Medicaid & Medicare

Email, Phone & Fax

Approximately 30% of states allow for some type of reimbursement for audio-only delivery, although it’s often limited to specific specialties, such as mental health, or for specific services, such as case management. A few states reimburse for telephone as a result of reimbursement for a communication technology-based service (CTBS) code that allows for audio-only interaction. Secure electronic messages are also beginning to be allowed through reimbursement of the eVisit code. No state allows for reimbursement of services delivered via fax.  This section only covers CTBS codes addressed in a states telehealth policy. Codes exclusively located in a state’s Fee Schedule were not examined as a source for this research.

See overview of states with telephone reimbursement >
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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 01/19/2022

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.

For the duration of the Public Health Emergency as defined in § 400.200 of this chapter, Interactive telecommunications system means 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: 42 CFR Sec. 410.78 (Accessed Jan. 2022).

Mental Health Services

CMS revised definition of ‘interactive telecommunications system’ above to include audio-only communication technology.  They will create a service-level modifier for use to identify mental health telehealth services furnished to a beneficiary in their home using audio-only communications technology.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215, (Accessed Jan. 2022).

The 2 additional modifiers for CY 2022 relate to telehealth mental health services. The modifiers are:

  • FQ – A telehealth service was furnished using real-time audio-only communication technology
  • FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology

SOURCE: CY2022 Telehealth Update Medicare Physician Fee Schedule, MLN Matters 12549, (Jan. 1, 2022), (Accessed Sept. 2022).

FQHCs & RHCs Mental Health Services

Mental health visit includes audio-only interaction in cases where beneficiaries are not capable of, or do not consent to, the use of devices that permit a two-way, audio/video interaction for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

RHCs and FQHCs can report and be paid for furnishing those visits in the same way they currently do when these services are furnished in-person. RHCs and FQHCs will be paid for mental health visits furnished via telecommunications technology at the same rate they are paid for in-person mental health visits (that is, the AIR or FQHC PPS).

There must be an in-person mental health service furnished within 6 months prior to the furnishing of the telecommunications service and that in general, there must be an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders.  This applies only to patients receiving services at home.  If the patient and practitioner consider the risks and burdens of an in-person service and agree that, on balance, these outweigh the benefits, and the practitioner documents the basis for that decision in the patient’s medical record, then the in-person visit requirement is not applicable for that 12-month period.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215, (Accessed Sept. 2022).

RHCs and FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. You may use audio-only technology in situations when your patient can’t access or doesn’t consent to use audio-video technology. You can report and get paid in the same way as in-person visits.

Audio-video visits: Use modifier 95 (Synchronous Telemedicine Service Rendered via Real Time Interactive Audio and Video Telecommunications System).

Audio-only visits: Use new service-level modifier FQ.

SOURCE: Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health Centers, MLN Matters SE22001, (June 6, 2022), (Accessed Sept. 2022).

Communication Technology-Based Services (CTBS)

‘Brief communication technology-based service, e.g. virtual check-in’ allows for real-time audio-only telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Sept. 2022).

Interprofessional consultations are reimbursable by CMS as part of their CTBS services (CPT codes include 99451, 99452, 99446, 99447, 99448, and 99449). Cost sharing will apply. These interprofessional services may be billed only by practitioners that can bill Medicare independently for evaluation and management services.  Includes telephone and internet assessments.

SOURCE CY 2019 Final Physician Fee Schedule. CMS, p. 31-40 (Accessed Sept. 2022).

Online digital evaluation services (e-visit) are reimbursable for physicians and qualified non-physician health care professionals.  These are non-face-to-face codes that describe patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.

SOURCE: CY 2020 Final Physician Fee Schedule. CMS, p. 799 (Accessed Sept. 2022).

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes communication technology-based services (Includes the Brief Communication Technology-Based Service, Remote Evaluation of Pre-Recorded Patient Information) to an RHC or FQHC patient. RHCs and FQHCs receive payment for communication technology-based services or remote evaluation services when an RHC or FQHC practitioner provides at least 5 minutes of communications-based technology or remote evaluation services to a patient who has been seen in the RHC or FQHC within the previous year.

G0071 should be billed for both services.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, & Virtual Communication Services RHCs and FQHCs FAQs, December 2019, (Accessed Sept. 2022).

RHCs and FQHCs are not eligible for reimbursement of interprofessional consultation services, as only practitioners that can bill Medicare independently for evaluation and management services are eligible.

SOURCE CY 2019 Final Physician Fee Schedule. CMS, p. 31-40 (Accessed Sept. 2022).

Home Health Agencies

An individualized plan of care must be established and periodically reviewed by the certifying physician or allowed practitioner.  The plan of care must include all of the following: … Any provision of remote patient monitoring or other services furnished via telecommunications technology (as defined in § 409.46(e)) or audio-only technology. Such services must be tied to the patient-specific needs as identified in the comprehensive assessment, cannot substitute for a home visit ordered as part of the plan of care, and cannot be considered a home visit for the purposes of patient eligibility or payment.

Telecommunications technology, as indicated on the plan of care, can include: remote patient monitoring, defined as the collection of physiologic data (for example, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient or caregiver or both to the home health agency; teletypewriter (TTY); and 2-way audio-video telecommunications technology that allows for real-time interaction between the patient and clinician. The costs of any equipment, set-up, and service related to the technology are allowable only as administrative costs. Visits to a beneficiary’s home for the sole purpose of supplying, connecting, or training the patient on the technology, without the provision of a skilled service, are not separately billable.

SOURCE:  42 CFR Sec. 409.43 & 409.46 as updated by CMS Final Rule for CY 2021 Home Health Prospective Payment System (Accessed Sept. 2022).

No reference found for email and fax.

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Alabama

Last updated 11/15/2022

Covered services does not include a telephone conversation, electronic mail …

Covered services does not include a telephone conversation, electronic mail message, or facsimile transmission between the physician, recipient, or a consultation between two physicians.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p.17). Oct. 2022. (Accessed Nov. 2022).

Telephone consultations are not covered.

SOURCE:  AL Admin. Code r. 560-X-6-.14., p. 27 & 31. (Accessed Nov. 2022).

Therapy Services

Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site provider and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the provider, recipient, or a consultation between two providers).

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2022, pg. 37-16, (Accessed Nov. 2022).

Rehabilitative Services (ASD) – DMH

Video telecommunication … does not include a telephone conversation, electronic mail message, or facsimile transmission between the treatment provider, recipient, or a consultation between two treatment providers.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2022, 110-16, (Accessed Nov. 2022).

Family Planning

For any telephonic encounter a verbal consent is required. A recipient consent for services must be obtained at each Family Planning visit.

SOURCE:  AL Medicaid Management Information system Provider Manual, Appendix C Family Planning, Oct. 2022, C-1, (Accessed Nov. 2022).

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Alaska

Last updated 11/17/2022

The department shall pay for all services covered by the …

The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including …

  • services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio.

SOURCE: AK House Bill 265 (2022 Session) and Sec. 47.07.069, (Accessed Nov. 2022).

Live or interactive; to be eligible for payment under this paragraph, the service must be provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis; medical services provided by a telephone that is not part of a dedicated audio conference system or by a facsimile machine are not eligible for payment.

Audio only mode: Add modifier FQ for dates of service on or after 3/1/2022.

SOURCE:  Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Nov. 2022).

No reimbursement for telephone when not part of a dedicated audio conference system.

No reimbursement for FAX.

The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); Physician, ARNP and PA Services (5/13), & AK Admin Code, Title 7, 110.625 & 635 (Accessed Nov. 2022).

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Arizona

Last updated 10/19/2022

Telehealth – Audio Only:  The practice of synchronous (real-time) health …

Telehealth – Audio Only:  The practice of synchronous (real-time) health care delivery, through interactive audio-only communications.

SOURCE: AZ Health Cost Containment System, AHCCCS Contract and Policy Dictionary, 9/22, pg. 107, (Accessed Oct. 2022).

AHCCCS covers audio-only services if a Telemedicine encounter is not reasonably available due to the member’s functional status, the member’s lack of technology or telecommunications infrastructure limits, as determined by the provider. To submit a claim for an audio-only service, the provider must make the telehealth services generally available to members through Telemedicine.

The Contractor and AHCCCS shall reimburse providers at the same level of payment for equivalent in-person mental health and substance use disorder services, as identified by HCPCS, if provided through Telehealth using an audio-only format. The AHCCCS Telehealth code set defines which codes are billable as an audio-only service and the applicable modifier(s) and place of service providers must use when billing for an audio-only
service.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 3). Apr. 2022. (Accessed Oct. 2022).

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

A list of reimbursable codes for permanent telephonic delivery is linked on the AHCCCS Telehealth Services webpage.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Oct. 2022).

Two HCPCS codes are included in this section of the 2021/2022 Fee Schedule:

  • G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
  • G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 344. (Accessed Oct. 2022).

HCPCS code H0030 (Behavioral Health Hotline Service) shall replace T1016 as the dedicated crisis telephone billing code. The applicable rates and modifiers for crisis telephone billing that were valid for T1016 will now be valid for H0030. This includes modifiers HO (Master’s Degree level), HN (Bachelor’s Degree level) and ET (Emergency Services). Note: Providers rendering telephonic crisis services to Tribal ALTCS members shall also bill for these services with H0030. When billing more than (1) unit of H0030 per day, all units should be included on the same line. Reporting units on more than one line may cause the claim to deny as a duplicate.

SOURCE: Fee-for-Service Provider Billing Manual Behavioral Health Services, Ch. 19, p. 11 (Revised 10/1/21), (Accessed Oct. 2022)

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Arkansas

Last updated 10/17/2022

Telemedicine does not include the use of:

  • Audio-only communication unless

Telemedicine does not include the use of:

  • Audio-only communication unless the audio-only communication is in real-time, is interactive, and substantially meets the requirements for a health care service that would otherwise be covered by the 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 the conversation, medical decision-making, and plan of care after the contact;
    • Medical documentation 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 Medicaid Provider Manual. Section I General Policy.  Rule 105.190. Updated Jan. 1, 2022, (Accessed Oct. 2022).

Provider-Led Arkansas Shared Savings Entity (PASSE) Program

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

SOURCE: PASSE Program, p. II-8, (3/1/19).  (Accessed Oct. 2022).

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California

Last updated 09/06/2022

Synchronous, Telephone or Other Interactive Audio-only Telecommunications Systems: Modifier 93

Synchronous, Telephone or Other Interactive Audio-only Telecommunications Systems: Modifier 93

Modifier 93 must be used for Medi-Cal covered benefits or services delivered via synchronous, telephone or other interactive audio-only telecommunications systems. Only the portion(s) of the telehealth service rendered at the distant site are billed with modifier 93. The use of modifier 93 does not alter reimbursement for the CPT or HCPCS code. See manual for audio-only telecommunications system requirements, totality of communication information components, and consent specific to audio-only policy.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (July 2022), Pg. 7. (Accessed Sept. 2022).

Effective January 1, 2023

Recently enacted legislation requires CA Medicaid and Medi-Cal managed care plans to reimburse health care providers of applicable health care services delivered via telehealth, including via synchronous audio-only modalities, at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.

A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forwardtelephonic (audio-only) synchronous interaction, remote patient monitoring, or other virtual communication modalities. The department may provide for specific exceptions to this prohibition, which shall be developed in consultation with affected stakeholders and published in departmental guidance.

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice. The department may provide specific exceptions to the requirement based on a Medi-Cal provider’s access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.

Effective on the date designated by the department pursuant to above, a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also do one of the following:

  • Offer those services via in-person, face-to-face contact.
  • Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.

In implementing this subdivision, the department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.

SOURCE: Welfare and Institutions Code 14132.725, as amended by SB 184 (2022 Session). (Accessed Sept. 2022).

FQHCs/RHCs – Effective January 1, 2023

Visits shall also include an encounter between an FQHC or RHC patient and a physician, physician assistant, nurse practitioner, certified nurse-midwife, clinical psychologist, licensed clinical social worker, visiting nurse, comprehensive perinatal services program practitioner, dental hygienist, dental hygienist in alternative practice, or marriage and family therapist using audio-only synchronous interaction, when services delivered through that modality meet the applicable standard of care. A visit described in this clause shall be reimbursed at the applicable FQHC’s or RHC’s per-visit PPS rate to the extent the department determines that the FQHC or RHC has met all billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter.

An FQHC or RHC may not establish a new patient relationship using an audio-only synchronous interaction. Notwithstanding this prohibition, the department may provide for specific exceptions to this prohibition, which shall be developed in consultation with affected stakeholders and published in departmental guidance.

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, an FQHC or RHC furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice. The department may provide specific exceptions to the requirement based on an FQHC’s or RHC’s access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.

Effective on the date designated by the department pursuant to above, an FQHC or RHC furnishing services through video synchronous interaction or audio-only synchronous interaction shall also do one of the following:

  • Offer those services via in-person, face-to-face contact.
  • Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.

SOURCE: Welfare and Institutions Code 14132.100, as amended by SB 184 (2022 Session). (Accessed Sept. 2022).

E-Consult includes interprofessional telephone/internet/electronic health record assessment and management services.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual.  Telehealth.  (Aug. 2020), Pg. 9. (Accessed Sept. 2022).

Telehealth services, telephonic services and other specified services must be reimbursed when provided by specific entities during or immediately following an emergency, subject to the Department obtaining federal approval and matching funds and Department guidance.

SOURCE: Welfare and Institutions Code Sec. 14132.723 & 724 (AB 1494 – 2019 Legislative Session). (Accessed Sept. 2022).

The department shall seek any federal approvals it deems necessary to extend the approved waiver or flexibility implemented pursuant to subdivision (a), as of July 1, 2021, that are related to the delivery and reimbursement of services via telehealth modalities in the Medi-Cal program, including audio-only. The department shall implement those extended waivers or flexibilities for which federal approval is obtained, to commence on the first calendar day immediately following the last calendar day of the federal COVID-19 public health emergency period, and through December 31, 2022.

For purposes of informing the 2022–23 proposed Governor’s Budget, released in January 2022, the department shall convene an advisory group consisting of consultants, subject matter experts, and other affected stakeholders to provide recommendations to inform the department in establishing and adopting billing and utilization management protocols for telehealth modalities to increase access and equity and reduce disparities in the Medi-Cal program. The advisory group shall analyze the impact of telehealth in increased access for patients, changes in health quality outcomes and utilization, best practices for the appropriate mix of in-person visits and telehealth, and the benefits or liabilities of any practice or care model changes that have resulted from telephonic visits.

SOURCE: AB 133, Sec. 380 (2021 Session). (Accessed Sept. 2022).

Vision Services

Asynchronous telecommunications system (store and forward telehealth) in single media format does not include telephone calls, images transmitted via facsimile machine, and text messages without visualization of the patient (electronic mail).

SOURCE: CA Department of Health Care Services. Medi-Cal Professional Services Manual. Page 6. (Aug. 2020). (Accessed Sept. 2022).

LEA Services

Medi-Cal does not reimburse for telephone calls, electronic mail messages or facsimile transmissions.

SOURCE: CA Department of Health Care Services. Medi-Cal Local Educational Agency (LEA) Telehealth Manual. Page 3. (Aug. 2021). (Accessed Sept. 2022).

Drug Medi-Cal Treatment Program

A county that enters into a Drug Medi-Cal Treatment Program contract with the department shall reimburse Drug Medi-Cal certified providers for medically necessary Drug Medi-Cal reimbursable services, as defined in Section 14124.24, provided by a licensed practitioner of the healing arts, or a registered or certified alcohol or other drug counselor or other individual authorized by the department to provide Drug Medi-Cal reimbursable services when those services meet the standard of care, meet the requirements of the service code being billed, and are delivered through video synchronous interaction or audio-only synchronous interaction.

A Drug Medi-Cal certified provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other virtual communication modalities. The department may provide for specific exceptions to this prohibition, which shall be developed in consultation with affected stakeholders and published in departmental guidance.

SOURCE: Welfare and Institutions Code 14132.731, as amended by SB 184 (2022 Session). (Accessed Sept. 2022).

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Colorado

Last updated 10/19/2022

Telemedicine includes interactive audio (including but not limited to telephone …

Telemedicine includes 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). Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

SOURCE: Colorado Adopted Rule 8.200.3.B. (Accessed Oct. 2022).

No reimbursement for telephone.

No reimbursement for FAX.

No reimbursement for email.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 10/22. (Accessed Oct. 2022).

Recently adopted Rule – Behavioral Health

“Face-to-Face clinical assessment” means a formal and continuous process of collecting and evaluating information about an individual for service planning, treatment, referral, and funding eligibility as outlined in 21.190, and takes place at a minimum upon a request from the responsible person for funded services through the Children and Youth Mental Health Treatment Act. This information establishes justification for services and Children and Youth Mental Health Treatment Act funding. The child or youth must be physically in the same room as the professional person during the Face-to-Face clinical assessment. If the child is out of state or otherwise unable to participate in a Face- to-Face assessment, video technology may be used. If the Governor or local government declares an emergency or disaster, telephone may be used. Telephone shall only be used as necessary because of circumstances related to the disaster or emergency.

SOURCE: 2 CO Code of Regulation 502-1, 21.200.41. pg. 37 (Accessed Oct. 2022).

Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat as long as the technologies are compliant with HIPAA.  The health care or mental health care services are subject to reimbursement policies developed pursuant to the medical assistance program. Reimbursement rate must be, at minimum, the same as a comparable in-person services.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Oct. 2022).

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Connecticut

Last updated 08/10/2022

Effective Now Until June 30, 2024

Notwithstanding the provisions of …

Effective Now Until June 30, 2024

Notwithstanding the provisions of section 19a-906 of the general statutes, as amended by this act, and subdivision (1) of this subsection, a telehealth provider that is an in-network provider or a provider enrolled in the Connecticut medical assistance program that provides telehealth services to a Connecticut medical assistance program recipient, may, during the period beginning on May 10, 2021 and ending on June 30, 2024, use any information or communication technology in accordance with the directions, modifications or revisions, if any, made by the Office for Civil Rights of the United States Department of Health and Human Services to the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191, as amended from time to time, or the rules and regulations adopted thereunder.

Telehealth does not include facsimile, texting or electronic mail. The Commissioner of Social Services may, in the commissioner’s discretion and to the extent permissible under federal law, provide coverage under the Connecticut medical assistance program for audio-only telehealth services until June 30, 2023. 

SOURCE: HB 5596 (2021 Session), Sec. 1, 6. & SB 2 (2022 Session), Sec. 32. (Accessed Aug. 2022).

Permanent Policy/Statute

The department shall not pay for information or services provided to a client over the telephone except for case management behavioral health services for patients aged 18 and under.

SOURCE: CT Provider Manual. Clinic. Sec. 17b-262-823. Jan. 31, 2018. Ch. 7, pg. 20Behavioral Health. Sec. 17b-262-918. Oct. 2020 Ch. 7, Pg. 6; CT Provider Manual. Physician and Psychiatrist. Sec. 17b-262-342 & 17b-262-456. Oct. 2020 Pg. 9 & 20; CT Provider Manual. Psychologist. Sec. 17b-262-472. Oct. 2020. Ch. 7, pg. 7; CT Provider Manual. Hospital Inpatient Services. Sec. 150.2(E)(III)(l). Oct. 2020. Ch. 7, pg. 44; CT Provider Manual. Chiropractic. Sec. 17b-262-540. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Dental. Sec. 17b-262-698. Oct. 2020. Ch. 7, Pg. 44; CT Provider Manual. Home Health. Sec. 17b-262-729. Oct. 2020. Ch. 7, pg. 12; CT Provider Manual. Naturopath. Sec. 17b-262-552. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Nurse Practitioner/Midwife. Sec. 17b-262-578. Oct. 2020. Ch. 7, pg. 7; CT Provider Manual. Podiatry. Sec. 17b-262-624. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Vision Care. Sec. 17b-262-564. Oct. 2020. Ch. 7, pg. 4. (Accessed Aug. 2022).

The price for any supply listed in the fee schedule published by the department shall include and the department shall pay the lowest: … information furnished by the provider to the client over the telephone.

SOURCE: CT Provider Manual. Medical Services, Sec. 17b-262-720, p. 7. (Accessed Aug. 2022).

Telephonic consultations are not reimbursable under CMAP.

SOURCE: CT Policy Transmittal 2019-12. Effective Jan. 1, 2019. Released Mar. 1, 2019. (Accessed Aug. 2022).

Notwithstanding the provisions of section 17b-245c, 17b-245e or 19a-906 of the general statutes, as amended by this act, or any other section of the general statutes, regulation, rule, policy or procedure governing the Connecticut medical assistance program, the Commissioner of Social Services shall, to the extent permissible under federal law, provide coverage under the Connecticut medical assistance program for audio-only telehealth services when (1) clinically appropriate, as determined by the commissioner, (2) it is not possible to provide comparable covered audiovisual telehealth services, and (3) provided to individuals who are unable to use or access comparable, covered audiovisual telehealth services.

SOURCE: CT Statute Sec. 17b-245g, as added by CT HB 6470 (2021 Session). (Accessed Aug. 2022).

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Delaware

Last updated 08/24/2022

Telephone, chart review, electronic mail messages, facsimile transmissions or internet …

Telephone, chart review, electronic mail messages, facsimile transmissions or internet services for online medical evaluations are not considered telemedicine.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 2/21/22. Ch. 16.8.1, Telemedicine, pg. 76, (Accessed Aug. 2022). 

Adult Behavioral Health

Telephone calls, internet services for online medical evaluations, electronic mail messages or facsimile transmissions between a health care practitioner and a patient or a consultation between two health care practitioners are non-covered services.

SOURCE: DE Adult Behavioral Health Service Certification and Reimbursement Provider Specific Policy Manual (12/1/16), 1.8, p. 14. (Accessed Aug. 2022).

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District of Columbia

Last updated 09/03/2022

Under recently effective final regulations, DHCF added audio-only communication as …

Under recently effective final regulations, DHCF added audio-only communication as an allowable method of telemedicine services.

A telemedicine provider that utilizes audio-only communication methods is required to use audio equipment that ensures clear communication and includes echo cancellation.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.2. & 910.13 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022. (Accessed Sept. 2022).

DC Medicaid does not reimburse for service delivery using e-mail messages or facsimile transmissions.

SOURCE: DC Code Sec. 31-3861 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 1, (Accessed Sept. 2022).

The physician, clinic, and FQHC billing manuals still reference an audio-only exclusion in addition to e-mail messages or facsimile transmissions within the definition of telehealth.

SOURCE: Physicians Billing Manual. DC Medicaid. (June 7, 2022) Sec. 15.10, P. 66; FQHC Billing Manual, 15.2.1, P. 49.; Clinic Billing Manual (Aug. 24, 2022) 15.2.1, P. 51. (Accessed Sept. 2022).

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Florida

Last updated 10/26/2022

No reimbursement for telephone, chart review, electronic mail messages or …

No reimbursement for telephone, chart review, electronic mail messages or facsimile transmissions.

SOURCE: FL Admin Code 59G-1.057. (Accessed Oct. 2022).

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Georgia

Last updated 10/22/2022

Non-covered Services Modalities

  • Telephone conversations.
  • Electronic mail messages.
  • Facsimile.
  • Services

Non-covered Services Modalities

  • Telephone conversations.
  • Electronic mail messages.
  • Facsimile.
  • Services rendered via a webcam or internet-based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance.
  • Video cell phone interactions.
  • The cost of telehealth equipment and transmission.
  • Failed or unsuccessful transmissions.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 11 (Oct 2022). (Accessed Oct. 2022).

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Hawaii

Last updated 10/29/2022

No Reimbursement for:

  • Telephone
  • Facsimile machine
  • Electronic mail

SOURCE: Code

No Reimbursement for:

  • Telephone
  • Facsimile machine
  • Electronic mail

SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 69 (Accessed Oct. 2022).

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Idaho

Last updated 08/22/2022

No reimbursement for telephone, email, text or fax.

SOURCE:  Idaho

No reimbursement for telephone, email, text or fax.

SOURCE:  Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers. July 20, 2022, Section 10.9 p. 128. (Accessed Aug. 2022).

Fee for service reimbursement is not available for an electronic mail message (e-mail), or facsimile transmission (fax).

SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09). (Accessed Aug. 2022).

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Illinois

Last updated 11/18/2022

Audio-Only

Modifier 93 is a new modifier used to identify …

Audio-Only

Modifier 93 is a new modifier used to identify services that are provided via telephone or other real-time interactive audio-only telecommunication systems. It does not replace modifier GT, which should continue to be used to identify telehealth interactions using both audio and video telecommunications systems. When using modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of a face-to-face interaction. Modifier 93 is effective with dates of service beginning April 1, 2022.

SOURCE: IL Dept. of Healthcare and Family Services, Provider Notice 03/21/2022, Modifier 93 and Place of Service 10 Implementation April 1, 2022. (Accessed Nov. 2022).

Diabetes Prevention Program (DPP) & Diabetes Self-Management Education and Support (DSMES)

New Modifier 93 – Synchronous Telemedicine Service rendered via telephone or other real-time interactive audio-only telecommunications system, is billable effective with dates of service beginning July 1, 2022. Refer to informational notices dated March 31, 2022, and March 21, 2022.

SOURCE: IL. Dept. of Healthcare and Family Services, Provider Notice 7/29/2022, Billing Update for Diabetes Prevention and Management Programs. (Accessed Nov. 2022).

No reimbursement for telephone.

No reimbursement for FAX.

No reimbursement for text or email.

SOURCE: IL Dept. of Healthcare and Family Services, Handbook for Practitioners Rendering Medical Services, Chapter 200 (June 2021). 220.5.7 p. 25; Handbook for Podiatrists, F-200, 220.6 p. 27 (Oct. 2016); Handbook for Encounter Clinic Services, Chapter D-200 Policy & Procedures, p. 17 (Aug 2016) & IL Administrative Code, Title 89 ,140.403. (Accessed Nov. 2022).

See regulations for exceptions during a public health emergency.

SOURCE: IL Admin. Code, Title 89,140.403. (Accessed Nov. 2022). 

Care Coordination and Support Organization (CCSO)

Care Coordination and Support (CCS) services are reimbursed if certain requirements met, including completing two oral communications with family within the calendar month via telephonic, video or in-person.

SOURCE: IL Dept. of Healthcare and Family Services, Care Coordination and Support Organization Provider Handbook (Oct. 5, 2022), p. 56-57.  (Accessed Nov. 2022).

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Indiana

Last updated 10/30/2022

Most telehealth services must be provided via video and audio, …

Most telehealth services must be provided via video and audio, although a few designated telehealth services can be provided via audio only. Audio-only delivery is allowable for all nonhealthcare virtual services.

Unless the practitioner has an established relationship with the patient, telehealth does not include the use of electronic mail, an instant messaging conversation, facsimile, internet questionnaire or an internet consultation.

SOURCE:  Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Sept. 27, 2022), p. 1.  (Accessed Oct 2022).

For certain telehealth services, an audio-only modifier (93) can be used to signify when a service is delivered via audio-only telehealth. Services eligible for reimbursement when billed with this new modifier are identified within this finalized code set. All other codes must be delivered via video and audio telehealth.  See Bulletin for code set.  Effective July 21, 2022 through end of 2022 at which point they will be re-evaluated for 2023.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT 202239 (May 19, 2022). (Accessed Oct. 2022).

The IHCP will continue to allow and offer reimbursement for audio-only telehealth. The IHCP will continue to explore the option of audio-only telehealth and its effectiveness in delivering healthcare services and provide updates when more specific policy details have been determined. Until further notice, audio-only telehealth services should be billed according to the guidance released in BT2020106 and used only when the care can be properly delivered via audio-only telehealth.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Oct. 2022).

Physical Therapy

The physical therapy assistant (PTA) is precluded from performing or interpreting tests, conducting initial or subsequent assessments, or developing treatment plans. See the Covered Procedures for Physical Therapist Assistants section for details. The PTA is required to meet with the supervising physical therapist each working day to review treatment, unless the physical therapist or physician is on the premises to provide constant supervision. The consultation can be either face-to-face or by telephone.

SOURCE: IN Therapy Services Module, Oct. 1, 2020, p. 4, (Accessed Oct. 2022).

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Iowa

Last updated 10/25/2022

Note that in almost all program-specific manuals, telephonic interpretive services …

Kansas

Last updated 08/18/2022

Telemedicine does not include communication between:

  • A healthcare provider that

Telemedicine does not include communication between:

  • A healthcare provider that consists solely of a telephone voice-only conversation, email, or facsimile transmission.
  • A physician and a patient that consists solely of an email or facsimile transmission.

Email, telephone, and facsimile transmissions are not covered as telemedicine services.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31 & 2-32 (Jul. 2022). (Accessed Aug. 2022).

Email, telephone, and facsimile transmissions are not covered as telemedicine services.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-13, (Aug. 2022). (Accessed Aug. 2022).

Hospital E&M

A “comprehensive exam” is considered a “hands on” specialist examination. Telephone consultation with a specialist is not the equivalent of comprehensive exam.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospital, p. 8-4 (Aug 2022). (Accessed Aug. 2022).

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Kentucky

Last updated 11/02/2022

Telehealth services and telehealth consultations shall not be reimbursable under …

Telehealth services and telehealth consultations shall not be reimbursable under this section if they are provided through the use of a facsimile machine, text, chat, or electronic mail unless the Department for Medicaid Services determines that telehealth can be provided 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.

Medicaid-participating practitioners and home health agencies are strongly encouraged to use audio-only encounters as a mode of delivering telehealth services only when no other approved mode of delivering telehealth services is available.

SOURCE: KY Revised Statute Sec. 205.559. (Accessed Nov. 2022).

Any recipient, upon being offered the option of an asynchronous or audio-only telehealth visit, shall have the opportunity or option to request to be accommodated by that provider in an in-person encounter or synchronous telehealth encounter.

If a telehealth service is delivered as an audio-only encounter and a telephonic code exists for the same or similar service, the department shall reimburse at the lower reimbursement rate between the two (2) types of services.

Telephonic Services. Telephonic code reimbursement shall be:

  • An alternative option for telehealth care providers to deliver audio-only telecommunications services, and shall not supersede reimbursement for an audio-only telehealth service as established pursuant to KRS 205.559 or 205.5591;
  • For a service that has an evidence base establishing the service’s safety and efficacy;
  • Subject to any relevant licensure board restrictions of the telehealth care provider;
  • Subject to any synchronous telehealth limits of this administrative regulation or other state or federal law; and
  • For a service that is listed on the most recent version of the Medicaid Physician Fee Schedule, as established by 907 KAR 3:010, Section 1(17).

SOURCE: KY 907 KAR 3:170. (Accessed Nov. 2022).

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system; and
    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 (Accessed Nov. 2022).

 

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Louisiana

Last updated 11/08/2022

Hospices may report some social worker calls as a visit. …

Hospices may report some social worker calls as a visit. Hospices may not report any other types of phone calls.

SOURCE: LA Medicaid, Chapter 24: Hospice, Sec. 24.9, Medicaid Svcs. Manual, p. 62, (As issued on Feb. 7, 2022), (Accessed Nov. 2022).

Rural health clinics (RHC) and federally qualified health clinics (FQHC) are required to indicate the appropriate place of service, either 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of and append modifier 95 for the billing of telemedicine/telehealth services. Services delivered via an audio/video system and via an audio-only system are to be coded the same way.

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

Early and Periodic Screening, Diagnostics and Treatment Health Services (EPSDT)

  • All services eligible for telemedicine/telehealth may be delivered via an interactive audio/video telecommunications system;
  • A secure, HIPAA-compliant platform is preferred, if available. However, for the duration of the COVID-19 event, if a HIPAA-compliant system is not immediately available at the time it is needed, providers may use everyday communications technologies such as cellular phones with widely available audio/video communication platforms;
  • Providers should follow guidance from the Office for Civil Rights at the Department of Health and Human Services for software deemed appropriate for use during this event;
  • For the duration of the COVID-19 event, in cases where an interactive audio/video system is not immediately available at the time it is needed, an interactive audio-only system (e.g., telephone) without the requirement of video may be employed, unless noted otherwise;
  • For use of an audio-only system, the same standard of care must be met, and the need and rationale for employing an audio-only system must be documented in the clinical record; and
  • Please note, some telemedicine/telehealth services require delivery through an audio/video system due to the clinical nature of these services. Where applicable, this requirement is noted explicitly.

SOURCE: LA Dept. of Health and Hospitals, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on Sept. 22, 2021), (Accessed Nov. 2022).

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Maine

Last updated 10/19/2022

Telephonic Services:  The use of telephone communication by a Health …

Telephonic Services:  The use of telephone communication by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment.

Telephonic services may be reimbursed if the following conditions are met:

  • Interactive telehealth services are unavailable; and
  • A telephonic service is medically appropriate for the underlying covered service.

Except as specified in the manual, services may not be delivered through electronic mail.

Interprofessional telephone/internet assessment are among the listed reimbursable procedure codes.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 3, 6, 10 & 16. (June 15, 2020). (Accessed Oct. 2022). 

New Medicaid Policy (Effective Upon Approval from CMS)

The Department will reimburse providers for Telephone Evaluation and Management Services provided to members. The restrictions set forth in the MaineCare Benefits Manual, Ch. I, Sec. 4.04-3 are inapplicable to Telephone Evaluation and Management Services, as these are separate and apart from the Telephonic Services set forth in Sec. 4.04-3.

Telephonic Evaluation and Management Services must be rendered by a qualified professional actively enrolled in MaineCare or contracted through an enrolled MaineCare provider.

Telephone Evaluation and Management Services are not to be billed if clinical decision-making dictates a need to see the member for an office visit within 24 hours or at the next available appointment. In those circumstances, the telephone service shall be considered a part of the subsequent office visit. If the telephone call follows an office visit performed and reported within the past seven (7) days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable.

The Department shall seek and anticipates receiving CMS approval for these provisions. Pending CMS approval, these provisions are effective.

Coverage also includes the virtual check-in, which can occur telephonically or through interactive services.  See manual for requirements.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 7-8. (June 15, 2020). (Accessed Oct. 2022). 

For Indian Health Services, a second-tier consultation can utilize direct email communications or telephone consultation.

SOURCE: MaineCare Benefits Manual, Indian Health Services, 10-144 Ch. II, Sec. 9, p. 5 (March 21, 2012). (Accessed Oct. 2022). 

Under Targeted Case Management, monitoring and follow-up activities may involve either face-to-face or telephone contact.

SOURCE:  MaineCare Benefits Manual, Targeted Case Management Services, 10-144 Ch. 101, Sec. 13.02, p. 6 (Mar. 20, 2014). (Accessed Oct. 2022). 

For crisis resolution services, under Behavioral health, covered services do include direct telephone contacts with both the member and the member’s parent or guardian or adult’s member’s guardian when at least one face-to-face contact is made with the member within seven (7) days prior to the first contact related to the crisis resolution service. The substance of the telephone contact(s) must be such that the member is the focus of the service, and the need for communication with the parent or guardian without the member present must be documented in the member’s record.

Also covered for Functional Family Therapy (FFT) and Multi-Systemic Therapy.

SOURCE:  MaineCare Benefits Manual, Behavioral Health Services, 10-44 Ch. II, Sec. 65, p. 4, 5 & 12 (Aug, 19, 2020). (Accessed Oct. 2022).

An examination following use of restraint or seclusion can be done by a telephone in consult with a registered nurse.  When a telephonic consult occurs, the physician, or nurse practitioner must examine the member in person within the following time constraints:

  • Within one (1) hour of when the registered nurse requests an examination;
  • Within one (1) hour of when information relayed is suggestive of causes leading to physical harm to the member;
  • Within one (1) hour if an examination has not yet occurred during the member’s stay; or
  • Within six (6) hours in all other circumstances.

SOURCE:  MaineCare Benefits Manual, Psychiatric Residential Treatment Facility Services, 10-44 Ch. II, Sec. 107, p. 32 (Oct. 3, 2018). (Accessed Oct. 2022).

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Maryland

Last updated 08/02/2022

“Telehealth” includes, from July 1, 2021, to June 30, 2023, …

“Telehealth” includes, from July 1, 2021, to June 30, 2023, 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.

“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 (Accessed Aug. 2022).

To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service. Services delivered via telehealth using two-way audio-visual technology assisted communication should be billed using the “-GT” modifier. The use of audio-only telehealth services is only permitted during the Public Health State of Emergency.

SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 74. Updated Jan. 2022. (Accessed Aug. 2022).

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for FAX.

No reimbursement for telephone conversation, electronic mail message or facsimile transmission between the originating and distant site providers.  There is also no reimbursement for telecommunication between providers without the participant present.

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 4,  Code of Maryland Admin. Regs., Sec. 10.09.49.09(B). (Accessed Aug. 2022).

Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) Services

MDH Will reimburse IEP and IFSP providers for certain procedure codes via telehealth. Providers must identify telehealth services on the child’s IEP/IFSP and bill using the appropriate modifier (GT or UB). Service coordination procedures (T1023, T1023-TG, T2022, W9322, W9323, and W9324) and individual psychotherapy services (90791, 90832 and 90834) may continue with an audio-only component. See Provider Transmittal for approved Maryland Medicaid Fee-for-Service approved IEP/IFSP Telehealth Services.

SOURCE: MD Medical Assistance Program. Early Intervention and School Health Service Providers Transmittal No. 3. Sept. 23, 2021. (Accessed Aug. 2022).

Therapy Services (Physical Therapists, Occupational Therapists, Speech Therapists, Therapy Groups, EPSDT Providers, Managed Care Organizations)

MDH will reimburse providers for certain procedure codes when provided via audio-visual telehealth. MDH will not reimburse for services provided via an audio-only delivery model or for codes not included on the Provider Transmittal regarding approved therapy telehealth services when provided via any method of telehealth.

SOURCE: MD Medical Assistance Program. Guidance on the Continuation of Telehealth for Therapy Services. PT 09-22. Oct. 7, 2021. (Accessed Aug. 2022).

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Massachusetts

Last updated 11/18/2022

“Telehealth”, the use of synchronous or asynchronous audio, video, electronic …

“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.

The rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same service delivered by other telehealth modalities.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).

MassHealth reimburses the V3 modifier which is used when providers are rendering services via audio-only telehealth.

MassHealth Guidance Regarding Telephone and Internet Connectivity

MassHealth guidance available at www.mass.gov/doc/masshealth-provider-resource-telephone- and-internet-connectivity-for-telehealth aims to help providers guide members who want to receive services via telehealth, but have concerns about limited phone and internet access. This resource includes information about the federal Lifeline program, which provides free or low-cost phone service to low-income households, and information on the Affordable Connectivity Program (ACP), which is a federal benefit program that helps ensure that households can afford broadband internet.

SOURCE:  MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Telehealth and Children’s Behavioral Health Initiative (CBHI) Services

As under All Provider Bulletin 327 (corrected), existing performance specifications for Children’s Behavioral Health Initiative (CBHI) services allow for the telephonic delivery of services, other than for initial assessments. Notwithstanding any requirements that initial assessments be conducted in person, where appropriate, services for new clients may be initiated via telephonic means or other telehealth modality. CBHI providers must use the regular CBHI codes, as well as the POS code and modifiers described above, as appropriate, when billing for CBHI services delivered via approved telehealth modalities.

Consistent with All Provider Bulletin 327 (corrected) and its predecessor bulletins, through September 30, 2023, MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart. Likewise, through September 30, 2023, an eligible distant-site provider delivering covered services via telehealth in accordance with this bulletin may bill MassHealth a facility fee if such a fee is permitted under the provider’s governing regulations or contracts. MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through September 30, 2023, and may change those policies after that date.

Providers must include the place of service (POS) code 02 when submitting a professional claim for telehealth provided in a setting other than in the patient’s home, and POS code 10 when submitting a professional claim for telehealth provided in the patient’s home. Additionally, for any such professional claim, providers must include:

  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;

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

  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;

MassHealth will implement modifiers 95, 93, GQ, GT, FQ, and FR through an informational edit period. Thus, effective for dates of service (DOS) between April 16, 2022, and March 30, 2023, MassHealth will not deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers. Effective for DOS on or after April 1, 2023, MassHealth will discontinue this informational edit, and will deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers.

*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE:  MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Psychiatric Services- After-Hours Telephone Service

The physician or psychiatric clinical nurse specialist (PCNS) must provide telephone coverage during the hours when the physician or PCNS is unavailable, for members who are in a crisis state.

SOURCE: MassHealth Provider Manual Series Physician Manual, Transmittal Letter PHY-154, pg. 4-22, (Accessed Nov. 2022).

Substance Use Disorder Treatment Code Revisions

Effective for dates of service beginning March 12, 2020, in accordance with All Provider Bulletins 289 and 291, this letter transmits revisions to behavioral health service codes in Subchapter 6 of the Substance Use Disorder Treatment Manual, allowing substance use disorder (SUD) treatment providers to bill for the following telephonic codes: (98966, 98967, 98968, 99441, 99442, 99443).

Please refer to All Provider Bulletins 289 and 291 for additional information and limitations on the uses of these codes.

SOURCE: Mass Health Substance Use Disorder Treatment Manual, Service Codes and Descriptions, Transmittal Letter SUD-22, page 6-9MassHealth Transmittal Letter SUD-22, Jun. 2022, (Accessed Nov. 2022).

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Michigan

Last updated 11/22/2022

Interprofessional Telephone/Internet/Electronic Health Record Consultations

Interprofessional telephone/Internet/electronic health record consultations,

Interprofessional Telephone/Internet/Electronic Health Record Consultations

Interprofessional telephone/Internet/electronic health record consultations, including e-Consults, are a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating physician (e.g., attending or primary) or practitioner requests the opinion and/or treatment advice of a Medicaid enrolled physician or practitioner with the specialty expertise to assist in the diagnosis of a condition and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consultant. The service concludes with a written report from the consultant to the treating physician/requesting provider.

The beneficiary for whom the service is requested may be either a new patient to the consulting provider or an established patient with a new problem. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology specimens, is included in the service and should not be separately reported. The written or verbal request for the consult must be documented in the beneficiary’s medical record by the treating physician/requesting provider. Providers must consult with the American Medical Association (AMA) coding guidelines to ensure appropriate reporting of these services. Providers should not report interprofessional telephone/Internet/electronic health record consultations when the sole purpose of the communication is to arrange a transfer of care or other face-to-face service.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022).

Medication Therapy Management (MTM)

The following are not eligible to be covered as MTM services:

Services provided by telephone, email or US Postal Service Mail.

SOURCE: MI Medicaid Provider Manual, p. 1804 Oct. 1, 2022 (Accessed Nov. 2022).

Telemedicine Coding Changes

MDHHS acknowledges the addition of POS 10-Telehealth provided in a patient’s home, the new definition of POS 02-Telehealth provided other than in a patient’s home, and the addition of modifier FQ-audio only service.

MDHHS will require modifier FQ to be appended in addition to modifier GT. When a provider submits modifier FQ for an audio only service, the provider does not need to include a note in the remarks section stating that the service was provided via telephone (per bulletin MSA 20-13). Please note, modifier GT must be included for the claim to be processed correctly. For FQHCs/RHCs/THCs and Tribal FQHCs, please use modifier GT and modifier FQ as indicated above.

Further updates to telemedicine reporting will be provided in future bulletins.

SOURCE: MI Health and Aging Services Administration Bulletin HASA 22-03 (Feb. 8, 2022), (Accessed Nov. 2022).

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Minnesota

Last updated 10/24/2022

Telehealth does not include communication between health care providers, or

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, e-mail, or facsimile transmission or as specified by law.

SOURCE: MN Statute Sec. 256B.0625, Subsection 3(b)(e)(1). (Accessed Oct. 2022).

Case management for Child Welfare Transitional Case Management services is covered through telephone in certain circumstances.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Child Welfare Case Management Services, As revised Jun. 14, 2022. (Accessed Oct. 2022).

Audio only (until July 1, 2023)

Audio only is the delivery of health care services or consultations through telephone communication while the patient is at one site and the qualified health care provider is at a distant site.

Audio-only communication will be covered if:

  • There is a scheduled appointment and the standard of care for that particular service can be met through the use of audio-only communication.
  • Substance use disorder (SUD) treatment services and mental health services delivered without a scheduled appointment when initiated by the member while in an emergency or crisis situation and a scheduled appointment was not possible due to the need of an immediate response.

Telehealth does not include:

  • Communication between health care provider and a patient that consists solely of an email or facsimile.
  • Electronic connections that are not conducted over a secure encrypted website as specified by the Health Insurance Portability and Accountability Act of 1996 Privacy and Security rules

Providers who have an approved Telehealth Provider Assurance Statement (DHS-6806) (PDF) on file with MHCP who submit professional claims for services via telehealth should use claim format 837P (professional), CPT or HCPCS codes that describes the services rendered and with a required place of service 02 or new place of service 10 for services via telehealth. Include the 93 modifier when billing for services provided via audio only (telephone communication).

Modifier 93 Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires modifier 93 when audio-only telehealth is used.

Outpatient facilities (APC or ASC claims) will continue to use telehealth modifiers on their claims.

Providers who service SUD H2035/HQ on type of bill 89X should continue to use telehealth modifiers on their claims.

SOURCE: MN Dept. of Human Services, Telehealth Services Provider Manual, Jun. 14, 2022. (Accessed Oct. 2022).

New Telehealth Modifier and Use of Current Telehealth Modifiers

Modifier 93, Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires this modifier when audio-only telehealth is used.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Telehealth Delivery of Mental Health Services, Revised Oct. 2022 (Accessed Oct. 2022).

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Mississippi

Last updated 11/17/2022

The following are not considered telehealth services:

  • Telephone conversation
  • Chart

The following are not considered telehealth services:

  • Telephone conversation
  • Chart reviews
  • Electronic mail messages
  • Facsimile transmission
  • Internet services for online medical evaluation, or
  • Communication through social media or,
  • Any other communication made in the course of usual business practices including, but not limited to,
    1. Calling in a prescription refill, or
    2. Performing a quick virtual triage.

SOURCE: MS Admin. Code 23, Part 225, Rule. 1.4. (Accessed Nov. 2022).

During a state of emergency, Telehealth services are expanded to include use of telephonic audio that does not include video when authorized by the State of Mississippi. A beneficiary may use the beneficiary’s personal telephonic land line in addition to a cellular device, computer, tablet, or other web camera-enabled device to seek and receive medical care in a synchronous format with a distant-site provider.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.7. (Accessed Nov. 2022).

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Missouri

Last updated 08/19/2022

MHD also allowed the use of telephone for telehealth services, …

MHD also allowed the use of telephone for telehealth services, and allowed quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number. MHD did not require additional CMS flexibility for these options, and they will continue.

SOURCE:  MO Medicaid Provider Tips, Telehealth services, Jan. 11, 2022, (Accessed Aug. 2022).

Mental Health

Audio-only is real-time, interactive voice-only discussion between an individual and the service provider.

The CR Modifier will be ending on June 30, 2022, regardless of the PHE declaration end date.

Starting July 1, 2022, Audio-Only services shall utilize the FQ Modifier.

The GT modifier will continue to be utilized for Telemedicine, with the exception of CSTAR programs that have transitioned to American Society of Addiction Medicine (ASAM), as this billing structure no longer utilizes modifiers.

Starting July 1, 2022, CSTAR programs that have transitioned to ASAM, will use the 02 Place of Service, instead of the GT modifier.

See bulletin for audio-only service guidance.

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

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Montana

Last updated 11/01/2022

Telemedicine reimbursement does not include:

  • Consultation by telephone
  • Facsimile machine

Telemedicine reimbursement does not include:

  • Consultation by telephone
  • Facsimile machine transmissions
  • Crisis hotlines

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Oct. 2022).

Telehealth services may be provided using secure portal messaging, secure instant messaging, telephone communication, or audiovisual communication.

SOURCE: Montana Code Annotated 53-6-122 (Accessed Oct. 2022)

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Nebraska

Last updated 11/18/2022

Telehealth also includes audio-only services for the delivery of individual …

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.

SOURCE: NE Rev. Statute, 71-8503, (Accessed Nov. 2022).

Telephone Consultations

Nebraska Medicaid does not cover telephone calls to or from an individual, pharmacy, nursing home, or hospital. Nebraska Medicaid may cover telephone consultations with another physician if the name of the consulting physician is indicated on or in the claim.

SOURCE: NE Admin. Code Title 471, Ch. 18-005.30, . (Accessed Nov. 2022).

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Nevada

Last updated 11/04/2022

Audio only telehealth for behavioral health delivery is limited to:…

Audio only telehealth for behavioral health delivery is limited to:

  • Targeted Case Management
  • Crisis Intervention Services

Non-Covered Services

  • Images transmitted via facsimile machines (faxes)
  • Text messages
  • Electronic mail (email)

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.6, p. 3 (Jun. 1, 2022) (Accessed Nov. 2022).

Medicaid does not reimburse providers for telephone calls between providers and patients (including those in which the provider gives advice or instructions to or on behalf of a patient) except documented psychiatric treatment in crisis intervention (e.g. threatened suicide).

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Physician Services Chapter, Section 603, p. 5 (Jul. 13, 2022) (Accessed Nov. 2022).

For crisis intervention, modifier GT includes telephonic services.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Behavioral Health Outpatient Treatment, p. 17 (3/18/22), (Accessed Nov. 2022)NV Dept. of Health and Human Svcs., Provider Type 82 Billing Guide, Behavioral Health Rehabilitative Treatment, p. 3. (2/1/19). (Accessed Nov. 2022). Special Clinics: Substance Abuse Agency Model (SAAM) p. 5 (2/16/22) (Accessed Nov. 2022), School Health Services (SHS), p. 25 (Jan. 20, 2022). (Accessed Nov. 2022).

Case management services are reimbursable when provided to Medicaid eligible recipients, on a one-to-one (telephone or face-to-face) basis.

Monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers. Monitoring may involve either face-to-face or telephone contact, at least annually.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Case Management Section 2500, pgs. 2 & 4 (Jan. 30, 2019) (Accessed Nov. 2022). 

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New Hampshire

Last updated 11/10/2022

“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).

SOURCE: NH Revised Statutes 167:4-d & 42 CFR Sec. 410.78(a)(3). (Accessed Nov. 2022).

The Medicaid program shall provide reimbursement for all modes of telehealth, including video and audio, audio-only, or other electronic media provided by medical providers to treat all members for all medically necessary services. Eligible medical providers shall be allowed to perform health care services through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media.

SOURCE: NH Revised Statutes Annotated, 167:4-d, (Accessed Nov. 2022).

Effective as of 4/1/2022, FQ modifier identifying the service was furnished using audio-only communication technology has been added to MMIS.

SOURCE: NH Medicaid Provider Bulletin, New Modifiers and Teleheath POS (Mar. 25, 2022), (Accessed Nov. 2022).

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New Jersey

Last updated 09/06/2022

Telephones, facsimile machines, and electronic mail systems do not meet …

Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system. Sessions may not be recorded.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 2 (Accessed Sept. 2022).

Telemedicine does not include the use, in isolation, of electronic mail, instant messaging, phone text or facsimile transmission.

In no case shall the State Medicaid and NJ FamilyCare Programs:

  • Restrict the ability of a provider to use any electronic or technical platform to provide services using telemedicine or telehealth, including but no limited to interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:
    • Allows the provider to meet the same standard of care as would be provided if the services were provided in person’
    • Is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164.

SOURCE: NJ Statute C.30:4D-6K(e) – cites: NJ Statute C.45:1-61. (Accessed Sept. 2022). 

Recently Passed Legislation

Establishes the Statewide mobile behavioral health crisis response team.

Mobile crisis response teams shall be community-based and may incorporate the use of: emergency medical technicians and other health care providers, to the extent a medical response is needed; law enforcement personnel, to the extent that the crisis cannot be resolved without the presence of law enforcement, provided that, whenever possible, the mobile crisis response team shall seek to engage the services of law enforcement personnel who have completed training in behavioral health crisis response; and other professionals as may be necessary and appropriate to provide a comprehensive response to a behavioral health crisis.

Notwithstanding the requirement that mobile crisis response teams be community based, nothing in this section shall be construed to prohibit the provision of crisis intervention services via telephone, video chat, or other appropriate communications media, if the use of these media are necessary to provide access to a needed service in response to a particular behavioral health crisis, and the provision of services using telephone, video chat, or other media is consistent with the needs of the person experiencing the behavioral health crisis.

Each mobile crisis response team shall submit a monthly report to the Department of Human Services identifying, for the preceding month: the number of dispatch calls the team received; the number of dispatch calls the team responded to; the number of dispatch calls that included a response by emergency medical services providers, law enforcement, or both; the proportion of total services that were provided in person, via telephone, via video call, and via other means; the number of mobile crisis responses that resulted in referrals for services and the types of services that were referred; the number of responses that did not result in a referral or follow-up service; to the extent possible, information regarding the nature of the mobile crisis responses that did and did not result in a referral or follow-up service; and any other information as shall be required by the Commissioner of Human Services.

Commencing 24 months after the effective date of this act, and annually thereafter, the Commissioner of Human Services shall prepare and submit to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, a report concerning the Statewide behavioral health crisis system of care, including, for the preceding year: the total number of calls received by crisis hotline centers that have contracted with the Department of Human Services pursuant to subsection a. of section 2 of this act, including the number of direct 9-8-8 calls and the number of calls referred from a 9-1-1 call center; the total number of mobile crisis response teams dispatched; the number of crisis interventions that involved emergency medical services, law enforcement, or both; the proportion of total mobile crisis response services that were provided in person, via telephone, via video call, and via other means; the number of referrals made to services, including the number of referrals made to each type of service; the nature of behavioral health crisis stabilization services provided and an analysis of the effects of providing behavioral health crisis stabilization services in lieu of a response by law enforcement or services provided through a hospital emergency department or other medical care provider; the nature of follow-up services provided and an analysis of the effects of providing follow-up services; program operating costs of the Statewide behavioral health crisis system of care; the commissioner’s assessment of the benefits and limitations of the Statewide behavioral health crisis system of care and the commissioner’s recommendations for legislative or administrative action to support and improve the Statewide behavioral health crisis system of care; and any other information the commissioner deems necessary and appropriate.

SOURCE: NJ Statute C.26:2MM-7 & 8 as amended by  S311 (2022 Session). (Accessed Sept. 2022).

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New Mexico

Last updated 10/28/2022

Applied Behavior Analysis

Telephonic is the use of a telephone …

Applied Behavior Analysis

Telephonic is the use of a telephone or cell phone to render services in real time with only audio. Currently only under an Emergency Order from the Governor may some services be rendered telephonically. A MAD supplement is issued informing providers and practitioners of the Emergency Order and codes allowed to be rendered telephonically.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Oct. 2022).

MAD will reimburse eligible providers for limited professional services delivered by telephone without video.  No additional reimbursement is made to the originating-site for an interactive telemedicine system fee.

SOURCE: NM Administrative Code 8.310.2.12 M(2). (Accessed Oct. 2022).

MAD covers service plan updates through the participation of interdisciplinary teams.

The six elements of teaming may be performed by using a variety of media (with the person’s knowledge and consent) e.g., texting members to update them on an emergent event; using email communications to ask or answer questions; sharing assessments, plans and reports; conducting conference calls via telephone; using telehealth platforms conferences; and, conducting face-to-face meetings with the person present when key decisions are made. Only the last element, that is, conducting the final face-to-face meeting with the recipient present when key decisions that result in the updates to the service plan, is a billable event.

SOURCE: NM Administrative Code 8.321.2.9 (L)(3c). (Accessed Oct. 2022). 

 

 

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New York

Last updated 08/25/2022

Reimbursement shall be made for telehealth services provided by use …

Reimbursement shall be made for telehealth services provided by use of telephone and other audio-only technologies.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538.2. (Accessed Aug. 2022).

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 shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Aug. 2022).

The commissioner may specify in regulation additional acceptable modalities for the delivery of health care services via telehealth, including but not limited to audio-only or video-only telephone communications, online portals and survey applications, and may specify additional categories of originating sites at which a patient may be located at the time health care services are delivered to the extent such additional modalities and originating sites are deemed appropriate for the populations served.

SOURCE: NY Public Health Law Article 29 – G Section 2999-ee. (Accessed Aug. 2022).

Health care services delivered by means of telehealth shall be entitled to reimbursement under section three hundred sixty-seven-u of the social services law; provided however, reimbursement for additional modalities, provider categories and originating sites specified in accordance with section twenty-nine hundred ninety-nine-ee of this article, and audio-only telephone communication defined in regulations promulgated pursuant to subdivision four of section twenty-nine hundred ninety-nine-cc of this article, shall be contingent upon federal financial participation.

SOURCE: NY Public Health Law Article 29 – G Section 2999-dd. (Accessed Aug. 2022).

Telephone conversations, e-mail or text messages, and facsimile transmissions between a practitioner and a Medicaid member or between two practitioners are not considered telehealth services and are not covered by Medicaid when provided as standalone services. Remote consultations between practitioners, without a Medicaid member present, including for the purposes of teaching or skill building, are not considered telehealth and are not reimbursable. The acquisition, installation and maintenance of telecommunication devices or systems is not reimbursable.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 2. (Aug. 2022).

Telemental health services do not include telephone conversation, electronic mail message, or facsimile transmission between a provider and a recipient or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support Telemental Health Services.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(r), NY State Office of Mental Health Telemental Guidance (Nov. 2019), p. 3. (Accessed Aug. 2022).

Telephone conversations, e-mail or text messages, and facsimile transmissions between a dentist and a Medicaid member or between two dentists are not considered telehealth services and are not covered by Medicaid when provided as standalone services.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 86 (Accessed Aug. 2022).

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North Carolina

Last updated 11/04/2022

No reference found for email or fax.

Covered virtual communication …

No reference found for email or fax.

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).

Covered virtual communication services include telephone evaluation and management codes (audio only): 99441-99443 and G2012.

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 & 14, Oct. 1, 2022. (Accessed Nov. 2022).

A special COVID-19 Medicaid bulletin lists telephone E/M codes that have been made permanently eligible for reimbursement that have not yet been incorporated into the 1H Telehealth, Virtual Communication and Remote Patient Monitoring provider manual.

SOURCE: NC Medicaid Special Bulletin COVID-19 #237, Oct. 2022, (Accessed Nov.  2022).

Outpatient Behavioral Health

Telephonic services may be transmitted between a patient and provider in a manner that is consistent with the CPT code definition for those services. This service delivery method is reserved for circumstances when:

  • The beneficiary’s physical or behavioral health status prevents them from participating in in-person or telehealth services; or
  • Access issues (e.g., transportation, telehealth technology) prevent the beneficiary from participating in in-person or telehealth services.

Excluding psychotherapy for crisis services, Medicaid and NCHC shall require prior approval for services provided via the telephonic, audio-only communication method.

See Outpatient Behavioral Health manual for telephone-specific criteria, eligible providers, and covered codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 4, 6-7, 10, 37-39, Sept. 1, 2021. (Accessed Nov. 2022).

FQHCs/RHCs

FQHCs and RHCs may conduct telephonic evaluation and management services using HCPCS code G0071. Eligible providers include physicians, nurse practitioners, psychiatric nurse practitioners, physician assistants, and certified nurse midwives.

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, p. 19, Dec. 1, 2020. (Accessed Nov. 2022).

Enhanced Mental Health and Substance Abuse Services

Telephonic response is covered to assess the crisis and determine the risk, mental status, medical stability, and appropriate response.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy Enhanced Mental Health and Substance Abuse Services, p. 31, Apr. 1, 2022 (Accessed Nov. 2022).

Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD)

Telephonic services my be transmitted between a patient and provider in a manner that is consistent with the CPT code and definition for those services.

This service delivery method is reserved for circumstances when:

  • The caregiver’s physical or behavioral health status prevents them from participating in in-person or telehealth services; or
  • Access issues (e.g., transportation, telehealth technology) prevent the caregiver from participating in in-person or telehealth services.

Refer to Subsection 3.2.5 for Telephonic-Specific Criteria ; Subsections 5.1 and 5.2 for Prior Approval requirements; and Subsection 7.1 for Compliance requirements.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8F, Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD), pgs. 6,9-10, 12 & 17, Amended Dec. 1, 2020, (Accessed Nov. 2022). 

Peer Support Services

As outlined in Attachment A, select services within this clinical coverage policy may be provided via the telephonic, audio-only communication method. Telephonic services may be transmitted between a beneficiary and provider in a manner that is consistent with the CPT and HCPCS code definition for those services.

Refer to subsection 3.2.5.1 for Telephonic-Specific Criteria; and subsection 7.1 for Compliance requirements.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8G, Peer Support Services pgs. 5, 7 &17  & Attachment A, pgs. 20-21, Amended Aug. 15, 2022. (Accessed Nov. 2022).

 

 

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North Dakota

Last updated 11/08/2022

Telephonic encounters are not covered by ND Medicaid.

ND Medicaid …

Telephonic encounters are not covered by ND Medicaid.

ND Medicaid does not cover non face to face services (e.g., telephone, email).

No reference found for FAX.

SOURCE: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs. (Oct. 2022) P. 65 & 101 (Accessed Nov. 2022).

Targeted Case Management

Telephone calls, in person and email contacts are allowable costs under transitional care management (TCM).

SOURCE:  North Dakota Department of Human Services: Targeted Case Management – Individuals with a serious mental illness or serious emotional disturbance. (Jul. 2022) P. 8 (Accessed Nov. 2022).

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Ohio

Last updated 09/07/2022

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

“Telehealth” is the direct delivery of health care services to a patient related to 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 & OAC 5160-1-18.  (Accessed Sept. 2022).

Office of Mental Health and Addiction Services

Services must be provided using interactive, secure, real-time audiovisual communications of such quality 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. This expressly excludes telephone calls, images transmitted via facsimile machine, and text messages with visualization of the other person. Services that may be provided by certified community behavioral health centers by telephone contact are CPST and SUD case management.

SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Sept. 2022).

Pre-admission Screening and Resident Review

Pre-admission Screenings and Resident Reviews (PASRR) should be completed via the electronic HENS system as they are today as these screenings are primarily via desk review. In instances where a face-to-face is required, a telephonic and/or desk review is permissible. Level II evaluations can be provided either by telephone or desk review when appropriate. There is no system or reimbursement impact as these functions are supported by the level II entities and the applicable contractor.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022.  (Accessed Sept. 2022).

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Oklahoma

Last updated 09/06/2022

Telehealth shall not include consultations provided by telephone audio-only communication, …

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. 317:30-3-27(a). (Accessed Sept. 2022).

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Oregon

Last updated 11/10/2022

“Audio only” means the use of audio technology, permitting real-time …

“Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include the delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE: OAR 410-141-3566. Health Systems Division: Medical Assistance Programs. Oregon Health Plan (Accessed Nov. 2022).

“Audio only” does not include:

  • The use of facsimile, electronic mail or text messages.
  • The delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

  • Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
  • Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
  • Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Ch. 414.723, (Accessed Nov. 2022).

Covered telephonic and online services include services related to evaluation, assessment and management as well as other technology-based services (CPT 98966-98968, 99441-99443, 99421-99423, 98970-98972, G2012, G2061-G2063, G2251-G2252).

Covered telephone and online services billed using these codes do not include either of the following:

  • Services related to a service performed and billed by the physician or qualified health professional within the previous seven days, regardless of whether it is the result of patient-initiated or physician-requested follow-up.
  • Services which result in the patient being seen within 24 hours or the next available appointment.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the January 1, 2022 Prioritized List of Health Services, p. AD-3. (8/02/22). (Accessed Nov. 2022).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio, or member portal and may include transmission of data from remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

SOURCE: OAR 410-141-3566 Health Systems Division: Medical Assistance Programs, Oregon Health Plan. (Accessed Nov. 2022). 

“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 via landlines, and wireless communications, including the Internet and telephone networks.

SOURCE: OR OAR 410-120-1990 & OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Nov. 2022).

Behavioral Health

Patient consultations using telephone and online or electronic mail (e-mail) are covered when billed services comply with the practice guidelines set forth by the Health Evidence Review Commission and the applicable HERC-approved code requirements, delivered consistent with the HERC Evidence-Based Guidelines; Patient consultations using videoconferencing, a synchronous (live two-way interactive) video transmission resulting in real time communication between a provider located in a distant site and the recipient being evaluated and located in an originating site, is covered when billed services comply with the billing requirements in rule.  Behavioral health services specifically identified as allowable for telephonic delivery are listed on the Behavioral Health Fee schedule published by the Authority.

Unless expressly authorized in OAR 410-120-1200 (Exclusions), other types of telecommunications are not covered such as images transmitted via facsimile machines and electronic mail when:

  • Those methods are not being used in lieu of videoconferencing, due to limited videoconferencing equipment access; or
  • Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Nov. 2022).

Teledentistry

Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry and health care and public health practices and education.

Unless authorized in OAR 410-120-1200 Exclusions or OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered:

  • When those types are not being used in lieu of teledentistry, due to limited teledentistry equipment access; or
  • When those types and specific services are not specifically allowed in this rule per the Oregon Health Evidence Review Commission’s Prioritized List of Health Services.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Nov. 2022).

School Based Health Services

Telehealth can be interactive audio/telephonic services provided to a child/student in a geographical area where synchronous audio and video is not available or consent for audio/video is refused for services provided to a child/student.

SOURCE: OR OAR 410-133-0040 Health Systems Division: Medical Assistance Programs, School-Based Health Services. (Accessed Nov. 2022).

The Authority may reimburse telehealth, tele-electronic/telephonic School-Based Health Services (SBHS) provided to the same extent the services would be covered if they were provided in person and billed to Medicaid using appropriate SBHS procedure codes and modifiers.  See rule for requirements.

For services covered using synchronous audio and video with modifiers GT, the Division will cover the same services provided by synchronous audio (e.g. telephone), when billed with the same codes but without modifier GT when provision of the same service via synchronous audio and video is not available or feasible, when the patient declines to enable video, or necessary consents cannot reasonably be obtained with appropriate documentation in the child/student’s plan of care.

SOURCE: OR OAR 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Coverage (Accessed Nov. 2022).

Indian Health Services

For the provision of services defined in Titles XIX and XXI and provided through an IHS or Tribal 638 facility, an “encounter” is defined as a face-to-face, telephone contact, or a prescription fill as defined in OAR 410-146-0085(8) between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. Section (7) of this rule outlines limitations for telephone contacts that qualify as encounters. For purposes of this rule, face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per 410-130-0610.

Telephone encounters qualify as a valid encounter for specific services. Telephone encounters must include all the same components of the service when provided face-to-face. Providers may not make telephone contacts at the exclusion of face-to-face visits.

SOURCE: OR OAR 410-146-0085, Health Systems Division: Medical Assistance Programs American Indian/Alaska Native.  (Accessed Nov. 2022).

Federally Qualified Health Center and Rural Health Clinics

For the provision of services defined in Titles XIX and XXI and provided through an FQHC or RHC, an “encounter” is defined as a face-to-face or telephone contact between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. See rule for limitations for telephone contacts that qualify as encounters. For purposes of this rule, a face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per OAR 410-130-0610.

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management (MCM) and 410-130-0190, Tobacco Cessation (see also OAR 410-120-1200). Except as set forth below, providers may not make telephone contacts at the exclusion of face-to-face visits. Telephone encounters must include all the same components of the service as if provided face-to-face.

SOURCE: OR OAR 410-147-0120, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services.  (Accessed Nov. 2022).

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Pennsylvania

Last updated 09/06/2022

Telemedicine, for purposes of Medicaid payment, does not include telephone,

Telemedicine, for purposes of Medicaid payment, does not include telephone, asynchronous or store and forward technology or facsimile machines, electronic mail systems or remote patient monitoring devices. However, these technologies may be utilized as a part of the provision of a MA-covered service.

In response to CMS’s policy changes during the COVID-19 PHE, the MA Program has allowed for audio-only services in situations where the beneficiary does not possess or have access to video technology and when clinically appropriate. The Department will continue to allow providers to utilize audio-only telecommunication when the beneficiary does not have access to video capability or for an urgent medical situation, provided that the use of audio-only telecommunication technology is consistent with state and federal requirements, including guidance by CMS with respect to Medicaid payment and OCR with respect to compliance with Health Insurance Portability and Accountability Act (HIPAA). Services rendered via telemedicine, including those delivered using audio-only telecommunication technology, must use technology that is two-way, real-time, and interactive between beneficiary and provider.

Audio-only telecommunications technology may be used when the beneficiary does not have video capability or for an urgent medical situation, if consistent with state and federal law.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-22-02, pgs. 2-4, May 6, 2022 (Accessed Sept. 2022).

Audio-only refers to the delivery of behavioral health services at a distance using real-time, two-way interactive audio only transmission. Audio-only does not include text messaging, electronic mail messaging or facsimile (fax) transmissions. Providers may utilize audio-only when the individual served does not have access to video capability or for an urgent medical situation, provided that the use of audio-only is consistent with Pennsylvania regulations and federal requirements, including guidance by the Centers for Medicare & Medicaid Services with respect to Medicaid payment and the US Department of Health and Human Services Office of Civil Rights enforcement of HIPAA compliance.

Audio-only and text messages may also continue to be utilized for non-service activities, such as scheduling appointments.

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Puerto Rico

Last updated 09/08/2022

No reference found.

No reference found.

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Rhode Island

Last updated 10/21/2022

No Reference Found

No Reference Found

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South Carolina

Last updated 08/12/2022

No reimbursement for email. No reimbursement for telephone. No reimbursement …

No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.
No reimbursement for video cell phone interactions.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 159 (July 2022). (Accessed Aug. 2022).

FQHCs/RHCs Behavioral Health Services
Family Therapy: Billing for telephone calls is not allowed.

SOURCE: SC Health and Human Svcs. Dept. Federally Qualified Health Center Behavioral Health Services Provider Manual, p. 25, (July 2019), (Accessed Aug. 2022).

Medicaid Targeted Case Management
Electronic visual encounters (e.g., Skype, teleconferencing or other media) with the beneficiary are not considered a face-to-face contact and will be reimbursed at the T1016 MTCM encounter rate.

  • A telephone contact is in lieu of a face-to-face contact when environmental considerations preclude a face-to-face encounter, for the purpose of rendering one or more MTCM components. Documentation must include details precluding a face-to-face encounter.
  • A relevant email contact via secured transmittal, on behalf of the beneficiary for the purpose of rendering one or more MTCM components.

For Medicaid purposes, a face-to-face contact is preferable with phone and/or email contact being acceptable if necessary.

SOURCE: SC Health and Human Svcs. Dept., Medicaid Targeted Case Management Provider Guide, p. 21 (Apr. 2021). (Accessed Aug. 2022).

Dental Telephonic Encounters
As of July 1, 2021, patient triage and care coordination via telephonic or telehealth encounter, along with oral evaluations performed in conjunction with the telehealth encounters, will no longer be allowed.

Source: SC Health and Human Svcs. Dental Services Provider Manual. (Jan. 2022). Pg. 82. (Accessed Aug. 2022).

Licensed Independent Practitioner’s Rehabilitative Services.
Service Plan Development (SPD) is a face-to-face or telephonic interaction between the beneficiary and a qualified clinical professional or a team of professionals.

Crisis Management (CM) is a face-to-face, or telephonic, short-term service is to assist a beneficiary, who is experiencing a marked deterioration of functioning related to a specific precipitant, in restoring his/her level of functioning and/or to stabilize the beneficiary.

Telephonic interventions are provided either to the beneficiary or on behalf of the beneficiary to collect an adequate amount of information to provide appropriate and safe services, stabilize the beneficiary, and prevent a negative outcome

When necessary/appropriate, consultation shall only include telephone or face-to-face contact by a Psychologist/LPES to the family, school, or another health care provider to interpret or explain the results of psychological testing and/or evaluations related to the care and treatment of the beneficiary. The Psychologist/LPES must document the recommended course of action.

Telephone contact related to office procedures or appointment times are not covered.

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South Dakota

Last updated 11/10/2022

Telephones, facsimile machines, and electronic mail systems do not meet …

Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system.

Audio-Only Modifier

  • CMHC and SUD Agencies: Bill modifier GT in addition to the POS code 77.
  • All other providers allowed to bill audio only services: Bill modifier 93 in addition to the POS code 77.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, pgs. 11-12 (Sept. 2022) (Accessed Nov. 2022).

Audio-Only Behavioral Health Services

Effective August 22, 2021, South Dakota Medicaid covers real time, two-way audio-only behavioral health services delivered by a Substance Use Disorder (SUD) Agency or a Community Mental Health Center (CMHC) when the recipient does not have access to face-to-face audio/visual telemedicine technology.

Effective October 3, 2021, South Dakota Medicaid covers real-time, two-way audio-only behavioral health services delivered by an Independent Mental Health Practitioner (IMHP) when the recipient does not have access to face-to-face audio/visual telemedicine technology.

SUD agencies and CMHCs, and IMHPs must utilize traditional audio/visual telemedicine technology when possible. Audio-only services are not covered when used for the convenience of the provider or recipient. The provider must document in the medical record that the use real time video/audio technology was not possible or was unsuccessful.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Sept. 2022) (Accessed Nov. 2022).

Telephonic Evaluation and Management Services

Audio-only evaluation and management services are covered for established patients if the recipient does not have access to face-to-face audio/visual telemedicine technology. The provider must document in the medical record that the use real time video/audio technology was not possible or was unsuccessful.

The service must be initiated by the patient. The service should include patient history and/or assessment, and some degree of decision making. Telephonic evaluation and management services are only allowed to be provided by a physician, podiatrist, nurse practitioner, physician assistant, or optometrist. The service must be 5 minutes or longer. Services may be provided via telephone or via another device or service that allows real-time audio communication.

Audio-only evaluation and management services are not to be billed if clinical decision-making dictates a need to see the patient for an office visit, including a telemedicine office visit, within 24 hours or at the next available appointment time. In those circumstances, the telephone service is considered a part of the subsequent office visit. If the telephone call follows a billable office visit performed in the past seven calendar days for the same or a related diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable. Telephone services provided by an RN or LPN are not billable. See manual for other conditions and requirements.

CMHCs may provide all covered services via audio-only technology when coverage requirements are met. SUD agencies may only provide covered SUD agency services listed in the Audio-Only Procedure Code table in Appendix via audio-only technology when the coverage requirements are met. Contact the Division of Behavioral Health for questions regarding unlisted codes.

For FQHCs/RHCs and IHS/Tribal 638 Providers, SUD agency services may also be provided via audio-only if the provider is an accredited and enrolled agency. Audio-only behavioral health services are reimbursed at the encounter rate.

Services other than those specifically stated as covered when provided via an audio-only modality are considered non-covered if provided via an audio-only modality and must not be billed to South Dakota Medicaid.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 5 (Sept. 2022), (Accessed Nov. 2022).

Crisis assessment and intervention services are covered which includes an immediate therapeutic response available 24 hours a day 7 days a week that involves direct telephone or face-to-face contact with a recipient exhibiting acute psychiatric symptoms and/or inappropriate behavior that left untreated, presents an immediate threat to the recipient or others.

SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 5 (Sept. 2022), (Accessed Nov. 2022).

Collateral contacts is covered which involves telephone or face-to-face contact with an individual other than the identified recipient to plan appropriate treatment, assist others so they can respond therapeutically regarding the recipient’s difficulty or illness, or link the recipient, family, or both, to other necessary and therapeutic community support.

SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 8 (Sept. 2022) & Substance Use Disorder Agency Services, p. 6-7 (Nov. 2022) (Accessed Nov. 2022).

SD Medicaid does not cover physician telephone patient services, online medical evaluation, interprofessional telephone/internet/electronic health record consultations (CPT codes 99441-99443, 99444, 99446- 99449 and 99451-99452).

SOURCE: SD Medicaid Billing and Policy Manual: Physician Services, p. 10 (Oct. 2022), (Accessed Nov. 2022).

Teledentistry

Synchronous teledentistry services may not be provided via email, audio-only, or facsimile transmissions.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 3, (Oct. 2021), (Accessed Nov. 2022).

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Tennessee

Last updated 09/05/2022

Telehealth does not include:

  • An audio-only conversation;
  • An electronic mail

Telehealth does not include:

  • An audio-only conversation;
  • An electronic mail message; or
  • A facsimile transmission

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Sept. 2022).

“Provider-based telemedicine” 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 Sept. 2022).

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Texas

Last updated 09/07/2022

Conditions for reimbursement applicable to behavioral health services provided using …

Conditions for reimbursement applicable to behavioral health services provided using a synchronous audio-only technology platform are those that meet the following conditions:

  • Must be designated for reimbursement by HHSC.
  • Provider must obtain informed consent from the client, client’s parent, or the client’s legally authorized representative prior to rendering a behavioral
  • health service through a synchronous audio-only technology platform; except when doing so is not feasible or could result in death or injury to the client. Verbal consent is permissible and must be documented in the client’s medical record.
  • Must be clinically effective and cost-effective, as determined and published in the benefit language by HHSC.
    May not be denied solely because an in-person medical service between a provider and client did not occur.
  • May not be limited by requiring the provider to use a particular synchronous audio-only technology platform to receive reimbursement for the service.
  • Other conditions for reimbursement applicable to behavioral health services may vary by service type. Providers may refer to the appropriate TMPPM handbook for additional information on audio-only coverage conditions.

Conditions for reimbursement applicable to non-behavioral health services provided using a synchronous audio-only technology platform:

  • Must be designated for reimbursement by HHSC.
  • Clinically effective and cost-effective, as determined and published by HHSC.
  • May not be denied solely because an in-person medical service between a provider and client did not occur.
  • May not be limited by requiring the provider to use a particular synchronous audio-only technology platform to receive reimbursement for the service.

Note: Behavioral or non-behavioral health services that HHSC has determined are clinically effective and cost-effective when provided via a synchronous audio-only technology platform can be found in the appropriate TMPPM handbooks.

Procedure codes that are reimbursed to distant site providers when billed with the 93 modifier (audio-only services) are included in the individual TMPPM handbooks. Procedure codes that indicate telephone or audio-only delivery in their description do not need to be billed with the 93 modifier.

Behavioral health procedure codes that are reimbursed to distant site providers when billed with the FQ modifier (audio-only services) are included in the individual TMPPM handbooks. Procedure codes that indicate telephone or audio-only delivery in their description do not need to be billed with the FQ modifier.

See manual for codes MCOs must reimburse when delivered via telemedicine services.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 7, 9, & 12 (Sept. 2022). (Accessed Sept. 2022).

The following delivery methods may be used to provide telemedicine within fee-for-service (FFS) Medicaid:

  • Synchronous audiovisual technology between the distant site provider and the client in another location
  • Synchronous audio-only technology between the distant site provider and the client in another location
  • Store and forward technology in conjunction with synchronous audio-only technology between the distant site provider and the client in another location. The distant site provider must use one of the following:
    • Clinically relevant photographic or video images, including diagnostic images
    • The client’s relevant medical records, such as medical history, laboratory and pathology results, and prescriptive histories

A Texas Medicaid Managed Care organization (MCO) is not required to provide reimbursement for telemedicine services that are provided through the following methods:

  • A text-only email message
  • A facsimile transmission

Texas Medicaid MCOs may optionally provide reimbursement for telemedicine services that are provided through asynchronous audio-only technology, such as voice mail technology. Distant site providers should contact each MCO to determine whether an MCO provides reimbursement for a specified modality.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 9 &13 (Sept. 2022). (Accessed Sept. 2022).

Outpatient Mental Health Services

The following outpatient mental health services may be provided by synchronous telephone (audio-only) technology to persons with whom the treating provider has an existing clinical relationship and, if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as, the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology.

  • Outpatient mental health services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.
  • Psychiatric diagnostic evaluation services with and without medical services
  • Psychotherapy (individual, family, or group) services
  • Pharmacological management services (most appropriate E/M code with modifier UD) for psychiatric care only

See manual for procedure codes

Mental Health Targeted Case Management (MHTCM) Services

Mental health targeted case management (MHTCM) services may be provided by synchronous telephone (audio-only) technology to persons with whom the treating provider has an existing clinical relationship and, if clinically appro- priate and safe, as determined by the provider, and agreed to by the person receiving services or LAR. In addition, approval to deliver the services by synchronous telephone (audio-only) technology must be documented in the plan of care of the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers of MHTCM services must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. MHTCM services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

An existing clinical relationship occurs when a person has received at least one in-person or synchronous audiovisual MHTCM service from the same provider within the six months prior to the initial service delivered by synchronous telephone (audio-only) technology. The six-month requirement for at least one in-person or synchronous audiovisual service prior to the initial synchronous telephone (audio-only) service may not be waived. See manual for additional information.

Mental Health Rehabilitative Services

The following MHR services may be provided by by synchronous telephone (audio-only) technology to persons with whom the treating provider has an existing clinical relationship and if clini- cally appropriate and safe, as determined by the provider, and agreed to by the person receiving services or LAR. In addition, except for crisis intervention services, approval to deliver the services by synchronous telephone (audio-only) technology must be documented in the plan of care of the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. MHR services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ. See manual for procedure codes and additional requirements.

  • Medication training and support
  • Skills training and development
  • Psychosocial rehabilitation services
  • Crisis intervention services

Synchronous telephone (audio-only) technology may only be used for crisis intervention services as a back-up mode of delivery only, meaning if the person who is in crisis, not the treating provider, is unwilling or has limited technological capabilities that prevent them from using a synchronous audiovisual platform at the time the crisis intervention services are delivered. Also, the existing clinical relationship requirement is waived.

Peer Specialist Services

Peer specialist services may be provided by synchronous telephone (audio-only) technology to persons with whom the peer specialist has an existing clinical relationship and if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. In addition, approval to deliver the services by synchronous telephone (audio-only) technology must be documented in the person-centered recovery plan of the person receiving services.

Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. Peer specialist services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

An existing clinical relationship occurs when a person has received at least one in-person or synchronous audiovisual peer specialist service from the same provider within the six months prior to the initial service delivered by synchronous telephone (audio-only) technology. The six-month requirement for at least one in-person or synchronous audiovisual service prior to the initial synchronous telephone (audio-only) service may not be waived.

The provider is required to conduct at least one in-person or synchronous audiovisual peer specialist service every rolling 12 months from the date of the initial service delivered by synchronous telephone (audio-only) technology unless the person receiving services and the provider agree that an in-person or synchronous audiovisual service is clinically contraindicated, or the risks or burdens of an in-person or synchronous audiovisual service outweigh the benefits. The decision to waive the 12- month requirement applies to that particular rolling 12-month period and the basis for the decision must be documented in the person’s medical record. Examples of when a synchronous telephone (audio-only) service may be more clinically appropriate or beneficial than an in-person or synchronous audiovisual service include, but are not limited to, the following:

  • The person receiving services is located at a qualifying originating site in an eligible geographic area, e.g., a practitioner office in a rural Health Professional Shortage Area.
  • An in-person or synchronous audiovisual service is likely to cause disruption in service delivery or has the potential to worsen the person’s condition.

See manual for additional information.

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

SBIRT services may be provided by synchronous telephone (audio-only) technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. SBIRT services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.  See manual for additional information.

Medication Assisted Treatment Services

The following SUD services may be provided by synchronous telephone (audio-only) technology to persons with whom the treating provider has an existing clinical relationship and if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. SUD services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

  • Comprehensive assessment (procedure code H0001) – Only during certain public health emergencies or natural disasters; to the extent allowed by federal law (assessments for withdrawal management services are excluded); and the existing clinical relationship requirement is waived.
  • Individual and group counseling (procedure codes H0004 and H0005)

See manual for additional requirements.

SOURCE: TX Medicaid Behavioral Health and Case Management Services Handbook, pgs. 31, 49-50, 59, 72-73, 80-81, & 89,  (Sept. 2022). (Accessed Sept. 2022).

A cardiac rehabilitation program in which the cardiac monitoring is done using telephonically transmitted electrocardiograms (ECGs) to a remote site is not a benefit of Texas Medicaid.

SOURCE: TX Medicaid Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, pg. 65. (Sept. 2022). (Accessed Sept. 2022).

To the extent permitted by state and federal law and to the extent it is cost-effective and clinically effective, as determined by the commission, the executive commissioner by rule shall develop and implement a system that ensures behavioral health services may be provided using an audio-only platform consistent with Section 111.008, Occupations Code, to a Medicaid recipient, a child health plan program enrollee, or another individual receiving those services under another public benefits program administered by the commission or a health and human services agency.

If the executive commissioner determines that providing services other than behavioral health services is appropriate using an audio-only platform under a public benefits program administered by the commission or a health and human services agency, in accordance with applicable federal and state law, the executive commissioner may by rule authorize the provision of those services under the applicable program using the audio-only platform. In determining whether the use of an audio-only platform in a program is appropriate under this subsection, the executive commissioner shall consider whether using the platform would be cost-effective and clinically effective.

SOURCE: TX Government Code Title 4, Subtitle I, Chapter 531, Subchapter A, Sec. 531.02161. (Accessed Sept. 2022).

Telehealth Exclusions

Any PT, OT, ST, and SST services delivered through synchronous telephone (audio-only) technology is not a benefit.

During a Declaration of State of Disaster, HHSC may issue direction to providers regarding the use of a telehealth service to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law. A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

See Children’s Services Handbook for a list of procedure codes that are in-person only and will not be reimbursed if provided through telehealth delivery.

Health and Behavior Assessment and Intervention

HBAI services may be provided by synchronous telephone (audio-only) technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. HBAI services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ. See manual for eligible services and additional requirements.

Medical Nutrition Counseling Services (CCP)

Procedure code S9470 may be authorized for delivery using synchronous telephone (audio-only) technologies during a Declaration of State of Disaster. Services delivered using audio-only technologies must be billed using modifier 93.

Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audio-visual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services.

Medical Checkups During a Declaration of State Disaster

During a Declaration of State Disaster, Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of telemedicine or telehealth services to include the use of synchronous telephone (audio-only) platform to provide coverage of services outside of the allowances described herein. A Declaration of State of Disaster is when an executive order or proclamation by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

The following limitations apply to all THSteps preventive medical checkups and exception-to- periodicity checkups during a Declaration of State Disaster when HHSC issues direction regarding the use of synchronous audiovisual and synchronous telephone (audio-only) technologies:

  • Clients who are 2 years through 20 years of age may receive a THSteps medical checkup or exception-to-periodicity checkup using synchronous audiovisual or synchronous telephone (audio-only) technologies.
  • Clients from birth through 2 years of age may not receive a THSteps checkup or exception-to-periodicity checkup using synchronous audiovisual or synchronous telephone (audio-only) technologies.
  • Clients from birth through 24 months of age must receive in-person checkups.

A medical checkup provided using synchronous audiovisual or synchronous telephone (audio-only) technologies must be completed according to the age-specific checkup requirements listed on the THSteps Periodicity Schedule.

Synchronous audiovisual delivery for medical checkups is preferred over synchronous telephone (audio-only) delivery.

An in-person THSteps follow-up visit must be completed within six months of the synchronous audiovisual or synchronous telephone (audio-only) checkup in order for the checkup to be considered a complete THSteps checkup.

THSteps providers should use their clinical judgement regarding which checkup components may be appropriate for completion using synchronous audiovisual or synchronous telephone (audio-only) technologies.

See Children’s Services Handbook for additional information and a list of procedure codes.

SOURCE:  TX Medicaid Children’s Services Handbook, pgs. 57, 67, 71 & 186-187, (Sept. 2022), (Accessed Sept. 2022).

Synchronous audio-only, also called synchronous telephone (audio-only), technology – An interactive, two-way audio telecommunications platform, including telephone technology, that uses only sound and meets the privacy requirements of the Health Insurance Portability and Accountability Act.

Procedure codes that are reimbursed to distant site providers when billed with the 93 modifier (audio-only services) are included in the individual TMPPM handbooks. Procedure codes that indicate telephone or audio-only delivery in their description do not need to be billed with the 93 modifier.

Behavioral health procedure codes that are reimbursed to distant site providers when billed with the FQ modifier (audio-only services) are included in the individual TMPPM handbooks. Procedure codes that indicate telephone or audio-only delivery in their description do not need to be billed with the FQ modifier.

SOURCE: TX Medicaid Telecommunication Services Handbook, pgs. 6, 9 and 12 (Sept. 2022). (Accessed Sept. 2022).

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Utah

Last updated 08/23/2022

Interprofessional telephone/internet assessment and management services are listed as a …

Interprofessional telephone/internet assessment and management services are listed as a covered service for psychiatrists.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Apr. 2022), (Accessed Aug. 2022).

Telephone contact can be billed in the Targeted Case Management for Early Childhood program.

SOURCE: Utah Medicaid Provider Manual: Targeted Case Management, Early Childhood Ages 0-4, p. 10, (Jul. 2016).  (Accessed Aug. 2022).

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Vermont

Last updated 10/28/2022

Services delivered via audio-only telephone, facsimile, or electronic mail messages …

Services delivered via audio-only telephone, facsimile, or electronic mail messages are not considered telemedicine and are not covered.

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.7), Telehealth, (Accessed Oct. 2022).

Audio-Only Telephone

Subject to the limitations of the license under which the individual is practicing and, for Medicaid patients, to the extent permitted by the Centers for Medicare and Medicaid Services, a health care provider may deliver health care services to a patient using audio-only telephone if the patient elects to receive the services in this manner and it is clinically appropriate to do so. A health care provider shall comply with any training requirements imposed by the provider’s licensing board on the appropriate use of audio-only telephone in health care delivery.

A health care provider delivering health care services using audio-only telephone shall include or document in the patient’s medical record:

  • The patient’s informed consent for receiving services using audio-only telephone in accordance with subsection (c) of this section; and
  • The reason or reasons that the provider determined that it was clinically appropriate to deliver health care services to the patient by audio-only telephone.

A health care provider shall not require a patient to receive health care services by audio-only telephone if the patient does not wish to receive services in this manner.

A health care provider shall deliver care that is timely and complies with contractual requirements and shall not delay care unnecessarily if a patient elects to receive services through an in-person visit or telemedicine instead of by audio-only telephone.

Neither a health care provider nor a patient shall create or cause to be created a recording of a provider’s telephone consultation with a patient.

Audio-only telephone services shall not be used in the following circumstances:

  • For the second certification of an emergency examination determining whether an individual is a person in need of treatment pursuant to section 7508 of this title; or
  • For a psychiatrist’s examination to determine whether an individual is in need of inpatient hospitalization pursuant to 13 V.S.A. § 4815(g)(3).

SOURCE: VT Statute 18 VSA Sec. 9362, (Accessed Oct. 2022).

On or before July 1, 2021, the Department of Final the Department of Financial Regulation, in consultation with the Department of Vermont Health Access, the Green Mountain Care Board, representatives of health care providers, health insurers, and other interested stakeholders, shall determine the appropriate codes or modifiers, or both, to be used by providers and insurers, including Vermont Medicaid to the extent permitted by the Centers for Medicare and Medicaid Services, in the billing of and payment for health care services delivered using audio-only telephone in order to allow for consistent data collection, identify appropriate codes for services that do not have in-person equivalents, and minimize the administrative burden on providers. To the extent possible, the use of codes or modifiers, or both, shall be done in a manner that allows data on the use of audio-only telephone services to be identified using the Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES).

Not later than January 1, 2022, all Vermont-licensed health care providers and health insurers offering major medical health insurance plans in Vermont shall use the codes and modifiers determined by the Department of Financial Regulation pursuant to subdivision (1) of this subsection when delivering services by audio-only telephone. Vermont Medicaid shall participate to the extent permitted by the Centers for Medicare and Medicaid Services.

The Department of Financial Regulation, in consultation with the Department of Vermont Health Access, the Green Mountain Care Board, representatives of health care providers, health insurers, and other interested stakeholders, shall determine the amounts that health insurance plans shall reimburse health care providers for delivering health care services by audio-only telephone during plan years 2022, 2023, and 2024. In determining the reimbursement amounts, the Department shall seek to find a reasonable balance between the costs to patients and the health care system and reimbursement amounts that do not discourage health care providers from delivering medically necessary, clinically appropriate health care services by audio-only telephone. The Department may determine different reimbursement amounts for different types of services and may modify the rates that will apply in different plan years as appropriate but shall finalize its determinations not later than April 1 for plan years after 2022.

See bill for requirements of Department in 2023 and 2024.

SOURCE:  Senate Bill 117 (2021 Session), (Accessed Oct. 2022).

See the Miscellaneous section of the Professional Regulation category for additional requirements.

 

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Virgin Islands

Last updated 09/08/2022

No reference found.

No reference found.

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Virginia

Last updated 11/23/2022

Telehealth encompasses telemedicine as well as a broader umbrella of …

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.

This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine does not include an audio-only telephone.

All fee-for-service claims for audio only codes should be billed directly to DMAS, including those delivered in the context of mental health and substance use disorder services. See Chapter V of the Physician/Practitioner Manual for detailed billing instructions.

See Table 6 for a list of  Audio-Only Services.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 2  (Oct. 2022) (Accessed Nov. 2022).

Audio Only Services

Additions to the Telehealth Supplement include defining virtual check-in services, identifying covered codes, specifying reimbursement requirements, and outlining fee-for-service (FFS) billing details.  See Update for list of codes.

As noted in the Telehealth Supplement (Attachment A), all FFS claims for audio only codes should be billed directly to DMAS, including those delivered in the context of mental health and substance use disorder services. Chapter V of the Physician/Practitioner Manual provides detailed billing instructions for submitting claims to DMAS.

SOURCE: VA Department of Medical Assistance Services, Coverage of Virtual Check-In and Audio Only Services/Updates to Telehealth Services Supplement, April 1, 2022. (Accessed Nov. 2022).

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Washington

Last updated 08/27/2022

Effective August 1, 2022

HCA will pay for audio-only services …

Effective August 1, 2022

HCA will pay for audio-only services for specific billing codes when provided and billed as directed in HCA provider billing guides. This shift in billing practice comes because of 2021 legislation (HB 1196), which requires coverage at parity of audio-only telemedicine that can be safely and effectively provided according to generally accepted health care practices and standards. HCA has published a list of billing codes that are payable when services are provided by audio-only telemedicine (over the phone). The new list of audio-only codes is published on HCA’s Provider billing guides and fee schedules webpage (scroll down to Telehealth under Billing guides and fee schedules).

Apple Health (Medicaid) policies require the appropriate audio-only modifiers (93 or FQ). Information related to specific service areas and billing guidelines includes the following:

For services that are partially audio/visual and partially audio-only, a service is considered audio-only if 50% or more of the service was provided via audio-only telemedicine.

SOURCE: WA State Health Care Authority. Telehealth Services Billing Guide Audio-only Supplement. (June 2022). WA State Health Care Authority, Medicaid Provider Guide, Telemedicine Policy and Billing, p. 12 (Aug. 2022). (Accessed Aug. 2022).

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. 5 (Aug. 2022)WA State Health Care Authority. Medicaid Provider Guide. Maternity Support Services and Infant Case Management Billing, p. 10 (Aug. 2022). (Accessed Aug. 2022).

Providers must obtain consent before rendering audio-only services and document the consent in the client record.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Telemedicine Policy and Billing, p. 12 (Aug. 2022). (Accessed Aug. 2022).

The authority shall adopt rules regarding medicaid fee-for-service reimbursement for services delivered through audio-only telemedicine.  The rules must establish a manner of reimbursement for audio-only telemedicine that is consistent with RCW 74.09.325. The rules shall require rural health clinics to be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between a patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.  It does not include:

  • The use of facsimile or email; or
  • The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

SOURCE: RCW 74.09.327 (Accessed Aug. 2022).

Managed Care & Behavioral Health Administrative Services Organizations

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.  It does not include:

  • The use of facsimile or email; or
  • The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

Upon initiation or renewal of a contract with the Washington state health care authority to administer a medicaid managed care plan, a managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine or store and forward technology if … Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

“Established relationship” means the covered person has had at least one in-person appointment within the past year with the provider providing audio-only telemedicine or with a provider employed at the same clinic as the provider providing audio-only telemedicine or the covered person was referred to the provider providing audio-only telemedicine by another provider who has had at least one in-person appointment with the covered person within the past year and has provided relevant medical information to the provider providing audio-only telemedicine.

A rural health clinic shall be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.

If a provider intends to bill a patient or a managed health care system for an audio-only telemedicine service, the provider must obtain patient consent for the billing in advance of the service being delivered. The authority may submit information on any potential violations of this subsection to the appropriate disciplining authority, as defined in RCW 18.130.020.

Effective June 9, 2022: Established relationship means the provider providing audio-only telemedicine has access to sufficient health records to ensure safe, effective, and appropriate care services and, for health care services included in the essential health benefits category of mental health and substance use disorder services, including behavioral health treatment:

  • The covered person has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicine; or
  • The covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine.

SOURCE: Revised Code of Washington 74.09.325 & 71.24.335, as amended by HB 1821 (2022 Legislative Session). (Accessed Aug. 2022).

Effective June 9, 2022: For any other health care service:

  • The covered person has had, within the past two years, at least one in-person appointment with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicine; or
  • The covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past two years, at least one in-person appointment with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine.

SOURCE: Revised Code of Washington 74.09.325, as amended by HB 1821 (2022 Legislative Session). (Accessed Aug. 2022).

School-Based Health Services

The SBHS program reimburses for some services when provided through audio-only telemedicine (i.e., telephone service delivery).

To indicate that the service was provided through audio-only telemedicine (i.e., telephone service delivery with no visual component), school districts must submit claims for telemedicine services using either place of service (POS) 02 or POS 10 and must add modifier 93 to the claim to indicate services were provided through audio-only telemedicine. When billing for audio-only telemedicine through the SBHS program, the school district always submits a claim on behalf of both the originating and distant site.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, SBHS Billing, p. 37-39 (July 2022). (Accessed Aug. 2022).

Obstetrical Services

HCA allows obstetrical services to be provided via audio-only. Audio-only visits for pregnant clients must:

  • Be utilized only when clinically appropriate for the individual client, based on current clinical guidance and standards of care from ACOG and AAFP.
  • Not be used when client circumstances call for an in-person assessment or procedure.
  • Be informed by client preference. Clients must have input on and choice regarding how services are delivered.
  • Have documentation that complies with HCA’s telemedicine policies. Must include start and stop time of audio-only interaction.

HCA does not pay for abortion services provided via audio-only telemedicine.

See manual for audio-only billing instructions relative to global OB care and unbundled obstetrical care.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 214-215, 218-221 (Aug. 2022). (Accessed Aug. 2022).

Comprehensive assessment and care planning for persons living with cognitive impairment

Face-to-face visits via an in-person or audio-visual encounter are allowed, but HCA does not allow telephonic and email encounters.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 72 (Aug. 2022). (Accessed Aug. 2022).

Applied Behavior Analysis (ABA) Services

The following services are not paid for as telemedicine:

  • Email, telephone, and facsimile transmissions.
  • Installation or maintenance of any telecommunication devices or systems.
  • Purchase, rental, or repair of telemedicine equipment.
  • Home health monitoring.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide. ABA Program Billing, p. 32 (Aug. 2022). (Accessed Aug. 2022).

Telephone Services

HCA pays for telephone services when used by a physician to report and bill for episodes of care initiated by an established patient (i.e., someone who has received a face-to-face service from you or another physician of the same specialty in your group in the past three years) or by the patient’s guardian.  See manual for codes and additional requirements.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 53 (Aug. 2022). (Accessed Aug. 2022).

Teledentistry

The agency does not cover email or facsimile transmissions as teledentistry services.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental-Related Services, p. 75, (Aug. 2022). (Accessed Aug. 2022).

FACILITY FEE

HCA does not pay an originating site facility fee for audio-only services.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Telemedicine Policy and Billing, p. 9 (Aug. 2022); WA State Health Care Authority, Medicaid Provider Guide, SBHS Billing, p. 37-39 (July 2022). (Accessed Aug. 2022).

A hospital that is an originating site or distant site for audio-only telemedicine may not charge a facility fee.

SOURCE: RCW 70.41.530, as added by HB 1708 (2022 Session). (Accessed Aug. 2022).

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West Virginia

Last updated 09/02/2022

No reimbursement for FAX.

No reimbursement for email.

The Jan. …

No reimbursement for FAX.

No reimbursement for email.

The Jan. 1, 2022 update to the WV Medicaid Provider Manual on Telehealth Services removed the reference to telephones under Non-Covered Services.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. p. 4, 6 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

FQHCs/RHCs, Behavioral Health Outpatient Services & Licensed Behavioral Health Centers

No reimbursement for telephone.

No reimbursement for FAX.

No reimbursement for email.

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, Behavioral Health Outpatient Services Chapter 521, p. 9 (Jan. 15, 2018). WV Dept. of Health and Human Svcs, Licensed Behavioral Health Centers, Chapter 503, p. 9 (July 15, 2018). (Accessed Sept. 2022).

Substance Use Disorder

Reimbursement is not available for a telephone conversation, electronic mail message (e-mail), or facsimile transmission (fax) between a provider and a member except for targeted case management services.

SOURCE: WV Dept. Health and Human Svcs., Substance Use Disorder, Chapter 504, p. 10 (October 1, 2020). (Accessed Sept. 2022).

Children with Serious Emotional Disorder Waiver

Reimbursement is not available for a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a provider and a member except for wraparound facilitation services.

In extenuating circumstances, plan of care members may participate by teleconferencing (i.e., telephone).

SOURCE: WV Dept. of Health and Human Svcs, Children with Serious Emotional Disorder Waiver, Chapter 502, p. 14, 33 (July 1, 2021). (Accessed Sept. 2022).

Diabetes Self-Management Programs

Diabetes self-management programs may offer telehealth education when resources are limited, and may otherwise communicate by telephone when patients lack access to broadband internet.

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Wisconsin

Last updated 11/21/2022

The Department may promulgate rules specifying any telehealth service that …

The Department may promulgate rules specifying any telehealth service that is provided solely by audio-only telephone, facsimile machine or electronic mail as reimbursable under Medical Assistance.

SOURCE: WI Statute Sec. 49.45 (61). (Accessed Nov. 2022).

School-Based Services 

The FQ or 93 modifiers should be used for any service performed via audio-only telehealth. The GT modifier should only be used to indicate services that were performed using audio-visual technology.

When possible, telehealth services should include both an audio and visual component. In circumstances where audio-visual telehealth is not possible due to member preference or technology limitations, telehealth may include real- time interactive audio-only communication if the provider feels the service is functionally equivalent to the in-person service and there are no face-to-face or in-person restrictions listed in the procedural definition of the service.

Documentation should include that the service was provided via interactive synchronous audio-only telehealth.

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

When possible, telehealth services should include both an audio and visual component. In circumstances where audio-visual telehealth is not possible due to member preference or technology limitations, telehealth may include real-time interactive audio-only communication if the provider feels the service is functionally equivalent to the in-person service and there are no face-to-face or in-person restrictions listed in the procedural definition of the service.

Documentation should include that the service was provided via interactive synchronous audio-only telehealth.

Modifier 93 should be used for any service performed via audio-only telehealth. Modifier 93 is effective for dates of service on and after January 1, 2022.

Behavioral Health Services

Effective January 1, 2022, the FQ modifier should be used for audio-only behavioral health services and modifier FR should be used for behavioral health services where the supervising provider is present through audio-visual means and the patient and supervised provider are in-person.

For instances where the patient, supervising/billing provider, and supervised/ rendering provider are all interacting through audio-visual means, providers should use modifier 95 GT.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth & ForwardHealth Update Dec. 2021, No. 2021-50. (Accessed Nov. 2022). 

Teledentistry

Modifier 93 should be used for any service performed via audio-only telehealth. The GT modifier should only be used to indicate services performed using audio-visual technology.

When possible, telehealth services should include both an audio and visual component. In circumstances where audio-visual telehealth is not possible due to member preference or technology limitations, telehealth may include real-time interactive audio-only communication if the provider feels the service is functionally equivalent to the in-person service and there are no face-to-face or in-person restrictions listed in the procedural definition of the service.

Documentation should include that the service was provided via interactive synchronous audio-only telehealth.

SOURCE: ForwardHealth Update, Jan. 2022, No. 2022-01. (Accessed Nov. 2022).

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Wyoming

Last updated 10/20/2022

Telehealth does not include a telephone conversation, electronic mail message …

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 health care practitioners asynchronous “store and forward” technology.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, pg. 134 (Sept. 30, 2022), WY Division of Healthcare Financing Tribal Provider Manual, Ch. 6 Institutional/UB Common Billing Information, pg. 145 & Ch. 7 CMS-1500 Common Billing Information, pg. 225 (Sept. 30, 2022) & Institutional Provider Manual pg. 143.  (Sept. 30, 2022). (Accessed Oct. 2022).

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, (Oct. 14, 2022). (Accessed Oct. 2022).

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Medicaid & Medicare

Email, Phone & Fax

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