place of service code 02 must be added to the allowed procedure codes to indicate the services are related to telehealth services.
SOURCE: GA Dept of Community Health: Early Intervention Case Management Program, p. 28 (Jan. 1, 2024). (Accessed Jan. 2024).
Children’s Intervention Services
The Department of Community Health will allow some speech therapy, therapy and audiology services to be rendered via telehealth. See manual for appropriate codes.
SOURCE: GA Dept. of Community Health, Division of Medicaid, Children’s Intervention Services (Jan. 1, 2024), p. 47. GA Dept. of CommunityHealth, Childrens Intervention School Services (Jan. 1, 2024). (Accessed Jan 2024).
Comprehensive Supports Waiver Program (COMP)
All components of Adult Occupational Therapy, Adult Physical Therapy, Speech and Language Therapy, Adult Nutrition Services, Interpreter Services can be safely provided via telehealth modalities according to prevailing best practice standards published by the American Speech and Language Hearing (Occupational or Physical Therapy) Association and in accordance with the Georgia license requirements under O.C.G.A. § 43-44-7. Therapists are expected to use synchronous “in real time” audio/video technology for telehealth sessions. Telephone calls and store and forward (asynchronous) modalities are not allowed for billable therapy evaluation and services.
Some components of Behavior Supports Services can be provided via a telehealth modality to supplement in-person service delivery. The following components are the only components that are allowable for a telehealth option:
- Indirect assessment component for functional behavior assessment;
- Follow up or refresher staff training for behavior support plans;
- Additional fidelity monitoring of plan implementation and oversight;
- Distant site observations of the individual for the purposes of consultation, modeling, and recommendations for interventions to staff/caregivers in real time;
- Team meetings for the purpose of gathering feedback related to behavior support plans effectiveness; and
- Review of data analysis summaries and behavior graphing.
See manual for more details.
SOURCE: GA Dept. of Community Health, Comprehensive Supports Waivers Program (COMP) Chapters 1300-3700 (Jan. 1, 2024), GA Dept. of CommunityHealth, New Options Waiver Program (NOW) (Jan. 1, 2024). (Accessed Jan 2024).
Independent Care Waiver Services
Counseling services are available to members needing treatment for personal, social or behavioral disorders to maintain and improve effective functioning. Counseling services can be provided via telehealth with or without a visual component.
SOURCE: GA Dept. of Community Health, Independent Care Waiver Services (Jan. 1, 2024), p. 78. (Accessed Jan. 2024).
ELIGIBLE PROVIDERS
The consulting provider must be an enrolled provider in Medicaid in the state of Georgia and must document all findings and recommendations in writing, in the format normally used for recording services in the member’s medical records. The provider at the distant site must obtain prior approval when services require prior approval. Both the originating site and distant site must document and maintain the member’s medical records. The report from the distant site provider may be faxed to the originating provider.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 15 (Jan. 1, 2024). (Accessed Jan. 2024).
Autism Spectrum Disorder Services
Practitioners of ASD services can use telehealth to assess, diagnose and provide therapies to patients. Providers must hold either a current and valid license to practice Medicine in Georgia, hold a current and valid license as a Psychologist as required under Georgia Code Chapter 39 as amended, or hold a current and valid Applied Behavior Analysis (ABA) Certification. In addition to licensed Medicaid enrolled Physicians and Psychologists, Georgia Medicaid will enroll Board Certified Behavioral Analysts (BCBAs) as Qualified Health Care Professionals (QHCPs) to provide ASD treatment services. The BCBA must have a graduate-level certification in behavior analysis. Providers who are certified at the BCBA level are independent practitioners who provide behavior-analytic services. In addition, BCBAs supervise the work of Board-Certified Assistant Behavior Analysts (BCaBAs), and Registered Behavior Technicians (RBTs) who implement behavior-analytic interventions.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 24 (Jan. 1, 2024). (Accessed Jan 2024).
Community Behavioral Health and Rehabilitation Services
See manual for eligible practitioner types and levels for CBHRS.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 33-34 (Jan. 1, 2024). (Accessed Jan 2024).
Teledentistry
Licensed dentists and dental hygienists are eligible providers.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 36 (Jan. 1, 2024). (Accessed Jan 2024).
Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)
FQHCs and RHCs can serve as the originating or distant site. They cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 38 (Jan. 1, 2024) & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23, (Jan. 1, 2024). (Accessed Jan 2024).
Nursing Facility Specialized Services
See manual for eligible providers and levels.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 46 (Jan. 1, 2024). (Accessed Jan. 2024).
Advanced Nurse Practitioner & Nurse Midwifery Services
GT modifier must be used in conjunction with the appropriate codes for Telemedicine following full implementation of HIPAA compliance (see “Telemedicine Consultations.”).
SOURCE: GA Dept. of Community Health, GA Medicaid Division, Advanced Nurse Practitioner Services (Jan. 1, 2024), p. 23. GA Dept. of Community Health, GA Medicaid Division, Nurse Midwifery Services, p. 36 (Jan. 1, 2024). (Accessed Jan 2024).
School-Based Settings (Local Education Agencies)
Telehealth services are allowed in school-based settings upon enrollment into COS 600. The following requirements must be met:
- The provider is an authorized health-care provider enrolled in Georgia Medicaid
- The client is a child who is receiving the service in a primary or secondary school-based setting
- The parent or legal guardian of the client provides consent before the service is provided
Telehealth services provided in a school-based setting are also a benefit if the referring provider delegates provision of services to a nurse practitioner, clinical nurse specialist, physician assistant, or other licensed specialist as long as the above-mentioned providers are working within the scope of their professional license and within the scope of their delegation agreement with the provider.
The school must enroll as a Health Check Provider in order to bill the telehealth originating site facility fee.
LEAs must submit an Attestation Form for the provision of telehealth services.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 50 (Jan. 1, 2024)., GA Dept. of CommunityHealth, Childrens Intervention School Services (Jan. 1, 2024), p. 9. (Accessed Jan 2024).
ELIGIBLE SITES
Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014 with a payment of $20.52. Hospitals are eligible to receive reimbursement for a facility fee for telehealth when operating as the originating site. Claims must be submitted with revenue code 780 (telehealth) and type of bill 131. There is no separate reimbursement for telehealth serves when performed during an inpatient stay, outpatient clinic or emergency room visit or outpatient surgery, as these are all-inclusive payments.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 12 (Jan. 1, 2024). (Accessed Jan 2024).
Ambulance Providers
They may serve as originating sites and the ambulance may bill a separate origination site fee. They are not authorized to provide distant site services.
Limitation (Emergency Ambulance Services Handbook): Emergency ambulance services are reimbursable only when medically necessary. The recipient’s physical condition must prohibit use of any method of transportation except emergency for a trip to be covered. See Emergency Ambulance Handbook for more specific information.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 21 (Jan. 1, 2024). & Emergency Ambulance Services Handbook, p. 18 (Jan. 1, 2024). (Accessed Jan 2024).
Community Behavioral Health and Rehabilitation Services
Member may be located at home, schools and other community-based settings or at traditional sites named in the Department of Community Health Telehealth Guidance. See manual for detailed instructions explanation for when and which type of practitioner can bill for telehealth services.
Traditional sites include:
- Physician and Practitioner’s Offices;
- Hospitals;
- Rural Health Clinics;
- Federally Qualified Health Centers;
- Local Education Authorities and School Based Clinics;
- County Boards of Health;
- Emergency Medical Services Ambulances; and
- Pharmacies.
SOURCE: GA Dept. of Community Health, Community Behavioral Health Rehabilitation Services Handbook Appendix O, p.98 (Jan. 1, 2024). GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 31 (Jan. 1, 2024). (Accessed Jan 2024).
Teledentistry
Department of Public Health (DPH) Districts and Boards of Health Dental Hygienists shall only perform duties under this protocol at the facilities of the DPH District and Board of Health, at school-based prevention programs and other facilities approved by the Board of Dentistry and under the approval of the District Dentist or dentist approved by the District Dentist.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 36 (Jan. 1, 2024). (Accessed Jan 2024).
Services can now be provided in Federally Qualified Health Centers, volunteer community health settings, senior centers and family violence shelters.
SOURCE: GA Dept. of Community Health, Dental Services p. 60 (IX-21) (Oct. 2023). (Accessed Jan 2024).
Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)
FQHCs and RHCs can serve as originating sites and are paid an originating site facility fee. They cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 38 (Jan. 1, 2024). & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 23, (Jan. 1, 2024). (Accessed Jan 2024).
Dialysis Services
Dialysis facilities are eligible originating sites for dialysis services.
SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 40 (Jan. 1, 2024). & GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. 17 (IX-10). (Jan. 1, 2024) (Accessed Jan 2024).
Nursing Facility Specialized Services
Nursing facilities can be eligible sites for nursing facility specialized services.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 45 (Jan. 1, 2024). & GA Dept. of Community Health, Nursing Facility Services, p. H-7 (p. 223). (Jan. 1, 2024). (Accessed Jan 2024).
School-Based Settings (Local Education Agencies)
Telehealth services are allowed in school-based settings upon enrollment into COS 600. The following requirements must be met:
- The provider is an authorized health-care provider enrolled in Georgia Medicaid
- The client is a child who is receiving the service in a primary or secondary school-based setting
- The parent or legal guardian of the client provides consent before the service is provided
Telehealth services provided in a school-based setting are also a benefit if the referring provider delegates provision of services to a nurse practitioner, clinical nurse specialist, physician assistant, or other licensed specialist as long as the above-mentioned providers are working within the scope of their professional license and within the scope of their delegation agreement with the provider.
The school must enroll as a Health Check Provider in order to bill the telehealth originating site facility fee.
LEAs must submit an Attestation Form for the provision of telehealth services.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 50 (Jan. 1, 2024)., GA Dept. of CommunityHealth, Childrens Intervention School Services (Jan. 1, 2024), p. 9. (Accessed Jan 2024).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Originating sites are paid an originating site facility fee. Hospitals are eligible to receive reimbursement for a facility fee for telehealth when operating as the originating site. There is no separate reimbursement for telehealth serves when performed during an inpatient stay, outpatient clinic or emergency room visit or outpatient surgery, as these are all-inclusive payments.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 12 (Jan. 1, 2024). (Accessed Jan 2024).
Community Behavioral Health and Rehabilitation Services
Originating fees (as referenced in some of the other Georgia Medicaid programs) are not offered for telemedicine when utilized in the CBHRS category of service. Telemedicine costs are attributed to the services intervention rates.
SOURCE: GA Dept. of Community Health: Community Behavioral Health and Rehabilitation Services, p. 99 (Jan. 1, 2024), GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 33 (Jan. 1, 2024). (Accessed Jan 2024).
School-Based Settings (Local Education Agencies)
LEAs that enroll as Health Check providers to serve as telehealth originating sites only will be allowed to bill the originating site facility fee. The telehealth originating facility fee is reimbursed at the current DEFAULT rate.
SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 50-1 (Jan. 1, 2024). & GA Dept. of Community Health, Children’s Intervention Services, p. 46 (Jan. 1, 2024) GA Dept. of CommunityHealth, Childrens Intervention School Services (Jan. 1, 2024), p. 9. (Accessed Jan 2024).
Ambulance Providers
Ambulances may bill a separate origination site fee. The Telehealth originating fee (Q3014) cannot be billed in combination with other rendered EMS services.
SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 21 (Jan. 1, 2024). & Emergency Ambulance Services Handbook p. 17 (Jan. 1, 2024). (Accessed Jan 2024).
Dialysis Services
The originating facility/site (Dialysis Facility) will bill with the revenue code and procedure codes listed in the manual.
SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 40 (Jan. 1, 2024). & GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. IX-10 (17) (Jan. 1, 2024). (Accessed Jan 2024).
FQHC/RHC
FQHCs and RHCs that serve as an originating site for telehealth services are paid an originating site facility fee.
FQHCs and RHCs cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.
SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 38 (Jan. 1, 2024). GA Dept. of Community Health, GA Medicaid Federally Qualified Health Centers and Rural Health Clinics (Jan. 1, 2024), p. 23. (Accessed Jan 2024).
EPSDT Services – Health Check Program
LEAs enrolled as Health Check providers to serve as telemedicine originating sites only will be allowed to bill the telemedicine originating site facility fee (procedure code Q3014).
SOURCE: GA Dept. of Community Health, EPSDT Services – Health Check Program, p. 70 (X-7). (Jan. 1, 2024). (Accessed Jan 2024).
Children’s Intervention Services
Originating sites are paid an originating site facility fee for telehealth services by billing procedure code Q3014.
SOURCE: GA Dept. of Community Health, Division of Medicaid, Children’s Intervention Services (Jan. 1, 2024), p. 46. (Accessed Jan. 2024).