Federally Qualified Health Center (FQHC)

Eligible Distant Site

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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 12/14/2023

Temporary Policy – Ends Dec. 31, 2024

In the case …

Temporary Policy – Ends Dec. 31, 2024

In the case that such emergency period ends before December 31, 2024, during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024—

  • the Secretary shall pay for telehealth services that are furnished via a telecommunications system by a Federally qualified health center or a rural health clinic to an eligible telehealth individual enrolled under this part notwithstanding that the Federally qualified health center or rural clinic providing the telehealth service is not at the same location as the beneficiary;
  • the amount of payment to a Federally qualified health center or rural health clinic that serves as a distant site for such a telehealth service shall be determined under subparagraph (B); and
  • for purposes of this subsection—
    • the term “distant site” includes a Federally qualified health center or rural health clinic that furnishes a telehealth service to an eligible telehealth individual; and
    • the term “telehealth services” includes a rural health clinic service or Federally qualified health center service that is furnished using telehealth to the extent that payment codes corresponding to services identified by the Secretary under clause (i) or (ii) of paragraph (4)(F) are listed on the corresponding claim for such rural health clinic service or Federally qualified health center service.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Dec. 2023).

Payment for Medicare Telehealth Services: Section 3704 of the CARES Act authorized RHCs and FQHCs to furnish distant site telehealth services to Medicare beneficiaries during the COVID-19 PHE. Medicare telehealth services generally require an interactive audio and video telecommunications system that permits real-time communication between the practitioner and the patient. (Some telehealth services can be furnished using audio-only technology.) RHCs and FQHCs with this capability could provide and be paid for telehealth services furnished to Medicare patients located at any site, including the patient’s home, through December 31,

2024. Telehealth services could be furnished by any health care practitioner working for the RHC or the FQHC within their scope of practice. Practitioners could furnish telehealth services from any distant site location, including their home, during the time that they are working for the RHC or FQHC, and could furnish any telehealth service that is included on the list of Medicare telehealth services under the Physician Fee Schedule (PFS), including those that have been added on an interim basis during the PHE. A list of these services, including which could be furnished via audio-only technology, is available at https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.

Beginning on or after January 1, 2022, RHCs and FQHCs can report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way in-person visits are reported and reimbursed, including audio-only visits when the beneficiary is not capable of or does not consent to, the use of video technology. Payment under HCPCS code G2025 will no longer apply to mental health visits furnished via telehealth. This payment policy for mental health visits was made permanent for RHCs and FQHCs in the CY 2022 PFS final rule.

SOURCE: Centers for Medicare and Medicaid Services, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): CMS Flexibilities to Fight COVID-19, 5/10/23, (Accessed Dec. 2023).

Security Act (CARES Act). Section 3704 of the CARES Act authorized RHCs and FQHCs to provide distant site telehealth services to Medicare patients during the COVID-19 PHE. Section 4113 of the Consolidated Appropriations Act, 2023, extended this authority through December 31, 2024.

Any health care practitioner working for you within your scope of practice can provide distant site telehealth services. Practitioners can provide distant site telehealth services – approved by Medicare as a distant site telehealth service under the physician fee schedule (PFS) – from any location, including their home, during the time that they’re working for you.

SOURCE: Centers for Medicare and Medicaid Services, New & Expanded Flexibilities for Rural Health Clinics & Federally Qualified Health Centers, MLN Matters Number: SE20016, May 12, 2023, (Accessed Dec. 2023).

FQHCs are not listed as an eligible distant site provider that can deliver services via telehealth.  However, FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. See MLN Guidance for requirements.

SOURCE: Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health Centers, MLN Matters SE22001, (May 23, 2023), (Accessed Dec. 2023).

Medicare-covered mental health services furnished incident to an RHC or FQHC visit are included in the payment for a medically necessary mental health visit when an RHC or FQHC practitioner furnishes a mental health visit. Group mental health services do not meet the criteria for a one-one-one, face-to-face encounter in an FQHC or RHC.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, Jan. 26, 2023, pg. 20 (Accessed Dec. 2023).

 

* The US Health and Human Services Administration maintains a website that summarizes information for Billing Medicare as a safety-net provider.

See: Federal Medicare Live Video Distant Site

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Alabama

Last updated 02/26/2024

Not included on distant site provider list in Medicaid Telemedicine …

Alaska

Last updated 02/27/2024

Live Video:

Submitting a claim for a telemedicine service is …

Live Video:

Submitting a claim for a telemedicine service is identical to the way a claim would be submitted for a face-to-face visit. Depending on the method of telemedicine used and the role of the provider in the consultation determines whether a modifier should be added to the procedure code. The role of the provider falls into three categories:

  • Consulting Provider: Evaluates the patient and/or medical data/images using telemedicine mode of delivery upon recommendation of the referring provider.

NOTE: Manual is under review.

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Section II: Professional Claims Management [listed under FQHC tab], Feb. 6, 2020, pg. 20, (Accessed Feb. 2024).

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Arizona

Last updated 02/09/2024

Telehealth and telemedicine may qualify as a FQHC/RHC visit if …

Telehealth and telemedicine may qualify as a FQHC/RHC visit if it meets the requirements as specified in AMPM Policy 320-I.  To qualify as a reimbursable telehealth visit, claims with procedure code T1015 must additionally include another eligible code from the AHCCCS Telehealth Code Set.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10 Addendum: FQHC/RHC, (8/25/22), pg. 3, (Accessed Feb. 2024).

Telehealth and Telemedicine may qualify as a FQHC/RHC visit if it meets the requirements as specified in AMPM Policy 320-I.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) Reimbursement, Ch 670, (pg. 3), Effective 10/1/15. (Accessed Feb. 2024).

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Arkansas

Last updated 02/06/2024

To comply with CMS mandate, telehealth visits are to be

To comply with CMS mandate, telehealth visits are to be paid the same as a face-to-face encounter visit for FQHC providers. The following procedure codes have had the rates updated to match their encounter rate: G2025

SOURCE: AR Department of Human Services, FQHC Provider Rate for G2025, Sept. 15, 2023, (Accessed Feb. 2024).

The telemedicine procedure code and procedure codes for ancillary services, except for family planning-related laboratory procedures listed in this manual, will be denied.

SOURCE:  AR Medicaid Provider Manual. Section II FQHC. Rule 252.140. Updated Oct. 13, 2003. pg. II-27, (Accessed Feb. 2024).

FQHC Manual refers providers to Telemedicine policy manual for encounters.  

See:  AR Medicaid Live Video Eligible Providers.

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California

Last updated 12/20/2023

Yes, see manual for distant site scenarios and billing/reimbursement policies …

Yes, see manual for distant site scenarios and billing/reimbursement policies applicable.

The billable provider, employed or under direct contract with an FQHC or RHC can respond from any location, including their home, during a time that they are scheduled to work for the FQHC or RHC.

For the purposes of payment for covered treatment or services provided through telehealth, the department shall not limit the type of setting where services are provided for the patient or by the health care provider.

SOURCE: CA Department of Health Care Services (DHCS). Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual (Jan 2023), p. 16-20. (Accessed Dec. 2023).

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Colorado

Last updated 01/29/2024

For Health First Colorado a billable encounter at an FQHC/RHC …

For Health First Colorado a billable encounter at an FQHC/RHC is an in person or telemedicine face to face visit with a Health First Colorado member. Telemedicine services are limited to the procedure codes identified on the Telemedicine Provider Information web page and Telemedicine Manual under General Billing Information. When a Federally Qualified Health Center or a Rural Health Clinic provides care through telemedicine, the claim must include the modifier GT on line(s) identifying the service(s).

SOURCE: CO FQHC & RHC Billing Manual 8/22. (Accessed Jan. 2024).

Health First Colorado allows telemedicine visits to qualify as billable encounters for Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs), and Indian Health Services (IHS). Services allowed under telemedicine may be provided via telephone, live chat, or interactive audiovisual modality for these provider types.

All distant site rendering providers bill the appropriate procedure code using Place of Service code 02 or 10 and the appropriate modifiers FQ or FR on the CMS 1500 paper claim form or as an 837P transaction.

Place of Services codes 02 and 10 can be used during telehealth encounters:

  • POS 02: Telehealth provided other than in the patient’s home. The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
  • POS 10: Telehealth Provided in Patient’s Home. The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

Additionally, modifiers FQ, FR, 93, and 95 can be added to POS 2 and 10:

  • FQ: The service was furnished using audio-only communication technology.
  • FR: The supervising practitioner was present through two-way, audio/video communication technology.
  • 93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
  • 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

FQHC/RHCs may bill using modifier GT. When used by an FQHC or RHC, the modifier GT identifies the services as being delivered through telemedicine modality. There is no enhanced payment to FQHCs and RHCs when using the modifier GT.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 1/24. (Accessed Jan. 2024).

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Connecticut

Last updated 01/10/2024

Federally Qualified Health Centers (FQHCs) are eligible to bill their …

Federally Qualified Health Centers (FQHCs) are eligible to bill their encounter rate when an approved, medically necessary telehealth service is rendered. FQHCs must use the services identified on the CMAP Telehealth Table in combination with their approved scope of service to identify the services eligible to be rendered using telehealth. FQHCs must continue to bill HCPCS code, T1015 and all eligible telehealth procedure codes to reflect all of the services rendered during the telehealth visit.

SOURCE: CMAP Telehealth Table. (Accessed Jan. 2024).

FQHCs are listed as eligible providers for a variety of services via telehealth and guidance states that the modifier GT is used when the member’s originating site is located in a healthcare facility or office; or modifier 95 Is used when the member is located at home.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Jan. 2024).

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Delaware

Last updated 01/15/2024

FQHCs are not explicitly listed as eligible distant site providers, …

FQHCs are not explicitly listed as eligible distant site providers, although the provider list states that other providers can be approved by DMAP. In addition, COVID-19 guidance implied that FQHCs should “continue” typical billing practices for telehealth services as distant site/rendering providers:

  • FQHC Rendering Providers billing for Interactive Telehealth Services or Telephonic Services should continue to bill their appropriate HCPCS (Healthcare Common Procedure Coding System) “G” visit payment code for each payable encounter visit, along with the appropriate code for the service provided and use Place of Service value 02 for all Telehealth Charges. For Telephonic Services, the same codes listed above should be used as appropriate.

SOURCE: DE Medical Assistance Program. Changes to DMMA Telehealth Policies to Respond to COVID-19. April 23, 2020. (Accessed Jan. 2024).

Generally, to receive payment for services delivered through telemedicine technology from DMAP or MCOs, healthcare practitioners must:

  • Act within their scope of practice;
  • Be licensed (in Delaware, or the State in which the provider is located if exempted under Delaware State law to provide telemedicine services without a Delaware (license) for the service for which they bill DMAP;
  • Be enrolled with DMAP/MCOs;
  • Be located within the continental United States;
  • Be credentialed by DMMA-contracted MCOs, when needed;
  • Submit a DMMA Disclosure Form.

SOURCE: DE Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 11. (Accessed Jan. 2024).

Explicitly listed eligible distant site providers include:

  • Inpatient/outpatient hospitals (including ER)
  • Physicians (or PAs under the physician’s supervision)
  • Certified Nurse Practitioners
  • Nurse Midwives
  • Licensed Psychologists
  • Licensed Clinical Social Workers
  • Licensed Professional Counselors of Mental Health
  • Speech Language Therapists
  • Audiologists
  • Other providers as approved by the DMAP

SOURCE: Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. Pg. 12. (Accessed Jan. 2024).

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Florida

Last updated 02/23/2024

No Reference Found.

No Reference Found.

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Georgia

Last updated 01/31/2024

FQHC’s and RHC’s are authorized to serve as a distant …

Hawaii

Last updated 02/13/2024

Distant/Hub Site:

The location of the enrolled Hawai’i Medicaid provider …

Distant/Hub Site:

The location of the enrolled Hawai’i Medicaid provider delivering Medicaid eligible services through telehealth. The U.S. Department of Health and Human Services Office for Civil Rights expects health care providers will implement HIPAA safeguards and conduct telehealth in private settings, such as a doctor in a clinic or office connecting to a patient who is at home or at another clinic.

If a provider does not have the capacity to provide in-person services, they must inform the patient that: the patient has the right to receive in-person services if they prefer; they (the provider) are incapable of providing in-person services; and they (the provider) must inform the patient that their QI MCO can assist with finding a provider who can provide in-person services.

With exceptions, the FQHC provider must be located at their contracted FQHC’s HRSA approved site or satellite.

Exceptions:

  • Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.
  • If prescribing controlled substances, the provider must be located in the State of Hawai’i.

SOURCE: Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).

Distant site means the location of the health care provider delivering services through telehealth at the time the services are provided.

SOURCE: HI Revised Statues Section 346-59.1(g). (Accessed Feb. 2024).

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Idaho

Last updated 02/13/2024

Medicaid policy is not subject to Medicare restrictions for virtual …

Medicaid policy is not subject to Medicare restrictions for virtual care unless the participant has Medicare primary. Otherwise, all Medicaid providers, including federally qualified health centers (FQHC’s), rural health centers (RHC’s), and Indian health clinics (IHC’s) may bill for virtual care services according to these guidelines.

FQHC, RHC or IHS providers should not report the GT or FQ modifier with encounter code T1015 but should include it with each applicable supporting codes.

SOURCE: ID Medicaid Provider Handbook: General Information and Requirements for Providers (Jan. 30, 2024), p. 133-134ID MedicAide May 2023.  (Accessed Feb. 2024).

Telehealth services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Idaho Medicaid Telehealth Policy and applicable handbooks. See the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook for more information about eligible services and billing requirements.

SOURCE: ID Medicaid Provider Handbook, IHS, FQHC, and RHC Services, p. 31 (Nov. 18, 2022).  (Accessed Feb. 2024).

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Illinois

Last updated 02/27/2024

The Distant Site is the site where the provider rendering …

The Distant Site is the site where the provider rendering the telehealth service is located. The Distant Site shall be reimbursed as follows:

  • If the Originating Site is an encounter clinic, the Distant Site may not seek reimbursement from the Department for their services. The Originating Site encounter clinic is responsible for reimbursing the Distant Site.
  • If the Originating Site is not an encounter clinic, the Distant Site encounter clinic can seek reimbursement from the Department.

For telemedicine services, the provider rendering the service at the Distant Site can be a physician, podiatrist, advanced practice nurse (APN), or a Physician Assistant (PA) who is licensed by the State of Illinois or by the state where the participant is located. For telepsychiatry services, the provider rendering the service at the Distant Site must be a physician licensed by the State of Illinois, or by the state where the patient is located, who has completed an approved general psychiatry residency program or a child and adolescent psychiatry residency program. Telepsychiatry is not a covered service when rendered by an APN or PA. Group psychotherapy is not a covered telepsychiatry service.

SOURCE: Handbook for Encounter Clinic Services. Ch. 200, pg. 17-18.  Aug. 2016. (Accessed Feb. 2024).

An encounter clinic serving as the distant site shall be reimbursed as follows:

  1. If the originating site is another encounter clinic, the distant site encounter clinic shall receive no reimbursement from the Department.  The originating site encounter clinic is responsible for reimbursement to the distant site encounter clinic; and
  2. If the originating site is not an encounter clinic, the distant site encounter clinic shall be reimbursed for its medical encounter.  The originating site provider will receive a facility fee as defined in subsection (a)(4) of this Section.

SOURCE: IL Administrative Code 89 140.403 (3). (Accessed Feb. 2024).

See billing examples in appendix.

SOURCE:  IL Dept of Healthcare and Family Services All Providers Handbook Supplement (Sept. 23, 2020). Encounter Clinic Services – Appendices. (Accessed Feb. 2024).

FQHCs, RHCs, and ERCs billing for FFS reimbursement of LARCs at the Practitioner Fee Schedule rate, as well as virtual check-in and e-visit services at the FFS rate indicated on the COVID-19 Virtual Healthcare Expansion Billing Codes fee schedule found on the COVID-19 Updates webpage, must adhere to the following guidelines for proper reimbursement:

  • Report only the applicable CPT or HCPCS procedure code, without reporting the T1015 encounter code.
  • Report one of the following taxonomy codes in billing loop 2010AA, in accordance with the Chapter 300 Taxonomy table for 837P, in order for the clinic to be correctly identified as the provider of record for FFS reimbursement:

o   261QF0400X (FQHC)

o   261QR1300X (RHC)

o   261QP2300X (ERC)

Additional detailed reimbursement criteria specific to FFS billing of LARCs is also found in Topic 210.5.2 of the Handbook for Providers of Encounter Clinic Services.

SOURCE: Provider Notice Billing Procedures for Fee-For-Service Reimbursement and Telehealth Billing Clarification (May 20, 2020). (Accessed Feb. 2024).

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Indiana

Last updated 12/05/2023

When the FQHC or RHC is the distant site, the …

When the FQHC or RHC is the distant site, the service provided by the FQHC or RHC must meet the requirements both for a valid encounter and for an approved telehealth service. The claim must include the following:

  • Encounter code T1015 (or D9999 for valid dental encounters), billed with POS code 02, 03, 04, 10, 11, 12, 31, 32, 50 or 72
  • One or more appropriate procedure codes for the specific services rendered, billed with modifier 93 or 95, and a POS code of either 02 or 10, depending on the originating site/location of the patient

SOURCE: Indiana Health Coverage Programs, Provider Reference Manual, Telehealth and Virtual Services (Sept. 27, 2022), p. 6. (Accessed Dec. 2023).

Subject to the following criteria, reimbursement is available to FQHCs and RHCS when they are serving as either the distant site or the originating site for telehealth services.

SOURCE: IHCP Bulletin BT 202239 (May 19, 2022), p. 3. (Accessed Dec. 2023).

The Indiana Health Coverage Programs (IHCP) published IHCP Banner Page BR202152 introducing the addition of place of service (POS) code 10. The Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) is clarifying that the IHCP will allow the use of POS code 10 for federally qualified healthcare centers (FQHCs) and rural health clinics (RHCs) for dates of service (DOS) on or after July 21, 2022. Any FQHC or RHC claims with DOS before July 21, 2022, will deny if the POS 10 is present on the claim. Please correct these claims using the appropriate POS 02 and resubmit. The definitions for the telehealth POS codes changed on Jan. 1, 2022:

  • POS 02 – Telehealth provided other than in patient’s home
  • POS 10 – Telehealth provided in patient’s home

As posted in IHCP Bulletin BT202239, the following modifiers are used on telehealth claims:

  • Modifier 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
  • Modifier 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system

Beginning July 21, 2022, FQHC and RHC providers must have one or more appropriate procedure codes for the specific services rendered, billed with modifier 93 or 95, and a POS code of either 02 or 10, depending on the originating site/location of the patient.

SOURCE: IHCP Allows New POS Code for FQHCs and RHCs July 21 BT 202253 (July 14, 2022).  (Accessed Dec. 2023).

Reimbursement for medically necessary telemedicine services is available to the following providers regardless of the distance between the provider and member:

  • A federally qualified health center
  • A rural health clinic
  • A community mental health center
  • A critical access hospital
  • A home health agency licensed under IC 16-27-1.
  • A provider, as determined by the office to be eligible, providing a covered telehealth service.

SOURCE: IN Admin Code, “Article 5” 405 5-38-4(3) p. 199-200 IN Code, 12-15-5-11 (Accessed Dec. 2023).  

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Iowa

Last updated 01/15/2024

FQHCs may serve as distant sites.

See: IA Medicaid Live

Kansas

Last updated 12/06/2023

The consulting or expert provider at the distant site must …

The consulting or expert provider at the distant site must bill an appropriate code from the list below with place of service (POS) 02 – Telemedicine and will be reimbursed at the same rate as face-to-face services.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-14 (Aug. 2023), (Accessed Dec. 2023).

See: KS Medicaid Live Video Eligible Providers

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Kentucky

Last updated 12/11/2023

For rural health clinics, federally qualified health centers, and federally …

For rural health clinics, federally qualified health centers, and federally qualified health center look-alikes, reimbursement for covered telehealth services and telehealth consultations shall:

  • To the extent permitted under federal law, include an originating site fee in an amount equal to that which is permitted under 42 U.S.C. sec. 1395m for Medicare-participating providers if the Medicaid beneficiary who received the telehealth service or telehealth consultation was physically located at the rural health clinic, federally qualified health center, or federally qualified health center look-alike at the time of service or consultation delivery and the provider of the telehealth service or telehealth consultation is not employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike; or
  • If the telehealth service or telehealth consultation provider is employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike, include a supplemental reimbursement paid by the Department for Medicaid Services in an amount equal to the difference between the actual reimbursement amount paid by a Medicaid managed care organization and the amount that would have been paid if reimbursement had been made directly by the department.

A health-care facility that receives reimbursement under this section for consultations provided by a Medicaid-participating provider who practices in that facility and a health professional who obtains a consultation under this section shall establish quality-of-care protocols, which may include a requirement for an annual in-person or face-to-face consultation with a patient who receives telehealth services, and patient confidentiality guidelines to ensure that telehealth consultations meet all requirements and patient care standards as required by law.

The Department for Medicaid Services and any managed care organization with whom the department contracts for the delivery of Medicaid services shall not deny reimbursement for telehealth services covered by this section based solely on quality-of-care protocols adopted by a health-care facility.

SOURCE: KY Statute Sec. 205.559. (Accessed Dec. 2023).

See: KY Medicaid Live Video Eligible Providers

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Louisiana

Last updated 02/15/2024

Reimbursement for service codes appropriate to telemedicine/telehealth will be at …

Reimbursement for service codes appropriate to telemedicine/telehealth will be at the all-inclusive prospective payment rate on file for the date of service (DOS).

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Feb. 2024).

See: LA Medicaid Live Video Eligible Providers

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Maine

Last updated 02/03/2024

Telehealth Services may be included in a Federally Qualified Health …

Telehealth Services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by the State. If approved, these facilities may serve as the provider site and bill under the encounter rate.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 12. (Nov. 6, 2023). (Accessed Feb. 2024).

Also see: ME Medicaid Live Video Eligible Providers

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Maryland

Last updated 02/21/2024

All distant site providers enrolled in Maryland Medicaid may provide …

All distant site providers enrolled in Maryland Medicaid may provide services via telehealth as long as telehealth is a permitted delivery model within the rendering provider’s scope of practice.

A distant site may be any location where a licensed, certified, or otherwise authorized provider is located when rendering a service using technology-assisted communication.

SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 2, 7. Updated Aug. 2023. (Accessed Feb. 2024).

The Program shall provide health care services appropriately delivered through telehealth to Program recipients regardless of the location of the Program recipient at the time telehealth services are provided and allow a distant site provider to provide health care services to a Program recipient from any location at which the health care services may be appropriately delivered through telehealth.

SOURCE: MD General Health Code 15-141.2(b). (Accessed Feb. 2024).

“Distant site provider” means the licensed, certified, or otherwise authorized provider at the distant site who provides medically necessary services via telehealth to the patient

“Provider” means:

  • An individual, association, partnership, corporation, unincorporated group, or any other person authorized, licensed, or certified to provide services for Medical Assistance participants and who, through appropriate agreement with the Department, has been identified as a Maryland Medical Assistance Provider by the issuance of an individual account number;
  • An agent, employee, or related party of a person identified in §B(12)(a) of this regulation;
  • An individual or any other person with an ownership interest in a person identified in §B(12)(a) of this regulation.

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

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Massachusetts

Last updated 01/12/2024

MassHealth lists specific codes that may be used by community …

MassHealth lists specific codes that may be used by community health centers for services delivered through telehealth.

SOURCE: MassHealth, Community Health Center Manual, Service Codes and Descriptions, 1/1/23, (Accessed Jan. 2024).

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

  • modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
  • modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
  • modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

Billing and Payment Rates for Services

Providers billing under an 837I/UB-04 form must include the modifier GT when submitting claims for services delivered via telehealth. Providers billing under an 837P/1500 form must include the place of service (POS) code 02 or 10 when submitting claims for services delivered via telehealth.

Additionally, for any such professional claim, providers must include:

  • modifier 95 to indicate counseling and therapy services rendered via audio-video telehealth;
  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier GQ to indicate services rendered via asynchronous telehealth;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications; and/or
  • modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology.

Rates of payment for services delivered via telehealth will be the same as the rates of payment for services delivered via traditional (i.e., in-person) methods as set forth in the applicable regulations.

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Jan. 2024).

See: MA Medicaid Live Video Distant Site

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Michigan

Last updated 01/19/2024

Clinics are also permitted to submit for reimbursement telemedicine services …

Clinics are also permitted to submit for reimbursement telemedicine services (using simultaneous audio/visual technologies) per bulletin MSA 20-09 if all other provisions of telemedicine policy are maintained. Simultaneous audio/visual telemedicine services, as indicated by CPT/HCPCS codes listed on the telemedicine fee schedule and considered qualifying visits, will also be considered face-to-face and will trigger the PPS/AIR if the service billed is listed as a qualifying visit.

Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC)/Tribal Health Center (THC)/ Tribal Federally Qualified Health Centers (Tribal FQHC) Considerations – PT, OT and ST, when provided in accordance with this policy using both audio/visual modalities, will be considered face-to-face and will trigger the PPS AIR if the service billed is listed as a qualifying visit. For FQHCs, RHCs, THCs and Tribal FQHCs, the appropriate CPT/HCPCS code, PPS/AIR payment code (if the service generates a Qualifying Visit), and modifier 95 – synchronous telemedicine must be used. Refer to www.michigan.gov/medicaidproviders >> Provider Specific Information for additional information.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

All current Medicaid policy for telemedicine services, including definitions requirements and parameters of telemedicine apply to FQHCs and RHCs. FQHCs and RHCs are responsible for ensuring compliance with all telemedicine policy within the Medicaid provider manual and any applicable supplemental Medicaid policy bulletins.

Distant site services, provided by qualified Medicaid enrolled practitioners, may be covered when the qualified practitioner is employed by the clinic or working under the terms of a contractual agreement with the clinic. FQHCs and RHCs must maintain all practitioner contracts and provide them to MDHHS upon request.

During the Medicaid provider enrollment process contracted providers must associate to the FQHC or RHC billing national provider identifier. Refer to the billing and reimbursement for institutional providers chapter of the Medicaid provider manual for further information.

Telemedicine service(s) provided at the distant site that qualify as a face-to-face visit may generate the PPS payment. All current PPS rules and encounter criteria apply to telemedicine visits.

If both originating and distant sites submit identical procedure codes for a telemedicine visit for the same beneficiary on the same date of service it is considered a duplicate billing. MDHHS will recover payment from the appropriate FQHC, RHC or contracted provider. Recovery will be based on the terms specified in the contract.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] & Dept. of Health and Human Services Medicaid Provider Manual, p. 2152-2153, Jan. 1, 2024 (Accessed Jan. 2023).

Claims for telemedicine services must be submitted using the ASC X 12N 837 5010 form using the appropriate telemedicine HCPCS or CPT code. All telemedicine claims must include the corresponding modifier 95- “Synchronous Telemedicine Service rendered via a real-time interactive audio and video telecommunications system” or 93 – “Synchronous Telemedicine Service rendered via telephone or other real-time interactive audio-only telecommunications system” and the appropriate revenue code.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2152, Jan. 1, 2024 (Accessed Jan. 2024).

A Tribal facility may choose to enroll as a Tribal FQHC and be reimbursed for outpatient face-to-face visits within the FQHC scope of services provided to Medicaid beneficiaries, including telemedicine and services provided by contracted employees. Tribal FQHCs are eligible to receive the IHS outpatient AIR for eligible encounters.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 2197, Jan. 1, 2024 (Accessed Jan. 2024).

An FQHC can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 747, Jan. 1, 2024 (Accessed Jan. 2024).

See: MI Medicaid Live Video Distant Site

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Minnesota

Last updated 02/29/2024

Face-to-face service includes telehealth services provided by an eligible provider

Face-to-face service includes telehealth services provided by an eligible provider

SOURCE: MN Department of Human Services, Federally Qualified Health Center and Rural Health Center, Revised Jan. 10, 2022. (Accessed Feb. 2024).

Telehealth visits provided through audio and visual communication or accessible video-based platforms may be used to satisfy the face-to-face requirement for reimbursement under the payment methods that apply to a federally qualified health center, rural health clinic, Indian health service, 638 tribal clinic, and certified community behavioral health clinic, if the service would have otherwise qualified for payment if performed in person.

SOURCE: MN Statute 256B.0625. (Accessed Feb. 2024).

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Mississippi

Last updated 12/23/2023

The division shall recognize federally qualified health centers (FQHCs), rural

The division shall recognize federally qualified health centers (FQHCs), rural health clinics (RHCs) and community mental health centers (CMHCs) as both an originating and distant site provider for the purposes of telehealth reimbursement. The division is further authorized and directed to reimburse FQHCs, RHCs and CMHCs for both distant site and originating site services when such services are appropriately provided by the same organization.

An encounter for face-to-face telehealth services provided by the FQHC acting as a distant site provider. MS Medicaid reimburses a FQHC for both the distant and originating provider site when such services are appropriately provided by the FQHC.

SOURCE: MS Admin. Code Title 23, Part 211, Rule. 1.5. (Accessed Dec. 2023).

See: MS Medicaid Live Video Distant Site

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Missouri

Last updated 01/20/2024

Federally Qualified Healthcare Clinics (FQHC)

FQHC providers must remove originating …

Federally Qualified Healthcare Clinics (FQHC)

FQHC providers must remove originating site charges and payments for telemedicine services from their year-end cost reports.

FQHC providers must leave the Rendering Provider ID field (24j on CMS-1500) blank on their claims when billing the Q3014 originating site facility charge.

FQHC Cost Reporting: Distant Site

The telemedicine charges and costs, including the depreciation cost for equipment, are allowed on the FQHC cost report.

The clinic must have medical records in their clinic for the person being seen to be able to report these charges on their cost report. If the person being seen is not one of the clinic’s patients, all costs will need to be removed from the cost report.

SOURCE: MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Jan. 2024).

See:  MO Medicaid Live Video Distant Site

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Montana

Last updated 02/13/2024

No direct reference to whether or not FQHCs can be …

No direct reference to whether or not FQHCs can be eligible distant site providers.

See: MT Medicaid Live Video Eligible Providers

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Nebraska

Last updated 01/04/2024

FQHC and RHC payment for telehealth services is the Medicaid …

FQHC and RHC payment for telehealth services is the Medicaid rate for a comparable in-person service. FQHC & RHC core services provided via telehealth are not covered under the encounter rate.

SOURCE: NE Admin. Code Title 471, Sec. 29-004.05, Ch. 29. (Accessed Jan. 2023).

See: NE Medicaid Live Video Distant Site

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Nevada

Last updated 12/18/2023

Facilities that are eligible for encounter reimbursement (e.g. Indian Health

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1, (Jun. 2022). (Accessed Dec. 2023).

Distant Site: FQHCs providing services for a recipient from a distant site may bill the appropriate encounter rate with Place of Service (POS) Code 02. Use of the POS code certifies the service meets telehealth requirements.

SOURCE: NV Medicaid FQHC Billing Guidelines. 8/30/19. (Accessed Dec. 2023).

See: NV Medicaid Live Video Eligible Providers

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New Hampshire

Last updated 12/19/2023

Not listed as eligible distant site, however there is no …

Not listed as eligible distant site, however there is no restriction on eligible distant sites according to statute.

SOURCE: NH Revised Statutes 167:4-d (Accessed Dec. 2023).

See: NH Medicaid Live Video Distant Site

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New Jersey

Last updated 02/02/2024

For the provision of services, providers are expected to follow …

For the provision of services, providers are expected to follow the same rules they would follow if the patient visit was face-to-face. This includes instances when a license is for an entity such as an independent clinic (which includes FQHC). This license is for a specific address and is not tied to specific personnel. In this instance, the service may only be billed when provided at the address listed on the license. When billed by the clinic, the service provider (for example a physician) may provide services from a remote location but the patient must receive those services while physically present at the independent clinic (licensed location). Independent practitioners have a person specific license that is not tied to a specific address. Services billed by independent practitioners do not have location restrictions. The patient and/or the provider may be at any location as long as the provider is licensed to practice in New Jersey.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 2 (Accessed Feb. 2024).

Teledentistry (D9995) can only be billed in conjunction with CDT code D0140 – limited oral evaluation – problem focused. For Federally Qualified Health Centers – the encounter code (D0120 with modifier 22), along with D9995 and D0140, must be billed for the same date with all services submitted on the same claim.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 33, No. 13, Aug. 2023, p. 3. (Accessed Feb. 2024).

See: NJ Medicaid Live Video Distant Site

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New Mexico

Last updated 02/26/2024

An originating clinical service fee is billed at the encounter …

An originating clinical service fee is billed at the encounter rate.

SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, pg. 30, (Accessed Feb. 2024).

All specialized behavioral health services provided within the HRSA-approved scope of practice of the FQHC will be paid using the prospective payment system rate.

SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, pg. 33, (Accessed Feb. 2024).

See:  NM Medicaid Live Video Distant Sites

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New York

Last updated 11/18/2023

Any secure site within the fifty United States (U.S.) or …

Any secure site within the fifty United States (U.S.) or U.S. territories, is eligible to be a distant site for delivery and payment purposes, including Federally Qualified Health Centers (FQHCs) and providers homes, for NYS Medicaid-enrolled patients. To receive reimbursement from NYS Medicaid, providers submitting telehealth claims or encounters must be NYS-licensed and enrolled in NYS Medicaid.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 4. (Accessed Nov. 2023).

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North Carolina

Last updated 12/12/2023

The distant site is the location from which the provider …

The distant site is the location from which the provider furnishes the telehealth, virtual communications, or remote patient monitoring services. There are no restrictions on distant sites. Distant sites may be wherever the provider may be located. Provider(s) shall ensure that beneficiary privacy is protected (such as taking calls from private, secure spaces; using headsets).

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. Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes and Rural Health Centers (RHCs) are considered eligible distant sites and shall follow the coding and billing guidelines in Attachment A below.

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

Core Visit Services: Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) core service providers may deliver core services via telehealth if the service is:

  • Defined as a core visit service in Section 5.3 of Clinical Coverage Policy 1D-4: Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics; and,
  • Covered as a telehealth-eligible core visit service in Attachment A, Section C.1 of this policy.

Non-Core Visit Services: FQHCs and RHCs may also deliver a select set of services via telehealth, virtual patient communications, and remote patient monitoring that are not
defined as a core visit service in Section 5.3 of Clinical Coverage Policy 1D-4: Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics. FQHCs and RHCs would be reimbursed on a fee-for-service basis for delivering non-core visit services via telehealth, virtual patient communications, or remote patient monitoring. See Attachment A, Section C.1 of this policy for further guidance for billing virtual patient communications and remote patient monitoring codes.

Please refer to Clinical Coverage Policy 1-H: Telehealth, Virtual Patient Communications, and Remote Patient Monitoring for a list of other related clinical coverage policies that include telehealth, virtual patient communications and remote patient monitoring-eligible non-core visit services that may be delivered by eligible providers at an FQHC or RHC.

Core Services: Core visit services delivered via telehealth are billed under the FQHC and RHC provider number using the HCPCS code T1015 (clinic visit/encounter, all-inclusive), T1015-HI (for behavioral health services), or T1015-SC (subsequent sick visit) and appended with the GT modifier. Eligible providers include all core service providers as defined in Section 3.2.1 of this policy, which includes physicians, physician assistants, nurse practitioners, nurse midwives, clinical psychologists, clinical social workers, licensed psychological associates, licensed clinical mental health counselors, licensed marriage and family therapists, advance practice nurse specialists, clinical nurse specialists, and licensed clinical addiction specialists.

Hybrid Telehealth with Supporting Home Visit: In addition, FQHC and RHC core service providers may conduct telehealth visits with a supporting home visit by a delegated staff member (“hybrid model”) with new or established patients and bill using HCPCS code T1015 (or T1015-HI, T1015-SC), for a range of scenarios including (but not limited to) chronic disease management and perinatal visits.  See manual for additional guidance.

Telehealth Claims: Modifier GT must be appended to the CPT or HCPCS code to indicate that a service has been provided via interactive audio-visual communication. This modifier is not appropriate should not be used for virtual patient communications (including telephonic evaluation and management services) or remote patient monitoring.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, Aug. 15, 2023. (Accessed Dec. 2023).

See: NC Medicaid Live Video Eligible Providers

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North Dakota

Last updated 02/19/2024

FQHCs and RHCs

Revenue code 0780 should only be reported …

FQHCs and RHCs

Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing telehealth services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue codes listed in the FQHC and RHC portions of this manual along with the CPT® or HCPCS code for the service rendered appended with modifier GT or 95.

Refer to the FQHC and RHC portions of this manual for the revenue codes to bill for the various services.

SOURCE: ND Medicaid, Telehealth, Jan. 2024, (Accessed Feb. 2024).

Payment to FQHCs for covered services furnished to members is made by means of an all-inclusive rate for each encounter.   Encounter in this chapter means a face-to-face visit or synchronous telehealth visit during which a qualifying encounter service is rendered. FQHCs may furnish services that qualify as a medical, dental, or behavior health encounter. Each encounter includes services and supplies incident to the service.

SOURCE: ND Medicaid General Information, Federally Qualified Health Center, Jan. 2024, (Accessed Feb. 2024).

FQHCs and RHCs – Dentistry

Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.

Revenue Code 512: Dental Clinic.

One dental encounter is allowed per day. The encounter must be a face to face encounter to qualify for payment. Asynchronous teledentistry performed as a stand-alone service does not qualify for an encounter payment. At least one covered service must be performed as a face to face service to qualify for the dental encounter payment.

SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Feb. 2024).

See: ND Medicaid Live Video Eligible Providers

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Ohio

Last updated 02/16/2024

For a covered telehealth service that is also an FQHC

For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived.

There is no limitation on the practitioner or patient site.  FQHCs are listed as eligible billing ‘pay-to’ providers.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022, p 5 & 9.  (Accessed Feb. 2024).

Managed Care

Providers Eligible to submit claims for telehealth …

  • A federally qualified health center (FQHC) or rural health clinic (RHC) as defined in Chapter 5160-28 of the Administrative Code (using a professional claim form).

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

See: OH Medicaid Live Video Distant Site

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Oklahoma

Last updated 12/04/2023

Clinic Services

Telehealth and audio-only health service delivery requires either …

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to the Code of Federal Regulations. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Dec. 2023).

See: OK Medicaid Live Video Distant Site

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Oregon

Last updated 12/20/2023

OR Medicaid requires providers to be enrolled and meet certain …

OR Medicaid requires providers to be enrolled and meet certain requirements.  They also state that the distant site can be any location in which appropriate privacy and confidentiality is ensured, however no explicit reference is made to FQHCs.

See: OR Medicaid Live Video Distant Site

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Pennsylvania

Last updated 01/22/2024

Teledentistry may be used by dentists, FQHCs, and RHCs to …

Teledentistry may be used by dentists, FQHCs, and RHCs to provide dental services to MA beneficiaries. The provider must be licensed in Pennsylvania and enrolled in the MA Program.

FQHCs and RHCs are to continue billing procedure code T1015 with the U9 modifier to indicate dental visits/encounters rendered via teledentistry to patients. FQHCs and RHCs should no longer use the GT modifier, as previously directed in Provider Quick Tip # 237, “Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health  Clinics”(https://www.dhs.pa.gov/providers/QuickTips/Documents/PROMISeQuickTip237.pdf), and must begin using POS 02 as of May 2, 2022.

Teledentistry visits must be provided according to the same standard of care as if delivered in-person.

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

Telepsychiatry Services – Only applicable to Behavioral Health Managed Care delivery system claims and not fee-for-service delivery. Mental health services are provided through the use of approved electronic communication and information technologies to provide or support clinical psychiatric care at a distance. Qualifying telepsych services utilize real-time, two-way interactive audio-video transmission, and do not include a telephone conversation, electronic mail message, or facsimile transmission between a health care practitioner and a service recipient, or a consultation between two healthcare practitioners, although these activities may support the delivery of telepsych services. Telepsych services require service providers to have a service description approved by the Office of Mental Health and Substance Abuse Services (OMHSAS) and deliverable through the managed care option.

SOURCE: PA PROMISe, 837 Professional/CMS-1500 Claim Form, Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Apr. 22, 2014). (Accessed Jan. 2024).

I work as a licensed professional at a Federally Qualified Health Center (FQHC). Will I be able to bill for services delivered via telemedicine after October 31, 2022?

Yes, as clarified in MA Bulletin 99-22-02 (NOTE: Bulletin 99-22-02 has been replaced by 99-23-08) telemedicine remains a mode of service delivery that providers can utilize.  Providers that are licensed by the Office of Mental Health and Substance Abuse Services should refer to bulletin OMHSAS-22-02 – Revised Guidelines for Delivery of BH Services Through Telehealth 7.1.22.pdf (pa.gov) when rendering the behavioral health services for which they are licensed.  In addition, DHS recently issued MA Bulletin 08-22-13, 27-22-07 related to tele dentistry services that is also relevant to FQHC providers that offer dental services.

SOURCE: PA Department of State, Frequently asked Questions About Telemedicine in Pennsylvania, (Accessed Jan. 2024).

See: PA Medicaid Live Video Distant Site

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Puerto Rico

Last updated 12/18/2023

No reference found.

No reference found.

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Rhode Island

Last updated 02/01/2024

An encounter must include a face-to-face or telemedicine (telephone-only and …

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Feb. 2024).

Law requires that all medically necessary and clinically appropriate telemedicine services delivered by in-network primary care providers, registered dietitian nutritionists and behavioral health providers be reimbursed at a rate not lower than services provided in-person. No explicit reference is made to FQHCs.

See: RI Medicaid Live Video Eligible Providers

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South Carolina

Last updated 02/08/2024

The RHCs and FQHCs would bill an encounter code when …

The RHCs and FQHCs would bill an encounter code when operating as the consulting site. Only one encounter code can be billed for a DOS. Both provider types will use the appropriate encounter code for the service along with the “GT” modifier (via interactive audio and video telecommunications system) indicating interactive communication was used.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 215 (Feb. 2024). (Accessed Feb. 2024).

A consultant site means the site at which the provider is located at the time the telehealth service is delivered. The provider performing the medical care must be currently and appropriately licensed in South Carolina. FQHC and RHC providers are eligible to serve as consulting site providers for telehealth services.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 32-33 (Feb. 2024). (Accessed Feb. 2024).

Federally Qualified Health Centers (FQHC) and Rural Health Centers (RHC) will continue to be eligible for reimbursement for services rendered via telehealth. When billing for any telehealth procedure code, providers must submit claims with a GT modifier. If a code requires any other billing modifiers when submitting claims, the GT modifier should be listed after any other modifiers.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 23-018. (May 2023). (Accessed Feb. 2024).

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South Dakota

Last updated 12/21/2023

FQHC/RHCs are eligible to serve as an originating site for …

FQHC/RHCs are eligible to serve as an originating site for telemedicine services and may also provide distant site telemedicine services. An originating site is the physical location of the Medicaid recipient at the time the service is provided. A distant site is the physical location of the practitioner providing the service via telemedicine. Please refer to the Telemedicine manual for additional information.

SOURCE: SD Medicaid Billing and Policy Manual, FQHC and RHC Services, Dec. 2023, (Accessed Dec. 2023).

The following providers can provide services via telemedicine at a distant site:

  • Federally Qualified Health Center (FQHC)

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1 (Dec. 2023), (Accessed Dec. 2023),

See: SD Medicaid Live Video Distant Site

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Tennessee

Last updated 01/21/2024

A provider-based telemedicine provider who seeks to contract with or …

A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity’s network.

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

A telehealth provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network shall be subject to the same requirements and contractual terms as a healthcare services provider in the health insurance entity’s network.

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

“Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33 .

SOURCE:  TN Code Annotated, Sec. 56-7-1002 & 1003, (Accessed Jan. 2024).

See: TN Medicaid Live Video Distant Site

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Texas

Last updated 01/07/2024

Telemedicine

FQHCs may be reimbursed the distant-site provider fee for

Telemedicine

FQHCs may be reimbursed the distant-site provider fee for telemedicine services at the Prospective Payment System (PPS) rate or Alternative Prospective Payment System (APPS) rate.

FQHC practitioners may be employees of the FQHC or contracted with the FQHC.

Telehealth

FQHCs may be reimbursed the distant-site provider fee for telehealth services at the Prospective Payment System (PPS) rate or Alternative Prospective Payment System (APPS) rate.

FQHC practitioners may be employees of the FQHC or contracted with the FQHC.

SOURCE:  TX Medicaid Telecommunication Services Handbook, Jan. 2024). (Accessed Jan. 2024).

See: TX Medicaid Live Video Distant Site

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Utah

Last updated 02/28/2024

Not mentioned explicitly, however state does not have a specific …

Not mentioned explicitly, however state does not have a specific provider list.

See: UT Medicaid Live Video Eligible Providers

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Vermont

Last updated 12/05/2023

A distant site is defined broadly to mean the location …

A distant site is defined broadly to mean the location of a health care provider delivering services through telemedicine at the time the services are provided. However, there is no explicit reference to FQHCs.

See: VT Medicaid Live Video Eligible Providers.

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Virgin Islands

Last updated 12/18/2023

No reference found.

No reference found.

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Virginia

Last updated 01/05/2024

Telehealth services may be included in a Federally Qualified Health …

Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider site and bill under the encounter rate.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals), (Oct. 2022) (Accessed Jan. 2024).

See: VA Medicaid Live Video Distant Site

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Washington

Last updated 12/15/2023

FQHCs may receive the encounter rate when billing as a

FQHCs may receive the encounter rate when billing as a distant site provider if the service being billed is encounter eligible. Clients enrolled in an agency-contracted MCO must contact the MCO regarding whether or not the plan will authorize telemedicine coverage.

SOURCE: Federally Qualified Health Centers, p. 64. (Oct. 2023). (Accessed Dec. 2023).

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West Virginia

Last updated 02/13/2024

Ongoing Telehealth Medicaid Flexibilities until December 31, 2024:

As noted …

Ongoing Telehealth Medicaid Flexibilities until December 31, 2024:

As noted in a 2023 WV Medicaid Provider Newsletter, with the end of the federal Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) have extended telehealth flexibilities until December 31, 2024. West Virginia Medicaid and the WVCHIP will also continue to follow CMS in allowing Telehealth flexibilities until this date. For more information on WV Medicaid COVID Telehealth Policies, see the Medicaid memos located on the WV Medicaid COVID-19 Telehealth Website, and in terms of FQHCs in particular, the Non-emergent E&M visits through Telehealth Memo. In addition, in August 2023 WV Medicaid added an appendix to its Practitioners Services Medicaid Policy Manual Telehealth Section with available codes specific to the PHE Medicaid Telehealth Services Flexibilities – see Policy 519.17 Appendix B.


FQHCs may now serve as a distant site for Telehealth consultations by a psychiatrist or psychologist only and be reimbursed at the encounter rate. The distant-site practitioner must bill the appropriate Current Procedural Technology/Healthcare Common Procedure Coding System (CPT/HCPCS) code with the appropriate Place of Service on a HCFA1500 form.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 9. (July 1, 2019); WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 3 (Effective Jan. 1, 2022). (Accessed Feb. 2024).

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Wisconsin

Last updated 01/09/2024

For the purpose of this Online Handbook topic, FQHC refers

For the purpose of this Online Handbook topic, FQHC refers to Tribal and Out-of-State FQHCs. This topic does not apply to Community Health Centers subject to PPS reimbursement.

FQHCs and RHCs may serve as originating site and distant site providers for telehealth services.

FQHCs and RHCs may report services provided via telehealth on the cost settlement report when the FQHC or RHC served as the distant site and the member is an established patient of the FQHC or RHC at the time of the telehealth service. For currently covered services, services that are considered direct when provided in-person will be considered direct when provided via telehealth for FQHCs.

Services billed with modifier GQ, GT, FQ, or 93 will be considered under the PPS reimbursement method for non-tribal FQHCs. Billing HCPCS procedure code T1015 (Clinic visit/encounter, all-inclusive) with a telehealth procedure code will result in a PPS rate for fee-for-service encounters. Fee-for-service claims must include HCPCS procedure code T1015 when services are provided via telehealth in order for proper reimbursement.

SOURCE: WI ForwardHealth Handbook, Originating and Distant Sites, Topic #22739, (Accessed Jan. 2024).

CHCs may serve as originating and distant site providers for telehealth services.

Services billed with modifier GQ, GT, FQ, FR, or 93 will be considered under the PPS reimbursement. Billing HCPCS procedure codes T1015 (Clinic visit/encounter, all-inclusive) with a telehealth procedure code will result in a PPS for an allowable encounter.

SOURCE: WI ForwardHealth Handbook, Telehealth for Community Health Centers, Topic #21997, (Accessed Jan. 2024).

See: WI Medicaid Live Video Distant Site

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Wyoming

Last updated 01/31/2024

Not explicitly listed on eligible provider list.

“Visit” means a …

Not explicitly listed on eligible provider list.

“Visit” means a face-to-face encounter between a FQHC or RHC client and a FQHC or RHC professional staff member for the purpose of providing FQHC or RHC services. Telehealth visits are considered face-to-face visits.

SOURCE: WY Admin Rules. Department of Health, (Title 48). Medicaid Program 37, Ch. 37 Sec. 3. (Accessed Jan. 2024).

See: WY Medicaid Live Video Eligible Providers

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Federally Qualified Health Center (FQHC)

Eligible Distant Site

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