Email, Phone & Fax

Temporary Policy – Ends Dec. 31, 2024

In the case that the emergency period described in section 1320b–5(g)(1)(B) of this title ends before December 31, 2024, the Secretary shall continue to provide coverage and payment under this part for telehealth services identified in paragraph (4)(F)(i) as of March 15, 2022, that are furnished via an audio-only communications system during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024. For purposes of the previous sentence, the term “telehealth service” means a telehealth service identified as of March 15, 2022, by a HCPCS code (and any succeeding codes) for which the Secretary has not applied the requirements of paragraph (1) and the first sentence of section 410.78(a)(3) of title 42, Code of Federal Regulations, during such emergency period.

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

This waiver allows the use of audio-only equipment to furnish services described by the codes for audio-only telephone evaluation and management services, and behavioral health counseling and educational services. Unless provided otherwise, other services included on the Medicare Telehealth Services List must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site. Additionally, after the PHE ends, the Consolidated Appropriations Act, 2023 extends availability of the telehealth services that can be furnished using audio-only technology through December 31, 2024. In the CY 2022 Physician Fee Schedule Rule, CMS revised the regulation at 42 CFR § 410.78(a)(3) to permit the use of audio-only equipment for telehealth services furnished to patients in their homes under certain circumstances for purposes of diagnosis, evaluation, or treatment of a mental health disorder (including substance use disorder).

Telephone Evaluation, Management/Assessment and Management Services, and Behavioral Health and Education Services

• During the PHE, a broad range of clinicians, including physicians, have been able to provide certain services by telephone to their patients.
• Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020. After the PHE ends, the Consolidated Appropriations Act, 2023 provides for an extension for this flexibility through December 31, 2024.
• When clinicians have furnished an evaluation and management (E/M) service that otherwise would have been reported as an in-person or telehealth visit, using audio-only technology, practitioners have been able to bill using these telephone E/M codes provided that it is appropriate to furnish the service using audio-only technology and all of the required elements in the applicable telephone E/M code (99441-99443) description are met.
• Using section 1135 waiver authority, CMS has been allowing many behavioral health and education services to be furnished via telehealth using audio-only communications. The full Medicare Telehealth Services List notes which services are eligible to be furnished via audio-only technology, including the telephone evaluation and management visits: https://www.cms.gov/Medicare/Medicare-GeneralInformation/Telehealth/Telehealth-Codes.

After the PHE ends, the Consolidated Appropriations Act, 2023 extends availability of the telehealth services that can be furnished using audio-only technology through December 31, 2024.

In the CY 2022 Physician Fee Schedule Rule, CMS revised the regulation at 42 CFR § 410.78(a)(3) to permit the use of audio-only equipment permanent policy for telehealth services furnished to patients in their homes under certain circumstances for purposes of diagnosis, evaluation, or treatment of a mental health disorder (including a substance use disorder).

Opioid Treatment Programs (OTPs): In the CY 2023 PFS final rule, we extended the flexibility for OTPs to furnish periodic assessments via audio-only (telephone) interactions under certain circumstances through the end of 2023.

SOURCE: Centers for Medicare and Medicaid Services, Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19, 6/26/23, (Accessed Jun. 2023).

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

SOURCE: 42 CFR Sec. 410.78 (Accessed Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

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.

In person requirement delayed under Medicare until on or after January 1, 2025.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215 & delay in implementation in HR 2617 (2022 Session).  (Accessed Jul. 2023).

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 or 93.

These in-person visit requirements apply only to a patient getting mental health visits via telecommunications at home:

• There must be an in-person mental health visit 6 months before the telecommunications visit
• In general, there must be an in-person mental health visit at least every 12 months while the patient is getting services from you via telecommunications to diagnose, evaluate, or treat mental health disorders

NOTE: Section 4113 of the Consolidated Appropriations Act (CAA), 2023, delayed the in-person visit requirements under Medicare for mental health visits that RHCs and FQHCs provide via telecommunications technology. For RHCs and FQHCs, we won’t require in-person visits until January 1, 2025.

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

A mental health visit is a medically-necessary face-to-face encounter between an RHC or FQHC patient and an RHC or FQHC practitioner during which time one or more RHC or FQHC mental health services are rendered. Effective January 1, 2022, a mental health visit is a face-to-face encounter or an encounter furnished using interactive, real-time, audio and video telecommunications technology or audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

The CAA, 2023 extends the telehealth policies of the CAA, 2022 through December 31, 2024 if the PHE ends prior to that date. The in-person visit requirements for mental health telehealth services and mental health visits furnished by RHCs and FQHCs begin on January 1, 2025 if the PHE ends prior to that date. There must be an in-person mental health service furnished within 6 months prior to the furnishing of the mental health service furnished via telecommunications and that 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, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reasons for this decision in the patient’s medical record.

RHCs and FQHCs are instructed to append modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) in instances where the mental health visit was furnished using audio-video communication technology and to append modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System) in cases where the service was furnished using audio-only communication.

Mental health services that qualify as stand-alone billable visits in an FQHC are listed on the FQHC center website, http://www.cms.gov/Center/Provider-Type/FederallyQualified-Health-Centers-FQHC- Center.html. Services furnished must be within the practitioner’s state scope of practice.

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

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

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 Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

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 2018, (Accessed Jul. 2023).

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 Jul. 2023).

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, (Accessed Jul. 2023).

Starting on or after January 1, 2023, they may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. CMS will require this information on HH claims starting on July 1, 2023. Home Health Agencies will submit the use of telecommunications technology on the HH claim using the following 3 G-codes:

• G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
• G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
• G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)

SOURCE: Telehealth Home Health Services: G-Codes, MLN Matters MM12805, (Effective Date: Jan. 1, 2023), (Accessed Jul. 2023).

No reference found for email and fax.

* The US Health and Human Services Administration maintains a website that summarizes Medicare policies that includes audio-only allowances.

Providers meeting the telemedicine provider requirements listed above must append the modifier GT to all procedure codes billed for covered telemedicine services via audio and visual telecommunications. Additional modifiers may be required; see the chapter of the Provider Billing Manual that describes services provided for further information. At this time, reimbursement for services provided through telemedicine via audio and audio and video telecommunications will be paid at parity to those services provided face-to-face. Medicaid will continue to monitor and reevaluate, if deemed necessary. On October 1, 2023, new rates for audio-only telecommunications will be established.

Providers should place a FQ modifier on an audio-only telemedicine claim to designate that the claim was delivered through audio-only telecommunications.

SOURCE: AL Medicaid, Telemedicine Policy, 5/26/23, Effective June 1, 2023, (Accessed Jun 2023).

Medicaid will continue to allow audio-only telecommunications to be reimbursed at parity for dates of services rendered through September 30, 2023. On October 1, 2023, new rates for audio-only telecommunications will be established.

This audio-only telecommunications method can only be used in lieu of the audio and video telecommunications method where telemedicine services are approved by Medicaid.

Providers must place the ‘FQ’ modifier on the claim to designate that the service was rendered via an audio-only telecommunications method.

SOURCE: AL Medicaid, Provider Alert, Telemedicine Delivery of Services, 4/26/23, (Accessed Jun. 2023).

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). Apr. 2023. (Accessed Jun. 2023).

Telephone consultations are not covered.

SOURCE:  AL Admin. Code r. 560-X-6-.14., p. 27 & 31. (Accessed Jun. 2023).

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, Apr. 2023, pg. 37-16, (Accessed Jun. 2023).

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, Apr. 2023, 110-16, (Accessed Jun. 2023).

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, Apr. 2023, C-1, (Accessed Jun. 2023).

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 Statute Sec. 47.07.069, (Accessed Jun. 2023).

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 Jun. 2023).

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

No reimbursement for facsimile.

No reimbursement for equipment and systems.

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) (Accessed Jun. 2023).

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: AK Admin Code, Title 7, 635 (Accessed Jun. 2023).

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, 10/22, pg. 107, (Accessed May 2023).

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). Approved Dec. 2022. (Accessed May 2023).

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 May 2023).

Two HCPCS codes are included in this section of the 2022/2023 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. 338. (Accessed May 2023).

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. 10 (Revised 2/11/23) & IHS/Tribal Billing Manual, Ch. 12 Behavioral Health, (Revised 2/11/23) pg. 11-12, (Accessed May 2023).

Behavioral Health Crisis Services and Care Coordination

Crisis Telephone Services: All ACC-RBHA Contractors shall jointly oversee the delivery of crisis telephone services provided in their respective GSAs through a single statewide crisis phone line vendor utilizing an easy to use, single statewide, toll-free crisis phone number.   See manual for details.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Behavioral Health Crisis Services and Care Coordination, Ch 590, (pg. 3), Approved 4/14/22. (Accessed May 2023).

Ongoing support to maintain employment may be provided individually or in a group setting, as well as telephonically.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Title XIX/XXI Behavioral Health Service Benefit, Ch 310-B, (pg. 6), Approved 9/15/22. (Accessed May 2023).

Direct Care Services

The initial supervisory/monitoring visit is required by the 5th day from the initial service provision and shall not occur on the same day of the initial service provision. For homemaker services only, the 5th day supervisory/monitoring visit (depending on the nature of the care being performed) may be conducted telephonically.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Direct Care Services, Ch 1240-A, (pg. 8), Approved 4/20/17. (Accessed May 2023).

A health benefit plan (includes Medicaid) may voluntarily reimburse for healthcare services provided through Sec. 23-79-1601(7)(C).  See below.

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

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

SOURCE: AR Code 23-79-1602 & 1601(7)(c). (Accessed May 2023).

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 May 2023).

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, (1/1/23).  (Accessed May 2023).

Targeted Care Management – Covered Case Management Services

Face to face or telephone contacts with the beneficiary and/or other individuals for the purpose of assisting in the beneficiary’s needs being met

1. Communications through FAX or email are covered when the purpose of the communication is to gather information from an individual other than the beneficiary AND the purpose of the communication meets the TCM service definition.
2. Billable communication is limited to time spent sending emails and/or faxes. Receiving faxes and/or emails is not a billable TCM service.  Hard copies of emails and faxes must be maintained in the beneficiary’s file for audit purposes by the Arkansas Medicaid Program or its representatives.  Documentation must support all claims for Medicaid reimbursement, as is currently required by the Medicaid Program.
3. Communications through fax or email is not billable when communication is with the beneficiary.

SOURCE: Targeted Case Management, 213.000 p. II-8, (Updated 10/1/12).  (Accessed May 2023).

For services or benefits provided via synchronous telephone or other real-time interactive audio-only telecommunications systems, the health care provider bills with 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.

Health care providers must use an interactive audio-only telecommunications system that permits real-time communication between the provider at the distant site and the patient at the originating site. The audio telehealth system used must, at a minimum, have the capability of meeting the procedural definition of the code provided through telehealth. The telecommunications equipment must be of a quality or resolution to adequately complete all necessary components to document the level of service for the CPT code or HCPCS code billed.

The totality of the communication of information exchanged between the provider and the patient during the audio-only service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

Providers must document in the patient’s medical file that the patient has given a written or verbal consent to the audio-only telehealth encounter.

See Telehealth Modifier Reference Sheet- Organized by Delivery System​​ ​for more information on modifiers.

Brief Virtual Communications and Check-ins

Virtual or telephonic communication includes a brief communication with an established patient not physically present (face-to-face). Medi-Cal providers may be reimbursed using HCPCS codes G2010 and G2012 for brief virtual communications.

HCPCS code 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 to 10 minutes of medical discussion. G2012 can be billed when the virtual communication via a telephone call.

Establishing a Relationship

Providers may establish a relationship with new patients via audio-only synchronous interaction only if one or more of the following applies:

• The visit is related to sensitive services as defined in subsection (n) or Section 56.06 of the Civil Code. Section 56.06 of the Civil Code defines “sensitive services” as all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender-affirming care, and intimate partner violence, and includes services described in Sections 6924 through 6930 of the Family Code, and Sections 121020 and 124260 of the Health and Safety Code, obtained by a patient at or above the minimum age specified for consenting to the service specified in the section.
• The patient requests an audio-only modality.
• The patient attests they do not have access to video.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth (Jan. 2023). Pg. 3, 6-7, 10. (Accessed Jun. 2023).

The department shall reimburse health care providers of applicable health care services delivered via synchronous audio-only modality 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.

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 this requirement specified in subparagraph 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.

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, 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.

A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via telephonic (audio-only) synchronous interaction except:

• when the visit is related to sensitive services, as defined in subdivision (n) of Section 56.05 of the Civil Code, and when established in accordance with department specific requirements and consistent with federal and state law, regulations and guidance
• when the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department specific requirements and consistent with federal and state laws, regulations and guidance.

SOURCE: Welfare and Institutions Code 14132.725. (Accessed Jun. 2023).

FQHCs/RHCs 

An audio-only synchronous interaction is eligible for reimbursement if provided by a billable provider and FQHC or RHC patient.

Medi-Cal benefits or services being provided are clinically appropriate and meet the procedural and billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter

A patient may not be “established” using an audio-only synchronous interaction unless the visit is related to a “sensitive service”, as defined in the California Civil Code, section 56.05, subdivision (n), or if the patient requests “audio only” or does not have access to video.

SOURCE: CA Dept. Health Care Services, Medi-Cal Part 2 RHCs and FQHCs Manual, (Jan. 2023), p 14.  (Accessed Jun. 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. Exceptions shall include but not be limited to:

• An FQHC or RHC may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (n) of Section 56.05 of the Civil Code, or when the patient requests an audio-only modality or attests they do not have access to video – in accordance with department-specific requirements and consistent with federal and state laws, regulations, and 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) and AB 32 (2022 Session). (Accessed Jun. 2023).

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. (Accessed Jun. 2023).

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 Jun. 2023).

IHS-MOA

An audio-only visit is eligible for reimbursement if provided by a billable provider, regardless of the location of the patient or provider.

SOURCE: DHCS IHS Manual. May 2023. Pg. 9. (Accessed Jun. 2023).

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. (Dec. 2022). (Accessed Jun. 2023).

LEA Services

Allowable services delivered via telehealth must be synchronous telehealth service rendered via a real-time interactive audio and video telecommunications system only.

SOURCE: CA Department of Health Care Services. Medi-Cal Local Educational Agency (LEA) Telehealth Manual. Page 3. (Jun. 2023). (Accessed Jun. 2023).

SOURCE: CA Department of Health Care Services. Family PACT Clinical Services manual. Jun. 2023. Pg. 7. (Accessed Jun. 2023).

A Family PACT provider may enroll and recertify clients through synchronous video or audio-only synchronous telehealth modalities. See manual for more information.

SOURCE: CA Department of Health Care Services. Family PACT Client Eligibility Manual. Apr. 2023. Pg. 1. (Accessed Jun. 2023).

CCS Service Code Groupings

Effective for dates of service on or after July 1, 2023, CPT^® codes 99358 (Prolonged evaluation and management service before and/or after direct patient care; first hour) and 99359 (Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes) have been added to the California Children’s Services (CCS) Service Code Grouping (SCG).

SOURCE: CA Dept. of Health Care Services. CCS Service Code Groupings Policy Update. June 2023. (Accessed Jul. 2023).

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 Aug. 2023).

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 Aug. 2023).

No reimbursement for provider-to-provider consultations provided by telephone (interactive audio).

No reimbursement for FAX.

No reimbursement for email.

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

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

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

FQHCs/RHCs/IHS

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

Physical Therapy, Occupational Therapy, Home Health, Hospice and Pediatric Behavioral Health Providers

Physical therapists, occupational therapists, hospice, home health providers and pediatric behavioral health providers are eligible to deliver telemedicine services.

1. Home Health Agency services and therapies, Hospice, and Pediatric Behavioral Treatment may be provided via telephone-only.
2. Outpatient Physical, Occupational, and Speech Therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 7/23. (Accessed Aug. 2023).

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, p. 37  (Accessed Aug. 2023).

Effective for dates of service on and after May 12, 2023, which is the first day after the federal COVID-19 public health emergency declaration ends, in accordance with sections 17b-245e and 17b-245g of the Connecticut General Statutes, the Department of Social Services (DSS) is issuing new guidance for services eligible for reimbursement under the Connecticut Medical Assistance Program (CMAP) when rendered via telehealth. DSS will continue to reimburse for specified services when rendered via telehealth as detailed in Provider Bulletin 2023-38 and on the CMAP Telehealth Table. This guidance applies to services rendered under CMAP for all HUSKY Health members.

Telehealth includes:

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

Comprehensive information regarding the specific procedure codes eligible are posted on the CMAP Telehealth Webpage. This web page will provide information on telehealth requirements, approved procedure codes, required modifiers, specific policy criteria and/or limitations, effective dates, and other telehealth policy information, including the Telehealth FAQs. Providers are responsible for verifying coverage of a specific procedure code as a telehealth service as well as a covered service on their applicable fee schedule prior to delivering and billing CMAP for the service.

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.

SOURCE: HB 5596 (2021 Session), Sec. 1, 6. & SB 2 (2022 Session), Sec. 32. (Accessed Jul. 2023).

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. Oct. 1, 2020. Ch. 7, pg. 20; Behavioral 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 Jul. 2023).

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 Jul. 2023).

Telephonic consultations are not reimbursable under CMAP.

SOURCE: CT Policy Transmittal 2019-12. Effective Jan. 1, 2019. Released Mar. 1, 2019. (Accessed Jul. 2023).

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 Jul. 2023).

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, 7/1/23. Ch. 16.8.1, Telemedicine, pg. 77, (Accessed Jul. 2023).

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 Jul. 2023).

When billing for any audio-only telemedicine services, distant site providers shall enter the “93” procedure modifier on the claim.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 2023, p. 4,  Physicians Billing Manual.  DC Medicaid.  (Apr. 2023) Sec. 15.4. P. 52, Clinic Billing Manual, DC Medicaid (Apr. 2023), Sec. 15.4, P. 50. FQHC Billing Manual, DC Medicaid 15.4 P. 52. (Apr. 2023), Behavioral Health Billing Manual (Apr. 2023) 14.4, p. 68., Inpatient Hospital Billing Guide, 11.4, p. 61 (Apr. 2023), Long-Term Care Billing Manual, 15.4, p. 52 (Apr. 2023).  (Accessed June 2023).

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. 2023, p. 6. (Accessed June 2023).

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. 2023, p. 1. (Accessed June 2023).

Services delivered through audio-only telephones, electronic mail messages or facsimile transmission are not included under telehealth services.

SOURCE: Physicians Billing Manual.  DC Medicaid.  (Apr. 2023) Sec. 15. P. 51, Clinic Billing Manual, DC Medicaid (Apr. 2023), Sec. 15, P. 49. FQHC Billing Manual, DC Medicaid 15 P. 51. (Apr. 2023), Behavioral Health Billing Manual (Apr. 2023) 14, p. 67., Outpatient Hospital Billing Guide, 15.8, p. 74 (Apr. 2023), Inpatient Hospital Billing Guide, 11, p. 60 (Apr. 2023), Long-Term Care Billing Manual, 15, p. 51 (Apr. 2023).  (Accessed June 2023).

Florida Medicaid will cover telehealth services in accordance with the Agency’s promulgated Telemedicine rule and will no longer cover audio-only telehealth services.

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

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

SOURCE: FL Admin Code 59G-1.057. (Accessed Jun. 2023).

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 (Apr. 2023). (Accessed May 2023).

Behavioral Health Clinical Consultation

Interprofessional telephone consultation covered, see manual.

SOURCE: FY 23 – 3rd Quarter Provider Manual for Community Behavioral Health Providers, p. 21. (May  2023), (Accessed May 2023).

Traditional/Enhanced Elderly and Disabled Waiver (EDWP) Traditional/Enhanced Case Management

Some case management and screening services may be provided telephonically.

SOURCE: GA Department of Community Health, Division of Medicaid, Policies and Procedures for Elderly and Disabled Waiver EDWP – (CCSP) Traditional/Enhanced Case Management, p. 45-47, 106. (Apr. 2023).  (Accessed May 2023).

Federally Qualified Health Centers

Except for services that meet the criteria for a TCM visit, telephone or electronic communication between a physician and a patient, or between a physician and someone on behalf of a patient, are considered physicians’ services and are included in an otherwise billable visit. They do not constitute a separately billable visit.

Telephone or electronic communication between a CP or CSW and a patient, or between such practitioner and someone on behalf of a patient, are considered CP or CSW services and are included in an otherwise billable visit

SOURCE: GA Department of Community Health, Division of Medicaid, Federally Qualified Health Centers Services and Rural Health Clinic Services, p. 17, 21 (Apr. 2023). (Accessed May 2023).

Community Behavioral Health and Rehabilitation Services

While some CBHRS services allow telephonic interactions, telephonic interventions do not qualify as telemedicine.

SOURCE: GA Department of Community Health, Division of Medicaid, Community Behavioral Health and Rehabilitation Services, p.  100.  (Apr. 2023).  (Accessed May 2023).

Recently Passed Legislation – Effective until December 31, 2025.

Med-QUEST Division (MQD) supports the medically appropriate use of interactive telecommunications system using two-way, real-time audio-only communication technology (audio-only) to increase access to healthcare and promote continuity of care. MQD will continue to reimburse select healthcare services delivered through audio-only communication technology after the Federal PHE expires. The following guidance is in effect until December 31, 2025, which aligns with the amended Hawaii Revised Statute 346-59.1 as amended by 2023 Hawaii legislative session HB 907 HD 2 SD 2.

MQD will reimburse the codes identified as “audio-only interaction” as listed in the Centers for Medicare & Medicaid Services List of Telehealth Services/Medicare professional fee schedule (PFS)2 , which meet required conditions listed below, and which are recognized as Medicaid covered services. Federally Qualified Health Centers and Rural Health Centers will be reimbursed the prospective payment system rate when applicable. Codes approved for reimbursement are subject to change.  See memo for additional guidelines and requirements.

SOURCE:  HI Med-Quest Memo No: QI-2306, CCS-2302, FFS23-04 (May 12, 2023).  (Accessed Jun. 2023).

Newly Amended Statute, Will be Repealed Dec. 31, 2025

Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78.  Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.

Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.

SOURCE: HI Revised Statute, Sec. 346-59.1 as amended by HB 907HD 2/SD 2 (Accessed Jun. 2023).

No Reimbursement for:

• Telephone
• Facsimile machine
• Electronic mail

SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 69 (Accessed Jun. 2023).  (NOTE: Temporarily suspended by Memo No.: QI-2306; CCS-2302, FFS23-04 (May 12, 2023).)

Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection

For on-treatment monitoring, an in-person or telehealth/phone visit may be scheduled, if needed, for patient support, assessment of symptoms, and/or new medications.

SOURCE: HI Med-Quest Memo No. QI-2227/FFS 22-08 (December 30, 2022). (Accessed Jun. 2023).

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

Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers: • FQ – A telehealth service was furnished using real-time audio-only communication technology. • GT – A telehealth service was furnished using real-time audio-visual communication technology.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  May 26, 2023, Sections 9.12 7 9.12.3 p. 131-132, Idaho MedicAide May 2023.  (Accessed Jun. 2023).

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), p. 25. (Accessed Jun. 2023).

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 Jun. 2023).

Interprofessional Consultation Codes for Psychiatric Services

Specific Interprofessional Consultation codes will be billable for psychiatric services.  See bulletin for specific codes.

SOURCE: IL Dept. of Healthcare and Family Services Provider Bulletin (Feb. 3, 2023).  (Accessed Jun. 2023).

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 Jun. 2023).

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 Jun. 2023).

See regulations for exceptions during a public health emergency.

SOURCE: IL Admin. Code, Title 89,140.403. (Accessed Jun. 2023). 

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 Jun. 2023).

The IHCP is updating the telehealth and virtual services code set to allow additional services to be reimbursed when rendered via telephone or other audio-only telecommunications systems. Effective for dates of service (DOS) on and after Dec. 9, 2022, the procedure codes in Table 1 (located in the memo) will be allowable when provided as audio-only telehealth.

As published in IHCP Bulletin BT202239, for a practitioner to receive reimbursement for telehealth services, the procedure code must be listed in the telehealth and virtual services code set (see Telehealth and Virtual Services Codes, accessible from the Code Sets page), and must be a service for which the member is eligible. Additionally, the claim detail must have:

One of the following place of service (POS) codes:

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

One of the following modifiers:

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

Modifier 93 (audio-only) is allowable only for certain, designated telehealth services.

SOURCE: IN Health Coverage Programs “IHCP expands and clarifies telehealth coverage” BT202297 (Nov. 8, 2022), p. 1.  (Accessed Jun. 2023).

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 Jun 2023).

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 Jun. 2023).

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 Jun. 2023).

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, Jan. 26, 2023, p. 5, (Accessed Jun. 2023).

Home and Community-Based Services Waivers

Caregiver Coaching and Behavior Management provided in the home of the participant, virtually or telephonically and through Health Insurance Portability and Accountability Act (HIPAA) secure communication platforms that allow for real time and asynchronous communication between caregivers and caregiver coaches and collaboration with waiver care managers.

SOURCE: ICHP Dept of Aging Home and Community-Based Services Waivers (Jan. 1, 2023), p. 55.  (Accessed Jun. 2023).

See approved procedure code list. Includes column that identifies if codes can be provided via audio-only interaction.  Certain codes include telephone services in their descriptions as well.

SOURCE: IA Medicaid. New Telehealth Approved Codes, 7/26/23, (Accessed Aug. 2023).

Note that in almost all program-specific manuals, telephonic interpretive services are allowed.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Physician Services. Dec. 3, 2021, p. 64 .  For other manuals, see:  Medicaid Provider Manual.  Provider Specific Manuals. (Accessed Aug. 2023).

Case management can occur by face-to-face contact or by telephone. The contact may also be by written communication, including letters, email, and fax, when the written communication directly pertains to the needs of the member. A copy of any written communication must be maintained in the case file.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Targeted Case Management. May 1, 2018, p. 10 (Accessed Aug. 2023).

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. 2023). (Accessed Jul. 2023).

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, (Apr. 2023). (Accessed Jul. 2023).

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 (May 2023). (Accessed Jul. 2023).

Hospice

Providers can submit claims for SIA end of life care if the following criteria are met: … The service is not covered if provided by a social worker via telephone.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospice, (Jan. 2023). (Accessed Jul. 2023).

Certified Community Behavioral Health Clinic (CCBHC) Services

Telephone evaluation and management service provided by a qualified healthcare professional to an established patient, parent, or guardian. National coding guidelines specify the criteria for appropriately billing these three codes.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Certified Community Behavioral Health Clinic (CCBHC) Services, (May 2023). (Accessed Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

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 1/11/23), (Accessed Jun. 2023).

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 Jun. 2023).

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, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on Sept. 22, 2021), (Accessed Jun. 2023).

Supports Waiver

Covered services include face-to-face support off the job site by provider staff that is necessary for the beneficiary to maintain gainful employment.  Examples of this kind of contact include, but are not limited to communications with the beneficiary by telephone, e-mail or fax that is necessary for the beneficiary to maintain gainful employment.

SOURCE: LA Dept. of Health, Support Services, Ch. 43.4, (As issued on 7/1/22), (Accessed Jun. 2023).

MaineCare Service Flexibilities Continuing after May 11, 2023

The Department will reimburse providers for telephonic evaluation and management services provided to members. The restrictions set forth in Ch. I, Section 4, Subsection 4.04-3 are waived for this purpose.

SOURCE:  MaineCare Update, Flexibilities Continuing: End of Public Health Emergency (PHE), May 16, 2023. (Accessed May 2023).

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 May 2023). 

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 May 2023). 

When there is a direct effect to Indian Health Services the second tier of consultation will be utilized. The second tier consultation consists of the following:

• Face-to-face meetings
• Direct email communications
• Written notification via the Interested Parties List
• Listserv updates
• Any other correspondence that pertains to general changes
• Telephone communications

SOURCE: MaineCare Benefits Manual, Indian Health Services, 10-144 Ch. II, Sec. 9, p. 5 (March 21, 2012). (Accessed May 2023). 

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 May 2023). 

Crisis Resolution Services

Covered services 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 Multi-Systemic Therapy.

SOURCE:  MaineCare Benefits Manual, Behavioral Health Services, 10-44 Ch. II, Sec. 65, p. 4, 12 (Nov. 2022). (Accessed May 2023).

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 May 2023).

“Telehealth” includes, from July 1, 2021, to June 30, 2025, both inclusive, an audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service.

“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, as amended by HB 1148/SB 582/SB 534 (2023 Session). (Accessed May 2023).

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 May 2023).

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 May 2023).

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 May 2023).

IEP Service Coordination may be rendered in person, in writing, by telephone or via telehealth.

SOURCE: MD Dept. of Health, Division of Children’s Services, Medicaid Policy & Procedure Manual, For Services Delivered Through the IEP/IFSP (July 1, 2022). p 13.  (Accessed May 2023).

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 May 2023).

“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 Aug. 2023).

Effective Until September 30, 2023:

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.

Telephonic codes are listed in the Substance Use Disorder Treatment Manual (98966, 98967, 98968, 99441, 99442, 99443).

SOURCE: Mass Health Substance Use Disorder Treatment Manual, Service Codes and Descriptions, Transmittal Letter SUD-22, (Accessed Aug. 2023).

Home Health Agencies

MassHealth is not imposing specific requirements for technologies used to deliver services via telehealth and will allow reimbursement for MassHealth home health services delivered through telehealth, as long as such services are medically necessary and clinically appropriate and comply with the guidelines established in this bulletin. Providers are encouraged to use appropriate technologies to communicate with individuals and should, to the extent feasible, ensure the same rights to confidentiality and security as provided in face-to-face services. Providers must inform members of any relevant privacy considerations.

Home health telehealth visits may be used for home health services that

• the member has provided consent for;
• are follow-up visits that do not require any hands-on care;
• pertain to any ongoing review of the member’s assessment, including the member’s 60-day recertification for home health services; or
• pertain to the discharge visit.

Follow-up visits do not include initial evaluations or certifications for home health services and may be conducted by telephone if appropriate, but live video is preferred.
Home health telehealth visits may not be used for

• any service that requires hands-on care;
• any start of care (SOC) assessment visit; or
• any resumption of care visit.

SOURCE:  MassHealth Home Health Agencies, Bulletin 87, Jul. 2023, (Accessed Aug. 2023).

Durable Medical Equipment

Federal regulations require that, for certain DME services, physicians or certain authorized nonphysician practitioners must document a face-to-face meetingwith the Medicaid-eligible beneficiary. See 42 CFR 440.70. Through the end of the FPHE, and as described in 42 CFR 440.70 (f) (6), any required face-to-face meeting may be delivered via telehealth (including telephone and live video)according to the standards in All Provider Bulletin 314.

This is consistent with Centers for Medicare & Medicaid Services (CMS) Interim Final Rules with Comment Period (CMS-1744-IFC (April 6, 2020) and CMS-5531-IFC (May 8, 2020) which provide that the face-to-face meeting requirement does not apply for DME for the duration of the COVID-19 emergency, except for power mobility devices (PMDs) with a statutory requirement for a face-to-face meeting. For those PMDs, a telehealth face-to-face meeting may satisfy the requirement. See  CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing Question AA.

On May 12, 2023, consistent with 42 CFR 440.70, providers may use telehealth for face-to-face meetings. Providers must follow the federal DME Face-to-Face Requirements identified in 42 CFR 440.70 and maintain the required documentation in the member’s record. See 130 CMR 409.430(C) and DME Bulletin 26. All documentation, recordkeeping, and other applicable provisions of 130 CMR 450.000 and 130 CMR 409.000 apply.

STATUS: MassHealth Durable Medical Equipment, Bulletin 32, Apr. 2023, (Accessed Aug. 2023).

Oxygen and Respiratory Therapy

Federal regulations require that, for certain oxygen services, physicians or certain authorized nonphysician practitioners, must document a face-to-face meeting with the Medicaid-eligible beneficiary. See 42 CFR 440.70. Through the end of the FPHE, and as described in 42 CFR 440.70(f)(6), any required face-to-face meetings may be delivered via telehealth (including telephone and live video) according to the standards in All Provider Bulletin 314.

This is consistent with Centers for Medicare & Medicaid Services (CMS) Interim Final Rules with Comment Period (CMS-1744-IFC (April 6, 2020) and CMS-5531-IFC (May 8, 2020), which provide that the face-to-face meeting requirement does not apply for oxygen and respiratory equipment for the duration of the COVID-19 emergency, except for power mobility devices (PMDs) with a statutory requirement for a face-to-face meeting. For those PMDs, a telehealth face-to-face meeting may satisfy the requirement. See the CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing.

On May 12, 2023, consistent with 42 CFR 440.70, providers may use telehealth for face-to-face meetings. Providers must follow the federal oxygen Face-to-Face Requirements identified in 42 CFR 440.70. Providers must also maintain the required documentation in the member’s record. See Oxygen and Respiratory Therapy Equipment Provider Bulletin 17. All documentation, recordkeeping, and other applicable provisions of 130 CMR 450.000 and 130 CMR 427.000 apply.

STATUS: MassHealth Oxygen and Respiratory Therapy, Bulletin 26, Apr. 2023, (Accessed Aug. 2023).

Therapy

Live video telehealth must be used, with the member’s consent, to conduct the comprehensive evaluation or reevaluation under 130 CMR 430.601(A)(9) for members receiving therapy. Telephone-only telehealth is not permitted to conduct the comprehensive evaluation or reevaluation.

STATUS: MassHealth Rehabilitation Center Bulletin 16, Apr. 2023; Speech and Hearing Center Bulletin 16, Apr. 2023, (Accessed Aug. 2023).

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 Jun. 2023).

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

SOURCE: MN Dept. of Human Svcs., Provider Manual, Child Welfare Case Management Services, As revised Jun. 6, 2023. (Accessed Jun. 2023).

Audio only (until July 1, 2025)

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:

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 Jun. 2023).

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

Providers must have documentation of services provided and have followed all clinical standards to bill for services via telehealth or telephonic (audio-only) telehealth. Refer to the Telehealth Services section of the MHCP Provider Manual under Billing for information about billing for services provided via telehealth.

SOURCE: MN Dept. of Human Services, Screening, Brief Intervention and Referral to Treatment, Dec. 29, 2022 (Accessed Jun. 2023).

Smoking Cessation

Medical assistance covers telephone cessation counseling services provided through a quitline. Notwithstanding section 256B.0625, subdivision 3b, quitline services may be provided through audio-only communications. The commissioner of human services may utilize volume purchasing for quitline services consistent with section 256B.04, subdivision 14.

SOURCE: MN Senate File 2995 (2023 Session), (Accessed Jun. 2023).

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. 1. Calling in a prescription refill, or
   2. Performing a quick virtual triage.

SOURCE: MS Admin. Code 23, Part 225, Rule. 1.4. (Accessed Aug. 2023).

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 Aug. 2023).

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, March 27, 2023, (Accessed Sept. 2023).

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 Sept. 2023).

Behavioral Health Crisis Centers

The center shall be staffed by a multidisciplinary team who is able to respond to the needs of individuals experiencing all levels of crisis. Staff shall include but is not limited to-

• Medical director-a licensed psychiatrist (available via telemedicine or audio-only). The medical director for the BHCC/U-BHCC can be the same individual who serves in this capacity for the CCBHO.

SOURCE: 9 CSR 30-7.010, (Accessed Sept. 2023).

All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable if the services:

• Are medically necessary and clinically appropriate for delivery via telemedicine/telehealth;
• Follow the guidelines set forth in the applicable Montana Healthcare Programs provider manual; and
• Are not a service specifically required to be face-to-face as defined in the applicable Montana Healthcare Programs provider manual.

There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.

Rates of payment for services delivered via telemedicine/telehealth will be the same as rates of payment for services delivered via traditional (e.g., in-person) methods set forth in the applicable regulations. Please refer to the fee schedules posted on the Provider Information website for current rates.

SOURCE:  MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Jun. 2023).

Despite the above more recent guidance, the General Information for Providers Telemedicine Manual still seems to restrict audio-only coverage.

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 Jun. 2023).

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 Jun. 2023)

Once the PHE ends on May 11, 2023: …

• Telephonic codes added during the peak of the PHE will no longer be available. Those codes are: 99441, 99442, 99443, 98966, 98967, 98968, G0071, and G2012.
• Certain evaluation and management services will continue to be covered through telehealth, and others must be performed in person. Learn more about services available via telehealth on our website.
• Certain behavioral health services will continue to be covered through telehealth. Other behavioral health services will be available through audio-only communication, while others must be performed in person. Learn more about services available via telehealth on our website.

Multiple modifiers can be added to a single CPT code. The payment modifier goes first, followed by any informational modifiers. The telehealth modifier is an informational modifier and should be placed after any payment modifier.

• 93 – synchronous telemedicine service rendered via telephone or other real-time interactive audio-only.
• 95 – telehealth services are provided in real-time with an audio-visual component.

SOURCE: NE Medicaid Program, Bulletin 23-08:  Guidance on Telehealth, Mar. 23, 2023, (Accessed Aug. 2023).

See code list for Nebraska Medicaid telehealth (and audio-only) codes.

SOURCE: NE Medicaid Program, Medical Telehealth Codes, (Accessed Aug. 2023).

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 Aug. 2023).

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 Aug. 2023).

Per Nevada Senate Bill (SB) 5 passed during the 81st (2021) Nevada Legislative Session, telehealth visits may be performed using only audio outside of the COVID-19 Public Health Emergency. Effective on claims with dates of service on or after October 1, 2022, the telephone evaluation and management (E&M) codes listed have been opened to allow audio-only telehealth services to be billed by the provider types (PT) listed. No claims will be reprocessed automatically as these are go-forward changes.

SOURCE: NV Medicaid, Audio-Only Services Allowed. Web Announcement 3006. Feb. 13, 2023, (Accessed Jul. 2023).

The telecommunications system used must be appropriate for the service being provided. Facsimile machines, electronic mail, and text messages do not meet this criteria.

SOURCE: NV Medicaid. Telehealth Billing Instructions. 2/22/23. (Accessed Aug. 2023).

The State Plan for Medicaid must include:

• A requirement that the State shall pay for the nonfederal share of expenses for services provided to a person through telehealth to the same extent and, except for services provided through audio-only interaction, in the same amount as though provided in person or by other means;
• A requirement that the State shall pay the nonfederal share of expenses for services described in paragraph (a) in the same amount as though provided in person or by other means:
  • If the services:
    • Are received at an originating site described in 42 U.S.C. § 1395m(m)(4)(C) or furnished by a federally-qualified health center or a rural health clinic; and
    • Except for services described in subparagraph (2), are not provided through audio-only interaction; or
  • For counseling or treatment relating to a mental health condition or a substance use disorder, including, without limitation, when such counseling or treatment is provided through audio-only interaction;

SOURCE: NV Revised Statute 422.2721, as amended by SB 119 (2023 Session), (Accessed Jul. 2023).

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, (Jun. 1, 2022) (Accessed Jul. 2023).

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, (Feb. 1, 2023) (Accessed Jul. 2023).

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), & NV Dept. of Health and Human Svcs., Provider Type 82 Billing Guide, Behavioral Health Rehabilitative Treatment, p. 3. (2/1/19); Special Clinics: Substance Abuse Agency Model (SAAM) p. 5 (2/16/22), School Health Services (SHS), p. 41 (4/6/23). (Accessed Jul. 2023).

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, (May 30, 2023) (Accessed Jul. 2023).

“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 Jul. 2023).

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 Jul. 2023).

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 Telehealth POS (Mar. 25, 2022), (Accessed Jul. 2023).

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 Aug. 2023).

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 Aug. 2023). 

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.

SOURCE: NJ Statute C.26:2MM-7. (Accessed Aug. 2023).

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 Jun. 2023).

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 Jun. 2023).

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 Jun. 2023).

“Audio-only visits” means the use of telephone and other audio-only technologies to deliver services.

“eConsults” means the asynchronous or synchronous, consultative, provider-to-provider assessment and management services conducted through telephone, internet, or electronic health records.

“Virtual Check-in” means a brief communication via a secure, technology-based service initiated by the patient or patient’s guardian/caregiver, e.g., virtual check-in by a physician or other qualified healthcare professional.

Payment for telehealth services shall be made in accordance with section 538.3 of this Part only if the provision of such services appropriately reduces the need for on-site or in-office visits and the following standards are met:

• An “audio-only visit” is reimbursable when the service can be effectively delivered without a visual or in-person component; and it is the only available modality or is the patient’s preferred method of service delivery; and the patient consents to an audio-only visit; and it is determined clinically appropriate by the ordering or furnishing provider; and the provider meets billing requirements, as determined and specified by the commissioner in administrative guidance. Services provided via audio-only visits shall contain all elements of the billable procedures or rate codes and must meet all documentation requirements as if provided in person or via an audio-visual visit.
•  “eConsults” are intended to improve access to specialty expertise through consultations between consulting providers and treating providers. eConsults are reimbursable when the providers meet minimum time and billing requirements, as determined and specified by the commissioner in administrative guidance.
• “Virtual Check-in” visits are intended to be used for brief medical discussions or electronic communications between a provider and a new or established patient, at the patient’s request. Virtual check-ins are reimbursable when the provider meets certain billing requirements, as determined and specified by the commissioner in administrative guidance.

As required by Social Services Law § 367-u and, except for services paid by State only funds, contingent upon federal financial participation, reimbursement shall be made in accordance with fees determined by the commissioner based on and benchmarked to in-person fees for equivalent or similar services.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538.1-3, as proposed by Final rule per Notice Of Adoption. (Accessed June 2023).

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 June 2023).

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 June 2023).

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 June 2023).

Telephonic service uses two-way electronic audio-only communications to deliver services to a patient at an originating site by a telehealth provider. Decisions on what type of visit the NYS Medicaid member receives should be based on their best interest, not that of the provider nor for the convenience of the provider. Providers must use professional judgment to determine whether audio-only services meet patient needs and whether a visit is eligible for audio-only based on criteria below.

NYS DOH anticipates only rare occasions when audio-only visits are appropriate for non-behavioral health (BH) services. For example, during weather emergencies when the patient is unable to use audiovisual technologies or when the visit could otherwise not occur unless provided via audio-only telehealth. NYS DOH will monitor audio-only billing and take steps to limit overuse and prevent misuse of audio-only services. This new policy will be monitored following the COVID-19 PHE to determine if additional guidance is necessary.

NYS Medicaid covers audio-only visits for NYS Medicaid members when all the following conditions are met:

• audio-visual telehealth is not available to the patient due to lack of patient equipment or connectivity or audio-only is the preference of the patient;
• the provider must make either audio-visual or in-person appointments available at the request of the patient;
• the service can be effectively delivered without a visual or in-person component, unless otherwise stated in guidance issued by the NYS DOH (this is a clinical decision made by the provider); and
• the service provided via audio-only visits contains all elements of the billable procedures or rate codes and meets all documentation requirements as if provided in person or via an audio-visual visit.

Providers must document in the chart of the NYS Medicaid member why audio-only services were used for each audio-only encounter.

Additional programmatic guidance may be published that specifically allows or prohibits the use of audio-only telehealth by type of service. For example, when specific Community Based Long Term Care Services and Supports will have allowable telephonic billing available, it will be defined in program-specific guidance. Additional agency-issued guidance outlines the appropriateness of audio-only visits for their specific populations.

All audio-only claims and encounters must include the 93 or FQ modifier unless modifiers are not allowable (e.g., teledentistry). The UA modifier should no longer be used to indicate the service as delivered via audio-only. Audio-only E&M procedure codes “99441” through “99443” are also billable.

Virtual Check-Ins

Virtual check-ins are brief medical interactions between a physician or other qualified health care professional and a patient. Virtual check-ins may be especially helpful for patients with ongoing chronic conditions that would benefit from recurring check-ins with their provider. A virtual check-in can be conducted via several technology-based modalities, including communication by telephone or by secure text-based messaging, such as electronic interactions via patient portal, secure email, or secure text messaging.

Communication must be Health Insurance Portability and Accountability Act (HIPAA)-compliant and don’t relate to an Evaluation and Management (E&M) visit the patient had within the past seven days, nor lead to a related E&M visit within 24 hours (see “VII. Billing Rules for Telehealth Services” on page 8 of this issue for specific information on code and modifiers).

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 4-5, 11. (Accessed June 2023).

Telemental Health

Audio-only or audio-video communication is an acceptable option only when determined appropriate by the provider of service, in accordance with guidelines established by the Office, and with informed consent from the recipient. Where the recipient is a minor, consent shall also be provided by the parent/guardian or other person who has legal authority to consent to health care on behalf of the minor.

Audio-only or audio-video communication is covered by Medicaid and the Child Health Insurance Plan to the extent consistent with regulations promulgated by the New York State Commissioner of Health pursuant to Section 2999-cc of the Public Health Law.

Telehealth services do not include an electronic mail message, text message. or facsimile transmission between a provider and a recipient, services provided where the originating and distant sites are the same location, or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support teleealth services.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.1(d)(e) & 596.4(r), as amended by Final Rule and Notice Of Adoption. (Accessed June 2023).

SOURCE: NY State Office of Mental Health Telehealth Services Guidance for OMH Providers (April 2023), p. 4-6, 8, 12. (Accessed June 2023).

Teledentistry

Telephonic (audio only) services use two-way electronic audio only communications to deliver services to a patient at on originating site by a telehealth provider located at a distant site. This service is billed utilizing Current Dental Terminology (CDT) code “D9991”. When billing for teledentistry services, modifiers cannot be used by dentists.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 9. (Accessed June 2023).

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

Virtual communication, including:

• online digital evaluation and management codes;
• telephonic evaluation and management;
• telephonic evaluation and management and virtual communication codes; and
• interprofessional assessment and management codes.

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, June 1, 2023. (Accessed Jul. 2023).

Telephonic Claims: Modifier KX must be appended to the CPT or HCPCS code to indicate that a service has been provided via telephonic, audio-only communication.

Telehealth and telephonic claims should be filed with the provider’s usual place of service code(s).

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), Amended Apr. 1, 2023.  (appears in multiple additional manuals), (Accessed Jul. 2023).

As outlined in Attachment A, select services within this clinical coverage policy can be provided via the telephonic, audio-only communication method. Telephonic services must be transmitted between a beneficiary 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:

• physical or behavioral health status prevent the beneficiary from participating in-person or telehealth services; or
• access issues (transportation, telehealth technology) prevent the beneficiary from participating in-person or telehealth services.

24-Hour Coverage for Behavioral Health Crises:  This coverage must incorporate the ability for the beneficiary to speak with the licensed clinician on call either in-person, via telehealth, or telephonically.

Medicaid shall require prior approval for services provided via the telephonic, audio-only communication method.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, Apr. 1, 2023. (Accessed Jul. 2023).

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 Jul. 2023).

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

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 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.

Telephonic-Specific Criteria

• Providers shall ensure that services can be safely and effectively delivered using telephonic, audio-only communication;
• Providers shall consider the caregiver’s abilities to participate in services provided using telephonic, audio-only communication;
• Delivery of services using telephonic, audio-only communication must conform to professional standards of care including but not limited to ethical practice, scope of practice, and other relevant federal, state and institutional policies and requirements including Practice Act and Licensing Board rules;
• Providers shall obtain and document verbal or written consent. In extenuating circumstances when consent is unable to be obtained, this should be documented;
• Providers shall verify the caregiver’s identity using two points of identification before initiating a telephonic, audio-only encounter; and
• Providers shall ensure that the beneficiary and caregivers’ privacy and confidentiality is protected.

Transition and discharge planning from a treatment program must document a written plan that specifies details for monitoring and follow-up as appropriate for the beneficiary and family or caregiver. The treatment plan is not to be used to provide respite, day care, or educational services and is not to be used to reimburse a parent for participating in a treatment program. The treatment or discharge plan must be available to a health plan upon request. A unit of service is defined according to the Current Procedural Terminology (CPT) approved code set unless otherwise specified.

See list of telephonic billable services on page 20-21.

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), Amended Apr. 1, 2023, (Accessed Jul. 2023). 

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 Jul. 2023).

Enhanced Mental Health and Substance Abuse Services

As outlined in Attachments A and D, select services within this clinical coverage policy may be provided via telehealth and telephonically. Services delivered via telehealth and telephonically must follow the requirements and guidance in clinical coverage Policy 1-H, Telehealth, Virtual Communications, and Remote Patient Monitoring, at https://medicaid.ncdhhs.gov/.

Certain services for mobile crisis management can be provided via telephonic consultation.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Enhanced Mental Health and Substance Abuse Services Amended Apr. 1, 2023, (Accessed Jul. 2023).

Community Alternatives Program

Providers can utilize telephony and other automated systems to document the provision of CAP/C services as subject to NC Medicaid guidelines on telephony, telehealth, and the CAP/DA policy guidance on electronic engagement.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Community Alternatives Program for Children, Amended Apr. 1, 2023, and Community Alternatives Program for Disabled Adults, Apr. 1, 2023, (Accessed Jul. 2023).

Audio-Only Telephone Services can be delivered by using older-style “flip” phones or a traditional “land-line” phones that only support audio-based communication. Only certain services are covered using audio-only telephone services (see linked list of covered services below).

Audio Only Telephone E/M Services

Services must be initiated by an established patient or guardian of the established patient.

Do not report this service if:

• It is decided that the patient will be seen within 24 hours or at the next available urgent visit appointment,
• There is an E/M service for the same or a similar problem within the previous seven days
• The patient is within a postoperative period and related to the surgical procedure.

Audio-only telephone services (CPT™ 99441-99443) are only available through December 31, 2024.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 155-156, (May 2023), (Accessed Jun. 2023).

Telephonic encounters are not covered by ND Medicaid.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 63, (May 2023), (Accessed Jun. 2023).

Targeted Case Management

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

SOURCE: North Dakota Department of Human Services: Targeted Case Management – Individuals with a serious mental illness or serious emotional disturbance. (Oct. 2022) P. 8, & Targeted Case Management Child Welfare, (Jul. 2022) p. 6 (Accessed Jun. 2023).

Teledentistry

Noncovered Services:

• Asynchronous teledentistry services
• Examinations via online/email/electronic communication
• Patient contact with dentist who provides the consultation using audio means only (no visual component)
• Virtual check-in

SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2019). (Accessed Jun. 2023).

Pharmacy Manual

Medication Therapy Management (MTM) services are allowable with audio-only telephone.  See manual for codes.

SOURCE: ND Medicaid Pharmacy Medical Billing Manual, May 2023, (Accessed Jun. 2023).

“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

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022, p. 3 & OAC 5160-1-18.  (Accessed Jun. 2023).

The American Medical Association has formally adopted modifier 93 for reporting audio-only telehealth services. ODM, however, is not adopting this modifier at this time.

SOURCE: OH Medicaid, Medicaid Advisory Letter (MAL) No 667 (Jan. 3, 2023).  (Accessed Jun. 2023).

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 Jun. 2023).

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, p. 12.  (Accessed Jun. 2023).

Managed Care

The following is considered telehealth:

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

SOURCE: OH Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, July 15, 2022, (Accessed Jun. 2023).

Audio- only modifiers listed as allowable including FQ and 93.

SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 2, 2023. (Accessed Jul. 2023).

See medical audio-only codes allowed after 5/11/23.

SOURCE: OK Health Care Authority, Audio-only Codes Allowed after 5/11/23, (Accessed Jul. 2023).

See behavioral health services audio only codes as of 5/12/23.

SOURCE: OK Health Care Authority, Audio-only Codes, 5/12/23, Accessed Jul. 2023).

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 Jul. 2023).

READ LESS

“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 and 410-120-1990 (Accessed Jul. 2023).

“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 Jul. 2023).

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.

Covered interprofessional consultations include consultations delivered online, through electronic health records or by telephone
(CPT 99446-99449, 99451-99452)..

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Jul. 2023).

“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 and 410-120-1990 (Accessed Jul. 2023).

“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 Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

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 Jul. 2023).

• Clinic visits, psychotherapy, diagnostic psychological evaluations, psychiatric evaluations and comprehensive medical evaluations conducted over the telephone, that is, any clinic service conducted over the telephone.

SOURCE:  PA 55 Code 1223.14 (Accessed Sept. 2023).

• A covered psychiatric outpatient clinic, MMHT or partial hospitalization outpatient service conducted over the telephone.

No reference found.

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

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed May 2023).

When audio/visual telehealth is not available, SCDHHS will continue to reimburse providers for one year beyond the end date of the current federal PHE for the audio-only CPT codes included in the source referenced below  (see bulletin).

Reimbursement for the CPT codes included will continue to be limited to encounters with established patients as described in Medicaid bulletin 20-004 when rendered by a physician, nurse practitioner, physician assistant or licensed independent practitioner (LIP). Additional services that can be provided via audio-only during this extended time period include certain services for BabyNet-enrolled Children.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2023).

Services that are eligible for telehealth reimbursement include consultation, office visits, individual psychotherapy, pharmacologic management, and psychiatric diagnostic interview examinations and testing, delivered via a telecommunication system, and audio-only (telephonic) care (available for established patients only).

While SC Medicaid includes the above mention of audio-only coverage, and certain telephonic codes are also noted as covered in the Telehealth Fee Schedule, the manual also states that the following interactions do not constitute reimbursable telehealth or telepsychiatry services and will not be reimbursed:

• Telephone conversations
• Email messages
• Video cell phone interactions
• Facsimile transmissions
• Services provided by allied health professionals

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 33, 161 (Jul. 2023). (Accessed Aug. 2023).

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. 26, (Feb. 2023) & Rural Health Clinic Behavioral Health Services Provider Manual, p. 25,  (Jan. 2020), (Accessed Aug. 2023).

Despite the above exclusion, according to a recent Medicaid bulletin, telehealth services rendered through an FQHC or RHC for certain audio-only CPT codes will be reimbursed.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2023).

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. 2023).

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

For distant site services billed on a CMS 1500 or 837P providers must bill;

• “02” for telemedicine services provided other than in patient’s home;
• “10” for telemedicine services provided in the patient’s home; or
• “77” for audio-only services.

Telemedicine Modifiers – Telemedicine provided at a distant site must be billed with the GT modifier in the first modifier position to indicate the service was provided via telemedicine/audio-only. Failure to comply with this requirement may lead to payment recoupment or other action as decided by South Dakota Medicaid.

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. 9 & 10 (Jun. 2023) (Accessed Aug. 2023).

Audio-Only Behavioral Health Services

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.

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.

Covered Services – 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 the Appendix via audio-only technology when the coverage requirements are met. Contact the Division of Behavioral Health for questions regarding unlisted codes.

For the purpose of this manual, an IMHP includes mental health providers who meet the requirements in ARSD 67:16:41:03 and physicians that provide behavioral health services. IMHPs may provide applicable services listed in the Audio-Only Procedure Code table in the Appendix via audio-only technology when the coverage requirements are met. Services not listed in the table are not allowed to be provided via telemedicine or audio-only technology. An IMHP cannot bill the following CPT codes: 98966, 98967, and 98968.

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. Non-covered Services 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.

Claim Instructions – Audio-only services will need the GT modifier and place of service 77.  Any additional modifiers must be coded alphabetically as shown on the CMHC and SUD fee schedules.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 5-6 (Jun. 2023) (Accessed Aug. 2023).

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.

Claim Instructions – Services must be billed using CPT codes 98966, 98967, and 98968. Providers should select the appropriate code based on the time associated with the service. Do not bill for these services using CPT codes 99441, 99442, or 99443 even if you believe the code description is more applicable. Billing with 99441, 99442, or 99443 will result in your claim being denied.

Reimbursement – Payment for services is limited to the lesser of the provider’s usual and customary charge or the fee contained on South Dakota Medicaid’s Physician Services fee schedule. FQHC/RHC and IHS/Tribal 638 providers may bill for audio-only evaluation and management services using codes 98966, 98967, and 98968 and be reimbursed at the fee schedule rate. These services must be submitted using the FQHC/RHCs non-PPS billing NPI. For more information regarding billing with a non-PPS NPI please refer to the FQHC/RHC Service Manual.

Billing a Recipient – There is no cost share for this service. Please refer to our Billing a Recipient Manual for additional requirements a provider must meet to bill a recipient.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 6-7 (Jun. 2023), (Accessed Aug. 2023).

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. 6 (Jun. 2023), (Accessed Aug. 2023).

Collateral Contacts are telephone or face-to-face contact with an individual other than the recipient receiving treatment in an outpatient setting. The contact may be with a spouse, family member,
guardian, friend, teacher, healthcare professional, or other individual who is knowledgeable of the recipient receiving treatment.

SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 8 (Jun. 2023) & Substance Use Disorder Agency Services, p. 7 (Jun. 2023) (Accessed Aug. 2023).

SD Medicaid does not cover:  Anticoagulant management (CPT codes 93792 and 93793), physician telephone patient services (CPT codes 99441-99443), online medical evaluation (CPT code 99444), interprofessional telephone/internet/electronic health record consultations (CPT codes 99446-99449 and 99451-99452), remote monitoring (CPT codes 99091,99453, 99454, and 99457), disability evaluation services (CPT codes 99450, 99455, 99456), cognitive assessment and care plan services (CPT code 99483), care management services (CPT codes 99487-99496), and behavioral health integration care management (CPT code 99484).

SOURCE: SD Medicaid Billing and Policy Manual: Physician Services, p. 11 (Aug. 2023), (Accessed Aug. 2023).

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. 4, (Jun. 2023), (Accessed Aug. 2023).

“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.

Provider-based telemedicine 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.

A healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting for reimbursement of an audio-only encounter under subdivision (a)(6)(C)(ii) shall:

• Confirm and maintain documentation that the patient:
  • Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter;
  • Is at a location where an audio-video encounter cannot take place due to lack of service; or
  • Has a physical disability that inhibits the use of video technology; and
• Notify the patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person or video encounters, prior to the audio-only telemedicine encounter.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug. 2023).

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 Aug. 2023).

School-Based Services

All TennCare medically necessary, covered services provided on school grounds shall be billed with the place of service code (03), defined by CMS as any facility whose primary purpose is education. School-based services rendered via telehealth shall be billed with place of service code (02), indicating telehealth was provided other than the student’s home or place of service code (10) indicating telehealth was provided in the student’s home. Additionally, the appropriate modifier should be used to indicate whether the telehealth service was delivered via a televisual visit (append using the GT modifier) or delivered via audio-only (append using the 93 modifier or FQ modifier as appropriate).

See manual for additional information.

SOURCE:  TennCare Biling Manual: Tennessee School Districts (July 2023), p. 11.  (Accessed Aug. 2023).

Telemedicine medical services and telehealth services are authorized service delivery methods for Texas Medicaid covered services as provided in this section. All telemedicine medical services and telehealth services are subject to the specifications, conditions, limitations, and requirements established by the Texas Health and Human Services Commission (HHSC) or its designee.

• A client must not be required to receive a covered service as a telemedicine medical service or telehealth service except in the event of an active declaration of state of disaster and at the direction of HHSC.
• In the event of a declaration of state of disaster, HHSC may issue direction to providers regarding the use of telemedicine medical services and telehealth services, including the use of an audio-only platform, to provide covered services to clients who reside in the area subject to the declaration of state of disaster.
• HHSC considers the following criteria when determining whether a covered service may be delivered as telemedicine medical service or telehealth service, including via an audio-only platform:
  • Clinical effectiveness;
  • Cost effectiveness;
  • Health and safety;
  • Patient choice and access to care; and
  • Other criteria specific to the service.

Conditions for reimbursement applicable to behavioral health services provided through an audio-only platform are described in this section.

• The provider must be enrolled in Texas Medicaid.
• The 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 via an audio-only 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.
• The covered services must be provided in compliance with the standards established by the respective licensing or certifying board of the professional providing the audio-only telemedicine medical service or audio-only telehealth service.
• Behavioral health services provided via audio-only platform must be designated for reimbursement by HHSC. Behavioral health services provided via an audio-only platform designated for reimbursement are those that are clinically effective and cost-effective, as determined by HHSC and in accordance with §354.1432(3) of this subchapter (relating to Telemedicine and Telehealth Benefits and Limitations). Behavioral health services that HHSC has determined are clinically effective and cost-effective when provided via an audio-only platform can be found in the Texas Medicaid Provider Procedures Manual (TMPPM).

• Synchronous audio-only technology between the distant site provider and the client in another location

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

• A text-only email message
• A facsimile transmission

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 6, 9, 12 &13 (Aug. 2023). (Accessed Aug. 2023).

Conditions for reimbursement applicable to telemedicine and telehealth provided using a synchronous audiovisual technology platform, or using store and forward technology in conjunction with
synchronous audio-only are those that meet the following conditions:

• Must be designated for reimbursement by HHSC.
• 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 audiovisual technology platform to receive reimbursement for the service.

Other conditions for reimbursement applicable to services may vary by service type. Providers may refer to the appropriate TMPPM handbook for additional information on synchronous audiovisual technology platform coverage conditions.

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.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 6-7 (Aug. 2023). (Accessed Aug. 2023).

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.

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. 8-9, Aug. 2023 (Accessed Aug. 2023).

Outpatient Mental Health 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.
  • Documented approval of the use of synchronous telephone (audio-only) technology in the plan of care is not required prior to the delivery of crisis intervention services. However, providers must document the justification for using synchronous telephone (audio-only) technology to deliver crisis intervention services in the medical record.

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.

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.

For the aforementioned mental health services, the following is required:

An existing clinical relationship occurs when a person has received at least one in-person or synchronous audiovisual outpatient mental health 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 outpatient mental health 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. See manual for additional information.

SOURCE: TX Medicaid Behavioral Health and Case Management Services Handbook, pgs. 32, 50, 59, 73, 80, & 89,  (Aug. 2023). (Accessed Aug. 2023).

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. (Aug. 2023). (Accessed Aug. 2023).

For the diagnosis, evaluation and treatment of a mental health or substance use condition, the following office and other outpatient 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 client 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 client’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. Established patient services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

Procedure code 99211 may be delivered by synchronous telephone (audio-only) technology during certain public health emergencies only.

See manual for more details on procedure codes.

SOURCE: TX Medicaid Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, pg. 175-176. (Aug. 2023). (Accessed Aug. 2023).

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 Aug. 2023).

Some service delivery to children or youth and to the parents or caregivers may be delivered remotely. It is the LBA’s responsibility to ensure that remotely delivered telehealth services are within scope of practice, are not contraindicated for the child or youth, family, or particular situation, are clinically appropriate and effective, and are in compliance with Texas licensure and standards for telehealth and the Texas Health Steps-CCP and these Medicaid Autism Services requirements.

ABA evaluation and treatment services may only be delivered via telehealth using synchronous audio-visual technology or a similar technology.

Telehealth services may be provided using synchronous audiovisual technologies if clinically appropriate and safe, as determined by the provider, and agreed to by the client 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 telehealth services.

Providers must defer to the needs of the client receiving services, allowing the mode of service delivery to be accessible, person- and family-centered, and primarily driven by the client in service’s choice and not provider convenience.

Services delivered by synchronous audiovisual technology will require participation of a parent or caregiver to assist with the treatment.

Therapy assistants may deliver services and receive supervision using synchronous audiovisual technology in accordance with each discipline’s rules. Providers should refer to state practice rules and national guidelines regarding supervision requirements for each discipline.

See manual for applicable codes.

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)

SOURCE: TX Medicaid School Health and Related Services (SHARS) Handbook, pgs. 27, 29, & 30 (Aug. 2023). (Accessed Aug. 2023).

SOURCE: TX Medicaid Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook pg. 10, (Aug. 2023). (Accessed Aug. 2023).

Healthy Texas Women Program

Certain telemedicine and telehealth services may be provided for HTW clients 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 interactions, 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. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology.

The Medicaid program shall reimburse for audio-only telehealth services as specified by division rule.

SOURCE: UT Code 26B-3-123 (Accessed Jun. 2023).

Audio-only telehealth – Utah Medicaid will continue to cover audio-only telehealth for services types when clinically appropriate.

Teledentistry – Utah Medicaid will continue to cover D9995 for audio-only teledentistry services when medically necessary.

SOURCE: UT Department of Health and Human Services, COVID-19 and the Public Health Emergency, (April 2023), (Accessed Jun. 2023).

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

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Dec. 2022). (Accessed Jun. 2023).

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 Jun. 2023).

“Audio-Only” means real-time health care delivery by a provider who is located at a distant site to a beneficiary at an originating site for purposes of evaluation, diagnosis, consultation, or treatment, using audio-only telecommunications technology.

Audio-Only: To be covered, services shall be:

• Clinically appropriate for delivery through audio-only, and
• Medically necessary.

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.7), Telehealth, (Accessed Jul. 2023).

Effective 7/1/23, Vermont Medicaid will continue allowing audio-only services for a defined list of codes that can be found at https://dvha.vermont.gov/providers/telehealth (watch for updates). This list mirrors what Medicare covers. It includes additional codes that are clinically appropriate and align with correct coding guidelines. Medicaid will cover audio-only services with a V3 modifier to signify it was completed via audio-only. Medicaid will consider covering audio-only services that are not on the approved list when unforeseen circumstances require the service to be delivered audio-only.

SOURCE: Department of VT Health Access, Banner Notice, June 30, 2023, Telehealth Guidance (Accessed Jul. 2023)

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 Jul. 2023).

See list of covered audio-only telehealth service codes.

SOURCE:  Department of VT Health Access, VT Medicaid Audio Only Telehealth Services 7.1.23, (Accessed Jul. 2023).

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 July 2023).

Is audio-only (telephone) a covered service under Vermont Medicaid?

Yes – Vermont Medicaid will provide reimbursement at the same rate for medically necessary, clinically appropriate services delivered by telephone. Reimbursement will be at the same rate as currently established for Medicaid-covered services provided through telemedicine/face-to-face as long as the claim is submitted to Vermont Medicaid with a V3 modifier (to indicate “service delivered via telephone, i.e., audio-only”).

SOURCE: Department of Vermont Health Access. Agency of Human Services. Telehealth: Methods for healthcare service delivery using telecommunications technologies. (Accessed Jul. 2022).

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

No reference found.

DMAS intends to update the Telehealth Services Supplement to continue allowing delivery of certain outpatient psychiatric and ARTS services via audio-only telehealth that are at present allowed under the authority of the federal COVID-19 Public Health Emergency (PHE). The federal COVID-19 PHE is set to expire on May 11, 2023 and the planned changes will allow continued audio-only telehealth delivery for specific CPT codes (see bulletin).

Providers must continue to follow the conditions for telehealth reimbursement outlined in the Reimbursable Telehealth Services section of the Telehealth Services Supplement when providing audio-only telehealth services. Documentation for services delivered via audio-only telehealth are the same as for a comparable in-person service. Providers should continue to bill for audio-only telehealth as they normally would if the service was provided in-person until otherwise notified. Additional reimbursement and billing guidelines for audio-only telehealth services will be included in a forthcoming update to the Telehealth Services Supplement.

DMAS will continue to evaluate whether there are additional CPT/HCPCS codes that should be authorized for audio-only telehealth coverage after the end of the Federal PHE.  Future audio-only telehealth policy changes will be included in updates to the Telehealth Services Supplement.

SOURCE:  Medicaid Bulletin:  Telehealth Updates to Outpatient Psychiatric and Addiction Recovery and Treatment Services (ARTS) Services. April 20, 2023, (Accessed Aug. 2023).

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 Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 2  (Oct. 2022) (Accessed Aug. 2023).

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 Aug. 2023).

Care Management includes care coordination, but is primarily conducted telephonically and is typically performed by a benefits administrator or managed care company.

The primary activities of care management include utilization management, triage (including telephonic assessment) and referral, service authorizations, facilitating open communication among identified providers, aligning care plans, proactive discharge planning following acute and other higher levels of care, appropriate transition and continuity of care between levels of care, quality management, and independent clinical review.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Mental health Services, Ch. 4, p. 7  (Jun. 2023) (Accessed Aug. 2023).

HCA will pay for audio-only services for specific billing codes when provided and billed as directed in HCA provider billing guides. Refer to HCA’s Provider billing guides and fee schedules webpage (scroll down to Telehealth under Billing guides and fee schedules) for a complete list of audio-only telemedicine procedure codes.

Apple Health (Medicaid) policies require the appropriate audio-only modifiers (93 or FQ).

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.

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

SOURCE: Medicaid Provider Guide, Telemedicine Policy and Billing, p. 21 (Feb. 2023). (Accessed Jun.  2023).

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 Jun. 2023).

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.

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 Jun. 2023).

Effective July 23, 2023: For any other health care service:

• The covered person has had, within the past two years, at least one in-person appointment, or, until July 1, 2024, 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 two years, at least one in-person appointment, or, until July 1, 2024, 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, as amended by SB 5036 (2023 Legislative Session). (Accessed Jun. 2023).

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. 35 &39 (Oct. 2022). (Accessed Jun. 2023).

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.

Medical abortion services provided via audio-only telemedicine are not eligible for the HCPCS code S0199 bundled payment.

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. 221-225 (Jun. 2023). (Accessed Jun. 2023).

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. 73 (Jun. 2023). (Accessed Jun. 2023).

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, Applied Behavior Analysis, p. 33 (Apr. 2023). (Accessed Jun. 2023).

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. 54-55 (Jun. 2023). (Accessed Jun. 2023).

Texting/Emailing/Virtual Check-Ins

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. 74, (Apr. 2023). (Accessed Jun. 2023).

Home Health and Hospice

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

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

SOURCE: WAC 246-335-510 & WAC 246-335-610. (Accessed Jun. 2023).

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. 17 (Feb. 2023); WA State Health Care Authority, Medicaid Provider Guide, SBHS Billing, p. 39 (Oct 2022). (Accessed Jun. 2023).

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 Jun. 2023).

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 May 2023).

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 May 2023).

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 (Jan. 1, 2023). (Accessed May 2023).

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 May 2023).

A virtual check-in is a brief patient-initiated asynchronous or synchronous communication and technology-based service intended to be used to decide whether an office visit or other service is needed. The encounter may involve synchronous discussion over a phone or exchange of information through video or image. A provider may respond to the member’s concern by phone, audio-visual communications, or a secure patient portal. Covered services include both the remote evaluation of a recorded video or image submitted by a member and the interpretation and follow-up by the provider.

An e-visit is a communication between a member and their provider through an online HIPAA-compliant patient portal. These patient-initiated asynchronous services involve a member having non-face-to-face communications cumulatively over a span of seven days with a provider with whom they have an established relationship. Providers who can bill evaluation and management (E&M) services may utilize online digital E&M codes while other providers may be eligible to bill online assessment and management codes.

Allowable procedure codes for virtual check-in and e-visit services can be found in the Attachment to this Update/Manual section. These services will not require prior authorization and are patient-initiated by established patients of the provider’s practice.

Virtual check-in and e-visit telehealth services are not covered or billable if they:

• Take place during an in-person visit.
• Take place within seven days after an in-person visit furnished by the same provider.
• Trigger an in-person visit within 24 hours or the soonest available appointment.
• Do not have sufficient information from the remote evaluation of an image or video (store and forward) for the provider to complete the service.

Only the relevant in-person procedure code that was rendered would be reimbursed if any of the above conditions apply.

Telephone Evaluation and Management Services:  See handbook for list of reimbursable for telephone E&M service codes.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, & Virtual Check-In, E-Visit and Telephone Evaluation and Management Services, Topic #22742. (Accessed Aug. 2023).

Can I receive services by phone (audio-only)?

Some services can be delivered over the phone with the same quality and effectiveness as an in-person service. These services can be provided by phone (audio-only). Your provider will let you know which type of technology is right for your appointment.

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

Modifiers

Providers should include all applicable modifiers to identify the delivery method for telehealth services. Claims for synchronous telehealth services should be indicated by one or more
of the following applicable modifiers:

• 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system)
• FQ (A telehealth service was furnished using audio-only communication technology) Use this modifier when the patient is unable to use audio and video communications. (This modifier is for behavioral health services
  only.)

Note: The FQ and FR modifiers are for behavioral health services only.

Providers are required to include any additional provider, benefit, or service specific modifiers that may apply to a service code when delivered through telehealth. For example, when a service is provided by a physical therapist (PT), the codes would need to include the corresponding therapy modifier GP (Services delivered under an outpatient physical therapy plan of care) to signify the telehealth service is furnished as therapy services furnished under a PT plan of care.

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

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 Aug. 2023).

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. The GT modifier should only be used to indicate services that were performed using audio-visual technology.

SOURCE: ForwardHealth Telehealth Policy Topic #510, (Accessed Aug 2023).

Behavioral Health Services

Behavioral health services should be indicated by the following modifiers.

• FQ*:  A telehealth service was furnished using audio-only communication technology
• FR*: A supervising practitioner was present through a real-time two-way, audio/video communication technology
• GQ: Via asynchronous telecommunications system
• GT: Via interactive audio and video telecommunication systems

*Use for behavioral health services only.

SOURCE: WI ForwardHealth Online Handbook. Topic #22737 Behavioral Health Telehealth Services, (Accessed Aug. 2023).

Interprofessional Consultations (E-Consults)

An interprofessional consultation or e-consult is an assessment and management service in which a member’s treating provider requests the opinion and/or treatment advice of a provider with specific expertise (the consultant) to assist the treating provider in the diagnosis and/or management of the member’s condition without requiring the member to have face-to-face contact with the consultant. Both the treating and consulting providers may be reimbursed for the e-consult as described below.

Consulting providers must be physicians enrolled in Wisconsin Medicaid as an eligible rendering provider. Consulting providers may bill CPT procedure codes 99446–99449 and 99451 under the following limitations:

• Services are not covered if the consultation leads to a transfer of care or other face-to-face service within the next 14 days or next available date of the consultant. Additionally, if the sole purpose of the consultation is to arrange a transfer of care or other face-to-face service, these procedure codes should not be submitted.
• Consulting services are covered once in a seven-day period.

Treating providers may be a physician, nurse practitioner, physician assistant, or podiatrist enrolled in Wisconsin Medicaid as an eligible rendering provider. Treating providers may bill CPT procedure code 99452 as a covered service once in a 14-day period.

Both the consulting and treating providers must be enrolled in Wisconsin Medicaid to receive reimbursement for the e-consult and the consultation must be medically necessary.

Providers are expected to follow CPT guidelines including that the CPT procedure codes should not be submitted if the consulting provider saw the member in a face-to-face encounter within the previous 14 days.

SOURCE: WI ForwardHealth Online Handbook. Topic #22738, Interprofessional Consultations (E-Consults), (Accessed Aug. 2023).

Crisis Intervention, Birth to 3 Telehealth Services, School Based Services, and Community Health Centers may use the FQ (audio-only) modifier.

SOURCE: WI ForwardHealth Online Handbook, Topic #6777, Topic #22617, Topic #1447, & Topic #21997.  (Accessed Aug. 2023).

• The consultation is a professional service furnished to a recipient by a certified provider at the request of the treating provider.
• The consultation constitutes an evaluation and management service in which the certified provider treating a recipient requests the opinion or treatment advice of a consulting provider with specific expertise to assist the treating provider in the evaluation or management of the recipient’s problem without requiring the recipient to have face–to–face contact with the consulting provider.
• The consulting provider provides a written report that becomes a part of the recipient’s permanent medical record.

SOURCE: Department of Health Services Administrative Rules Sec. 107.06, (Accessed Aug. 2023).

Except as provided in par. (b), outpatient psychotherapy services shall be covered services when provided by a provider certified under s. DHS 105.22, and when the following conditions are met: …  Psychotherapy is performed only in any of the following: …

• Via telehealth when the provider is in a location that ensures privacy and confidentiality of recipient information and communications.

The provider who performs psychotherapy shall engage in contact with the recipient in person, via real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth for at least 5/6 of the time for which reimbursement is claimed under MA.

AODA treatment services are performed only in the office of the provider, a hospital or hospital outpatient clinic, an outpatient facility, a nursing home or a school or by telehealth when functionally equivalent to services provided in person.

The provider who performs AODA treatment services shall engage in contact with the recipient in person, via real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth for at least 5/6 of the time for which reimbursement is claimed.

SOURCE: Department of Health Services Administrative Rules Sec. 107.13, (Accessed Aug. 2023).

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. 143 (Apr. 3, 2023), WY Division of Healthcare Financing Tribal Provider Manual, Ch. 6 Institutional/UB Common Billing Information, pgs. 144 & Ch. 7 CMS-1500 Common Billing Information, pg. 223 (Apr. 3, 2023) & Institutional Provider Manual pg. 140.  (Apr. 3, 2023). (Accessed May 2023).

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, (Jan. 1, 2023). (Accessed May 2023). Note: As of May 2023, Updated April 2023 School Based Services Manual PDF link on  Medicaid website is not working.