Medicaid & Medicare

Definitions

Each state differs in how they define the term ‘telemedicine’ or ‘telehealth’. In some states both terms are explicitly defined in law and/or policy and regulations. ‘Telehealth’ is sometimes used to reflect a broader definition, while “telemedicine” is used mainly to define the delivery of clinical services.  Additional variations of the term, primarily utilizing the “tele” prefix are also becoming more prevalent. Sometimes states use one definition that applies to Medicaid, private payers and professional regulation while other times states have separate definitions for each.

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Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Federal

Last updated 03/18/2024

Interactive telecommunications system means, except as otherwise provided in this …

Interactive telecommunications system means, except as otherwise provided in this paragraph, multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner. For services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology. A modifier designated by CMS must be appended to the claim for services described in this paragraph to verify that these conditions have been met.

SOURCE: 42 CFR Sec. 410.78 (Accessed Mar. 2024).

Telehealth is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance. At one time, telehealth in Medicaid had been referred to as telemedicine.

Telehealth seeks to improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the distant site. This  communication often requires  the use of interactive telecommunications equipment that can include both audio and video components, but can also be conducted via audio-only, as states deem appropriate.

Telehealth includes such technologies as telephones, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation.

SOURCE: Medicaid.gov.  Telehealth (Accessed Mar. 2024).

 

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Alabama

Last updated 02/26/2024

Telehealth medical services means “digital health, telehealth, telemedicine, and the …

Telehealth medical services means “digital health, telehealth, telemedicine, and the applicable technologies and devices used in the delivery of telehealth. The term does not include incidental communications between a patient and a physician.

  • Digital Health is defined as “the delivery of health care services, patient education communications, or public health information via software applications, consumer devices, or other digital media.”
  • Telehealth is defined as “the use of electronic and telecommunications technologies, including devices used for digital health, asynchronous and synchronous communications, or other methods, to support a range of medical care and public health services.”
  • Telemedicine is defined as “a form of telehealth referring to the provision of medical services by a physician at a distant site to a patient at an originating site via asynchronous or synchronous communications, or other devices that may adequately facilitate and support the appropriate delivery of care. The term includes digital health but does not include incidental communications between a patient and a physician.”

The term irregular or infrequent services refers to “telehealth medical services” occurring less than 10 days in a calendar year or involving fewer than 10 patients in a calendar year.

Synchronous is defined as “the real-time exchange of medical information or provision of care between a patient and a physician via audio/visual technologies, audio-only technologies, or other means.”

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Jan. 2024, (Accessed Feb. 2024).

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Alaska

Last updated 02/27/2024

“Telehealth” means the practice of health care delivery, evaluation, diagnosis, …

“Telehealth” means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment using the transfer of medical data, audio, visual, or data communications at two or more locations between a provider and recipient who are physically separated from each other.

SOURCE: AK Admin Code 7 AAC 110.639, (Accessed Feb. 2024).

“Telehealth” means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of health care data through audio, visual, or data communications, performed over two or more locations between providers who are physically separated from the recipient or from each other or between a provider and a recipient who are physically separated from each other.

SOURCE: AK Statute Sec. 47.05.270(e), (Accessed Feb. 2024).

“Alaska Medicaid will pay for telemedicine services delivered in the following manner:

  • Interactive method: Provider and patient interact in ‘real-time’ using video/camera and/or dedicated audio conference equipment.
  • Store-and-forward method: The provider sends digital images, sounds, or previously recorded video to a consulting provider at a different location. The consulting provider reviews the information and reports back his or her analysis.
  • Self-monitoring method: The patient is monitored in his or her home via a telemedicine application, with the provider indirectly involved from another location.”

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician Services, p. 31 (5/2013), (Accessed Nov. 2023).

Telemedicine means the practice of health care delivery, evaluation, diagnosis, consultation, or treatment, using the transfer of medical data through audio, video, or data communications that are performed over two or more locations between providers who are physically separated from the recipient or from each other.

SOURCE: AK Admin. Code, Title 7, 12.449; 12.49086.090 & Sec. 110.639 (Accessed Feb. 2024).

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Arizona

Last updated 05/29/2024

Telehealth:  Healthcare services delivered via asynchronous , audio-only, remote patient …

Telehealth:  Healthcare services delivered via asynchronous , audio-only, remote patient monitoring, teledentistry, or telemedicine.

Telemedicine: The practice of synchronous (real-time) health care delivery, diagnosis, consultation, and treatment and the transfer of medical data through interactive audio and video communications that occur in the physical presence of the member.

SOURCE: AZ Health Cost Containment System, AHCCCS Contract and Policy Dictionary, 4/24, pg. 113, (Accessed May 2024).

Telehealth means services delivered via:

  • Asynchronous (store and forward);
  • Remote patient monitoring;
  • Teledentistry; or
  • Telemedicine (real-time interactive audio-video)

Teledentistry is “the acquisition and transmission of all necessary subjective and objective diagnostic data through interactive audio, video or data communications by an AHCCCS registered dental provider to a dentist at a distant site for triage, dental treatment planning, and referral.”

Telemedicine is “the practice of synchronous (real-time) health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (5/2/24), pg. 49-50, & IHS/Tribal Provider Billing Manual, (5/2/2024), pg. 52-53. (Accessed May 2024).

Telemedicine services include health care delivery, diagnosis, consultation, treatment, and the transfer of medical data through real-time synchronous interactive audio and video communications that occur in the physical presence of the member.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 2). Approved 8/29/23. (Accessed May 2024).

Telehealth is the use of digital technology, like computers, telephones, smartphones, and tablets, to access health care services remotely.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed May 2024).

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Arkansas

Last updated 05/27/2024

Telemedicine is defined as the use of electronic information and

Telemedicine is defined as the use of electronic information and communication technology to deliver healthcare services including without limitation, the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a client. Telemedicine includes store-and-forward technology and remote client monitoring.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated April 1, 2024 & Section III Billing Documentation.  Rule 305.000.  Updated Jan. 1, 2022 (Accessed May 2024).

Provider-Led Arkansas Shared Savings Entity (PASSE) Program

The use of electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient. It included store-and-forward technology and remote patient monitoring. The following activities will not be considered a reportable encounter when delivered to a member of the PASSE:

  • Audio-only communication, including without-limitation, interactive audio;
  • A facsimile machine;
  • Text messaging; or
  • Electronic mail systems.

Virtual services are telemedicine, telehealth, e-consulting, and provider home visits that are part of a patient care treatment plan and are provided at the individual’s home or in a community setting. These services are provided using mobile secure telecommunication devices, electronic monitoring equipment, and include clinical provider care, behavioral health therapies, speech, occupational and physical therapy services, and treatment provided to an individual at their residence.

SOURCE: PASSE Program (1/1/23) Section II, Program Policy. (Accessed May 2024)

Rural Health Centers

Arkansas Medicaid defines telemedicine services as medical services performed as electronic transactions in real time.

SOURCE: AR Medicaid Provider Manual. Section II Rural Health.  Rule 211.300. p. 6, Updated 2/1/24. (Accessed May 2024).

“Telemedicine” means the use of electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient.

Telemedicine includes store-and-forward and remote patient monitoring.

For the purposes of this subchapter, “telemedicine” does not include the use of:

  • Audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan.
  • As with other medical services covered by a health benefit plan, documentation of the engagement between patient and provider via audio-only communication shall be placed in the medical record addressing the problem, content of conversation, medical decision-making, and plan of care after the contact.
  • The documentation described in subdivision (7)(C)(i)(b)of this section is subject to the same audit and review process required by payers and governmental agencies when requesting documentation of other care delivery such as in-office or face-to-face visits;
  • A facsimile machine;
  • Text messaging; or
  • Email

SOURCE: AR Code 23-79-1601(7). (Accessed May 2024).

Ambulance Services

“Telemedicine” means the use of audiovisual electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient.

“Telemedicine” includes store-and-forward technology and remote patient monitoring.

“Telemedicine” does not include the use of audio-only electronic technology.

SOURCE: AR Code 20-13-108 & 23-79-2702, (Accessed May 2024).

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California

Last updated 04/02/2024

“Telehealth” means the mode of delivering health care services and …

“Telehealth” means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store-and-forward transfers.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth (Jan. 2023). Pg. 1. (Accessed Apr. 2024).

“Telehealth” means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous, real-time interactions between a patient and a health care provider located at a distant site.

SOURCE: CA Department of Health Care Services. Medi-Cal LEA Telehealth Manual. Jun. 2023. Pg. 1. (Accessed Apr. 2024).

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Colorado

Last updated 04/25/2024

Telemedicine means the delivery of medical and health-care services and …

Telemedicine means the delivery of medical and health-care services and any diagnosis, consultation, or treatment using interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission).

SOURCE: Colorado Adopted Rule 8.095.1.A. (Accessed Apr. 2024).

Telemedicine is not a unique service, but a means of providing services approved by Health First Colorado through live interactive audio and video telecommunications equipment.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual.” (Accessed Apr. 2024).

Telemedicine” means the delivery of medical and health-care services and any diagnosis, consultation, or treatment using interactive audio, interactive video, or interactive data communication.

SOURCE: Colorado Revised Statute 25.5.-4-103 (25.7) (Accessed Apr. 2024).

Telehealth remote monitoring services include the installation and on-going remote monitoring of clinical data through technologic equipment in order to detect minute changes in the client’s clinical status that will allow Home Health agencies to intercede before a chronic illness exacerbates requiring emergency intervention or inpatient hospitalization.

SOURCE: CO Medical Assistance Program, Home Health Billing Manual, (9/23), (Accessed Apr. 2024). 

Telehealth allows for the monitoring of a member’s health status remotely via equipment, which transmits data from the member’s home to the member’s home health agency. The purpose of providing telehealth services is to assist in the effective management and monitoring of members whose medical needs can be appropriately and cost-effectively met at home through the frequent monitoring of data and early intervention.

SOURCE: CO Department of Health Care Policy and Financing. “Home Health Telehealth”. (Accessed Apr. 2024).

Home and Community-Based Services (HCBS)

Telehealth means the broad use of technologies to provide services and supports through HCBS waivers, when the Member is in a different location from the provider.

SOURCE: Colorado Adopted Rule 8.615.1 (M). (Accessed Apr. 2024).

Telehealth means the provision of health care remotely using telecommunications technologies to provide approved services and supports through HCBS waivers when the Member is in a different location from the provider.

SOURCE: 10 CCR 2505-10, Section 8.7402 as added by Permanent Rule. (Accessed Apr. 2024).

Early Childhood Intervention Program

Telehealth means a method of service provision that utilizes secure interactive videoconferencing to deliver early intervention services.

SOURCE: 8 CCR 1405-1, Section 5.103. (Accessed Apr. 2024).

Behavioral Health

“Telehealth” means delivery of services through telecommunications systems that are compliant with all federal and state protections of individual privacy, to facilitate individual assessment, diagnosis, consultation, treatment, and/or service planning/case management when the individual and the person providing services are not in the same physical location. Telecommunications systems used to provide telehealth include information, electronic, and communication technologies. Telehealth may include audio-only methods in accordance with state and federal regulation unless noted otherwise.

SOURCE: 2 CO Code of Regulation 502-1, 1.2, p. 18, 2.9, p. 40, 10.1, p. 174, 21.200.41, p. 357. (Accessed Apr. 2024).

Program of All-Inclusive Care for the Elderly (PACE)

Telehealth means a mode of delivery of health care services through HIPAA-compliant telecommunications systems, including information, electronic, and communication technologies, remote monitoring technologies and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the covered person is located at an originating site and the provider is located at a distant site.

SOURCE: 10 CCR 2505-10, Section 8.497 as proposed to be amended by Permanent Rule. (Accessed Apr. 2024).

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Connecticut

Last updated 04/12/2024

Effective Now Until June 30, 2024

“Telehealth” means the mode …

Effective Now Until June 30, 2024

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical, oral and mental health, and includes interaction between the patient at the originating site and the telehealth provider at a distant site, synchronous interactions, asynchronous store and forward transfers or remote patient monitoring, but does not include interaction through facsimile, texting or electronic mail.

SOURCE: SB 2 (2022 Session), Sec. 32.HB 5596 (2021 Session), Sec. 1. (Accessed Apr. 2024).

Permanent Statute

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store and forward transfers or remote patient monitoring. Telehealth does not include the use of facsimile, audio-only telephone, texting or electronic mail.

SOURCE: CT General Statute 19a, Sec. 906. (Accessed Apr. 2024).

Telehealth includes (1) telemedicine (synchronized audio-visual two-way communication services) and, where specified by DSS, (2) audio-only two-way synchronized communication services delivered via telephone.

SOURCE: CT Policy – Provider Bulletin 2023-38. May 2023. (Accessed Apr. 2024).

“Telehealth” means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical, oral and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store and forward transfers or remote patient monitoring. “Telehealth” does not include the use of facsimile, texting or electronic mail.

SOURCE: CT General Statute 17b, Sec. 245g. (Accessed Apr. 2024).

Definition for Telemedicine Demonstration Program for FQHCs: “Telemedicine means the use of interactive audio, interactive video or interactive data communication in the delivery of medical advice, diagnosis, care or treatment and includes services described in subsection (d) of section 20-9 and 42 CFR 410.78(a)(3). Telemedicine does not include the use of facsimile or audio-only telephone.”

SOURCE: CT General Statute 17b, Sec. 245c. (Accessed Apr. 2024).

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Delaware

Last updated 04/24/2024

Telehealth can be a cost-effective alternative to face-to-face in-person encounters …

Telehealth can be a cost-effective alternative to face-to-face in-person encounters under several circumstances, including where access to care is compromised due to the lack of available service providers in the patient’s geographical location. This definition is modeled on Medicare’s definition of telehealth services located at 42 CFR §410.78. Note that the Federal Medicaid statute (Title XIX of the Social Security Act) does not recognize telehealth as a distinct service.

For purposes of DMAP, telehealth means the use of information and communication technologies consisting of telephones, remote patient monitoring devices, or other electronic means to provide or support health care delivery. It occurs when the patient is at an originating site and the health care provider is at a distant site.

Telemedicine is a subset of telehealth that is the delivery of clinical health care and other services, as authorized under Delaware Medicaid, by means of real-time two-way electronic interactive telecommunications system between the patient at the originating site and the health care provider is at the distant site. Two-way electronic interactive communications systems include audio, visual, or other telecommunication or electronic communication, including the application of secure video conferencing or store and forward transfer technology. Telemedicine facilitates the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health.

Interactive Communication is defined as telehealth delivered using multimedia communication technology that permits 2-way, real-time, interactive communications between a health care provider at a distant site and the patient at the originating site.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 01/12/24. Ch. 16 Telemedicine, 16.1 & 16.2 (Accessed Apr. 2024).

“Telemedicine is the use of medical or behavioral health information exchanged from one site to another via an electronic interactive telecommunications system to improve a patient’s health. Telemedicine services are provided with specialized equipment at each site including real-time streaming via the use of:

  • Video Camera
  • Audio Equipment
  • Monitor
  • The telecommunications must permit real-time encryption of the interactive audio and video exchanges with the consulting provider.”

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement. Dec. 14, 2016.  Sec. 1.8. (Accessed Apr. 2024).

Personal Assistance Services Agencies, Home Health Agencies and Aides

“Telehealth Mechanism” means the use of information exchange from 1 site to another via an electronic interactive telecommunication system. Telehealth is provided with specialized equipment at each site including real-time streaming via the use of video streaming and audio equipment. The telecommunications must permit real-time encryption of the interactive audio and video exchanges with the personal assistance services agency.

SOURCE: 16 DE Admin. Code 3345, 3350, 3351, as amended by 3345 Final Order, 3350 Final Order, and 3351 Final Order. Jul 2023. (Accessed Apr. 2024).

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District of Columbia

Last updated 06/05/2024

Telemedicine is a service delivery model that delivers healthcare services …

Telemedicine is a service delivery model that delivers healthcare services through a two-way, real time interactive video-audio communication or audio-only communication for the purpose of evaluation, diagnosis, consultation, or treatment.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.2; Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 2023, pg. 2. (Accessed Jun. 2024).

Telemedicine is a service delivery model that delivers healthcare services through a two-way, real time interactive video-audio communication for the purpose of evaluation, diagnosis, consultation, or treatment.

SOURCE: Physicians Billing Manual. DC Medicaid. (Jan. 2024) Sec. 15.1, P. 51; FQHC Billing Manual (Oct. 2023), 15.1, P. 51.; Clinic Billing Manual (Sept. 2023) 15.1, P. 49.; Behavioral Health Billing Manual (Feb. 2024) 14.1, p. 68. (Accessed Jun. 2024).

“Telehealth” means the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through email messages or facsimile transmissions are not included.

SOURCE; DC Code Sec. 31-3861 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 2023, pg. 1, (Accessed Jun. 2024).

“Telehealth” means the delivery of healthcare services using interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment, provided, that services delivered through audio-only telephones, electronic mail messages, or facsimile transmissions are not included.

SOURCE: Physicians Billing Manual, DC Medicaid (Jan. 2024). Section 15, p. 51. Clinic Billing Manual (Sept. 2023) 15, P. 49; Behavioral Health Billing Manual (Feb. 2024) 14, p. 68. FQHC Billing Manual (Oct. 2023), 15, P 51. (Accessed Jun. 2024).

For the purposes of coverage by the Department of Health Care Finance (DHCF), telehealth and telemedicine shall be deemed synonymous.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 2023, pg. 1 & Physicians Billing Manual, DC Medicaid (Jan. 2024). Section 15, p. 51.  Clinic Billing Manual (Sept. 2023) 15, P. 49; Behavioral Health Billing Manual (Feb. 2024) 14, p. 68. FQHC Billing Manual (Oct. 2023), 15, P 51. (Accessed Jun. 2024).

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Florida

Last updated 06/11/2024

Telemedicine is the practice of health care delivery by a …

Telemedicine is the practice of health care delivery by a practitioner who is in a site other than the site where a recipient is located, using interactive telecommunications equipment that minimally includes real time, two-way interactive communication between a recipient and a practitioner using audio and video equipment.

SOURCE: FL Medicaid, Alert, Ending of Federal Public Health Emergency: Updated Co-Payment and Telemedicine Guidance for Medical and Behavioral Health Providers, May 4, 2023, (Accessed Jun. 2024).

Telemedicine – The practice of health care delivery by a practitioner who is located at a site other than the site where a recipient is located for the purposes of evaluation, diagnosis, or treatment.

SOURCE: FL Admin Code 59G-1.057. (Accessed Jun. 2024).

Substance Abuse Services

“Telehealth” as defined in Section 456.47(1)(a), F.S.

“Telehealth” means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include e-mail messages or facsimile transmissions.

SOURCE: FL Admin Code 65D-30.002 & FL Statute 456.47, (Accessed Jun. 2024).

Children’s Medical Services

Telemedicine is “the use of telecommunication and information technology to provide clinical care to individuals at a distance, and to transmit the information needed to provide that care.”

SOURCE: FL Admin Code 64C-8-001(6). (Accessed Jun. 2024).

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Georgia

Last updated 05/16/2024

Telemedicine is the use of medical information exchange from one …

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-1/168 (Apr. 2024). (Accessed May 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, (Apr 1, 2024). GA Community Behavioral Health Rehabilitation Services Manual p. 100 (Apr. 1, 2024) (Accessed May. 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, (Apr 1, 2024). (Accessed May. 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. 99 (Apr. 1, 2024) (Accessed May. 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. 6, (Apr 1, 2024)  (Accessed May. 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 (Mar 2024), p. 388 (Accessed May 2024).

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Hawaii

Last updated 06/04/2024

“Telehealth” means the use of telecommunications services, as defined in …

“Telehealth” means the use of telecommunications services, as defined in section 269‑1, to encompass four modalities:  store-and-forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non‑interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site. Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.”

SOURCE: HI Revised Statutes § 346-59.1(g). (Accessed Jun. 2024).

Telehealth services is the use of communication equipment to link health care practitioners and patients in different locations. It may be used in place of a face-to-face, “hands on” encounter for consultation, office visits, individual psychotherapy and pharmacologic management. For purposes of this section, the term “patient” refers to individuals eligible for medical assistance.

SOURCE: Code of HI Rules 17-1737-51.1(a). (Accessed Jun. 2024).

Audio-visual real-time telehealth – Multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QI-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).

Dentistry & Federally Qualified Health Centers

“Telehealth” means the use of telecommunication services to transmit patient health information for interpretation and diagnosis while a patient is at an originating site and the health care provider is at a distant site. . It is an intended to facilitate access for patients who would otherwise not receive services due to geographic barriers. “Teledentistry” is a form of telehealth.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 37 (Apr. 2024) (Accessed Jun. 2024).

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Idaho

Last updated 06/17/2024

Virtual care or telehealth means providing medically necessary health care …

Virtual care or telehealth means providing medically necessary health care services without actual physical contact, through the use of electronic means. Under Idaho Medicaid this means the participant and the provider are interacting in real-time or “live” from two physically different locations, by video or telephone.

Source: Medicaid Telehealth Policy, General Information and Requirements for Providers. Section 9.12 Pg. 1313 Rev. Jan. 30, 2024 ,Idaho MedicAide May 2023.  (Accessed Jun. 2024).

Covered virtual care services are real-time communication through interactive technology that enables a provider and a patient at two locations separated by distance to interact simultaneously through two-way video and audio transmission.

SOURCE: Idaho Medicaid Provider Handbook: Therapy Services, Section 4.6, p. 38, May 16, 2024. (Accessed Jun. 2024).

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Illinois

Last updated 02/26/2024

“Telemedicine” is the use of a telecommunication system to provide …

“Telemedicine” is the use of a telecommunication system to provide medical services for the purpose of evaluation and treatment when the patient is at one medical provider location and the rendering provider is at another location.

Source: IL Admin. Code, Title 89,140.403(a)(9) & IL Dept. of Healthcare and Family Svcs., Handbook for Podiatrists, F-200 (VI), p. 7 (Oct. 2016). (Accessed Feb. 2024).

Telehealth is the use of a telecommunication system to provide medical services between places of lesser and greater medical capability and/or expertise, for the purpose of evaluation and treatment. Medical data exchanged can take the form of multiple formats: text, graphics, still images, audio and video. The information or data exchanged can occur in real time (synchronous) through interactive video or multimedia collaborative environments or in near real time (asynchronous) through “store and forward” applications.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7, p. 25 (June 2021).Handbook for Podiatrists, F-200(220.6) (Oct. 2016) & Handbook for Encounter Clinic Services, D-210.2,  pg. 16-17 (Aug. 2016). (Accessed Feb. 2024).

“Telehealth” means services provided via a telecommunication system.

SOURCE: IL Admin. Code, Title 89,140.403(a)(8). (Accessed Feb. 2024). 

Telepsychiatry: Originating Site: The use of a telecommunication system to provide medical services between places of lesser and greater medical capability and/or expertise, for the purpose of evaluation and treatment. Medical data exchanged can take the form of multiple formats: text, graphics, still images, audio and video. The information or data exchanged can occur in real time (synchronous) through interactive video or multimedia collaborative environments or in near real time (asynchronous) through “store and forward” applications.  The Originating Site is the site where the customer is located.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Community-Based Behavioral Services Providers, 208.3.1 pg. 42 (June 6., 2022). (Accessed Feb. 2024).

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Indiana

Last updated 03/08/2024

Telehealth means the delivery of healthcare services between a practitioner …

Telehealth means the delivery of healthcare services between a practitioner in one location (the distant site) and a patient in another location (the originating site), using interactive electronic communications and information technology, in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), including any of the following:

  • Secure videoconferencing
  • Store-and-forward technology
  • Remote patient monitoring technology

SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Policies and Procedures (Nov. 1, 2023), p. 1.  (Accessed Mar. 2024).

Telehealth means the delivery of healthcare services using interactive electronic communications and information technology, in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), including: secure videoconferencing, store-and-forward technology or remote patient monitoring technology, between a provider in one location and a patient in another location. The term does not include the use of the following unless the practitioner has an established relationship with the patient: electronic mail, an instant messaging conversation, facsimile, internet questionnaire or an internet consultation.

SOURCE: IHCP Bulletin BT202142 (June 8, 2021). (Accessed Mar. 2024).

Telehealth services has the same meaning as telehealth in IN Code 25-1-9.5-6.

As used in this chapter, “telehealth” means the delivery of health care services using interactive electronic communications and information technology, in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), including:

  • secure videoconferencing;
  • store and forward technology; or
  • remote patient monitoring technology;

between a provider in one (1) location and a patient in another location.

The term does not include the use of the following unless the practitioner has an established relationship with the patient:

  • Electronic mail
  • An instant messaging conversation
  • Facsimile
  • Internet questionnaire
  • Internet consultation

The term does not include a health care service provided by:

  • an employee of a practitioner; or
  • an individual who is employed by the same entity that employs the practitioner;

who is performing a health care service listed in section 2.5(a)(2), 2.5(a)(3), or 2.5(a)(4) of this chapter under the direction and that is customarily within the specific area of practice of the practitioner.

SOURCE: IN Code, 12-15-5-11. (Accessed Mar. 2024).

“Telehealth services” means the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across a distance.

SOURCE: IN Admin Code Title 405, Sec. 5-2-27 & (Home Health Services) IN Admin Code Title 405 1-4.2-2, (Accessed Mar. 2024).

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Iowa

Last updated 04/22/2024

Crisis Response Services

“Telehealth” is the use of electronic information …

Crisis Response Services

“Telehealth” is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the Internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

SOURCE: Iowa Admin Code 441—24.20(225C) Definitions, p. 2 (Accessed Apr. 2024)

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Kansas

Last updated 03/04/2024

Telemedicine is the use of communication equipment to link health …

Telemedicine is the use of communication equipment to link health care practitioners and patients in different locations. This technology is used by health care providers for many reasons, including increased cost efficiency, reduced transportation expenses, improved patient access to specialists and mental health providers, improved quality of care, and better communication among providers.

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31 (Jan. 2024); FQHC/RHC, p. 8-14 (Dec. 2023), (Accessed Mar. 2024).

‘‘Telemedicine,’’ including ‘‘telehealth,’’ means the delivery of healthcare services or consultations while the patient is at an originating site and the healthcare provider is at a distant site. Telemedicine shall be provided by means of real-time two-way interactive audio, visual, or audio-visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, that facilitate the assessment, diagnosis, consultation, treatment, education and care management of a patient’s healthcare.

‘‘Telemedicine’’ does not include communication between:

    1. Healthcare providers that consist solely of a telephone voice-only conversation, email or facsimile transmission; or
    2. A physician and a patient that consists solely of an email or facsimile transmission.

SOURCE:  KS Statute Ann. § 40-2,211(5) & KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-32 (Jan. 2024). (Accessed Mar. 2024).

Telemedicine is the use of communication equipment to link health care practitioners and individuals in different locations.

Source: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Certified Community Behavioral Health Clinic (CCBHC), p. 8-5 (Jan. 2024). (Accessed Mar. 2024).

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Kentucky

Last updated 03/19/2024

Telehealth or digital health is defined in KRS 211.332 (5).…

Telehealth or digital health is defined in KRS 211.332 (5).

“Telehealth” or “digital health” means a mode of delivering healthcare services through the use of telecommunication technologies, including but not limited to synchronous and asynchronous technology, remote patient monitoring technology, and audio-only encounters, by a health care provider to a patient or to another health care provider at a different location. Shall not include:

  • The delivery of health care services through electronic mail, text, chat, or facsimile unless a state agency authorized or required to promulgate administrative regulations relating to telehealth determines that health care services can be delivered via these modalities in ways that enhance recipient health and well-being and meet all clinical and technology guidelines for recipient safety and appropriate delivery of services; or
  • Basic communication between a health care provider and a patient, including but not limited to appointment scheduling, appointment reminders, voicemails, or any other similar communication intended to facilitate the actual provision of healthcare services either in-person or via telehealth; and

Unless waived by the applicable federal authority, shall be delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996.

SOURCE: KY 900 KAR 12:005KY Revised Statute 211.332. (Accessed Mar. 2024).

“Telehealth consultation means a medical or health consultation, for purposes of patient diagnosis or treatment, that meets the definition of telehealth in this section.”

SOURCE: KY Revised Statutes. 205.510. (Accessed Mar. 2024).

Telehealth means two (2)-way, real time interactive communication between a patient and a physician or practitioner located at a distant site for the purpose of improving a patient’s health through the use of interactive telecommunication equipment that includes, at a minimum, audio and video equipment.

SOURCE: KY 907 KAR 1:055 (36). (Accessed Mar. 2024).

“Telemedicine” means two-way, real time interactive communication between a patient and a physician or practitioner located at a distant site for the purpose of improving a patient’s health through the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

SOURCE: KY 907 KAR 9:005. (Accessed Mar. 2024).

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Louisiana

Last updated 06/04/2024

“Telehealth” means healthcare services, including behavioral health services, provided by …

“Telehealth” means healthcare services, including behavioral health services, provided by a healthcare provider, as defined in this Section, to a person through the use of electronic communications, information technology, asynchronous store-and-forward transfer technology, or synchronous interaction between a provider at a distant site and a patient at an originating site, including but not limited to assessment of, diagnosis of, consultation with, treatment of, and remote monitoring of a patient, and transfer of medical data. The term “telehealth” shall not include any of the following:

  • Electronic mail messages and text messages that are not compliant with applicable requirements of the Health Insurance Portability and Accountability Act of 1996, as amended, 42 U.S.C. 1320d et seq.
  • Facsimile transmissions.

SOURCE: LA Revised Statutes 40:1223.3, (Accessed Jun. 2024).

“Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or other licensed practitioner and a beneficiary are not in the same location. The telecommunications system shall include, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the beneficiary at the originating site and the physician or other licensed practitioner at the distant site. The telecommunications system must be secure, ensure patient confidentiality, and be compliant with the requirements of the Health Insurance Portability and Accountability Act.”

SOURCE: LA Dept. of Health, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 166. (As issued 6/27/22), & MCO Manual (updated 6/11/24), pg. 176, (Accessed Jun. 2024).

Behavioral Health Outpatient Services, Outpatient Therapy by Licensed Practitioners:  Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or LMHP and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.

Rehabilitation:  For dates of service on or after May 1, 2023, telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician, LMHP, or other qualified professional (see staff qualifications) and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.

Addiction Services: Telemedicine/telehealth is the use of a telecommunications system to render healthcare services when a physician or LMHP and a member are not in the same location. Telehealth does NOT include the use of text, e-mail, or facsimile (fax) for the delivery of healthcare services.

SOURCE: LA Dept. of Health, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 113, 171 & 199 (As issued 5/13/24). (Accessed Jun. 2024).

Telecare is a delivery of care services to recipients in their home by means of telecommunications and/or computerized devices to improve outcomes and quality of life, increase independence and access to health care, and reduce health care costs. Telecare services include the following:

  • Activity and sensor monitoring;
  • Health status monitoring; and
  • Medication dispensing and monitoring.

See manual for description of monthly telecare services.

SOURCE: LA Dept. of Health, Community Choices Waiver Provider Manual, Chapter Seven of the Medicaid Svcs. Manual, Section 7.1, p. 23-24 (As issued 4/13/22). (Accessed Jun. 2024).

EPSDT Health and IDEA Related Services

Telemedicine/telehealth is not a covered service, but is a service delivery method. Louisiana Medicaid encourages the use of this delivery method, when appropriate, for any and all healthcare services (i.e., not just those related to COVID-19 symptoms). Louisiana Medicaid allows for the telemedicine/telehealth mode of delivery for many common healthcare services.

SOURCE: LA Dept. of Health, Provider Manual, Chapter Twenty of the Medicaid Svcs. Manual, Section 20.1, p. 13 (As issued 3/14/24). (Accessed Jun. 2024).

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Maine

Last updated 05/20/2024

Telehealth Services: The use of information technology by a Health …

Telehealth Services: The use of information technology by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment. Telehealth Services may be either Telephonic or Interactive and includes synchronous encounters, asynchronous encounters, store-and-forward transfers, and telemonitoring.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 2 (11/6/23). (Accessed May. 2024).

“Telehealth,” as it pertains to the delivery of MaineCare services, means the use of information technology and includes synchronous encounters, asynchronous encounters, store and forward transfers and telemonitoring.

SOURCE: ME Statute Sec. 22:855.3173-H(D). (Accessed May 2024).

Teledentistry, as it pertains to the delivery of oral health care services, means the use of interactive, real-time visual, audio or other electronic media for the purposes of education, assessment, examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by individuals licensed under 32 MRS Chapter 143 (Dental Professions) and includes synchronous encounters, asynchronous encounters, remote patient monitoring, and mobile oral health care in accordance with practice guidelines specified in rules adopted by the Board.

SOURCE: ME Benefits Manual, Dental Services and Reimbursement Methodology, 10-144, Ch. II, Sec. 25, pg. 1, (Sept. 28, 2022), (Accessed May 2024).

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Maryland

Last updated 05/24/2024

“Telehealth” means the delivery of medically necessary somatic, dental, or …

“Telehealth” means the delivery of medically necessary somatic, dental, or behavioral health services to a patient at an originating site by a distant site provider through the use of technology–assisted communication.

“Telehealth” includes:

  • Synchronous and asynchronous interactions;
  • From July 1, 2021, to June 30, 2025, both inclusive, an audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service; and
  • Remote patient monitoring services.

“Telehealth” does not include the provision of health care services solely through:

  • Except as provided above, an audio–only telephone conversation;
  • An e–mail message; or
  • A facsimile transmission.

SOURCE: MD Health General Code 15-141.2(a)(7). (Accessed May 2024).

“Telehealth means the delivery of medically necessary somatic or behavioral health services to a patient at an originating site by distant site provider, through the use of technology-assisted communication.”

SOURCE: MD Medical Assistance Program Professional Services Provider Manual (Jan 2024), p. 12. (Accessed May 2024).

“Telehealth” means the synchronous delivery of medically necessary services to a patient at an originating site by distant site provider, through the use of technology-assisted communication.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.02. (Accessed May 2024).

Hospitals

“Telehealth services means the delivery of health care services provided through the use of interactive audio, video, or other telecommunications or electronic technology by a health care provider at a hospital to a patient at a location other than at the hospital, or to a patient at the hospital where the provider is at a location other than the hospital, which enables the patient to interact with the health care provider at the time the health care services are provided.”

SOURCE: Code of Maryland Admin. Regs. Sec. 10.37.10.07-1. (Accessed May 2024).

“Telemedicine” means the use of interactive audio, video, or other telecommunications or electronic technology by a physician in the practice of medicine outside the physical presence of the patient. “Telemedicine” does not include:

  • An audio only telephone conversation between the physician and patient;
  • An electronic mail message between a physician and a patient; or
  • A facsimile transmission between a physician and a patient.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.07.01.01(B)(33). (Accessed May 2024).

Individualized Education Program (IEP)/Individualized Family Service Plan (IFSP)

Telehealth – The delivery of medically necessary services to a patient at an originating site by distant site provider, through the use of technology-assisted communication.

SOURCE: MD Dept of Health, Medicaid Policy & Procedure Manual For Services Delivered through the IEP/IFSP (January 1, 2024). p. 6.  (Accessed May 2024).

Student Telehealth Appointments – Effective July 1, 2024

Telehealth means a mode of delivering health care services through the use of telecommunications technologies by a health care practitioner to a patient at a different physical location than the health care practitioner.

SOURCE: MD Education Code 4–142 as proposed to be added by HB 522/SB 492 (2024 Legislative Session). (Accessed May 2024).

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Massachusetts

Last updated 04/15/2024

Telehealth – the use of synchronous or asynchronous audio, video, …

Telehealth – the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to:

  • interactive audio-video technology;
  • remote patient monitoring devices;
  • audio-only telephone; and
  • online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

SOURCE: MA Regulations Sec. 418.402 & 101 CMR Sec. 362.02, 130 CMR 461.402 [definition found in multiple additional manual sections] (Accessed Apr. 2024).

”Telehealth”, the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

SOURCE: Massachusetts General Laws Part I, Title IV, Ch. 32A. Sec. 30 . (Accessed Apr. 2024).

Telehealth is the use of electronic communication and information technologies to provide or support clinical care at a distance. The delivery of services through telehealth involves the use of secure interactive audio and video telecommunications systems that permit two-way, real-time communication between a patient and a provider.

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Apr. 2024).

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Michigan

Last updated 04/29/2024

Telemedicine is the use of telecommunication technology to connect a …

Telemedicine is the use of telecommunication technology to connect a beneficiary with a Medicaid enrolled health care professional in a different location. The Michigan Department of Health and Human Services (MDHHS) covers both synchronous (real-time interactions) and asynchronous (over separate periods of time) telemedicine services.

MDHHS aligns the definition of telemedicine with Section 3476 of the Insurance Code of 1956, 1956 PA 218 MCL 500.3476, as updated on December 20, 2017. Therefore, “Telemedicine” means the use of an electronic media to link beneficiaries with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the beneficiary via a real-time, interactive audio or video (or both) telecommunications system, and the beneficiary must be able to interact with the off-site health care professional at the time the services are provided.

When referenced within MDHHS Telemedicine Policy, face-to-face refers to either an in-person visit, or a visit performed via simultaneous audio/visual technology.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2118 & 2121, Apr. 1, 2024 &  MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Apr. 2024).

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.

SOURCE: MI Compiled Law Services, Section 330.1100(d)(16), (Accessed Apr. 2024).

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.

SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) & MI Compiled Law Services Sec. 5501401k(2). (Accessed Apr. 2024).

Behavioral Health – Assertive Community Treatment Program

Telemedicine is the use of telecommunications and information technologies for the provision of psychiatric services to ACT consumers and is subject to the same service provisions as psychiatric services provided in person. The telemedicine modifier must be used in conjunction with the ACT encounter reporting code when telemedicine is used

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 3684, Apr. 1, 2024. (Accessed Apr. 2024).

Telemedicine for MTM Services

Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services. Telemedicine must be obtained through real-time interactions between the beneficiary’s physical location (originating site) and the pharmacist provider’s physical location (distant site). MTM telemedicine audio/visual services are provided to beneficiaries through hardwire or internet connection. It is the expectation that providers and facilitators involved in telemedicine are trained in the use of equipment and software prior to servicing beneficiaries.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1820, Apr. 1, 2024, (Accessed Apr. 2024).

Behavioral Health – Child Therapy

Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed therapy services may be prohibitive). Telemedicine must be obtained through real-time interaction between the child’s/family’s physical location and the provider’s physical location. Telemedicine services are provided to patients through hardwire or internet connection. It is the expectation that providers involved in telemedicine are trained in the use of equipment and software prior to servicing children/families.

The technology used must meet the requirements of audio and visual compliance in accordance with current regulations and industry standards. Refer to the General Information for Providers Chapter of this manual for the complete Health Insurance Portability and Accountability Act (HIPAA) compliance requirements

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 342 Apr. 1, 2023  (Accessed Apr. 2024).

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Minnesota

Last updated 02/29/2024

“Telehealth” means the delivery of health care services or consultations …

“Telehealth” means the delivery of health care services or consultations using real-time two-way interactive audio and visual communication or accessible telehealth video-based platforms to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care. Telehealth includes: the application of secure video conferencing consisting of a real-time, full-motion synchronized video; store-and-forward technology; and synchronous interactions, between a patient located at an originating site and a health care provider located at a distant site. Telehealth does not include communication between health care providers, or between a health care provider and a patient that consists solely of an audio-only communication, email, or facsimile transmission or as specified by law

SOURCE:  MN Statute 256.0625, Subd. 3b, (e)(1), (Accessed Feb. 2024).

Telehealth is defined as the delivery of health care services or consultations through the use of real time, two-way interactive audio and visual communications. The purpose of telehealth is to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment education, and care management of a patient’s health care while the patient is at an originating site and the licensed health care provider is at a distant site.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Nov. 8, 2023 & Telehealth Services, As revised Jun. 2, 2023. (Accessed Feb. 2024).

Telehealth includes:

  • Secure video conferencing
  • Store-and-forward technology
  • Audio-only communication between the health care provider and the patient (until July 1, 2025)

SOURCE: MN Dept. of Human Services, Provider Manual, Telehealth Services, As revised Jun. 2, 2023. (Accessed Feb. 2024).

“Telehealth” means the practice of medicine as defined in Minnesota Statutes, section 147.081, subdivision 3, when the health care practitioner is not in the physical presence of the patient.

SOURCE: MN Admin Rules 4770.4002 Subp. 23. (Accessed Feb. 2024).

Chemical Dependency Treatment

“Telehealth” means the delivery of a substance use disorder treatment service while the client is at an originating site and the health care provider is at a distant site via telehealth as defined in section 256B.0625, subdivision 3b, and as specified in section 254B.05, subdivision 5, paragraph (f).

SOURCE: MN Statute Sec. 245G.01 Subd. 26. (Accessed Feb. 2024).

Home Health Agency

“Telehomecare” means the use of telecommunications technology via live, two-way interactive audiovisual technology which may be augmented by store-and-forward technology.

SOURCE: MN Statute Sec. 256B.0653(l). (Accessed Feb. 202).

Teledentistry Services

Teledentistry is the delivery of dental care services or consultations while the patient is at an originating site and the dentist is at a distant site.

SOURCE: MN Department of Human Services, Teledentistry Services, Revised Jan. 16, 2024. (Accessed Feb. 2024).

Telehealth Delivery of Mental Health Services

Telehealth is the delivery of health care services or consultations through the use of real time, two-way interactive audio and visual communications. Telehealth provides or supports health care delivery and facilitates the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care while the patient is at originating site and the licensed health care professional is at a distant site. Telehealth includes the application of secure video conferencing, store-and-forward technology, and synchronous interactions between a patient located at an originating site and a health care provider located at a distant site.

SOURCE: MN Dept. of Human Services, Provider Manual, Telemedicine Delivery of Mental Health Services, Revised Oct. 17, 2022, (Accessed Feb. 2024).

 

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Mississippi

Last updated 04/05/2024

“Telemedicine” means the delivery of health care services such as …

“Telemedicine” means the delivery of health care services such as diagnosis, consultation, or treatment through the use of HIPAA-compliant telecommunication systems, including information, electronic and communication technologies, remote patient monitoring services and store-and-forward telemedicine services. Telemedicine, other than remote patient monitoring services and store-and-forward telemedicine services, must be “real-time” audio visual capable. The Commissioner of Insurance may adopt rules and regulations addressing when “real-time” audio interactions without visual are allowable, which must be medically appropriate for the corresponding health care services being delivered.

SOURCE: MS Code Sec. 83-9-351. (Accessed Apr. 2024).

The Division of Medicaid defines telemedicine as a method which uses electronic information and communication equipment to supply and support health care when remoteness disconnects patients and links primary care physicians, specialists, providers, and beneficiaries which includes, but is not limited to, telehealth services, remote patient monitoring services, teleradiology services, store-and-forward and continuous glucose monitoring services.

The Division of Medicaid defines telehealth services as the delivery of health care by an enrolled Medicaid provider, through a real-time communication method, to a beneficiary who is located at a different site. The interaction must be live, interactive, and audiovisual.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.1 (Accessed Apr. 2024).

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Missouri

Last updated 05/01/2024

“Telehealth” or “telemedicine”, the delivery of health care services by …

“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

SOURCE: MO Revised Statute Title XII Public Health and Welfare Sec. 208.670 which references Title XII Sec. 191.1145. (Accessed May 2024).

Telemedicine is the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine also includes the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.

SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed May 2024).

Telemedicine services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at the distant site.

SOURCE: MO HealthNet, Telemedicine Overview, (Accessed May 2024).

Telemedicine [telehealth] Services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.

SOURCE: MO HealthNet, Physician Manual, 2.67 p. 112 (9/1/23), & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 59 (9/1/23). (Accessed May 2024).

Telemedicine shall mean the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.

SOURCE:  MO Code of State Regulations 13 CSR 70-3.330(B)(5) 1/30/24), (Accessed May 2024).

Telehealth Services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.

Telehealth offers participants, particularly those in rural areas of the state, access to health care services without having to travel extensive miles for an appointment.

SOURCE:  MO HealthNet, Rural Health Clinic, Provider Manual, 1.14, pg. 10 (9/1/23), (Accessed May 2024).

Department of Health and Senior Services – Comprehensive Emergency Medical Services Systems

Telemedicine—the use of medical information exchanged from one (1) site to another via electronic communications to improve patient’s health status. A neurology specialist will assist the physician in the center in rendering a diagnosis. This may involve a patient “seeing” a specialist over a live, remote consult or the transmission of diagnostic images and/or video along with patient data to the specialist

SOURCE: MO Code of State Regulation, Title 19, Sec. 30-40.710, (Accessed May 2024).

Mental Health

Telemedicine shall mean the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.

SOURCE: MO 13 CSR 70-3.330, (Accessed May 2024).

Telemedicine is the delivery of health care services by means of information and communication technologiesthat facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telemedicineshall also include the use of asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.

SOURCE: MO Division of Behavioral Health, Community Treatment Program, Clarification, July 8, 2022, (Accessed May 2024).

Telemedicine is the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.

SOURCE: MO HealthNet, Telemedicine, (Accessed May 2024).

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Montana

Last updated 06/03/2024

“Telehealth” means the use of telecommunications and information technology to …

“Telehealth” means the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance, including but not limited to the use of secure portal messaging, secure instant messaging, audiovisual communications, and audio-only communications.

The term includes both clinical and nonclinical services.

SOURCE: MT Code Annotated Sec. 53-6-155, (Accessed Jun. 2024).

Telemedicine is the use of interactive audio-video equipment to link practitioners and patients located at different sites.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jun. 2024).

Healthy Montana Kids

Telehealth – The Use of a secure interactive audio and video, or other telecommunications technology by a healthcare Provider to deliver healthcare services at a site other than the site where the patient is located. Does not include audio only (phone call), e-mail, and/or facsimile transmission.

SOURCE: MT Children’s health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Jan. 2023), p. 10. (Accessed Jun. 2024).

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Nebraska

Last updated 04/10/2024

Telehealth consultation means any contact between a client and a …

Telehealth consultation means any contact between a client and a health care practitioner relating to the health care diagnosis or treatment of such client through telehealth. For the purposes of telehealth services, a consultation includes any service delivered through telehealth.

Telemonitoring means the remote monitoring of a client’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.01, (Accessed Apr. 2024).

Telehealth means the use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care practitioner in the diagnosis or treatment of a patient.  Telehealth includes

  • Services originating from a patient’s home or any other location where such patient is located,
  • Asynchronous services involving the acquisition and storage of medical information at one site that is then forwarded to or retrieved by a health care practitioner at another site for medical evaluation, and
  • Telemonitoring.

Telehealth also includes audio-only services for the delivery of individual behavioral health services for an established patient, when appropriate, or crisis management and intervention for an established patient as allowed by federal law.

Telehealth consultation means any contact between a patient and a health care practitioner relating to the health care diagnosis or treatment of such patient through telehealth; and

Telemonitoring means the remote monitoring of a patient’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.

SOURCE: NE Rev. Statute, 71-8503 (Accessed Apr.. 2024).

Teledentistry is the use of technology, including digital radiographs, digital photos and videos, and electronic health records, to facilitate delivery of oral healthcare and oral health education services from a provider in one location to a patient in a physically different location. Teledentistry is to be used for the purposes of evaluation, diagnosis, or treatment.

SOURCE: NE Admin Code Title 471, Ch. 6, Sec. 002.06. (Accessed Apr. 2024).

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Nevada

Last updated 03/26/2024

“Telehealth” has the meaning ascribed to it in NRS 629.515.…

“Telehealth” has the meaning ascribed to it in NRS 629.515.

“Telehealth” means the delivery of services from a provider of health care to a patient at a different location through the use of information and audio-visual communication technology, not including facsimile or electronic mail. The term includes, without limitation, the delivery of services from a provider of health care to a patient at a different location through the use of:

  • Synchronous interaction or an asynchronous system of storing and forwarding information; and
  • Audio-only interaction, whether synchronous or asynchronous.

SOURCE: NV Revised Statute 422.2721 & 629.515, (Accessed Mar. 2024).

Telehealth is the use of a telecommunications system to substitute for an in-person encounter for professional consultations, office visits, office psychiatry services and a limited number of other medical services.

“Telehealth” is defined as the delivery of service from a provider of health care to a patient at a different location through the use of telecommunication technologies, not including facsimile or electronic mail.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3400 & 3403, (Nov. 23, 2023), (Accessed Mar .2024).

Telehealth is the use of a telecommunications system instead of an in-person recipient encounter for professional consultations, office visits, office psychiatry services, and a limited number of other medical services. Please review Medicaid Services Manual (MSM) Chapter 3400 (Telehealth Services) for complete policy, covered services, non-covered services and coverage requirements. The telecommunications system used must be appropriate for the service being provided. Facsimile machines, electronic mail, and text messages do not meet this criteria.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (2/22/23). (Accessed Mar. 2024).

Telehealth is the use of a telecommunications system instead of an in-person recipient encounter for professional consultations, office visits, office psychiatry services, and a limited number of other medical services. Please review Medicaid Services Manual (MSM) Chapter 3400 (Telehealth Services) for complete policy, covered services, non-covered services and coverage requirements. The telecommunications system used must be an interactive audio and video system. Standard telephones, facsimile machines, or electronic mail do not meet this criteria.

SOURCE: School Health Services (8/10/23), pg. 78. (Accessed Mar. 2024).

Telehealth is the use of a telecommunications system to substitute for an in-person encounter for professional consultations, office visits, office psychiatry services, and a limited number of other medical services. “Telehealth” is defined as the delivery of service from a provider of health care to a patient at a different location through the use of information and telecommunication technology, not including facsimile or electronic mail.

SOURCE: Nevada Dept. of Health and Human Services, School Health Services, (11/28/23) (Accessed Mar. 2024).

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New Hampshire

Last updated 03/28/2024

“Telehealth services” shall comply with 42 C.F.R. section 410.78, except …

“Telehealth services” shall comply with 42 C.F.R. section 410.78, except for 42 C.F.R. section 410.78(b)(4). The use of the term “telemedicine” shall comply with the Centers for Medicare and Medicaid Services requirements governing the aforementioned telehealth services.

SOURCE: NH Revised Statutes 167:4-d (Accessed Mar. 2024).

“Teledentistry” means the acquisition and transmission of all necessary subjective and objective diagnostic data through interactive audio, video, or data communications by a dental provider subject to RSA 317-A:21-e to a NH Medicaid enrolled dentist at a distant site for triage, dental treatment planning, and referral.

“Telehealth” means a two-way, real-time interactive communication between a patient and a physician or medical provider at a distant site through telecommunications equipment including video, audio, and audio-only equipment.

Source: NH Admin Rules, HE-C 5004.1, (Accessed Mar. 2024).

Telehealth is the use of telecommunications technologies for remote delivery of medical services. Telehealth is used to facilitate live contact directly between an individual/individual’s family and a provider.

SOURCE: NH Department of Health and Human Services, Medicaid to Schools Program Medicaid to Schools Technical Assistance Guide pg. 91, (May 3, 2022), (Accessed Mar. 2024).

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New Jersey

Last updated 05/09/2024

“Telehealth” means the use of information and communications technologies, including …

“Telehealth” means the use of information and communications technologies, including telephones, remote patient monitoring devices, or other electronic means, to support clinical health care, provider consultation, patient and professional health-related education, public health, health administration.

Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider. Telemedicine does not include the use, in isolation, of electronic mail, instant messaging, phone text, or facsimile transmission.

SOURCE: NJ Statute C.30:4D-6K(e) – cites: NJ Statute C.45:1-61, (Accessed May 2024).

Telehealth is defined as the use of electronic communication technologies to support clinical health care, provider consultation, patient and professional health-related education, public health, health administration and other services. Telemedicine and telehealth are often used interchangeably but telemedicine, a subset of telehealth, is considered the clinical application of electronic technology to provide long distance clinical health services. Telehealth is the broader application of communication technology, beyond clinical diagnostics and patient monitoring and shall be used throughout this newsletter to refer to both telemedicine and telehealth services.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018. (Accessed May 2024).

Home Care Services

“Telehealth technology” means the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient, and professional health-related education, public health, and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

SOURCE: NJ Admin Code Title 10:60-1.2, (Accessed May 2024).

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New Mexico

Last updated 02/26/2024

Behavioral Health

Telemedicine – the use of electronic information, imaging …

Behavioral Health

Telemedicine – the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well asstore and forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education when distance separates the patient and the health care provider (NMSA, 1978, Section 24-25-3. C).

Forwarding an image or information to a different provider for interpretation is not considered store-and-forward technology eligible for reimbursement unless it is to obtain information necessary for treating the recipient during the telemedicine session.

Telehealth services – An interactive HIPAAA compliant telecommunication system must include both interactive audio and video and be delivered on a real-time basis at both the originating and distant sites, as in subsection M of 8.310.2 NMAC.

The terms telehealth and telemedicine are used interchangeably in the Medicaid program. To qualify as a billable telemedicine service, the system must meet all federal requirements for interactivity using a secure connection and meet HIPAA standards for privacy and security.   It is important to note that during this COVID-19 pandemic the federal government has announced that it will not impose penalties for noncompliance with HIPAA rules related to good faith provision of telehealth (such as use of non-HIPAA compliant platforms like Skype or Facetime). For more details about platforms acceptable to the federal government at this time see the U.S. Department of Health and Human Services website: https://www.hhs.gov/hipaa/forprofessionals/special-topics/emergency-preparedness/notification-enforcement-discretiontelehealth/index.html

SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 27 (Accessed Feb. 2024).

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New York

Last updated 05/30/2024

“Telehealth” means the use of electronic information and communication technologies …

“Telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication, except that with respect to the medical assistance program established under section three hundred sixty-six of the social services law, and the child health insurance plan under title one-A of article twenty-five of this chapter, telehealth shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner. This subdivision shall not preclude the delivery of health care services by means of “home telehealth” as used in section thirty-six hundred fourteen of this chapter.

“Telemedicine” means the use of synchronous, two-way electronic audio visual communications to deliver clinical health care services, which shall include the assessment, diagnosis, and treatment of a patient, while such patient is at the originating site and a telehealth provider is at a distant site.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. (Accessed May 2024).

Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance. Medicaid covered services provided via telehealth include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a Medicaid member. This definition includes audio-only services when audio-visual is unavailable, or a member chooses audio-only.

Telemedicine, or audio-visual telehealth, uses two-way synchronous electronic audio-visual communications to deliver clinical health care services to a patient at an originating site by a telehealth provider located at a distant site. Telemedicine includes teledentistry.

SOURCE: NY Dept. of Health Medicaid Telehealth Policy Manual (May 2024), p. 6. (Accessed May 2024).

“Telehealth” means the use of electronic information and communication technologies by a health care provider to deliver health care services to an enrollee while such enrollee is located at a site that is different from the site where the health care provider is located.

SOURCE: NY Public Health Law Article 44 – G Section 4406-g (2). (Accessed May 2024).

Telemental Health 

Telehealth and telepsychiatry are both defined as the use of interactive audio and video technology to support interactive patient care and consultations between healthcare practitioners and patients at a distance.

SOURCE: Article 29-I VFCA Health Facilities License Guidelines, p. 55 (Dec. 2023). (Accessed May 2024).

Telehealth Services means the use of Telehealth Technologies by Telehealth Practitioners to provide mental health services at a distance. Such services do not currently include an electronic mail message, text message, or facsimile transmission between a practitioner and an individual receiving services, services provided where the originating and distant sites are the same location, or a consultation between two (2) physicians or nurse practitioners, or other staff, although these activities may support Telehealth Services. Telehealth Services must be synchronous. Where program regulations or guidance define an individual’s service provider as a collateral, a discussion or consultation between the Telehealth Practitioner and the individual’s other provider is considered a collateral contact, therefore is considered a Telehealth Service.

Telehealth Technologies means a dedicated, secure, and interactive Audio-only or Audiovisual linkage system approved by the Office to transmit data between an originating/spoke site and distant/hub site for purposes of providing Telehealth Services.

SOURCE: NY Office of Mental Health, Telehealth Services Guidance for OMH Providers, 2023, pg. 5. (Accessed May 2024).

Telehealth Services means the use of telehealth technologies by telehealth practitioners to provide and support mental health services at a distance. Such services do not include an electronic mail message, text message, or facsimile transmission between a provider and a recipient, services provided where the originating and distant sites are the same location, or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support telehealth services.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.4, as amended by OMH final rule and Notice Of Adoption. (Accessed May 2024).

Telehealth (formerly referred to as telepractice) as defined in 14 NYCRR Part 830 is the delivery of addiction treatment services via audio and video telecommunication, audio-only or video-only telecommunication.

SOURCE: OASAS Telehealth Standards for OASAS Designated Providers, p. 3, Aug. 2023. (Accessed May 2024).

Teledentistry

Teledentistry allows dentists and dental hygienists to deliver care from a distance; this includes performing evaluations and delivering services within scope of practice, using either synchronous or asynchronous means.

Telehealth is defined as “the use of electronic information and communication technologies to deliver health care to patients at a distance, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient (Medicaid member)”.

SOURCE: NY Dental Policy and Procedure Code Manual, 2024, page 64 (Accessed May 2024).

Caregiver Guide

Telehealth is the use of electronic technology to deliver health care to patients from a distance. Telehealth may take many forms including a video call with a doctor to discuss symptoms or treatment options; or the use of technology to remotely monitor and collect health data. Health and medical data collected remotely may include vital signs, blood pressure, heart rate, or blood oxygen levels.

SOURCE: NY State Caregiver Guide (2021), p. 36. (Accessed May 2024).

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North Carolina

Last updated 03/17/2024

Telehealth is the use of two-way real-time interactive audio and …

Telehealth is the use of two-way real-time interactive audio and video to provide and support health care services when participants are in different physical locations.

Virtual communications is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a beneficiary or a provider and another provider. As outlined in Attachment A and program specific clinical coverage policies, covered virtual communication services include: telephone conversations (audio only); virtual portal communications (secure messaging); and store and forward (transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, June 1, 2023. (Accessed Mar. 2024).

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North Dakota

Last updated 06/10/2024

Telehealth is the use of telecommunications and information technology to …

Telehealth is the use of telecommunications and information technology to provide access to physical, mental, and behavioral health care across distance.

Digital Health consists of online digital evaluation and management (E/M) services which are patient-initiated services with health care professionals. These are not realtime services. Patients initiate services through HIPAA-compliant secure platforms which allow digital communication with the health care professional. Online digital evaluation and management services are for established patients only. These services do not include nonevaluative electronic communications of test results, scheduling of appointments, or other communication that does not include evaluation and management.

Synchronous Telehealth is two-way, real-time interactive communication between a patient and their health care provider using technology such as interactive video/television, audio/visual secure online digital portals, and videoconferencing. Synchronous telehealth involves two collaborating sites: an “originating site” and a “distant site.” The patient is located at the originating site and the health care professional is located at the distant site.

Telehealth is an umbrella term which includes digital health and synchronous two-way real-time interactive audio/visual services. It does not include store and forward services.

SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).

Synchronous teledentistry (D9995) is delivery of patient care and education where there is live, two-way interaction between the patient and at least one dental, medical, or health caregiver at one physical location and an overseeing supervising or consulting dentist or dental provider at another location.

SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024) & North Dakota Department of Human Services: Teledentistry Policy. (July 2023), (Accessed Jun. 2024).

The communication is real-time and continuous between all participants who are working together as a group. Synchronous teledentistry must use both audio and visual means. The totality of the communication of the information exchanged between the providers or others and the member during the synchronous teledentistry service 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 an in-person interaction.

SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023), (Accessed Jun. 2024).

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Ohio

Last updated 06/05/2024

“Telehealth” is the direct delivery of health care services to …

“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.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022, p. 3-4. & OAC 5160-1-18. (Accessed Jun. 2024).

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 Jun. 2024).

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 Jun. 2024).

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 Jun. 2024).

“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 Jun. 2024).

“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 Jun. 2024).

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 Jun. 2024).

“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 Jun. 2024).

The following is considered telehealth:

  • Direct delivery of health care services to a patient via synchronous, interactive, real-time electronic communication that includes both audio and video elements; OR
  • Activities that are asynchronous and activities that do not have both audio and video elements such as:
    • Telephone calls
    • Remote patient monitoring; and
    • Communication with a patient through secure electronic mail or secure patient portal
  • For behavioral health providers eligible under rule 5160-27-01 of the OAC, telehealth is defined in rule 5122-29-31 of the OAC.

SOURCE: OH Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, July 15, 2022, (Accessed Jun. 2024).

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Oklahoma

Last updated 03/06/2024

Telehealth is the use of interactive audio, video or other …

Telehealth is the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment that occurs in real time and when the member is actively participating during the transmission. Telehealth service is not an expansion of SoonerCare but a different way to offer quality health care access to SoonerCare members.

SOURCE: Health Care Authority, Providers, Telehealth, Modified Jul. 18, 2023. (Accessed Mar. 2024).

“Telehealth” means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information by means of a two-way, real-time interactive communication, not to exclude store and forward technologies, between a patient and a health care provider with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit. Telehealth shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure video conference, or facsimile transmission.

“Telehealth” means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information by means of a two-way, real-time interactive communication, not to exclude store and forward technologies, between a patient and a healthcare provider with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit. Telehealth shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure video conference, or facsimile transmission. For audio-only health service delivery, see OAC 317:30-3-27.1.

“Telehealth medical service” means, for the purpose of the notification requirements of OAC 317:30-3-27(d)(2), telehealth services that expressly do not include physical therapy, occupational therapy, and/or speech and hearing services.

SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Mar. 2024).

Indian Health Services

“Telehealth” means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information by means of a two-way, real-time interactive communication, not to exclude store and forward technologies, between a patient and a healthcare provider with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit. Telehealth shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure video conference, or facsimile transmission.

SOURCE: OK Admin Code Sec. 317.30-5-1087, (Accessed Mar. 2024).

 

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Oregon

Last updated 03/30/2024

“Telemedicine” means the mode of delivering health services using information …

“Telemedicine” means the mode of delivering health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a patient’s health care.

SOURCE: OR Statute 414.723, (Accessed Mar. 2024).

“Telemedicine” means the mode of delivering remote clinical health services using information and telecommunication technologies to provide consultation and education or to facilitate diagnosis, treatment, care management or self-management of a [client or] member’s healthcare.

“Telehealth” includes telemedicine and includes the use of electronic information and telecommunications technologies to support remote clinical healthcare, [client or] member and professional health-related education, public health, and health administration.

“Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include video conferencing, store-and-forward imaging, streaming media including services with information transmitted using landlines, and wireless communications, including the Internet and telephone networks.

SOURCE: OR OAR  OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement & OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth & 410-120-0000, (Accessed Mar. 2024).

Rules for RHCare Clinics, Certification Requirements for CCare Clinics, Certification Requirements for AbortionCare clinics

“Telehealth” means the provision of healthcare remotely by means of telecommunications technology.

SOURCE: OR Admin Code 333-004-3010, (Accessed Mar. 2024).

Behavioral Health Services

“Telehealth” means a technological solution that provides two-way, video-like communication on a secure line.

SOURCE: OAR 309-032-0860, Health Systems Division: Medical Assistance Programs, Behavioral Health Services. (Accessed Mar. 2024).

Telemedicine encompasses different types of programs, services, and delivery mechanisms for medically appropriate covered services within the recipient’s benefit package.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Mar. 2024).

Telehealth services include a variety of health services provided by synchronous or asynchronous electronic communications, including secure electronic health portal, audio, or audio and video and clinician-to-clinician virtual consultations.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2024 Prioritized List of Health Services, p. AD-2. (1/22/24). (Accessed Mar. 2024).

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to:

  • Live video, a two-way interaction between a patient and dentist using audiovisual technology;
  • Store and forward, an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the member being present in real time;
  • Remote member monitoring, where personal health and dental information is collected by dental care providers in one location then transmitted electronically to a dentist in a distant site location for use in care; and
  • Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry, health care, public health practices, and education.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Mar. 2024).

Telehealth for School Based Health Services (SBHS) is a real time interactive and synchronous audio/video technology from site to site regarding a Medicaid-eligible child’s health-related service.  Telehealth is the equivalent to face-to-face therapy/treatment between a licensed practitioner/clinician or under the supervision of a practitioner/clinician within the scope of practice.

SOURCE: OR OAR 410-133-0040, Health Systems Division: Medical Assistance Programs, School-Based Health Services. (Accessed Mar. 2024).

The Behavioral Health Loan Repayment Program and Behavioral Health Care Bonus and Housing Stipend Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin Rule 309-081-0010 and 309-083-0010, (Accessed Mar. 2024).

Health Care Provider Incentive Program

“Telehealth” means the provision of health services from a distance using electronic communications.

SOURCE: OR Admin Rule 409-036-0010, (Accessed Mar. 2024).

Aging and People with Disabilities and Developmental Disabilities

“Technology and Telehealth” means electronic or virtual means or methods, including but not limited to computer technology, web or internet access, social media, videoconferencing or other technological means or methods to improve resident social isolation and allow for the provision of virtual health care.

SOURCE: OR OAR 411-062-0010, (Accessed Mar. 2024).

Assertive Community Treatment (ACT) 

“Telehealth” means services that are delivered using secure HIPAA compliant audio and video communication. All allowable accommodations will be made for any individuals with any hearing, visual or physical impairments or disabilities who agree to utilize services in this manner. per OAR 410-120-1990 rule set.

SOURCE: 309-019-0225, Oregon Health Authority, Health Systems Division: Behavioral Health Services,  DACT Model (Accessed Mar. 2024).

Health Professional Student Clinical Training

“Telehealth” means the provision of health services where the patient and professional are not present in the same location but interact via technology.

SOURCE: 409-030-0110, Oregon Health Authority, Health Systems Division: Health Professional Student Clinical Training (Accessed Mar. 2024).

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Pennsylvania

Last updated 05/07/2024

Historically, “telemedicine” for purposes of Medicaid payment was the use …

Historically, “telemedicine” for purposes of Medicaid payment was the use of two-way, real time interactive telecommunication equipment that included, at a minimum, audio and video equipment, as a mode of delivering healthcare services. However, the term “telehealth” has emerged as the umbrella term that encompasses the full range of services furnished remotely. In response to this shift, the Department will now refer to the remote delivery of services as telehealth.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-23-08, p. 2. Aug. 2, 2023.  (Accessed May 2024).

FQHC/RHC Manual

Telemedicine: An encounter between a practitioner and a beneficiary in which physical health services are provided through the use of approved electronic communication and information technologies to provide medical services at a distance.

Telehealth: An encounter between a licensed practitioner or provider agency and a beneficiary, in which behavioral health services are provided through the use of approved electronic communication and information technologies to provide behavioral health care at a distance.

SOURCE:  PA Department of Human Services, Medical Assistance Bulletin, Updates to The PROMISe™ Provider Handbook 837 Professional/CMS-1500 Claim Form, Appendix E – FQHC/RHC Handbook, March 1, 2024, Number 08-24-04, & PA PROMISe, 837 Professional/CMS-1500 Claim Form, Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Revised Mar. 1, 2024) (Accessed May 2024).

Teledentistry is two-way, real time interactive communication between the patient and dentist. Teledentistry may be provided by any means that allows for two-way, real time interactive audio-video communication, such as through conferencing hosted by a secure mobile application. Audio only technology may be utilized for two procedure codes as described below.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin, Teledentistry Guidelines and Dental Fee Schedule Updates (May 2, 2022). (Accessed May 2024).

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Puerto Rico

Last updated 03/22/2024

Telehealth – It means the remote care of health professionals, …

Telehealth – It means the remote care of health professionals, beyond doctors, offered to their patients through the use of technologies, electronic services and telecommunications.

Telemedicine – It is the practice of remote medical care incorporating both diagnosis, treatment and medical education through the use of technological resources to optimize health care services. They must include, but are not limited to, complementary and instant services to the attention of a specialist; immediate diagnoses by a specialist doctor in a certain area or region; remote education of students from schools of nursing, health professionals and medicine; digital file services for radiological examinations, ultrasounds, medical emergencies and others. In the case of Rehabilitation Centers, physical therapists, occupational therapists and speech therapists will be included for Telemedicine purposes.

SOURCE: Telesalud. Departamento de Salud. (Accessed Mar. 2024).

Telehealth is the use of communication technologies to provide health services at a distance. Telehealth is a broad term that includes telemedicine, but also involves aspects such as: training for health professionals, coordination of medical care and related services such as mental health and pharmacy.

Telemedicine is the remote provision of clinical services by health professionals; through the use of technology and communication for the exchange of valid information for diagnosis, treatment, disease prevention, research and evaluation. All this with the aim of improving the health of communities.

Source: Telemedicina Y Telesalud. Departamento de Salud. (Accessed Mar. 2024).

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Rhode Island

Last updated 05/15/2024

“Telemedicine” means the delivery of clinical healthcare services by use …

“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 the 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 May 2024).

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South Carolina

Last updated 05/07/2024

Telehealth is defined as the provision of healthcare via electronic …

Telehealth is defined as the provision of healthcare via electronic communications technology between a provider in one location and a patient in another location without loss of quality of care.

Electronic communication means the use of interactive telecommunication equipment that typically includes audio and video equipment permitting two-way, real-time interactive communication between the patient and the provider at the referring site.

Though there are differences in the definitions of telehealth and telemedicine, the two terms are generally used interchangeably, and SCDHHS will reference telehealth in this and other provider manuals addressing the provision of services via electronic communications.

Telehealth includes consultation, diagnostic and treatment services. Telehealth as a service delivery option, in some cases, can provide beneficiaries with increased access to specialists, better continuity of care, and eliminate the hardship of traveling extended distances.

SOURCE: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 32 (Apr. 2024). (Accessed May 2024).

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South Dakota

Last updated 04/02/2024

 

“Telemedicine,” The use of an interactive telecommunications system to …

 

“Telemedicine,” The use of an interactive telecommunications system to provide two-way, real time, interactive communication between a provider and a Medicaid recipient across a distance.

“Telehealth” – A method of delivering services, including interactive audio-visual or audio-only technology, in accordance with SDCL chapter 34-52.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 13 (Feb. 2024), SD Regulations 67:16:44:01, SD Regulations 67:61:01(45), SD Regulations 67:62:01(35), & Community Health Worker, pg. 9 (Dec. 2023) [telemedicine definition only]. (Accessed Apr. 2024).

Office of Adult Services and Aging

“Telehealth services” is a home-based health monitoring system used to collect and transmit an individual’s clinical data for monitoring and interpretation.

SOURCE: SD Regulation 67:40:19:01(21) (Accessed Apr. 2024).

Teledentistry

“Teledentistry”, the delivery of dental care while the patient and the dentist are in different locations via synchronous telecommunication technology or the transmission and review of recorded health information collected by another oral health professional and transmitted via asynchronous communication to create a treatment plan.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 4, (Jun. 2023), (Accessed Apr. 2024).

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Tennessee

Last updated 05/03/2024

Telehealth means the use of real-time interactive audio, video telecommunications …

Telehealth means the use of real-time interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

  • Such provider is at a qualified site other than the site where the patient is located; and
  • The patient is at a qualified site at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section or a public elementary or secondary school staffed by a health care services provider and equipped to engage in the telecommunications described in this section; and
  • Does not include:
    • Audio only conversation;
    • An electronic mail message; or
    • Facsimile transmission;

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed May 2024).

“Provider-based telemedicine”: Means the use of Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

  • The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient;
  • The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and
    • The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare service provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit;
    • The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit is tolled for the duration of a state of emergency declared by the governor pursuant to § 58-2-107; provided, that the healthcare services provider or the patient, or both, are located in the geographical area covered by the applicable state of emergency; and
    • The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment;
  • Does not include:
    • An audio-only conversation;
    • An electronic mail message or phone text message;
    • A facsimile transmission;
    • Remote patient monitoring; or
    • Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity’s business.

Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of:

  • behavioral health services or
  • healthcare services when the means described in subdivision (a)(6)(A) are unavailable.

SOURCE: TN Code Annotated, Sec. 56-7-1003 (Accessed May 2024).

TN Department of Mental Health and Substance Abuse Services

“Telehealth is the use of electronic information and telecommunication technologies to support clinical care between an individual with mental illness and/or substance abuse issues and a healthcare practitioner.”

“Telehealth systems provide a live, interactive audio-video communication or videoconferencing connection between the individual in need of services and the crisis service delivery system.”

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care. p. 46, (2017) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guideline. p. 4 (Accessed May 2024).

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Texas

Last updated 04/25/2024

Teledentistry

“Teledentistry dental service” means a health care service delivered …

Teledentistry

“Teledentistry dental service” means a health care service delivered by a dentist, or a health professional acting under the delegation and supervision of a dentist, acting within the scope of the dentist’s or health professional’s license or certification to a patient at a different physical location than the dentist or health professional using telecommunications or information technology.

SOURCE: Insurance Code Title 8, Subtitle F, Ch. 1455.001 refers to Occupations Code, Sec. 111.001. (Accessed Apr. 2024).

“Telehealth service” means a health service, other than a telemedicine medical service or a teledentistry dental service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology.

“Telemedicine medical service” means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician’s or health professional’s license to a patient at a different physical location than the physician or health professional using telecommunications or information technology.

SOURCE: TX Admin. Code, Title 1 Sec. 354.1430, & TX Government Code, Sec. 531.001  refers to Occupations Code, Sec. 111.001. (Accessed Apr. 2024).

Synchronous audiovisual technology – An interactive, two-way audio and video telecommunications platform that meets the privacy requirements of the Health Insurance Portability and Accountability Act.

Telemedicine services are defined as health-care services delivered by a physician licensed in Texas or a health professional who acts under the delegation and supervision of a health professional licensed in Texas and within the scope of the health professional’s license to a client at a different physical location using telecommunications or information technology. Telemedicine excludes teledentistry services.

Telehealth services are defined as health-care services, other than telemedicine medical services or a teledentistry service, delivered by a health professional licensed, certified or otherwise entitled to practice in Texas and acting within the scope of the health professional’s license, certification or entitlement to a patient at a different physical location other than the health professional using telecommunications or information technology.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 5, 7 & 12 (Apr. 2024). (Accessed Apr. 2024).

Standards of Care in Crisis Stabilization Units

Telehealth service–A health-care service, other than telemedicine medical services, delivered by a health professional licensed, certified or otherwise entitled to practice in Texas and acting within the scope of the health professional’s license, certification or entitlement to an individual at a different physical location other than the health professional using telecommunications or information technology.

Telemedicine medical service–A health-care service delivered to an individual at a different physical location using telecommunications or information technology by:

  • a physician licensed in Texas; or
  • a health professional who acts under the delegation and supervision of a physician licensed in Texas and within the scope of the health professional’s license in Texas.

SOURCE: TX Admin Code, Title 26, Part 1, Ch. 306, Subchapter B, Sec. 306.45, (Accessed Apr. 2024).

Hospital Licensing
Telehealth service–A health service, other than a telemedicine medical service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state and acting within the scope of the health professional’s license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology as defined in Texas Occupations Code §111.001.

Telemedicine medical service–A health care service delivered by a physician licensed in this state, or health professional acting under the delegation and supervision of a physician licensed in this state and acting within the scope of the physician’s or health professional’s license to a patient at a different physical location than the physician or health professional using telecommunications or technology as defined in Texas Occupations Code §111.001.

SOURCE: TX Admin Code Sec. 133.182, (Accessed Apr. 2024).

Children with Special Health Care Needs (CSHCN) Program

Telemedicine is defined as a health-care service that is either initiated by a physician who is licensed to practice medicine in Texas or provided by a health professional who is acting under physician delegation and supervision.

SOURCE:  TX Medicaid CSHCN Services Program Provider Manual: Telecommunication Services (Mar. 2024), p. 4.  (Accessed Apr. 2024).

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Utah

Last updated 02/27/2024

“Telehealth services” means the transmission of health-related services or information …

“Telehealth services” means the transmission of health-related services or information through the use of electronic communication or information technology.

“Telemedicine services” means telehealth services including:

  • clinical care;
  • health education;
  • health administration;
  • home health;
  • facilitation of self-managed care and caregiver support; or
  • remote patient monitoring occurring incidentally to general supervision; and

provided by a provider to a patient through a method of communication that:

  • uses asynchronous store and forward transfer or synchronous interaction; and
  • meets industry security and privacy standards, including compliance with the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health Act.

SOURCE: UT Code Sec. 26B-4-704, (Accessed Feb. 2024).

“Telehealth services” means the transmission of health-related services or information through the use of electronic communication or information technology.

“Teledentistry” means the use of information technology and telecommunications for dental care, consultation, and education.

“Telepsychiatric consultation” means a consultation between a licensed provider and a board-certified psychiatrist that utilizes:

  • the health records of the member, provided from the member or the referring provider; and
  • a written, evidence-based member questionnaire.

SOURCE: UT Admin. Code R414-42-2. (Accessed Feb. 2024).

Telehealth – is the use of electronic information and telecommunications technologies that support distant healthcare to provide ease of access to health assessments, diagnostics, intervention, consultations, supervision, and education.

Telemedicine – see Telehealth.

Teledentistry is the use of information technology and telecommunications for dental care, consultation, and education.

Telepsychiatric Consultation is a consultation between a physician and a board-certified psychiatrist that utilizes:

  • the health records of the patient, provided from the patient or the referring physician
  • a written, evidence-based patient questionnaire

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Jan. 2024). (Accessed Feb. 2024).

“Early childhood psychotherapeutic telehealth consultation” means a consultation regarding a child’s mental health care during the child’s early childhood between a child care provider or a mental health therapist and a child mental health therapist that is focused on psychotherapeutic and psychosocial interventions and is completed through the use of electronic or telephonic communication.

SOURCE: UT Code 26B1-328, (Accessed Feb. 2024).

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Vermont

Last updated 03/05/2024

“Telemedicine” means the delivery of health care services, including dental …

“Telemedicine” means the delivery of health care services, including dental services, such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k(h)(7), (Accessed Mar. 2024).

“Telehealth” means methods for health care service delivery using telecommunications technologies. Telehealth includes telemedicine, store and forward, and telemonitoring.

“Telemedicine” means health care delivery by a provider who is located at a distant site to a beneficiary at an originating site for purposes of evaluation, diagnosis, consultation, or treatment, using telecommunications technology via two-way, real-time, audio and video interactive communication, through a secure connection that complies with HIPAA.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101), Telehealth, (Accessed Mar. 2024).

Telehealth means methods for healthcare service delivery using telecommunications technologies. Telehealth includes telemedicine, store and forward, and telemonitoring.

The term telehealth is also often used more generally to describe electronic information and telecommunications technologies to support long-distance clinical healthcare, as well as patient and professional health-related education, public health and health administration.

Telemedicine means health care delivered by a provider who is located at a distant site to a beneficiary at an originating site for purposes of evaluation, diagnosis, consultation, or treatment using telecommunications technology via two-way, real-time, audio and video interactive communication, through a secure connection that complies with HIPAA.

The term “telemedicine” is sometimes used interchangeably with “telehealth.” Telehealth encompasses the following:

  • Real-time, audio-video communication tools that connect providers and patients in different locations. Tools can include interactive videoconferencing or videoconferencing using mobile health (mHealth) applications (apps) that are used on a computer or hand-held mobile device.
  • Store-and-forward technologies that collect images and data to be transmitted and interpreted later, which may also involve the use of mHealth apps.
  • Remote patient-monitoring tools such as home blood pressure monitors, Bluetooth-enabled digital scales and other devices that can communicate biometric data for review, which may also involve the use of mHealth apps.

SOURCE: Department of Vermont Health Access. Agency of Human Services. Telehealth: Methods for healthcare service delivery using telecommunications technologies. (Accessed Mar. 2024).

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Virgin Islands

Last updated 03/25/2024

Crisis Intervention Program

Telehealth Services. Delivery of health care services,

Crisis Intervention Program

Telehealth Services. Delivery of health care services, through the use of interactive real-time visual and audio or other electronic media for the purpose of consultation and education concerning diagnosis, treatment, care management and self-management of patient’s physical and mental health and includes real-time interaction between the patient and the telehealth provider, synchronous encounters, asynchronous encounters, store, and forward transfers and telemonitoring.

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Virginia

Last updated 04/22/2024

Telemedicine is a means of providing services through the use

Telemedicine is a means of providing services through the use of two-way, real time interactive electronic communication between the member and the Provider located at a site distant from the member. This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine does not include an audio-only telephone.

Telehealth means the use of telecommunications and information technology to provide access to medical and behavioral health assessment, diagnosis, intervention, consultation, supervision, and information across distance. Telehealth encompasses telemedicine as well as a broader umbrella of services that includes the use of such technologies as telephones, interactive and secure medical tablets, remote patient monitoring devices, and store-and-forward devices. Telehealth includes services delivered in the dental health setting (i.e., teledentistry), and telehealth policies for dentistry are covered in the dental manuals.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services,  (1/10/24). (Accessed Apr. 2024).

Telemedicine is a means of providing covered services through the use of two-way, real time interactive electronic communication between the student and the qualified provider located at a site distant from the student. This electronic communication must include, at a minimum, the use of audio and video equipment.

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Local Education Agency, (Jan. 12, 2024). (Accessed Apr. 2024).

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Washington

Last updated 03/25/2024

“Telemedicine” means the delivery of health care services through the …

“Telemedicine” means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. For purposes of this section only, “telemedicine” includes audio-only telemedicine, but does not include facsimile or email.

SOURCE: RCW 74.09.325(9)(k) WAC 182-501-0300 (1)(h), & RCW 71.24.335(9)(i). (Accessed Mar. 2024).

Telemedicine is the delivery of health care services using interactive audio and video technology, permitting real-time communication between the client at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. Telemedicine includes audio-only telemedicine, but does not include any of the following services:

  • Email and facsimile transmissions
  • Installation or maintenance of any telecommunication devices or systems
  • Purchase, rental, or repair of telemedicine equipment
  • Incidental services or communications that are not billed separately, such as communicating laboratory results

Telemedicine is an interaction between a healthcare provider who is physically located at the distant site and a client who is physically located at the originating site.

Audio-only telemedicine is the delivery of health care services using audio-only technology, permitting real-time communication between the client at the originating site and the provider, for the purposes of diagnosis, consultation, or treatment.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide, Telemedicine Policy and Billing, p. 7, 16 (Apr. 2024); WAC 182-501-0300 (2)(a). (Accessed Mar. 2024).

Telemedicine is when a health care provider uses HIPAA-compliant, interactive, real-time audio and video telecommunications (including web-based applications) to deliver covered services that are within the provider’s scope of practice to a student at a site other than the site where the provider is located. The SBHS program also reimburses for some services when provided through audio-only telemedicine (i.e., telephone service delivery). HCA does not cover the following services provided through telemedicine:
  • Email and facsimile transmissions
  • Installation or maintenance of any telecommunication devices or systems
  • Purchase, rental, or repair of telemedicine equipment

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 35 (Oct. 2023). (Accessed Mar. 2024).

Home Health and Hospice

“Telehealth” means a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technology. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.

“Telemedicine” means the delivery of health care services through the use of HIPAA-compliant, interactive audio and video technology (including web-based applications), permitting real-time communication between the patient and the agency provider, for the purpose of consultation, education, supervision, diagnosis, or treatment, as appropriate per scope of practice. “Telemedicine” also includes supervision of home health aide services to evaluate compliance with the plan of care and patient satisfaction with care. “Telemedicine” does not include the use of audio-only telephone, facsimile, electronic mail, or text messages.

SOURCE: WAC 246-335-510 & WAC 246-335-610. (Accessed Mar. 2024).

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West Virginia

Last updated 05/15/2024

“Telehealth” is the use of digital information and telecommunications technologies …

“Telehealth” is the use of digital information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include video conferencing, the internet, store and forward imaging, streaming media, landline and wireless communications.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services, p. 5 (Effective Jan. 1, 2022). (Accessed May 2024).

Telehealth – for purposes of Medicaid, telemedicine seeks to improve a patient’s health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–200 Definitions and Acronyms. (Nov. 1, 2016), p. 19-20 & Ch. 502 Children with Serious Emotional Disorder Waiver, 7/1/21, Pg. 67-68. (Accessed May 2024).

“Telehealth Services: Health care services provided through advanced telecommunications technology from one location to another. Medical information is exchanged in real-time communication from an Originating Site, where the participant is located, to a Distant Site, where the provider is located, allowing them to interact as if they are having a face-to-face, “hands-on” session.”

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter 522 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 17. (Jul. 1, 2019). (Accessed May 2024).

Medication-Assisted Treatment Program Licensing Act

“Telehealth” means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.

SOURCE: WV Code Section 16-5Y-2 and SB 300 (2024 Session). (Accessed May 2024).

Certificate of Need

“Telehealth” means the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.

SOURCE: WV Code Section 16-2D-2(45). (Accessed May 2024).

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Wisconsin

Last updated 04/19/2024

Telehealth enables a provider who is located at a distant …

Telehealth enables a provider who is located at a distant site to render the service remotely to a member located at an originating site using a combination of interactive video, audio, and externally acquired images through a networking environment.

“Telehealth” means the use of telecommunications technology by a Medicaid-enrolled provider to deliver functionally equivalent health care services including assessment, diagnosis, consultation, treatment, and transfer of medically relevant data. Telehealth may include real-time interactive audio-only communication. Telehealth does not include communication between a provider and a member that consists solely of an email, text, or fax transmission.

“Functionally equivalent” means that when a service is provided via telehealth, the transmission of information must be of sufficient quality as to be the same level of service as an in-person visit. Transmission of voices, images, data, or video must be clear and understandable.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth & Telehealth Definitions Topic #22873. (Accessed Apr. 2024).

“In-person” refers to when the provider rendering a service and the member receiving that service are located together physically in the same space. In-person services are not considered to be delivered through telehealth, including audio-visual telehealth, unless there are applicable supervision components and requirements that are rendered through telehealth outside of the direct patient contact by the provider.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, & Telehealth Definitions Topic #22873. (Accessed Apr. 2024).

“Face-to-face” refers to requirements that can be met either in-person or through real-time, interactive audio-visual telehealth. An interactive telehealth service with face-to-face components must be functionally equivalent to an in-person service. It is delivered from outside the physical presence of a Medicaid member by using audio-visual technology, and there is no reduction in quality, safety, or effectiveness. ForwardHealth does not consider a “face-to-face” requirement to be met by audio-only or asynchronous delivery of services.

Under telehealth policy, “direct” refers to an in-person contact between a member and a provider. Direct services often require a provider to physically touch or examine the recipient and delegation is not appropriate.

SOURCE: WI ForwardHealth Telehealth Definitions Topic #22873, WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, (Accessed Apr. 2024).

“Telehealth” means a practice of health care delivery, diagnosis, consultation, treatment, or transfer of medically relevant data by means of audio, video, or data communications that are used either during a patient visit or a consultation or are used to transfer medically relevant data about a patient. “Telehealth” does not include communications delivered solely by audio-only telephone, facsimile machine, or electronic mail unless the department specifies otherwise by rule.

“Asynchronous telehealth service” is telehealth that is used to transmit medical data about a patient to a provider when the transmission is not a 2-way, real-time, interactive communication.

“Interactive telehealth” means telehealth delivered using multimedia communication technology that permits 2-way, real-time, interactive communications between a certified provider of Medical Assistance at a distant site and the Medical Assistance recipient or the recipient’s provider.

SOURCE: WI Statute Sec. 49.45 (61).  (Accessed Aug. 2024).

“Telehealth” means the use of telecommunications technology by a Medicaid-enrolled provider to deliver health care services including assessment, diagnosis, consultation, treatment, or transfer of medically relevant data in a functionally equivalent manner as that of an in-person contact:

  • Telehealth may include real-time interactive audio-only communication.
  • Telehealth does not include communication between a certified provider and a member (for example, a child) that consists solely of an email, text, or fax transmission.
  • School documentation may use a different term to represent telehealth such as, but not limited to, teleservice, virtual learning platform, or virtual services. ForwardHealth will accept the Individual Education Program (IEP) team’s chosen term for telehealth used in documentation.

SOURCE: ForwardHealth Update, No. 2022-02, January 2022. (Accessed Aug. 2024).

“Telehealth” means the use of telecommunications technology by a certified provider to deliver services allowable under s. DHS 107.02 (5) and ss. 49.45 (61) and 49.46 (2) (b) 21. to 23., Stats., including assessment, diagnosis, consultation, treatment, or transfer of medically relevant data in a functionally equivalent manner as that of an in-person contact.

“Telehealth” may include real-time interactive audio-only communication.

“Telehealth” does not include communication between a certified provider and a recipient that consists solely of an electronic mail message, text, or facsimile transmission.

SOURCE: Department of Health Services Administrative Rules Sec. 101.03, (Accessed Apr. 2024).

Clarification of Definitions for Existing Telehealth Policy

Under permanent telehealth policy, “direct” refers to face-to-face, in-person contact between a member and a provider. This is a change from how the term “direct” has been used under temporary telehealth policy. Under temporary telehealth policy flexibilities in place during the PHE, direct telehealth services were defined to include delivery through real-time, synchronous telecommunications (such as phone, audio-only, or audio-visual interactions) that do not involve face-to-face, in-person patient contact. Refer to ForwardHealth Update 2020-15, titled “Additional Services to Be Provided Via Telehealth,” for additional information on temporary policy.

“Face-to-face” refers to requirements that can be met either in-person or through real-time, interactive audio-visual telehealth. Face-to-face equivalence for interactive telehealth services exists when a service is delivered from outside the physical presence of a Medicaid member by using audio, video, or telecommunication technology, and there is no reduction in quality, safety, or effectiveness. ForwardHealth does not consider a “face-to-face” requirement to be met by to audio-only or asynchronous delivery of services.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, (Accessed Apr. 2024).

Telehealth is audio and video contact with your doctor or health care provider using your phone, computer, or tablet. It includes:

  • Health care services
  • Getting a diagnosis
  • Consultations to discuss your treatment
  • Treatment for your medical condition

SOURCE: Wisconsin Department of Health Services, Medicaid Telehealth Expansion: Frequently Asked Questions, May 11, 2023, (Accessed Apr. 2024).

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Wyoming

Last updated 05/13/2024

Telehealth is the use of an electronic media to link …

Telehealth is the use of an electronic media to link beneficiaries with health professionals in different locations. The examination of the Member is performed via a real time interactive audio and video telecommunications system. This means that the Member must be able to see and interact with the offsite practitioner at the time services are provided via telehealth technology.

Telehealth does not include a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a healthcare practitioner and a Member, or a consultation between two (2) health care practitioners asynchronous “store and forward” technology.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 135 & 137 (Apr, 1, 2024), WY Division of Healthcare Financing Tribal Provider Manual, pgs. 133, 141, 211, & 213 (Apr. 1, 2024),  & Institutional Provider Manual pg. 133 & 135.  (Apr. 1, 2024). (Accessed May 2024).

Telehealth is the use of an electronic media to link beneficiaries with health professionals in different locations.

Telehealth does not include a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a healthcare practitioner and a student, or a consultation between two health care practitioners asynchronous “store and forward” technology. 

SOURCE: WY Division of Health Insurance, School Based Services Manual, pg. 16 (Apr. 1, 2024). (Accessed May 2024).

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Medicaid & Medicare

Definitions

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