Telephonic and online services, including services related to diagnostic workup are covered for services for new and established patients.
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 February 1, 2021 Prioritized List of Health Services, p. C-2. (02/01/21). (Accessed Feb. 2021).
Telehealth services may be 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 Feb. 2021).
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 Feb. 2021).
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 410-130-0610 Telemedicine, 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. (Effective Jan. 1, 2021). (Accessed Feb. 2021).
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.
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 410-133-0040 & 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Coverage (Accessed Feb. 2021).
Indian Health Services
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 410-147-0120, Healthy Systems Division: Medical Assistance Programs, American Indian/Alaska Native. (Accessed Feb. 2021).
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. Telephone encounters qualify as a valid encounter for specific services.
SOURCE: OR OAR 410-147-0120, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services. (Accessed Feb. 2021).