Medicaid & Medicare

Live Video

The most predominantly reimbursed form of telehealth modality is live video, with Medicare and every state offering some type of live video reimbursement in their Medicaid program. However, what and how it is reimbursed varies widely.  The most common restrictions include restricting it to certain specialty types, service codes, types of providers or limiting the location of the patient to specific originating sites.

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Federal

Last updated 02/28/2021

POLICY

The Secretary shall pay for telehealth services that are …

POLICY

The Secretary shall pay for telehealth services that are furnished via a telecommunications system by a physician or a practitioner to an eligible telehealth individual notwithstanding that the individual physician or practitioner providing the telehealth service is not at the same location as the beneficiary.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

Medicare Part B pays for covered telehealth services included on the telehealth list when furnished by an interactive telecommunications system if certain conditions are met.


ELIGIBLE SERVICES/SPECIALTIES

The term “telehealth service” means professional consultations, office visits, and office psychiatry services (identified as of July 1, 2000, by HCPCS codes 99241–99275, 99201–99215, 90804–90809, and 90862 (and as subsequently modified by the Secretary)), and any additional service specified by the Secretary.  The Secretary shall establish a process that provides, on an annual basis, for the addition or deletion of services (and HCPCS codes), as appropriate.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

Medicare Part B pays for covered telehealth services included on the telehealth list when furnished by an interactive telecommunications system if certain conditions are met, except that for the duration of the Public Health Emergency as defined in § 400.200 of this chapter, Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management and end stage renal disease related services included in the monthly capitation payment furnished by an interactive telecommunications system if certain conditions are met.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

The physician visits required for rehabilitative services such as physical therapy, speech-language pathology, occupational therapy, and rehabilitative services for mental disorders and intellectual disability may not be furnished as telehealth services.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

A physician, NP, PA, or CNS must furnish at least one ESRD-related “hands on visit” (not telehealth) each month to examine the beneficiary’s vascular access site.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p. 7-10 (Accessed Feb. 2021).

Changes to the list of Medicare telehealth services are made through the annual physician fee schedule rulemaking process. During the Public Health Emergency for the COVID-19 pandemic, as defined in § 400.200 of this chapter, we will use a sub-regulatory process to modify the services included on the Medicare telehealth list during the Public Health Emergency taking into consideration infection control, patient safety, and other public health concerns resulting from the emergency. A list of the services covered as telehealth services under this section is available on the CMS website.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

See page 7-10 of the Telehealth Medicare Learning Network Factsheet for a full list of permanently eligible codes.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p. 7-10 (Accessed Feb. 2021).

List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth is available on the CMS website, including temporary codes during the public health emergency.

SOURCE:  Centers for Medicare and Medicaid Services. List of Telehealth Services.  (Accessed Feb. 2021).

Communication Technology-Based Services (CTBS)

CMS makes separate payment for brief communication technology-based services. This includes ‘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). The code (G2012) allows 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. The service is limited to established patients.

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.


ELIGIBLE PROVIDERS

The Secretary shall pay to a physician or practitioner located at a distant site that furnishes a telehealth service to an eligible telehealth individual an amount equal to the amount that such physician or practitioner would have been paid under this title had such service been furnished without the use of a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

The physician or practitioner at the distant site must be licensed to furnish the service under State law. The physician or practitioner at the distant site who is licensed under State law to furnish a covered telehealth service may bill, and receive payment for, the service when it is delivered via a telecommunications system.

The practitioner at the distant site is one of the following:

  • A physician
  • A physician
  • A nurse practitioner
  • A clinical nurse specialist
  • A nurse-midwife
  • A clinical psychologist
  • A clinical social worker
  • A registered dietitian or nutrition professional
  • A certified registered nurse anesthetist

SOURCE: 42 CFR Sec. 410.78 & Medicare Learning Network Factsheet. Telehealth Services, p. 6 (Accessed Feb. 2021).

A clinical psychologist and a clinical social worker may bill and receive payment for individual psychotherapy via a telecommunications system, but may not seek payment for medical evaluation and management services.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services. They cannot bill or get paid for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p. 6 (Accessed Feb. 2021).

CMS allows Opioid Treatment Programs (OTPs) to use two-way interactive audio-video communication technology, as clinically appropriate, in furnishing substance use counseling and individual and group therapy services.

SOURCE:  CY 2020 Final Physician Fee Schedule. CMS, p. 249.

Communication Technology-Based Services

Payment for communication technology-based and remote evaluation services. For communication technology-based and remote evaluation (including the virtual check-in) services furnished on or after January 1, 2019, payment to RHCs and FQHCs is at the rate set for each of the RHC and FQHC payment codes for communication technology-based and remote evaluation services.

SOURCE:  42 CFR 405.2464 (Accessed Feb. 2021).

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.

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

G0071 should be billed for both services.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, & Virtual Communication Services RHCs and FQHCs FAQs, December 2019, (Accessed Feb. 2021).


ELIGIBLE SITES

Eligible Sites:

  • The office of a physician or practitioner.
  • A critical access hospital
  • A rural health clinic
  • A Federally qualified health center
  • A hospital
  • A hospital-based or critical access hospital- based renal dialysis center (including satellites).
  • A skilled nursing facility
  • Rural emergency hospital
  • A community mental health center
  • A renal dialysis facility for purposes of individuals with end-stage renal disease getting home dialysis.
  • The home of an individual, but only for purposes of individuals with end-stage renal disease getting home dialysis or telehealth services to treat substance use disorder or individuals with co-occurring mental health disorders, or mental health disorders under certain circumstances.

SOURCE:  Social Security Act, Sec. 1834(m) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5 & 42 CFR Sec. 410.78.  (Accessed Feb. 2021).

Treatment of stroke telehealth services

The originating site and geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke, as determined by the Secretary.

With respect to telehealth services for acute stroke, the term “originating site” shall include any or critical access hospital, any mobile stroke unit, or any other site determined appropriate by the Secretary, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m) & Medicare Learning Network Factsheet. Telehealth Services, p. 5.  (Accessed Feb. 2021).

Providers qualify as originating sites, regardless of location, if they were participating in a Federal telemedicine demonstration project approved by (or getting funding from) the U.S. Department of Health & Human Services as of December 31, 2000.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 4 (Accessed Feb. 2021).

Accountable Care Organizations (two-sided model tested or expanded under 1115A of the Social Security Act)

In the case of telehealth services for which payment would otherwise be made under this title furnished on or after January 1, 2020, the home of a beneficiary shall be treated as an originating site.  In the case of telehealth services where the home of a Medicare fee-for-service beneficiary is the originating site, the following shall apply:

  • There shall be no facility fee paid to the originating site.
  • No payment may be made for such services that are inappropriate to furnish in the home setting such as services that are typically furnished in inpatient settings such as a hospital.

SOURCE:  Social Security Act Sec. 1899 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

The term “originating site” means only those sites described below:

·       In an area that is designated as a rural health professional shortage area under section 332(a)(1)(A) of the Public Health Service Act

·       In a county that is not included in a Metropolitan Statistical Area; or

·       From an entity that participates in a Federal telemedicine demonstration project that has been approved by (or receives funding from) the Secretary of Health and Human Services as of December 31, 2000.

The geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of the home dialysis monthly ESRD-related visit, at a hospital-based or critical access hospital-based renal dialysis center, a renal dialysis facility, or the home.

Additional exceptions exist for treatment of acute stroke, substance use disorder and mental health (see below).

SOURCE:  Social Security Act, Sec. 1834(m) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5.  (Accessed Feb. 2021).

Treatment of stroke telehealth services

The geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke, as determined by the Secretary.

With respect to telehealth services to treat acute stroke, the term “originating site” shall include any hospital or critical access hospital, any mobile stroke unit, or any other site determined appropriate by the Secretary, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

Substance Use Disorder

The geographic requirements shall not apply with respect to telehealth services furnished on or after July 1, 2019, to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or cooccurring mental health disorder, as determined by the Secretary, or, on or after the first day after the end of the emergency period described in section 1135(g)(1)(B), subject to subparagraph (B), to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder, as determined by the Secretary at any originating site except a renal dialysis facility.

Requirements for mental health services furnished through telehealth

Payment may not be made under this paragraph for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this title:

  • within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and
  • during subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

These requirements do not apply to services:

  • Under this paragraph (with respect to telehealth services furnished to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder); or
  • under this subsection without application of this paragraph.

SOURCE:  Social Security Act, Sec. 1834(m) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 (Accessed Feb. 2021).

Originating sites must be:

  • Located in a health professional shortage area (as defined under section 332(a)(1)(A) of the Public Health Service Act that is either outside of a Metropolitan Statistical Area (MSA) as of December 31st of the preceding calendar year or within a rural census tract of an MSA as determined by the Office of Rural Health Policy of the Health ReSOURCEs and Services Administration as of December 31st of the preceding calendar year, or
  • Located in a county that is not included in a Metropolitan Statistical Area as defined in section 1886(d)(2)(D) of the Act as of December 31st of the preceding year, or
  • An entity participating in a Federal telemedicine demonstration project that has been approved by, or receive funding from, the Secretary as of December 31, 2000, regardless of its geographic location.

The geographic requirements specified above do not apply to the following telehealth services:

  • Home dialysis monthly ESRD-related clinical assessment services furnished on or after January 1, 2019, at a hospital-based or critical access hospital-based renal dialysis center, a renal dialysis facility, or the home; and
  • Services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
  • Services furnished on or after July 1, 2019 to an individual with a substance use disorder diagnosis, for purposes of treatment of a substance use disorder or a co-occurring mental health disorder.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

The Health ReSOURCEs and Services Administration (HRSA) decides HPSAs, and the Census Bureau decides MSAs. To see a potential Medicare telehealth originating site’s payment eligibility, go to HRSA’s Medicare Telehealth Payment Eligibility Analyzer.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 4 (Accessed Feb. 2021).

Accountable Care Organizations (two-sided model tested or expanded under 1115A of the Social Security Act)

In the case of telehealth services for which payment would otherwise be made under this title furnished on or after January 1, 2020, the geographic limitation shall not apply with respect to any eligible originating site (including the home of a beneficiary) subject to State licensing requirements.

SOURCE:  Social Security Act Sec. 1899 (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

Eligible originating sites are eligible for a facility fee equal to:

  • for the period beginning on October 1, 2001, and ending on December 31, 2001, and for 2002, $20; and
  • for a subsequent year, the facility fee specified in subclause (I) or this subclause for the preceding year increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) for such subsequent year.

No facility fee shall be paid under this subparagraph to an originating site that is the home.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

Treatment of Acute Stroke:  No facility fee shall be paid to an originating site with respect to a telehealth service if the originating site does not otherwise meet the requirements for an originating site, including geographic requirements.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC for the separately billable Part B originating site facility fee. The originating site facility fee does not count toward the number of services used to determine payment for partial hospitalization services when a CMHC serves as an originating site.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 11 (Accessed Feb. 2021).

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Alabama

Last updated 02/28/2021

POLICY

Alabama Medicaid reimburses for live video for certain services …

POLICY

Alabama Medicaid reimburses for live video for certain services and under certain circumstances.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17). Jan. 2021. (Accessed Feb. 2021) & AL Admin. Code r. 560-X-6-.14(f)(5).


ELIGIBLE SERVICES/SPECIALTIES

Alabama Medicaid reimburses for the following services when billed with a GT modifier:

  • Consultations;
  • Office or other outpatient visits;
  • Individual psychotherapy;
  • Psychiatric diagnostic services;
  • Neurobehavioral status exams.

Procedure codes for Applied Behavior Analysis therapy is also covered.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17). Jan. 2021. (Accessed Feb. 2021).

Telemedicine services are covered for limited specialties and under special circumstances.

SOURCE:  AL Admin. Code r. 560-X-6-.14(f)(5). (Accessed Feb. 2021).

Rehabilitation services that are delivered face to face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.  Live video telehealth may also be used to deliver Nursing Assessment and Care and Rehabilitative Services when certain conditions are met.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services (105-1, 13 & 61). Jan. 2021. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

All physicians with an Alabama license, enrolled as a provider with the Alabama Medicaid Agency, regardless of location, are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients. In order to participate in the telemedicine program:

  • Physicians must be enrolled with Alabama Medicaid with a specialty type of 931 (Telemedicine Service)
  • Physician must submit the telemedicine Service Agreement/Certification form
  • Physician must obtain prior consent from the recipient before services are rendered. This will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17). Jan. 2021. (Accessed Feb. 2021).

For Nursing Assessment and Care services for DMH Mental Illness, and DMH Substance Abuse the following providers are eligible:

  • Licensed Registered Nurse
  • Licensed Practical Nurse

SOURCE: AL Medicaid Management Information System Provider Manual, (105-61). Jan. 2021. (Accessed Feb. 2021).

Rehabilitative services that are delivered face-to-face can either be in person or via telemedicine/telehealth, as approved by the Alabama Medicaid Agency.

SOURCE: AL Medicaid Management Information System Provider Manual, (105-1).  Jan. 2021. (Accessed Feb. 2021).


ELIGIBLE SITES

For rehabilitative services, the originating site must be at:

  • Physician’s office;
  • Hospital;
  • Critical Access Hospital;
  • Rural Health Clinic;
  • Federally Qualified Health Center;
  • Community mental health center (to include co-located sites with partnering agencies);
  • Public health department
  • ADMH Certified Substance Abuse Facility

SOURCE: AL Medicaid Management Information System Provider Manual, (105-12). Jan. 2021. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

For rehabilitative services, the distant site may be located outside of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider.

SOURCE: AL Medicaid Management Information System Provider Manual, (105-12).  Jan. 2021. (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

AL Medicaid reimburses providers for origination site fees for covered telemedicine services. The origination fee is limited to one per date of service per recipient.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (28-17). Jan. 2021. (Accessed Feb. 2021).

The Agency will not reimburse providers for origination site or transmission fees for tele-rehabilitative services.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services(105-15), Jan. 2021. (Accessed Feb. 2021).

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Alaska

Last updated 02/28/2021

POLICY

Alaska’s Medicaid program will reimburse for services “provided through …

POLICY

Alaska’s Medicaid program will reimburse for services “provided through the use of camera, video, or dedicated audio conference equipment on a real-time basis.”

SOURCE: AK Admin. Code, Title 7, 110.625(a)(1). (Accessed Feb. 2021).

Alaska Medicaid will pay for a covered medical service furnished through telemedicine application if the service is:

  • Covered under traditional, non-telemedicine methods;
  • Provided by a treating, consulting, presenting or referring provider;
  • Appropriate for provision via telemedicine

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 Services (5/13). (Accessed Feb. 2021).

The department will pay for telemedicine applications provided by a treating, consulting, presenting, or referring provider for a medical service covered by Medicaid and provided within the scope of the provider’s license. A presenting provider is only eligible to receive Medicaid payment for a live or interactive telemedicine application.

SOURCE: AK Admin. Code, Title 7, 110.630. (Accessed Feb. 2021).

The department will pay for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients. For the provider to receive payment, the provider’s use of telemedicine applications must comply with the standards for services delivered under the Medicaid program and for the medical services provided by the type of provider, including provisions that affect the efficiency, economy and quality of service; and coverage limitations.

SOURCE:  Alaska Admin Code. Title 7, Sec. 110.620. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Medically necessary office consultations provided via telemedicine may be covered only when used as a second opinion and the provider is of a different specialty than the requesting provider.  Documentation requirements apply.

SOURCE: Alaska Medicaid Policy Clarification: office Consultations via Telemedicine Applications.  March 30, 2017. (Accessed Sept. 2020) &

Alaska Medicaid Policy Clarification; Medicaid Telehealth Coverage. May 8, 2020. (Accessed Feb. 2021)

Eligible services:

  • Initial or one follow-up office visit;
  • Consultation made to confirm diagnosis;
  • A diagnostic, therapeutic or interpretive service;
  • Psychiatric or substance abuse assessments;
  • Psychotherapy; or
  • Pharmacological management services on an individual recipient basis.

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 Services (5/13) & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. May 8, 2020. (Accessed Feb. 2021).

Family psychotherapy may be provided through telemedicine, with or without recipient involvement, if the services could not be provided in person and the clinician documents the reason for providing the service telephonically in the recipient’s treatment notes for each session.

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Community Behavioral Health Clinic Services; Mental Health Physician Clinic (1/2/19). (Accessed Feb. 2021).

The GT or 95 modifier should be used to indicate live interactive mode.  Use place of service code 02.

SOURCE: Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. May 8, 2020. (Accessed Feb. 2021).

Dental services do not require the use of the telemedicine modifier.

SOURCE: AK Dept. of Health and Social Svcs.  Dental Services.  Tribal Services Manual (1/3/17).  (Accessed Feb. 2021).

No reimbursement for:

  • Direct entry midwife
  • Durable medical equipment (DME)
  • End-stage renal disease
  • Home and community-based waiver
  • Personal care assistant
  • Pharmacy
  • Private duty nursing
  • Transportation and accommodation
  • Vision (includes visual care, dispensing, or optician services)

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 Services (5/13), & AK Admin. Code, Title 7, 110.635 & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. May 8, 2020. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Providers fall into three categories:

  1. Referring Provider: Evaluates a patient, determines the need for a consultation, and arranges services of a consulting provider for the purpose of diagnosis and treatment.
  2. Presenting Provider: Introduces a patient to the consulting provider during an interactive telemedicine session (may assist in the telemedicine consultation).
  3. Consulting Provider: Evaluates the patient and/or medical data/images using telemedicine mode of delivery upon recommendation of the referring provider.

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Audiology  Services (6/12); Autism Services (6/12); Chiropractic Services (6/12)Community Behavioral Health Clinic Services (6/12); Direct-Entry Midwives Services (6/12); EPSDT (6/12); Family Planning (6/12); FQHC/RHC (6/12); Imaging Services (6/12); Independent Laboratory (6/12); Mental Health Physician Clinic (6/12); Nutrition (6/12); Physician (6/12); Private Duty Nursing (6/12); Psychologist (6/12); Podiatry (6/12); School-Based Services (6/12); Residential Behavioral Rehabilitation Services (6/12); Therapies (6/12); Vision (6/12) & Alaska Admin Code Title 7, Sec. 110.639. (Accessed Feb. 2021).

Office consultations performed by a provider of the same specialty within the same organization are not covered.

SOURCE: Alaska Medicaid Policy Clarification: office Consultations via Telemedicine Applications.  March 30, 2017. (Accessed Feb. 2021).


ELIGIBLE SITES

No reference found.


GEOGRAPHIC LIMITS

No reference found.


FACILITY TRANSMISSION FEE

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, 110.635(b). (Accessed Feb. 2021)

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Arizona

Last updated 02/28/2021

POLICY

Fee-for-Service Provider Manual

AHCCCS will reimburse for medically necessary, …

POLICY

Fee-for-Service Provider Manual

AHCCCS will reimburse for medically necessary, non-experimental and cost-effective services provided via telehealth in their fee for service program.

Telehealth may include healthcare services delivered via teledentistry, telemedicine, or asynchronous (store-and-forward).

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10/47-48), (07/01/2020) & IHS/Tribal Provider Billing Manual, (8/49-50), (07/14/2020). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Some of the services that can be covered via real-time telehealth include, but are not limited to:

  • Behavioral Health
  • Cardiology
  • Dentistry
  • Dermatology
  • Endocrinology
  • Hematology/Oncology
  • Home Health
  • Infectious Diseases
  • Inpatient Consultations
  • Medical Nutrition Therapy (MNT)
  • Neurology
  • Obstetrics/Gynecology
  • Oncology/Radiation
  • Ophthalmology
  • Orthopedics
  • Office Visits (adult and pediatric)
  • Outpatient Consultations
  • Pain Clinic
  • Pathology & Radiology
  • Pediatrics and Pediatric Subspecialties
  • Pharmacy Management
  • Rheumatology
  • Surgery Follow-Up and Consultations

Behavioral health services are covered for all Medicaid-eligible AHCCCS beneficiaries and KidsCare members.

Covered behavioral health services can include, but are not limited to:

  • Diagnostic consultation and evaluation,
  • Psychotropic medication adjustment and monitoring,
  • Individual and family counseling, and
  • Case management.

For a complete code set of services, along with their eligible place of service and modifiers, that can be billed as telehealth please visit the AHCCCS Medical Coding Resources webpage.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10/46-49), (07/01/2020); IHS/Tribal Provider Billing Manual, Ch. 8 Individual Practitioner Services (8/48 & 50), (07/14/2020) (Accessed Feb. 2021).

Prolonged preventive services, beyond the typical service of the primary procedure, that require direct patient contact and occur in either the office or another outpatient setting are covered under telehealth.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10/49), (07/01/2020), (Accessed Feb. 2020).

AHCCCS Policy Manual

AHCCCS covers medically necessary, non-experimental, and cost-effective Telehealth services provided by AHCCCS registered providers.

Synchronous (real-time) Telemedicine:

  • Shall not replace provider choice for healthcare delivery modality.
  • Shall not replace member choice for healthcare delivery modality.
  • Shall be AHCCCS-covered services that are medically necessary and cost effective.

AHCCCS covers Teledentistry for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) aged members when provided by an AHCCCS registered dental provider.  Teledentistry includes the provision of preventative and other approved therapeutic services by the AHCCCS registered Affiliated Practice Dental Hygienist, who provides dental hygiene services under an affiliated practice relationship with a dentist. Teledentistry does not replace the dental examination by the dentist, limited periodic and comprehensive examinations cannot be billed through the use of Teledentistry alone.

Non-emergency transportation (NEMT) is a covered benefit for member transport to and from the Originating Site where applicable.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2-3), Oct. 2019. (Accessed Feb. 2021)

Teledentistry services will be reimbursed for enrollees under the age of 21.

SOURCE: AZ Statute, Sec. 36-2907.13. (Accessed Feb. 2021).

Two HCPCS codes used for a Virtual check-in with physicians via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Virtual check-ins are initiated by the patient and may be performed via multiple technology modalities including telephone, secure text messaging, email, or use of a patient portal. The two HCPCS codes are included in the 2020/2021 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 Physician Fee Schedule (2020-2021); AZ  Evaluation and Management Codes & AZ Administrative Code Title 20, Ch. 5, pg. 435. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Fee-for-Service Provider Manual & IHS/Tribal Provider Billing Manual

Telehealth, including Teledentistry services, may be provided by AHCCCS registered providers, within their scope of practice.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-49), (07/01/2020)  & IHS/Tribal Provider Billing Manual (8/51), (07/14/2020). (Accessed Jan. 2021).

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

SOURCE: AZ Health Care Cost Containment System, AHCCCS. Provider Qualifications and Provider Requirements.  Ch. 600, (670 Pg. 3). Oct. 2015 (Accessed Jan. 2021) & AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10 Addendum: FQHC/RHC, (10-3), (7/26/2019) (Accessed Jan. 2021).


ELIGIBLE SITES

Fee-for-Service Provider Manual definitions:

Distant site means “the site at which the provider delivering the service is located at the time the service is provided via telehealth (formerly hub site).”

Originating site means “the location of the AHCCCS member at the service is being furnished via telehealth or where the asynchronous service originates (formerly spoke site). This is considered the place of service.”

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-48), (07/01/2020) & IHS/Tribal Provider Billing Manual, (8/50), (07/14/2020). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth. Services delivered via telehealth are covered by AHCCCS in rural and urban regions.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Oct. 2019 ; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-46), & IHS/Tribal Provider Billing Manual, (8/50), (07/14/2020). (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

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Arkansas

Last updated 02/28/2021

POLICY

Arkansas Medicaid provides payment to a licensed or certified …

POLICY

Arkansas Medicaid provides payment to a licensed or certified healthcare professional or a licensed or certified entity for services provided through telemedicine if the service provided through telemedicine is comparable to the same service provided in-person.

Coverage and reimbursement for services provided through telemedicine will be on the same basis as for services provided in-person. While a distant site facility fee is not authorized under the Telemedicine Act, if reimbursement includes payment to an originating site (as outlined in the above paragraph), the combined amount of reimbursement to the originating and distant sites may not be less than the total amount allowed for healthcare services provided in-person.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Aug. 1, 2018. & AR Admin. Rule 016.06.18. (Accessed Feb. 2021).

Arkansas Medicaid shall provide payment for telemedicine healthcare services to licensed or certified healthcare professionals or entities that are authorized to bill Arkansas Medicaid directly for healthcare services. Coverage and reimbursement for healthcare services provided through telemedicine shall be reimbursed on the same basis as healthcare services provided in-person.

SOURCE: Section III Billing Documentation.  Rule 305.000.  Updated Aug. 1, 2018.  (Accessed Feb. 2021).

Rural Health Centers

In order for a telemedicine encounter to be covered by Medicaid, the practitioner and the patient must be able to see and hear each other in real time.

SOURCE: AR Medicaid Provider Manual. Section II Rural Health.  Rule 211.300. Updated Oct. 13, 2003. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Arkansas Medicaid must provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as they provide coverage and reimbursement for health services provided in-person.

SOURCE: AR Code 23-79-1602(c). (Accessed Feb. 2021).

Telemedicine is listed as an allowed delivery mode under the Outpatient Behavioral Health Services manual to inpatient hospital patients and to nursing home residents.  Certain services can only be provided via telemedicine to patients 21 and above or 18 and above.  See the manual for more information.

SOURCE: AR Medicaid Provider Manual. Section II OBHS. Rule 252.100 & 111. Updated Mar. 1, 2019.  (Accessed Feb. 2021).

Rural Health Centers

Arkansas Medicaid covers RHC encounters and two ancillary services (fetal echography and echocardiology) as “telemedicine services”. Physician interpretation of fetal ultrasound is covered as a telemedicine service if the physician views the echography or echocardiography output in real time while the patient is undergoing the procedure.

SOURCE: AR Medicaid Provider Manual. Section II Rural Health.  Rule 211.300. Updated Oct. 13, 2003. (Accessed Feb. 2021).

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

Virtual services can be provided using mobile secure telecommunication devices, electronic monitoring equipment and include clinical provider care, behavioral health therapies, speech, occupational and physical therapy services, and treatment provided to an individual at their residence.  They may include the provision of on-going care management, remote telehealth monitoring and consultation, face to face or through the use secure web-based communication and mobile telemonitoring technologies to remotely monitor and evaluate the patient’s functional and health status.

SOURCE: PASSE Program, p. II-9, (3/1/19).  (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

The professional or entity at the distant site must be an enrolled Arkansas Medicaid Provider.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Aug. 1, 2018. (Accessed Feb. 2021) & Section III Billing Documentation.  Rule 305.000.  Updated Aug. 1, 2018.  (Accessed Feb. 2021)  & AR Admin. Rule 016.06.18.

The distant site provider should use the GT modifier and Place of Service 02 when billing CPT or HCPCS codes.

SOURCE: AR Medicaid Provider Manual. Section III Billing Documentation.  Rule 305.000.  Updated Aug. 1, 2018.  (Accessed Feb. 2021)  & AR Admin. Rule 016.06.18.

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

The provision of virtual care can include an interdisciplinary care team or be provided by individual clinical service provider.

SOURCE: PASSE Program, p. II-9 (3/1/19).  (Accessed Feb. 2021).

Medication-Assisted Treatment for Opioid Use Disorder

Providers are encouraged to use telemedicine services when in-person treatment is not readily accessible.

SOURCE: AR Admin. Rule 230.000 (9/1/2020) (Accessed Feb. 2021).


ELIGIBLE SITES

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

Virtual and telehealth services can be provided at the individual’s home or in a community setting.

SOURCE: PASSE Program, II-9 (3/1/19).  (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Payment will include a reasonable facility fee to the originating site operated by a licensed or certified healthcare professional or licensed or certified healthcare entity if the professional or entity is authorized to bill Arkansas Medicaid directly for healthcare services. There is no facility fee for the distant site.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Aug. 1, 2018.  & Section III Billing Documentation.  Rule 305.000.  Updated Aug. 1, 2018.  (Accessed Feb. 2021). & AR Admin. Rule 016.06.18.

The originating site submits a telemedicine claim under the billing providers “pay to” information using HCPCS code Q3014. For outpatient services, the distant provider must also use Place of Service code 22 with the originating site billing Q3014. In the case of in-patient services, HCPCS code Q3014 is not separately reimbursable because it is included in the hospital per diem.  See manual for further instructions.

SOURCE:  AR Medicaid Provider Manual. Section III Billing Documentation.  Rule 305.000.  Updated Aug. 1, 2018.  (Accessed Feb. 2021) & AR Admin. Rule 016.06.18.

Federally Qualified Health Centers

Use procedure code T1014 and type of service code Y (paper claims only) to indicate telemedicine charges.  The charge associated with the procedure code should be an amount attributable to the telemedicine service, such as line (or wireless) charges.  Medicaid will deny the charge and capture it in the same manner as with ancillary charges.

SOURCE:  AR Medicaid Provider Manual. Section II FQHC. Rule 262.120. Updated Nov. 1, 2017. (Accessed Feb. 2021).

Arkansas Medicaid must provide a reasonable facility fee to an originating site operated by a licensed healthcare entity or healthcare professional.

SOURCE: AR Code 23-79-1602(d) (1). (Accessed Feb. 2021).

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California

Last updated 02/28/2021

POLICY

Synchronous Interaction

“Synchronous interaction” means a real-time interaction between …

POLICY

Synchronous Interaction

“Synchronous interaction” means a real-time interaction between a patient and a health care provider located at a distant site.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 2. (Accessed Feb. 2021). 

Medi-Cal covered benefits or services, identified by CPT or HCPCS codes and subject to all existing Medi-Cal coverage and reimbursement policies, including any treatment authorization request requirements, may be provided via a telehealth modality if all of the following are satisfied:

  • The treating health care provider at the distant site believes that the benefits or services being provided are clinically appropriate based upon evidence-based medicine and/or best practices to be delivered via telehealth;
  • The benefits or services delivered via telehealth meet the procedural definition and components of the CPT or HCPCS code(s), as defined by the American Medical Association, associated with the Medi-Cal covered service or benefit, as well as any extended guidelines as described in this section of the Medi-Cal provider manual; and
  • The benefits or services provided via telehealth meet all laws regarding confidentiality of health care information and a patient’s right to his or her medical information.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 6. (Accessed Feb. 2021).

Family PACT

Family PACT telehealth policy mirrors the fee-for-service policy.

SOURCE:  CA Department of Health Care Services.  Family Planning, Access, Care and Treatment Program.  Benefits Manual.  Aug. 2020, Pg. 6. (Accessed. Feb. 2021).

Managed Care

Existing Medi-Cal covered services may be provided via a telehealth modality (includes live video) if certain conditions are met (as outlined in fee-for-service manual).

SOURCE: CA Department of Health Care Services (DHCS).  All Plan Letter 19-009:  Telehealth Services Policy.  Oct. 16, 2019. (Accessed Feb. 2021).  

Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC)

Services rendered via telehealth must be FQHC or RHC covered services.  Services provided through synchronous telehealth for an established patient are subject to the same program restrictions, limitations and coverage that exist when the service is provided in-person.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 12.  (Accessed Feb. 2021).

Indian Health Services, Memorandum of Understanding Agreement (IHS-MOA)

Services rendered via telehealth must be IHS-MOA covered services.

Services provided through synchronous telehealth for an established patient are subject to the same program restrictions, limitations and coverage that exist when the service is provided in-person.

SOURCE: CA Department of Health Care Services (DHCS).  Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual. Aug. 2020. Pg. 8.  (Accessed Feb. 2021). 

Local Education Agency:  Speech Therapy

Speech therapy services are reimbursable when performed according to telemedicine guidelines and billed with modifier 95 and the appropriate CPT code.

A telemedicine service must use interactive audio, video or data communication to qualify for reimbursement. The qualified service must be in real-time or near real-time (delay in seconds or minutes) to qualify as an interactive two-way transfer of medical data and information between the student and health care provider.

SOURCE:  CA Department of Health Care Services (DHCS).  Local Education Agency (LEA)Telehealth.  Aug. 2020. Pg. 2-3.  (Accessed Feb. 2021). 

Dental Services

The Department of Health Care Services has opted to permit the use of teledentistry (including live video) as an alternative modality for the provision of select dental services when the beneficiary requests it or if the health care provider believes the service is clinically appropriate.

SOURCE:  CA Department of Health Care Services (DHCS).  Denti-Cal Manual.  Nov. 2020. Pg. 4-14.  (Accessed Feb. 2021). 

In-person contact between a health care provider and a patient shall not be required under the Medi-Cal program for services appropriately provided through telehealth, subject to reimbursement policies adopted by the department to compensate a licensed health care provider who provides health care services through telehealth that are otherwise reimbursed pursuant to the Medi-Cal program.

SOURCE: Sec. 14132.72 of the Welfare and Institutions Code.  (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Medi-Cal covered benefits or services, identified by CPT or HCPCS codes and subject to all existing Medi-Cal coverage and reimbursement policies, including any treatment authorization request requirements, may be provided via a telehealth modality if all of the following are satisfied:

  • The treating health care provider at the distant site believes that the benefits or services being provided are clinically appropriate based upon evidence-based medicine and/or best practices to be delivered via telehealth;
  • The benefits or services delivered via telehealth meet the procedural definition and components of the CPT or HCPCS code(s), as defined by the American Medical Association, associated with the Medi-Cal covered service or benefit, as well as any extended guidelines as described in this section of the Medi-Cal provider manual; and
  • The benefits or services provided via telehealth meet all laws regarding confidentiality of health care information and a patient’s right to his or her medical information.

Certain types of benefits or services that would not be expected to be appropriately delivered via telehealth include, but are not limited to, benefits or services that are performed in an operating room or while the patient is under anesthesia, require direct visualization or instrumentation of bodily structures, involve sampling of tissue or insertion/removal of medical devices and/or otherwise require the in-person presence of the patient for any reason.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 6. (Accessed Feb. 2021).  

Medi-Cal covers an ‘e-visit’ which are communications between a patient and their provider through an online patient portal. A Treatment Authorization Request is required.  See manual for applicable codes.

SOURCE:  CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 2 & 10. (Accessed Feb. 2021).

Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC)

Services provided through synchronous telehealth for an established patient are subject to the same program restrictions, limitations and coverage that exist when the service is provided in-person.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 12.  (Accessed Feb. 2021). 

Indian Health Services, Memorandum of Understanding Agreement (IHS-MOA)

Services provided through synchronous telehealth for an established patient are subject to the same program restrictions, limitations and coverage that exist when the service is provided in-person.

SOURCE: CA Department of Health Care Services (DHCS).  Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual.  Aug. 2020. Pg. 8.  (Accessed Feb. 2021). 

Dental Services

Synchronous live transmissions are covered.  Live transmissions are limited to 90 minutes per beneficiary per provider, per day.  They may be provided at the beneficiary’s request or if the health care provider believes the service is clinically appropriate.  All dental information transmitted during the delivery of services become part of the patient’s dental record maintained by the Medi-Cal provider at the distant site.

SOURCE:  CA Department of Health Care Services (DHCS).  Denti-Cal Manual.  Nov. 2020. Pg. 4-16 & 4-17.  (Accessed Feb. 2021).  

Home Health & Durable Medical Equipment

Live video telehealth may be used to deliver a face-to-face encounter related to the primary reason a recipient requires home health services or a durable medical equipment item.

SOURCE: Department of Health Care Services. Home Health Agencies (HHA) Provider Handbook. (Aug. 2020), Pg. 3. & Department of Health Care Services. Durable Medical Equipment (DME): An Overview. (Sept. 2020), Pg. 6. (Accessed Feb. 2021).

CA Children’s Services (CCS)

CA Children’s Services Program lists eligible CPT/HCPCS codes in Numbered Letters 16-1217 & 09-0718.  Codes specifically include tele-speech, tele-auditory verbal therapy, tele-auditory habilitation and tele-auditory rehabilitation services in the home, with the parent or guardian working with the speech therapist at the distant site.

SOURCE:  Department of Health Care Services.  Numbered letter 16-1217 to the CA Children’s Services Program and Genetically Handicapped Persons Program (GHPP).  Dec. 22, 2017.  & Number Letter 09-0718 to CA Children’s Services Program.  Jul. 10, 2018.  (Accessed Feb. 2021). 

Drug Medi-Cal certified providers may receive reimbursement for individual counseling provided through telehealth. However, implementation is dependent on the extent of federal participation and federal approval. The Department of Health Care Services must adopt regulations by July 1, 2022 to implement this section in accordance with the Administrative Procedure Act.

SOURCE: Sec. 14132.731 of the Welfare and Institutions Code. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Providers must meet all of the following criteria:

  • The provider rendering covered benefits or services must meet the requirements of B&P 2290.5(a)(3) or equivalent requirements under California law in which the provider is considered licensed (ex: Behavior Analyst Certification Board).
  • Provider must be licensed in California, enrolled as a Medi-Cal rendering provider or non-physician medical practitioner (NMP) and affiliated with an enrolled Medi-Cal provider group.
  • The enrolled Medi-Cal provider group for which the health care provider renders services via telehealth must meet all Medi-Cal program enrollment requirements and must be located in California or a border community.

For purposes of telehealth [the distant site] can be different from the administrative location.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 3. (Accessed Feb. 2021). 

Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC)

Billable providers are eligible to deliver covered FQHC/RHC services.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 11.  (Accessed Feb. 2021).

Indian Health Services, Memorandum of Understanding Agreement (IHS-MOA)

Billable providers eligible to deliver available services offered under IHS-MOA services.

SOURCE: CA Department of Health Care Services (DHCS).  Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual.  Aug. 2019. Pg. 8.  (Accessed Feb. 2021). 

Dental Services

Enrolled Denti-Cal billing providers may submit documents for services rendered utilizing teledentistry. Allied dental professionals may render limited services via teledentistry so long as such services are within their scope of practice, and are rendered under the general supervision of a licensed dentist.

SOURCE:  CA Department of Health Care Services (DHCS).  Denti-Cal Manual. Nov. 2020. Pg. 4-15.  (Accessed Feb. 2021). 

Psychiatrists may bill for services delivered through telehealth in accordance with the Medicaid state plan.

SOURCE: Sec. 14132.73 of the Welfare and Institutions Code. (Accessed Feb. 2021)


ELIGIBLE SITES

For purposes of reimbursement for covered treatment or services provided through telehealth, the type of setting where services are provided for the patient or by the health care provider is not limited (Welfare and Institutions Code [WIC] Section 14132.72(e)). This may include, but is not limited to, a hospital, medical office, community clinic, or the patient’s home.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 2. (Accessed Feb. 2021).

Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC)

Refers to fee-for-service policy for the definition of an ‘originating site’.  See manual for examples.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 13.  (Accessed Feb. 2021).

Indian Health Services, Memorandum of Understanding Agreement (IHS-MOA)

Refers to fee-for-service policy for the definition of an ‘originating site’.

SOURCE: CA Department of Health Care Services (DHCS).  Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual.  Aug. 2020. Pg. 10.  (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

The originating site facility fee is reimbursable only to the originating site when billed with HCPCS code Q3014 (telehealth originating site facility fee).  Transmission costs incurred from providing telehealth services via audio/video communication is reimbursable when billed with HCPCS code T1014 (telehealth transmission, per minute, professional services bill separately).

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 11. (Accessed Feb. 2021). 

FQHC & RHC/IHS-MOA

These sites are not eligible for the facility or transmission fee.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 12.  (Accessed Feb. 2021).

Local Education Agency:  Speech Therapy

The facility and transmission fee are not covered.

SOURCE:  CA Department of Health Care Services (DHCS).  Local Education Agency (LEA) Telehealth.  Aug. 2020. Pg. 3.  (Accessed Feb. 2021).

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Colorado

Last updated 02/28/2021

POLICY

CO Medicaid will cover medically necessary medical and surgical …

POLICY

CO Medicaid will cover medically necessary medical and surgical services furnished to eligible members.

Telemedicine services may be provided under two arrangements.

  • The first arrangement is when a member receives services via a live audio/visual connection from a single provider. This is the predominant arrangement for telemedicine.
  • The second arrangement is when a member and a provider are physically in the same location and additional services are provided by a second (distant) provider via a live audio/visual connection. In this arrangement the provider who is present with the member is called the “originating provider”, and the provider located at a different site, acting as a consultant, is called the “distant provider”.

The member must be present during any Telemedicine visit.

It is acceptable to use Telemedicine to facilitate live contact directly between a member and a provider.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual,” 11/20 (Accessed Feb. 2021). 

In-person contact between a health care or mental health care provider and a patient is not required under the state’s medical assistance program for health care or mental health care services delivered through telemedicine that are otherwise eligible for reimbursement under the program. Any health care or mental health care service delivered through telemedicine must meet the same standard of care as an in-person visit. 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. This section also applies to managed care organizations that contract with the state department pursuant to the statewide managed care system only to the extent that:

  • Health care or mental health care services delivered through telemedicine are covered by and reimbursed under the Medicaid per diem payment program; and
  • Managed care contracts with managed care organizations are amended to add coverage of health care or mental health care services delivered through telemedicine and any appropriate per diem rate adjustments are incorporated.

Reimbursement rate must be, at minimum, the same as a comparable in-person services.

SOURCE: CO Revised Statutes 25.5-5-320 & HB 20-1230. (Accessed Feb. 2021).

Interim Therapeutic Restorations

In-person contact between a health care provider and a recipient is not required under the state’s medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health care provider may provide these services through telehealth, including store-and-forward, and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in person. The services are subject to the reimbursement policies developed pursuant to the state medical assistance program.

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Colorado Medicaid will reimburse for medical and mental health services delivered through telemedicine that are otherwise eligible for reimbursement under the program.

Health care or mental health care services includes speech therapy, physical therapy, occupational therapy, hospice care, home health care and pediatric behavioral health care.

SOURCE: CO Revised Statutes 25.5-5-320 & SB 20-212 (2020 Session). (Accessed Feb. 2021)..

Services may be rendered via telemedicine when the service is:

  • A covered Health First Colorado benefit,
  • Within the scope and training of an enrolled provider’s license, and
  • Appropriate to be rendered via telemedicine.

All services provided through telemedicine shall meet the same standard of care as in-person care.

Refer to ‘Telemedicine Website’ for list of billing codes.

The reimbursement rate for a telemedicine service shall, as a minimum, be set at the same rate as the medical assistance program rate for a comparable in-person service.

Providers may only bill procedure codes which they are already eligible to bill.

Health First Colorado does not pay for provider education via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual”, 11/20. (Accessed Feb. 2021).

Physician services may be provided as telemedicine.  Any health benefits provided through telemedicine shall meet the same standard of care as in-person care.

SOURCE:  Colorado Adopted Rule 8.200.3.B. (Accessed Feb. 2021). 

All services provided through telemedicine shall meet the same standard of care as in-person care.

The reimbursement rate for a telemedicine service shall, as a minimum, be set at the same rate as the medical assistance program rate for a comparable in-person service.

Providers may only bill procedure codes which they are already eligible to bill.

The following are listed under the covered services heading in the Telemedicine Manual:

  • Physician services may be provided as telemedicine
  • Providers may only bill procedure codes which they are already eligible to bill
  • Any health benefits provided through telemedicine shall meet the same standard of care as in-person care.

Place of Service 02 should be used to report services delivered via telecommunication, where the member may be in their home and the provider may be at their office.  See webpage for list of codes.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine – Provider Information”, CO Department of Health Care Policy and Financing. (Accessed Feb. 2021).

Procedure codes listed below under “Telemedicine Modifier GT” will receive an additional $5.00 to the fee listed on the most recent Health First Colorado Fee Schedule when billed using modifier GT.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 11/20.  (Accessed Feb 2021).

Durable Medical Equipment Encounters

Face-to-face encounters for durable medical equipment, prosthetics, orthotics, and supplies may be performed via telehealth if available.

SOURCE: CO Department of Health Care Policy and Financing.  “Durable Medical Equipment, Prosthetics, Orthotics, and Supplies”, 10/20. (Accessed Feb. 2021).

Pediatric Behavioral Therapy

Pediatric Behavioral Therapists are not listed as a provider type that can bill the facility fee (Q3014) or GT modifier. However, if the provider believes that providing behavioral therapy via telemedicine is medically appropriate in the situation and within the scope of their license/training, then doing so is allowed. In this case, the provider will not be paid the fee associated with Q3014 or GT modifier.

SOURCE: CO Department of Health Care Policy and Financing.  “Pediatric Behavioral Therapies Billing Manual”, 9/20 (Accessed Feb. 2021). 

Screening Brief Intervention Treatment

Screening Brief Intervention Treatment may be provided via simultaneous audio and video transmission with a member.

SOURCE: CO Department of Health Care Policy and Financing.  “Screening, Brief Intervention and Referral to Treatment”, 9/20. (Accessed Feb. 2021).

Education-Only Services

Colorado Medicaid provides reimbursement for education-only services provided through telemedicine. This includes services such as Diabetes Self-Management Education and Support (DSMES) and tobacco cessation counseling.

SOURCE: CO Department of Health Care Policy and Financing. Provider Bulletin B1900434. Aug. 2019. (Accessed Feb. 2021). 

Education-only services was removed from the list of “Not Covered Services” section in the provider manual in June 2019.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 11/20.  (Accessed Feb. 2021).

Community Mental Health Centers/Clinics

Group psychotherapy services shall be face-to-face, or 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) services that are insight-oriented, behavior modifying, and that involve emotional interactions of the group members. Group psychotherapy services shall assist in providing relief from distress and behavior issues with other clients who have similar problems and who meet regularly with a practitioner. Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

Individual psychotherapy services shall be face-to-face, or 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) services that are tailored to address the individual needs of the client. Services shall be insight-oriented, behavior modifying and/or supportive with the client in an office or outpatient facility setting. Individual psychotherapy services are limited to thirty-five visits per State fiscal year. 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 8.750.3.B. (Accessed Feb. 2021). 

FQHC/RHC

When a Federally Qualified Health Center or a Rural Health Clinic provides care through telemedicine, the claim must include the modifier GT on line(s) identifying the service(s).

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

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 11/20. (Accessed Feb. 2021).

For Health First Colorado a billable encounter at an FQHC is an in person or telemedicine face to face visit with a Health First Colorado member.

Telemedicine services are limited to the procedure codes identified on the Telemedicine-Provider Information web page at the Provider Telemedicine web page.

When a Federally Qualified Health Center or a Rural Health Clinic provides care through telemedicine, the claim must include the modifier GT on line(s) identifying the service(s).

SOURCE: CO FQHC & RHC Billing Manual 12/20. (Accessed Feb. 2021).

The visit definition for a FQHC 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) encounters.  Any health benefits provided through 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) must meet the same standard of care as in-person care.

SOURCE:  Colorado Adopted Rule 8.700.1. (Accessed Feb. 2021).

The visit for a RHC means a face-to-face encounter, or an 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) encounter between a clinic client and any health professional providing the services set forth in 8.740.4. 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 8.740.1. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

The following provider types may bill using modifier GT:

  • Physician
  • Clinic
  • Osteopath
  • FQHC
  • Doctorate Psychologist
  • MA Psychologist
  • Physician Assistant
  • Nurse Practitioner
  • RHC

A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’ when present with the patient. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.

A specialist is eligible to be an originating provider (if present with the patient) or distant provider.

The distant provider may participate in the telemedicine interaction from any appropriate location.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 11/20.  (Accessed Feb. 2021).

A telemedicine service meets the definition of a face-to-face encounter for a rural health clinic, Indian health service, or federally qualified health center.  The reimbursement rate for a telemedicine service provided by a rural health clinic or federal Indian health service or federally qualified health center must be set at a rate that is no less than the medical assistance program rate for a comparable face-to-face encounter or visit.

SOURCE:  CO Statute, Sec. 25.5-5-320 & Senate Bill 20-212 (2020 Session). (Accessed Feb. 2021)..


ELIGIBLE SITES

If no originating provider is present during a Telemedicine Services appointment, then the location of the originating site is at the member’s discretion and can include the member’s home. However, members can be required to choose a location suitable to delivery of telemedicine services that may include adequate lighting and environmental noise levels suitable for easy conversation with a provider.

Services can be provided via telemedicine between a member and a distant provider when a member is located in their home or other location of their choice.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 11/20.  (Accessed Feb. 2021).

A primary care provider (PCP) is eligible to be reimbursed as the ‘originating provider’ when present with the patient. In order for a PCP to be reimbursed as a distant provider, the PCP must be able to facilitate an in-person visit in the state of CO if necessary for treatment of the member’s condition.

A specialist is eligible to be an originating provider (if present with the patient) or distant provider.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 11/20.  (Accessed Feb. 2021). 

Telemedicine can work:

  • From a provider office:  You can connect through video with a provider in another office. Both offices must have telemedicine equipment.
  • From your home or other location like a library:  You may be able to use your mobile phone, tablet or desktop computer to connect to a provider. Health First Colorado will not pay for the equipment.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine”, (Accessed Feb. 2021).  

Speech Therapy

Telemedicine POS (02) is an allowed place of service code.

SOURCE: CO Department of Health Care Policy and Financing.  “Speech Therapy”, 12/20. (Accessed Feb. 2021). 

Eligible place of service includes Telemedicine, including 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 (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) must meet the same standard of care as in-person care.

SOURCE:  Colorado Adopted Rule 8.200.3.D.2. (Accessed Feb. 2021).

Home Health Services

Services shall be provided in the client’s place of residence or one of the following places of service:  Services may be provided using interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) instead of in-person contact. 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 8.520.4.B. (Accessed Feb. 2021).

Family Planning Services

Eligible places of service include:  Telemedicine, including 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 (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) must meet the same standard of care as in-person care.

SOURCE:  Colorado Adopted Rule 8.730.3.B. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found.


FACILITY/TRANSMISSION FEE

In some cases, the originating provider site will not be providing clinical services, but only providing a site and telecommunications equipment. In this situation, the telemedicine originating site facility fee is billed using procedure code Q3014.

Originating providers bill as follows:

  • If the originating provider is making a room and telecommunications equipment available but is not providing clinical services, the originating provider bills Q3014 (the procedure code for the telemedicine originating site facility fee).
  • If the originating provider also provides clinical services to the member, the provider bills the rendering provider’s appropriate procedure code and bills Q3014.
  • The originating provider may also bill, as appropriate, on the UB-04 paper claim form or as an 837I transaction for any clinical services provided on-site on the same day that a telemedicine originating site claim is made. The originating provider must submit two separate claims for the member’s two separate services.

Providers eligible for the originating site facility fee include:

  • Physician
  • Clinic
  • Osteopath
  • FQHC
  • Doctorate Psychologist
  • MA Psychologist
  • Physician Assistant
  • Nurse Practitioner
  • RHC

Provider types not listed above may facilitate Telemedicine Services with a distant provider but may not bill procedure code Q3014. Examples include Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities, etc.

Using modifier GT with specific codes adds $5.00 to the fee listed for the service.  A specific list of eligible codes is provided in the manual.  Other codes can be billed, but don’t pay the telemedicine transmission fee.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 11/20.  (Accessed Feb. 2021).

The state department shall establish rates for transmission cost reimbursement for telemedicine services, considering, to the extent applicable, reductions in travel costs by health care or mental health care providers and patients to deliver or to access such services and such other factors as the state department deems relevant.

SOURCE: CO Revised Statutes 25.5-5-320(3). (Accessed Feb. 2021).

Pediatric Behavioral Therapy

Pediatric Behavioral Therapists are not listed as a provider type that can bill the facility fee or GT modifier. However, if the provider believes that providing behavioral therapy via telemedicine is medically appropriate in the situation and within the scope of their license/training, then doing so is allowed. In this case, the provider will not be paid the fee associated with Q3014 or GT modifier.

SOURCE: CO Department of Health Care Policy and Financing.  “Pediatric Behavioral Therapies Billing Manual” 9/20. (Accessed Feb. 2021).

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Connecticut

Last updated 02/28/2021

POLICY

CT Medicaid is required to provide coverage for telehealth …

POLICY

CT Medicaid is required to provide coverage for telehealth services for categories of health care services that the commissioner determines are clinically appropriate to be provided through telehealth, cost effective for the state and likely to expand access to medically necessary services where there is a clinical need for those services to be provided by telehealth or for Medicaid recipients whom accessing healthcare poses an undue hardship.

The commissioner may provide coverage of telehealth services pursuant to this section notwithstanding any provision of the regulations of Connecticut state agencies that would otherwise prohibit coverage of telehealth services. The commissioner may implement policies and procedures as necessary to carry out the provisions of this section while in the process of adopting the policies and procedures as regulations.

SOURCE: CT General Statute 17b, Sec. 245e. (Accessed Feb. 2021)

In accordance with section 17b- 245e of the 2020 supplement to the Connecticut General Statutes, the Department of Social Services (DSS or Department) will implement full coverage of specified synchronized telemedicine, which is defined as an audio and video telecommunication system with real-time communication between the patient and practitioner. The coverage of specified synchronized telemedicine services will be covered under both Connecticut’s Medicaid Program and Children’s Health Insurance Program (CHIP) when they:

  • Are medically necessary, in accordance with the statutory definition of medical necessity
  • Are rendered via a HIPAA-compliant, real time audio and video communication system (but note that certain popular video    chatting software programs are not HIPAA-compliant); and
  • Comply with all CMAP requirements that would otherwise apply to the same service performed face-to-face (in-person), including, but not limited to, enrollment, scope of practice, licensure, documentation, and other applicable requirements.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020 (Accessed Feb. 2021).

Connecticut’s Medical Assistance Program will not pay for information or services provided to a client by a provider electronically or over the telephone, however there is an exception for case management behavioral health services for clients age eighteen and under.

SOURCE: CT Provider Manual. Physicians and Psychiatrists. Sec. 17b-262-342.  Pg. 9, Oct. 2020; CT Provider Manual. Psychologists. Sec. 17b-262-472. Oct. 2020. Pg. 7; & CT Provider Manual.  Behavioral Health. Sec. 17b-262-918. Oct. 2020. Pg. 6. (Accessed Feb. 2021).

A telehealth provider shall only provide telehealth services to a patient when the telehealth provider: (A) Is communicating through real-time, interactive, two-way communication technology or store and forward technologies; (B) has access to, or knowledge of, the patient’s medical history, as provided by the patient, and the patient’s health record, including the name and address of the patient’s primary care provider, if any; (C) conforms to the standard of care applicable to the telehealth provider’s profession and expected for in-person care as appropriate to the patient’s age and presenting condition, except when the standard of care requires the use of diagnostic testing and performance of a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient’s condition; and (D) provides the patient with the telehealth’s provider license number and contact information.

SOURCE: CA Gen. Statutes Sec. 19a-906(b)(1).  (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See manual for the behavioral health services that may be rendered via telemedicine.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020 (Accessed Feb. 2021).

Opioid Treatment Programs are required to perform a complete, fully documented physical evaluation prior to admission. The program physician may render the physical evaluation component of MAT services via telemedicine only when the all of the following are met:

  • The CMAP member’s originating site is another CMAP-enrolled Opioid Treatment Program (Methadone Maintenance Clinic) that is part of the same billing entity as the originating site;
  • The originating site is providing all the other required components of MAT services including the intake and psychiatric evaluation;
  • As required by 42 CFR 8.12(f), an authorized healthcare professional under the supervision of a program physician is present with the member at the originating site; and
  • The distant site provider must be located at a different service location/address than the originating site.

Induction services must always be rendered face-to-face (in-person) and only after the physical and psychiatric evaluation has been performed. Once a CMAP member has been inducted, routine psychotherapy services may be rendered via telemedicine.

MAT services that may be rendered via telemedicine include medication management and psychotherapy services.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020 (Accessed Feb. 2021).

CT does not pay for information or services furnished by a licensed behavioral health clinician to the client electronically or over the telephone, except for case management behavioral health services for clients age eighteen and under.

SOURCE: CT Provider Manual.  Behavioral Health. Sec. 17b-262-918. Oct. 2020. Pg. 6. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Only the following categories of CMAP-enrolled providers may provide and bill for such psychotherapy services or psychiatric diagnostic evaluations within their scope of practice via telemedicine:

  • Physician
  • Physician Assistant
  • Advanced Practice Registered Nurses
  • Licensed Behavioral Health Clinicians (defined below and which includes only the following: Licensed Psychologists, Licensed Clinical Social Workers, Licensed Marital and Family Therapists, Licensed Professional Counselors, and Licensed Alcohol and Drug Counselors)
  • Behavioral Health Clinics – including Enhanced Care Clinics (ECCs)
  • Behavioral Health Federally Qualified Health Centers (FQHCs)
  • Medical Clinics – excluding School Based Health Centers (SBHCs)
  • Rehabilitation Clinics
  • Outpatient Hospital Behavioral Health (BH) Clinics
  • Outpatient Psychiatric Hospitals
  • Outpatient Chronic Disease Hospitals (CDHs)

Modifiers GT is used when the member’s originating site is located in a healthcare facility or office; or modifier 95 Is used when the member is located at home.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020 (Accessed Feb. 2021).

Medication Assisted Treatment

  • Eligible providers:
  • Physician
  • APRNs
  • PAs
  • Behavioral Health Clinics

Medication Management

Eligible Providers:

  • Physicians
  • PAs
  • APRNs
  • Medical Clinics – excluding SBHCs
  • Behavioral Health Clinics – including ECCs
  • Behavioral Health FQHCs
  • Outpatient Hospital BH Clinics
  • Outpatient Chronic Disease Hospitals

Eligible providers for out of state surgery and homebound patients include:

  • Physicians
  • PAs
  • APRNs
  • CNMs
  • Podiatrists

For homebound patients, provider must document the reason the member is being determined homebound.

Documentation must be maintained by both the originating site provider and the distant site provider to substantiate the services provided. Originating site documentation must indicate the member received or has been referred for telehealth services.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020 (Accessed Feb. 2021).

Telehealth providers includes the following who are providing health care or other health services through the use of telehealth within such person’s scope of practice and in accordance with the standard of care applicable to the profession:

  • Any physician licensed under chapter 370
  • Physical therapist licensed under chapter 376
  • Chiropractor licensed under chapter 372
  • Naturopath licensed under chapter 373
  • Podiatrist licensed under chapter 375
  • Occupational therapist licensed under chapter 376a
  • Optometrist licensed under 380
  • Registered nurse or advanced practice registered nurse licensed under chapter 378
  • Physician assistant licensed under chapter 370
  • Psychologist licensed under chapter 383
  • Marital and family therapist licensed under chapter 383a
  • Clinical social worker or master social worker licensed under chapter 383b
  • Alcohol and drug counselor licensed under chapter 376b
  • Professional counselor licensed under chapter 383c
  • Dietitian-nutritionist licensed under chapter 384b
  • Speech and language pathologist licensed under chapter 399
  • Respiratory care practitioner licensed under chapter 381a
  • Audiologist licensed under chapter 397a
  • Pharmacist licensed under chapter 400j
  • Paramedic licensed under chapter 384d

SOURCE: CT Gen. Statutes Sec. 19a-906(a)(12).  (Accessed Feb. 2021).

Medication Assisted Treatment

The distant site provider cannot bill for the physical evaluation component rendered via telemedicine.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Feb. 2021).


ELIGIBLE SITES

There is no limitation on the originating site for a member receiving individual therapy, family therapy or psychotherapy with medication management.

Psychiatric diagnostic evaluations may be rendered via telemedicine only if the member is located at a CMAP-enrolled originating site.

Modifiers GT is used when the member’s originating site is located in a healthcare facility or office; or modifier 95 Is used when the member is located at home.

Documentation must be maintained by both the originating site provider and the distant site provider to substantiate the services provided. Originating site documentation must indicate the member received or has been referred for telehealth services.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020, (Accessed Feb. 2021).

Medication Assisted Treatment

Due to Opioid Treatment Programs (Methadone Maintenance Clinics) receiving a daily payment rate for all MAT services

provided, the daily payment rate will continue to be paid to the originating site only.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Feb. 2021).

Medical and Behavioral Health Federally Qualified Health Centers (FQHCs) are eligible to bill their encounter rate when an approved, medically necessary telemedicine service is rendered.

SOURCE: CT Policy – Provider Bulletin 2020-09. March 2020. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No telehealth provider shall charge a facility fee for telehealth services.

SOURCE: CT Gen. Statutes Sec. 19a-906(h).  (Accessed Feb. 2021).

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Delaware

Last updated 02/28/2021

POLICY

DE Medicaid reimburses for live video telemedicine services for …

POLICY

DE Medicaid reimburses for live video telemedicine services for up to three different consulting providers for separately identifiable telemedicine services provided to a member per date of service.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/20. Ch. 16 Telemedicine, Sec. 16..2, pg. 82 & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8, p. 14.  (Accessed Feb. 2021).

The GT modifier (which indicates the service occurred via interactive audio and video telecommunication system) can be used for Early and Periodic Screening, Diagnostic and Treatment Services through the School Based Health Services program in  Group Physical Therapy treatment utilizing code 97150 + the GT modifier.

SOURCE: DE School Based Health Services Specific Policy Manual, pg. 53 & 57 (8/20/18). (Accessed Feb. 2021).

The referring provider is not required to be present at the originating site, however the recipient of the services must be present.

Reimbursement to the referring provider will only occur when providing a separately identifiable covered service.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/20. Ch. 16.2.6.1.1, 16.2.6.1.2,& 16.5.1 Telemedicine, pg. 79-80 (Accessed Feb. 2021). 

The recipient:

  • must be able to verbally communicate, either directly or through a representative, with the originating and distant site providers,
  • must be able to receive services via telemedicine, and
  • must have provided consent for the use of telemedicine.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/20. Ch. 16.5.5 Telemedicine, pg. 81 (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

The service must be medically necessary, written in the patient’s treatment plan and, follow generally accepted standards of care. The service provided by the distant provider must be a service covered by DMAP.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/20. Ch. 16 Telemedicine, Sec. 16.5.2, pg. 80-81. (Accessed Feb. 2021).

Interactive audio and video telecommunications can be used for group physical therapy in the Early and Periodic Screening, Diagnostic and Treatment Services through the School Based Health Services program for group physical therapy treatment.

SOURCE: DE School Based Health Services Specific Policy Manual, pg. 53 & 57 (8/20/18). (Accessed Feb. 2021).

Tele-Dentistry

Synchronous real-time tele-dentistry services must be provided in accordance with the recommendations provided by the American Dental Association.  The evaluation is limited to a specific oral health problem or complaint.

SOURCE: DE Medical Assistance Program. Adult Dental Program Services Provider Specific Manual. Nov. 7, 2020.  Sec. 4.2. p. 8 (Accessed Feb. 2021).

Rate Methodologies for the CPT codes under the telemedicine section of the State Plan for Adult Behavioral Health Services are paid at a lower rate and provided in the manual.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. p. 14 (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

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

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

SOURCE:  Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. Pg. 11 (Accessed Feb. 2021).

Eligible distant site providers include:

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

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/20. Ch. 16.2.4.3 Telemedicine, pg. 77-78, & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. Pg. 12 (Accessed Feb. 2021).


ELIGIBLE SITES

An originating site refers to the facility in which the Medicaid patient is located at the time the telemedicine service is being furnished. An approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present and telemedicine can be effectively utilized.

Medical Facility Sites:

  • Outpatient Hospitals
  • Inpatient Hospitals
  • Federally Qualified Health Centers
  • Rural Health Centers
  • Renal Dialysis Centers
  • Skilled Nursing Facilities
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
  • Intermediate Care Facilities/Institutions for Mental Diseases (ICF/IMDs)
  • Outpatient Mental Health/Substance Abuse Centers/Clinics
  • Community Mental Health Centers/Clinics
  • Public Health Clinics
  • PACE Centers
  • Assisted Living Facilities
  • School-Based Wellness Centers
  • Patient’s Home (must comply with HIPAA, privacy, secure communications, etc., and does not warrant an originating site fee)
  • Other Sites as approved by the DMAP

 

Medical Professional Sites:

  • Physicians (or Physicians Assistants under the supervision of a physician)
  • Certified Nurse Practitioners
  • Medical and Behavioral Health Therapists

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/20. Ch. 16.2.5.4.1 & 16.2.5.4.2 Telemedicine, pg. 78, & 79 & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1. 8. pg. 11 & 12 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

There are no geographical limitations within Delaware regarding the location of an originating site provider.

SOURCE:  DE Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8, p. 12. (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

A facility fee is covered for originating sites.

Facility fees for the distant site are not covered.

Only one facility fee is permitted per date, per member.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/20. Ch. 16 Telemedicine, Sec. 16.2 & 16.8.3, pg. 77-82 (Accessed Feb. 2021).

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District of Columbia

Last updated 02/28/2021

POLICY

DC Medicaid must reimburse for health services through telehealth …

POLICY

DC Medicaid must reimburse for health services through telehealth if the same service would be covered when delivered in person.

SOURCE: DC Code Sec. 31-3863 (Accessed Feb. 2021).

The DC Medical Assistance Program will reimburse telemedicine services, if the Medicaid beneficiary meets the following conditions:

  • Be enrolled in the DC Medicaid Program;
  • Be physically present at the originating site at the time the telemedicine service is rendered; and
  • Provide written consent to receive telemedicine services in lieu of in-person healthcare services, consistent with all applicable DC laws.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.5. (Accessed Feb. 2021) & Physicians Billing Manual.  DC Medicaid.  Jan. 13, 2021) Sec. 15.9.3. P. 66.  (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Medicaid shall cover and reimburse for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person.

SOURCE: DC Code Sec. 31-3863 (Accessed Feb. 2021).

Covered Services:

  • Evaluation and management
  • Consultation of an evaluation and management of a specific healthcare problem requested by an originating site provider
  • Behavioral healthcare services including, but not limited to, psychiatric evaluation and treatment, psychotherapies, and counseling
  • Rehabilitation services including speech therapy

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.11 & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.6. P. 67 (Accessed Feb. 2021).

Distant site providers may only bill for the appropriate codes outlined (see manual and guidance).

SOURCE: DC Dept. of Health Care Finance. Telemedicine Provider Guidance. P. 3. (Mar. 2020), DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.12 & Physicians Billing Manual.  DC Medicaid. (Jan. 2021) Sec. 15.9.8. P. 67-68. (Accessed Feb. 2021).

Education-Related Services

The following reimbursement parameters apply for services delivered under the Office of the State Superintendent of Education through the Strong Start DC Early Intervention Program.

  • The LEA shall only bill for distant site services listed in Appendix A that are allowable healthcare services to be delivered at DCPS/DCPCS;
  • The LEA shall provide an appropriate primary support professional to attend the medical encounter with the member at the originating site.  In instances where it is clinically indicated, an appropriate healthcare professional shall attend the encounter with the member at the originating site.

SOURCE: DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 4 & 6 (Mar. 2020) (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Telemedicine providers must comply with the following:

  • Be an enrolled Medicaid provider and comply with requirements including having a completed, signed Medicaid Provider Agreement
  • Comply with technical, programmatic and reporting requirements
  • Be licensed; and
  • Comply with any applicable consent requirements, including but not limited to providing telemedicine services at DC public schools or public charter schools.

SOURCE: DC Municipal Regulation. Emergency Regulation. Title 29, Ch. 9, Sec. 910.6. (Accessed Feb. 2021).

D.C. Medicaid enrolled providers are eligible to deliver telemedicine services, using fee-for-service reimbursement, at the same rate as in-person consultations. All reimbursement rates for services delivered via telemedicine are consistent with the District’s Medical State Plan and implementing regulations.

SOURCE: Physicians Billing Manual. DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.4. P. 66 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 4  (Mar. 2020).  (Accessed Feb. 2021).

The following providers are considered an eligible distant site provider:

  • Hospital
  • Nursing facility
  • Federally Qualified Health Center
  • Clinic
  • Physician Group/Office
  • Nurse Practitioner Group/Office
  • DCPS
  • DCPCS; and
  • MHRS provider, ASARS provider and ASTEP provider certified by DBH and eligible to provide behavioral health services set forth under the State Plan

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.8 & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.3. P. 66 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 3 (Mar. 2020) (Accessed Feb. 2021).

When a beneficiary’s home is the originating site, the distant site provider shall ensure the technology in use meets the minimum requirements.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.30. (Accessed Feb. 2021).


ELIGIBLE SITES

Recently Adopted Rule

The beneficiary’s home may serve as the originating site. When the originating site is the beneficiary’s home the distant site provider is responsible for ensuring that the technology in use meets the minimum requirements set forth in Subsection 910.3.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910 & 910.30. (Accessed Feb. 2021).

Must be an approved telemedicine provider.  The following providers are considered an eligible originating site, as well as eligible distant site provider:

  • Hospital
  • Nursing facility
  • Federally Qualified Health Center
  • Clinic
  • Physician Group/Office
  • Nurse Practitioner Group/Office
  • District of Columbia Public Schools (DCPS)
  • District of Columbia Public Charter Schools (DCPCS)
  • Mental Health Rehabilitation Service (MHRS) provider, Adult Substance Abuse Rehabilitation Service (ASARS) provider, and Adolescent Substance Abuse Treatment Expansion Program (ASTEP) provider certified by the Department of Behavioral Health (DBH) and eligible to provide behavioral health services set forth under the District of Columbia Medicaid State Plan (State Plan).
  • The beneficiary’s home or other settings identified in guidance published on the DHCF website.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.7 (Accessed Feb. 2021) & Physicians Billing Manual.  DC Medicaid.  (09/14/2020) Sec. 15.9.3. P. 68 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 2 (Mar. 2020) (Accessed Feb. 2021).

When a beneficiary’s home is the originating site, the distant site provider shall ensure the technology in use meets the minimum requirements set forth in Subsection 910.13.

In the event the beneficiary’s home is the originating site, the distant site provider must bill using the GT modifier and specify the place of service ‘02’.

SOURCE: DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 4 & 6 (Mar. 2020) (Accessed Feb. 2021).

When DCPS or DCPCS is the originating site provider, a primary support professional (an individual designated by the school) shall be in attendance during the patient’s medical encounter.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.17. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No transaction or facility fee.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.28. (Accessed Jan. 2021) & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.7. P. 67 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 6 (Mar. 2020). (Accessed Feb. 2021).

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Florida

Last updated 02/28/2021

POLICY

FL Medicaid reimburses for real time, two-way, interactive telemedicine.…

POLICY

FL Medicaid reimburses for real time, two-way, interactive telemedicine.

Providers must include the GT modifier.

SOURCE: FL Admin Code 59G-1.057. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Florida Medicaid reimburses the practitioner who is providing the evaluation, diagnosis, or treatment recommendation located at a site other than where the recipient is located.

SOURCE: FL Admin Code 59G-1.057. (Accessed Feb. 2021).

Child Protective Team (CPT) Services

Real-time CPT telemedicine services for the evaluation of children suspected to be abused or neglected has been implemented in rural or remote areas.

SOURCE: FL Dept. of Health, Child Protection Team Program, Program Handbook, p. 24 (Jun. 28, 2019).  (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Telemedicine is available for use by all providers of Florida Medicaid services that are enrolled in or registered with the Florida Medicaid program and who are licensed within their scope of practice to perform the service.

SOURCE: FL Admin Code 59G-1.057. (Accessed Feb. 2021).

Child Protective Team (CPT) Services

Real-time CPT telemedicine services for the evaluation of children suspected to be abused or neglected has been implemented in rural or remote areas.  Only CPT medical providers approved as CMS medical providers and are specifically trained to do telemedicine exams can perform exams at the hub site.  Only registered nurses trained to assist in telemedicine exams can participate in the CPT medical exam at the remote site. All persons at remote site must act under the direct supervision of the telemedicine physician or physician extender.

SOURCE: FL Dept. of Health, Child Protection Team Program, Program Handbook, p. 24 (Jun. 28, 2019).  (Accessed Feb. 2021).


ELIGIBLE SITES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No Reference Found

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Georgia

Last updated 02/28/2021

POLICY

The use of a telecommunications system may substitute for …

POLICY

The use of a telecommunications system may substitute for an in-person encounter for professional office visits, pharmacologic management, limited office psychiatric services, limited radiological services and a limited number of other physician fee schedule services. See the telehealth guidelines for program specific policies.


ELIGIBLE SERVICES/SPECIALTIES

An interactive telecommunications system is required as a condition of payment. The originating site’s system, at a minimum, must have the capability of allowing the distant site provider to visually examine the patient’s entire body including body orifices (such as ear canals, nose and throat). The distant site provider should also have the capability to hear heart tones and lung sounds clearly (using a stethoscope) if medically necessary and currently within the provider’s scope of practice. The telecommunication system must be secure and adequate to protect the confidentiality and integrity of the information transmitted.

SOURCE: GA Dept. of Community Health, Physician Services Manual, p. R-1 (Jan. 1, 2021). (Accessed Feb. 2021).  

Claims must use the appropriate CPT or HCPCS code with the GT modifier and or the use of POS 02.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan. 2021). (Accessed Feb. 2021).

The service must be medically necessary and the procedure individualized, specific, and consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.

Physician Services:  When a provider, licensed in the state of Georgia, determines that medical care can be provided via electronic communication with no loss in the quality or efficacy of the member’s care, telehealth services can be performed.

See telehealth manual for list of eligible telehealth services and codes for specific programs.

Non-Covered Services:

  1. Telephone conversations.
  2. Electronic mail messages.
  3. Facsimile.
  4. 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.
  5. Video cell phone interactions.
  6. The cost of telehealth equipment and transmission.
  7. Failed or unsuccessful transmissions.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance, p. 5 & 10 (Jan. 2021). (Accessed Feb. 2021).

Nursing Facilities & Community Behavioral Health Rehabilitation Services

Those residents whose interest is best served by receiving mental health services in the nursing facility or in a nearby telehealth site can receive services in either of those locations, with the practitioner using out-of-clinic or telehealth/telemedicine procedure codes.

SOURCE: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Community Behavioral Health Rehabilitation Services, p. 29 (Jan. 2021) & GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facility Services, p. H-7 (p. 169).  (Jan. 2021). (Accessed Feb. 2021).

Teledentistry

See dental services manual for teledentistry codes.

SOURCE: GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Dental Services, IX-36 (Jan. 2021). (Accessed Feb. 2021).

Autism Spectrum Disorder Services

Prior authorization is required for all Medicaid-covered adaptive behavior services, behavioral assessment and treatment services (not telehealth specific). See manual for eligible codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.15-18 (Jan. 2021), (Accessed Feb. 2021).

Community Behavioral Health and Rehabilitation Services

The Departments of Community Health and Behavioral Health and Developmental Disabilities have authorized telehealth to be used to provide some services in the CBHRS program.  The circumstances in which it can be provided are:

  • For some services, any member who consents may receive services via telehealth;
  • For some services, telehealth is allowed only for members who speak English as a second language, and telehealth will enable the member to engage with a practitioner who can deliver services in his/her preferred language (e.g. American Sign Language, etc.) (one-to-one via Telehealth versus interpreters)

Telehealth is only allowed for certain CBHRS services and only two-way, real-time interactive audio and video communication as described in the Service Definitions section of this Guidance is allowable. Telehealth may not be used for any other Intervention.

See manual for approved codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 20 (Jan. 2021). (Accessed Feb. 2021).

To promote access, providers may use telemedicine as a tool to provide direct interventions to individuals for whom English is not their first language (one-to-one via telemedicine versus use of interpreters). Telemedicine may only be utilized when delivering this service to an individual for whom English is not their first language.

Community behavioral health providers can deliver a wide variety of services via telemedicine.  See manual for specific details and other services allowed.

SOURCE: GA Dept. of Behavioral Health and Developmental Disabilities, Community Behavioral Health Providers Manual, Pg. 22, (listed on multiple pages) (Effective Jan. 1, 2021, through Mar. 31, 2021). (Accessed Feb. 2021).

Teledentistry

The State allows certain services to be delivered via teledentistry.  See manual for approved codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.40 (Jan. 2021). (Accessed Feb. 2021).

Dialysis Services

Dialysis services are eligible to be provided under telehealth.  See manual for list of eligible CPT codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 44-46 (Jan. 2021). (Accessed Feb. 2021).

Nursing Facility Specialized Services

Those residents whose interest is best served by receiving mental health services in the nursing facility or in a nearby telehealth site can receive services in either of those locations, with the practitioner using out-of-clinic or telehealth procedure codes.  See manual for eligible codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 48-51 (Jan. 2021). (Accessed Feb. 2021).

School Based Services

Certain speech language pathology and physical therapy services are reimbursable via telehealth in the school-based setting.  See manual or eligible CPT/HCPCS codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 53-54 (Jan. 2021), & GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. X-10 (p. 39) (Jan. 2021). (Accessed Feb. 2021).

The Department of Community Health (DCH) will allow some speech therapy, audiology and therapy services to be rendered via telehealth.

SOURCE: GA Dept. of Community Health, Children’s Intervention Services (CIS). p. X-10 (Jan. 2021). (Accessed Feb. 2021). 

Dialysis Services

The Centers for Medicaid and Medicare Services (CMS) has added Dialysis Services to the list of services that can be provided under Telehealth.

SOURCE: GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. IX-10, p. 17 (Jan. 2021)  (Accessed Feb. 2021).

Durable Medical Equipment Services

A face-to-face encounter may be made through the use of telehealth technology by reporting the appropriate E&M code.

SOURCE: GA Dept. of Community Health, GA Medicaid Durable Medical Equipment Services Manual, p. 34  (Jan. 2021). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

The consulting provider must be an enrolled provider in Medicaid in the state of Georgia and must document all findings and recommendations in writing, in the format normally used for recording services in the member’s medical records.  The provider at the distant site must obtain prior approval when services require prior approval.  Both the originating site and distant site must document and maintain the member’s medical records. The report from the distant site provider may be faxed to the originating provider.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 9 (Jan. 2021). (Accessed Feb. 2021).

Autism Spectrum Disorder Services

Practitioners of ASD services can use telehealth to assess, diagnose and provide therapies to patients.  Providers must hold either a current and valid license to practice Medicine in Georgia, hold a current and valid license as a Psychologist as required under Georgia Code Chapter 39 as amended, or hold a current and valid Applied Behavior Analysis (ABA) Certification. In addition to licensed Medicaid enrolled Physicians and Psychologists, Georgia Medicaid will enroll Board Certified Behavioral Analysts (BCBAs) as Qualified Health Care Professionals (QHCPs) to provide ASD treatment services. The BCBA must have a graduate-level certification in behavior analysis. Providers who are certified at the BCBA level are independent practitioners who provide behavior-analytic services. In addition, BCBAs supervise the work of Board-Certified Assistant Behavior Analysts (BCaBAs), and Registered Behavior Technicians (RBTs) who implement behavior-analytic interventions.

New providers must submit an attestation upon enrollment, and existing providers must also do so in order to provide adaptive behavior services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.15 (Jan. 2021). (Accessed Feb. 2021).

Teledentistry

Licensed dentists and dental hygienists are eligible providers.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.40 (Jan. 2021). (Accessed Feb. 2021).

Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)

FQHCs and RHCs can serve as the originating or distant site. They cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan. 2021) & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 22, (Jan. 2021) (Accessed Feb. 2021).

Nursing Facility Specialized Services

See manual for eligible providers and levels.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 48-51 (Jan. 2021). (Accessed Feb. 2021).

School Based Settings

Speech language pathologists are eligible to bill for telehealth services with students in a school-based setting.  This includes time spent assisting the student with learning to use adaptive equipment and assistive technology.

See manual for eligible speech, audiology and physical therapy codes.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 54 (Jan. 2021). (Accessed Feb. 2021).


ELIGIBLE SITES

The referring provider must be enrolled in GA Medicaid and comply with policy and procedures as outlines in applicable Georgia Medicaid manuals.

The referring provider must be the member’s attending physician, practitioner or provider in charge of their care.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan. 2021). (Accessed Feb. 2021).

Ambulance Providers

They may serve as originating sites and the ambulance may bill a separate origination site fee. They are not authorized to provide distant site services.

Limitation (Emergency Ambulance Services Handbook):  Emergency ambulance services are reimbursable only when medically necessary. The recipient’s physical condition must prohibit use of any method of transportation except emergency for a trip to be covered.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 13 (Jan. 2021) & Emergency Ambulance Services Handbook, p. 19 (Jan. 2021). (Accessed Feb. 2021).

Community Behavioral Health and Rehabilitation Services

Member may be located at home, schools and other community-based settings or at traditional sites named in the Department of Community Health Telehealth Guidance.  See manual for detailed instructions explanation for when and which type of practitioner can bill for telehealth services.

Traditional sites include:

  • Physician and Practitioner’s Offices;
  • Hospitals;
  • Rural Health Clinics;
  • Federally Qualified Health Centers;
  • Local Education Authorities and School Based Clinics;
  • County Boards of Health;
  • Emergency Medical Services Ambulances; and
  • Pharmacies.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 20 (Jan. 2021) & GA Dept. of Community Health, Community Behavioral Health Rehabilitation Services Handbook Appendix O (Jan. 2021). (Accessed Feb. 2021).

Teledentistry

Department of Public Health (DPH) Districts and Boards of Health Dental Hygienists shall only perform duties under this protocol at the facilities of the DPH District and Board of Health, at school-based prevention programs and other facilities approved by the Board of Dentistry and under the approval of the District Dentist or dentist approved by the District Dentist.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 40 (Jan. 2021). (Accessed Feb. 2021).

Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)

FQHCs and RHCs can serve as originating sites and are paid an originating site facility fee. They cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan. 2021). & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 22, (Jan. 2021). (Accessed Feb. 2021).

Dialysis Services

Dialysis facilities are eligible originating sites for dialysis services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 44 (Jan. 2021). (Accessed Feb. 2021) & GA Dept. of Community Health, GA Medicaid Dialysis Services Handbook, p. IX-10, p. 17 (Jan. 2021) (Accessed Feb. 2021).

Nursing Facility Specialized Services

Nursing facilities can be eligible sites for nursing facility specialized services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 48 (Jan. 2021) & SOURCE: GA Dept. of Community Health, Nursing Facility Services Handbook, p. H-1 (Jan. 2021). (Accessed Feb. 2021)

School-Based Settings (Local Education Agencies)

Telehealth services are allowed in school-based settings upon enrollment into COS 600.  The following requirements must be met:

  • The provider is an authorized health-care provider enrolled in Georgia Medicaid
  • The client is a child who is receiving the service in a primary or secondary school-based setting
  • The parent or legal guardian of the client provides consent before the service is provided

Telehealth services provided in a school-based setting are also a benefit if the referring provider delegates provision of services to a nurse practitioner, clinical nurse specialist, physician assistant, or other licensed specialist as long as the above-mentioned providers are working within the scope of their professional license and within the scope of their delegation agreement with the provider.

The school must enroll as a Health Check Provider in order to bill the telehealth originating site facility fee.

LEAs must submit an Attestation Form for the provision of telehealth services.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 53 (Jan. 2021) & GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. VI-4 (p.9). (Jan. 2021).  (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found

 


FACILITY/TRANSMISSION FEE

Originating sites are paid an originating site facility fee.  Hospitals are eligible to receive reimbursement for a facility fee for telehealth when operating as the originating site. There is no separate reimbursement for telehealth serves when performed during an inpatient stay, outpatient clinic or emergency room visit or outpatient surgery, as these are all-inclusive payments.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 8 (Jan. 2021). (Accessed Feb. 2021).

Community Behavioral Health and Rehabilitation Services

Originating fees (as referenced in some of the other Georgia Medicaid programs) are not offered for telemedicine when utilized in the CBHRS category of service. Telemedicine costs are attributed to the services intervention rates.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 21 (Jan. 2021). (Accessed Feb. 2021).

School-Based Settings (Local Education Agencies)

LEAs that enroll as Health Check providers to serve as telehealth originating sites only will be allowed to bill the originating site facility fee.  The distant site provider must bill for the E/M office visit.  It is the responsibility of the LEA provider to contact the distant site provider to determine if the E/M visit was billed.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 53 (Jan. 2021). & GA Dept. of Community Health, Health Check EPSDT. (Jan. 2021). X-6-X-7 (p.68 &69)& GA Dept. of Community Health, Children’s Intervention School Services (CISS). p. VI-6. (Jan. 2021).  (Accessed Feb. 2021).

Federally Qualified Health Center (FQHC)/Rural Health Center (RHC)

FQHCs and RHCs cannot bill an originating site fee and distant site fee for telehealth services on the same encounter.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 42 (Jan. 2021) & GA Dept. of Community Health, Policies and Procedures for Federally Qualified Health Center Services and Rural Health Clinic Services, p. 22, (Jan. 2021). (Accessed Feb. 2021).

Ambulance Providers

Ambulances may bill a separate origination site fee.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 13 (Jan. 2021) & Emergency Ambulance Services Handbook, p. 19 (Jan. 2021). (Accessed Feb. 2021).

Dialysis Services

The originating facility/site (Dialysis Facility) will bill with the revenue code and procedure codes listed in the manual.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 44 (Jan. 2021) & GA Medicaid Dialysis Services Handbook, p. IX-10 (Jan. 2021). (Accessed Feb. 2021).

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Hawaii

Last updated 02/28/2021

POLICY

Hawaii Medicaid is required under statute to reimburse telehealth …

POLICY

Hawaii Medicaid is required under statute to reimburse telehealth equivalent to reimbursement for the same services provided via face-to-face contact.

SOURCE: HI Revised Statutes § 346-59.1(b). (Accessed Feb. 2021). 

Hawaii Medicaid will reimburse for live video, as long as it “includes audio and video equipment, permitting real-time consultation among the patient, consulting practitioner and referring practitioner.”

SOURCE: Code of HI Rules 17-1737-51.1(c). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

GT, GQ or 95 modifiers must be used.  See Attachment A for full list of CPT codes that are “prime candidates” for telehealth services.  Distant site providers should use the 02 Place of Service Code.  Codes listed in Attachment A are considered prime candidates for telehealth reimbursement.

SOURCE: HI Department of Human Services. Med-QUEST Division. Memo 17-01A.  & Medicaid.gov. Hawaii, SPA 16-0004.  Approval Letter. & HI Department of Human Services.  Med-QUEST Division.  Attachment A. (Accessed Feb. 2021).

Dentistry

Eligible codes for reimbursement are listed in Attachment A.  All claims for services provided through telehealth technology must be identified by the applicable teledentistry CDT code D9995 or D9996.

CDT code D9999 must be used to identify the claim for PPS payment by FQHCs and RHCs.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 79 (Jan. 2021). (Accessed Feb. 2021).

Applied behavioral analysis services (including family adaptive behavior treatment guidance) can be provided through telehealth.  MedQuest provides some areas of consideration when approving ABA services through telehealth (see memo).

SOURCE: HI Med-QUEST Memo QI-2028 (Jul. 21, 2020) & QI-2020 (Jun. 17, 2020), (Accessed Feb. 2021).

Federally Qualified Health Centers

Eligible services will be consistent with Memo QI-1702A and FFS 19-01.  See memo for specific billing scenarios.

SOURCE: Med-QUEST Memo 20-03 (Mar. 16, 2020), (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Dentistry

Dental providers who are eligible to bill Hawaii Medicaid are also eligible to bill for telehealth for specific services (see Dental Manual Attachment A for details).  The criteria for eligible dental providers are the same regardless whether or not telehealth is utilized (e.g., DDS or DMD).

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 77 (Jan. 2021) & MedQuest Memo, Reimbursement for Procedures Related to FFS Teledentistry Services, No. 19-01, Mar. 13, 2019. (Accessed Feb. 2021).

Federally Qualified Health Centers

Providers who are eligible to bill for Hawaii Medicaid services are also eligible to bill for telehealth. Please refer to Hawaii Provider Manual Chapter 21 (21.2.1) for a list of eligible providers.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Federally Qualified Health Centers, pg. 2 (March 2016) & Med-QUEST Memo 20-03 (Mar. 16, 2020), (Accessed Feb. 2021)


ELIGIBLE SITES

Eligible originating sites listed in the Administrative Rules:

  • The office of a physician or practitioner;
  • Hospitals;
  • Critical Access Hospitals;
  • Rural Health Clinics;
  • Federally Qualified Health Centers;
  • Federal telehealth demonstration project sites.

SOURCE: Code of HI Rules 17-1737-51.1(d).  – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation (Accessed Feb. 2021).

In statute, these locations are also included:

  • A patient’s home;
  • Other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.

SOURCE: HI Revised Statutes § 346-59.1. (Accessed Feb. 2021)

Guidance for Federally Qualified Health Centers:

Services must be provided at a HRSA approved site or satellite.

The spoke (originating site) is the location where the patient is located whether accompanied or not by a helath care provider through telehealth.  The originating site includes a patient’s residence.

SOURCE: HI Med-QUEST Memo 20-03. (Accessed Feb. 2021).

Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.

SOURCE: HI State Plan Amendment 16-0004, (Accessed Feb. 2021)


GEOGRAPHIC LIMITS

Telehealth services may only be provided to patients if they are presented from an originating site located in either:

  • A federally designated Rural Health Professional Shortage Area;
  • A county outside of a Metropolitan Statistical Area;
  • An entity that participates in a federal telemedicine demonstration project.

SOURCE: Code of HI Rules 17-1737.-51.1. (Accessed Feb. 2021). – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation.

Approved state plan amendment authorizes HI Medicaid to remove geographic and originating site requirements.

SOURCE: HI State Plan Amendment 16-0004. (Accessed Feb. 2021). 

Federally Qualified Health Centers:

Services must be provided at a HRSA approved site or satellite.

SOURCE: HI Med-QUEST Memo 20-03. (Accessed Feb. 2021).

Teledentistry

The criteria for eligible dental sites are the same regardless whether or not telehealth is utilized.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 77 (Jan. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

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Idaho

Last updated 02/28/2021

POLICY

Idaho Medicaid reimburses for specific services via live video …

POLICY

Idaho Medicaid reimburses for specific services via live video telehealth, consistent with ID Administrative Code. Telehealth services must be equal in quality to in-person services.

Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties.

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9, 8.9.2 & 8.9.4 p. 122-123. (Accessed Feb. 2021).

Rendering providers must provide timely coordination of services, within three business days, with the participant’s primary care provider who should be provided in written or electronic format a summary of the visit, prescriptions and DME ordered.

SOURCE:  Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9 p. 122. (Accessed Feb 2021). 

Telehealth services that are properly identified in accordance with billing requirements are covered under Medicaid for physicians, within limitations defined by the Department in the Idaho Medicaid Provider Handbook.

SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09) (3/13/20), Pg. 24 (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Services must be equal in quality to services provided in-person.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9 p. 122 (Accessed Feb. 2021).

Place of service 02 (telehealth) is not used by Idaho Medicaid. All normal Place of Service codes are acceptable for telehealth. The place of service used should be the location of the participant. Claims must include a GT modifier (Via interactive audio and video telecommunications systems) on CPT® and HCPCS. FQHC, RHC or IHS providers should not report the GT modifier with encounter code T1015, but should include it with the supporting codes.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9.4, pg. 123 July 23,2020. (Accessed Feb. 2021).

Physician/Non-Physician Practitioner Services:

  • Primary Care Services
  • Specialty Services
  • Health and Behavioral Assessment/Intervention
  • Psychiatric Crisis Consultation (Physicians and psychiatric nurse practitioners only)
  • Psychotherapy with evaluation and management
  • Psychiatric diagnostic interview
  • Pharmacological management
  • Tobacco Use Cessation

School-based Services

Community Based Rehabilitation Services (CBRS) supervision can be delivered via telehealth in educational environments, but not separately reimbursable.

Children with Developmental Disabilities

Therapeutic consultation and crisis intervention can be delivered via telehealth technology through the Bureau of Developmental Disability Services.

Early Intervention Services (EIS) for Infants and Toddlers

Services can be delivered via telehealth as long as the provider is employed by or contracted with the Idaho Infant Toddler Program and meet the IDEA Part C requirements.  Eligible services include:

  • Family training and counseling for child development, per 15 minutes (HCPCS T1027)
  • Home care training, family, per 15 minutes (HCPCS S5110)
  • Medical team conference with interdisciplinary team, 30 minutes (CPT 99366)

Primary Care

Primary care services can be delivered via telehealth.  Providers must be licensed by the Idaho Board of Medicine.

Therapy Services

Licensed occupational and physical therapists and speech language pathologists can provide services through telehealth.  Evaluations and reevaluations must be performed as an in-person visit to the participant and is not covered through telehealth.  Therapeutic procedures and activities are covered via telehealth. (Please see manual for a list of telehealth covered services.)

The therapist must certify that the services can be safely and effectively done with telehealth.  The physician order must specifically allow the services to be provided via telehealth.  The physician or non- physician practitioner order must specifically allow the services to be provided by telehealth.

Interpretation Services

Idaho Medicaid reimburses for interpretation, translation, Braille, and sign language in conjunction with a reimbursable Medicaid service.

Speech Language Pathology

Speech therapy services can be delivered via telehealth. Evaluations must be performed in-person. The speech therapist must certify that the services can safely and effectively be done with telehealth.

SOURCE:  ID Medicaid Provider Handbook, Therapy Services Feb. 2021, pg 38Occupational and Physical Therapy Services Jan. 1, 2020, p. 9  & Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Jan. 19, 2021, p. 122-123. (Accessed Feb. 2021).

Community Based Rehabilitation Services (CBRS) supervision is covered via telehealth

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Jan. 19, 2021, p. 123. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Physicians and non-physician practitioners enrolled as Healthy Connections primary care providers are eligible to provide primary care services via telehealth.

Idaho Medicaid will cover speech therapy (92507) when provided by a licensed speech language pathologist.

Idaho Medicaid will cover therapy services for occupational therapists and physical therapists.

Only one eligible provider may be reimbursed for the same service per participant per date of service.

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Jan. 19, 2021, p. 122-123 (Accessed Feb. 2021).

Idaho Medicaid will cover speech therapy (92507) when provided by a licensed speech language pathologist.

SOURCE: ID Medicaid Provider Handbook, Therapy Services Feb. 2021, pg 38  (Accessed Feb. 2021).

Physicians and psychiatric nurse practitioners may provide psychotherapy to participants in crisis via telehealth.

SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician Practitioner.  Sec. 4.28.3, Pg. 59. (Feb. 2021), (Accessed Feb. 2021).


ELIGIBLE SITES

Telehealth services as an encounter by a facility are reimbursable if the services are delivered in accordance with the ID Medicaid Telehealth Policy.

SOURCE: Idaho MMIS Provider Handbook: Ambulatory Health Care Facility. Nov. 1, 2018., p. 10 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No reimbursement for use of equipment at either the remote or originating site.

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers.  Jan.19, 2021, p. 123.  (Accessed Feb. 2021).

 

 

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Illinois

Last updated 02/28/2021

POLICY

The Department of Healthcare and Family Services shall reimburse …

POLICY

The Department of Healthcare and Family Services shall reimburse psychiatrists, federally qualified health centers as defined in Section 1905(l)(2)(B) of the federal Social Security Act, clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing, and mental health professionals and clinicians authorized by Illinois law to provide behavioral health services to recipients via telehealth.  The Department, by rule, shall establish: (i) criteria for such services to be reimbursed, including appropriate facilities and equipment to be used at both sites and requirements for a physician or other licensed health care professional to be present at the site where the patient is located; however, the Department shall not require that a physician or other licensed health care professional be physically present in the same room as the patient for the entire time during which the patient is receiving telehealth services; and (ii) a method to reimburse providers for mental health services provided by telehealth.

SOURCE:  305 ILCS 5/5-5.25.  (Accessed Feb. 2021).

Health insurance providers must include coverage for licensed dietitians, nutritionists, and diabetes educators who counsel senior diabetes patients, via telehealth, in the patients’ homes to remove the hurdle of transportation for patients to receive treatment.

SOURCE: 215 ILCS 5/356z.22 (Accessed Feb. 2021). 

Illinois Medicaid will reimburse for live video under the following conditions:

  • A physician or other licensed health care professional [or other licensed clinician, mental health professional or qualified mental health professional, for telepsychiatry must be present with the patient at all times with the patient at the originating site;
  • The distant site provider must be a physician, physician assistant, podiatrist or advanced practice nurse who is licensed by Illinois or the state where the patient is located.  For telepsychiatry, it must be a physician who has completed an accredited general psychiatry residency program or an accredited child and adolescent psychiatry residency program;
  • The originating and distant site provider must not be terminated, suspended or barred from the Department’s medical programs;
  • Telepsychiatry: The distant site provider must personally render the telepsychiatry service;
  • Medical data may be exchanged through a telecommunication system.  For telepsychiatry it must be an interactive telecommunication system;
  • The interactive telecommunication system must, at a minimum, have the capability of allowing the consulting distant site provider to examine the patient sufficiently to allow proper diagnosis of the involved body system.  The system must also be capable of transmitting clearly audible heart tones and lung sounds, as well as clear video images of the patient and any diagnostic tools, such as radiographs;
  • Telepsychiatry:  Group psychotherapy is not a covered telepsychiatry service.

SOURCE: IL Admin. Code Title 89, 140.403(b). (Accessed Feb. 2021). 

For telemedicine services, a physician or other licensed health care professional must be present at all times with the patient at the originating site.

For telepsychiatry services, a staff member meeting the minimum qualifications of a mental health professional (MHP) must be present at all times with the patient at the originating site.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7 p. 25, (Sept. 2020). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Appropriate CPT codes must be billed with the GT modifier for telemedicine and telepsychiatry services and the appropriate Place of Service code, 02, telehealth.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7 p. 25, (Sept. 2020). (Accessed Feb. 2021).

There is no reimbursement for group psychotherapy as a telepsychiatry service.

SOURCE: IL Admin. Code Title 89, 140.403. (Accessed Feb. 2021).

Home Health Services

A face-to-face encounter may occur through telehealth.

SOURCE: IL Dept. of Healthcare and Family Svcs., Handbook for Home Health Services. Ch. R-200 Policy and Procedures, R-205.1 p. 19, (May 2016). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

The Department of Healthcare and Family Services required to reimburse psychiatrists, federally qualified health centers, clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing and mental health professionals and clinicians authorized by Illinois law to provide behavioral health services via telehealth.

SOURCE:  ILCS 5/5.25, (Accessed Feb. 2021).

For telemedicine services, the distant site provider must be a physician, physician assistant, podiatrist, or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.

  • Practitioner Handbook:  When medically appropriate, more than one Distant Site provider may bill for services rendered during the telehealth visit.
  • Podiatry Handbook:  Services rendered by an APN can be billed under the collaborating physician’s NPI, or if the APN is enrolled, under the APN’s NPI. When medically appropriate, more than one Distant Site provider may bill for services rendered during the telehealth visit.

For telepsychiatry, the distant site provider must be a physician who is licensed by the State of Illinois or by the state where the patient is located who has completed an accredited general psychiatry residency program or an accredited child and adolescent psychiatry residency program.

  • Practitioner Handbook: To be eligible for reimbursement for telepsychiatry services, physicians must enroll in the correct specialty/sub-specialty in IMPACT.
  • Encounter Clinic Handbook:  Telepsychiatry is not a covered service when rendered by an APN or PA.  Group psychotherapy is not a covered telepsychiatry service.

SOURCE: IL Admin. Code Title 89, 140.403(b) ; IL Dept. of Healthcare and Family Svcs., Handbook for Podiatrists (physician services only), F-200, F-220.6.2 p. 28 (Oct. 2016);   & Handbook for Practitioner Services. Ch. 200, 220.5.7 p. 26 (Sept. 2020) & Handbook for Encounter Clinic Services. Ch. 200, 210.2.2 pg. 17. (Aug. 2016). (Accessed Feb. 2021).

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

  1. If the originating site is another encounter clinic, the distant site encounter clinic shall receive no reimbursement from the Department.  The originating site encounter clinic is responsible for reimbursement to the distant site encounter clinic; and
  2. If the originating site is not an encounter clinic, the distant site encounter clinic shall be reimbursed for its medical encounter.  The originating site provider will receive a facility fee.

See handbook supplement for telehealth billing examples.

SOURCE: IL Admin. Code Title 89, 140.403IL Dept. of Healthcare and Family Svcs., Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010; Handbook for Encounter Clinic Services. Ch. 200, pg. 17.  Aug. 2016 & IL All Providers Handbook Supplement (Sept. 2020), pg. 43-45. (Accessed Feb. 2021).

Encounter Rate Clinics, Federally Qualified Health Centers (FQHC), and Rural Health Clinics, are allowed to render telemedicine services.

SOURCE:  Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010 (Accessed Feb. 2021). 


ELIGIBLE SITES

The Department shall reimburse any Medicaid certified eligible facility or provider organization that acts as the location of the patient at the time a telehealth service is rendered, including substance abuse centers licensed by the Department of Human Services’ Division of Alcoholism and Substance Abuse.

SOURCE:  ILCS 5/5.25(c), (Accessed Feb. 2021).  

For telemedicine services, a physician or other licensed health care professional must be present at all times with the patient at the originating site.

For telepsychiatry services, A physician, licensed health care professional or other licensed clinician, mental health professional (MHP), or qualified mental health professional (QMHP), must be present at all times with the patient at the originating site.

SOURCE: IL Admin. Code Title 89, 140.403(b). (Accessed Feb. 2021). 

For telemedicine services, a physician or other licensed health care professional must be present at all times with the patient at the originating site.

For telepsychiatry services, a staff member meeting the minimum qualifications of a mental health professional (MHP) must be present at all times with the patient at the originating site.

SOURCE:  IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. A-200 Policy and Procedures, 220.5.7  p. 25, (Sept. 2020). (Accessed Feb. 2021).

See handbook supplement for telehealth billing examples.

SOURCE: All Providers Handbook Supplement (Sept. 2020), pg. 43-45. (Accessed Feb. 2021). 

Eligible originating sites for the facility fee include:

  • Physician’s office
  • Podiatrist’s office
  • Local health departments;
  • Community mental health centers;
  • Outpatient hospitals.

An encounter clinic is eligible as an originating site and is responsible for ensuring and documenting that the distant site provider meets the department’s requirements for telehealth and telepsychiatry services, since the clinic is responsible for reimbursement to the distant site provider.

Enrolled distant site providers may not seek reimbursement from the Department for their services when the originating site is an encounter clinic. The originating site encounter clinic is responsible for reimbursement to the distant site provider.

SOURCE: IL Dept. of Healthcare and Family Svcs., Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. 200, p. 25Handbook for Podiatrists, F-200, p. 27 (Oct. 2016); & Handbook for Encounter Clinic Services. Ch. D-200, pg. 17.  Aug. 2016. (Accessed Feb. 2021).

Local education agencies may submit telehealth services as a certified expenditure.

SOURCE: IL Admin. Code Title 89, 140.403(c)(1)(B). (Accessed Feb. 2021).

Non-enrolled providers rendering services as a Distant Site provider shall not be eligible for reimbursement from the department, but may be reimbursed by the Originating Site provider from their facility fee payment.

SOURCE: IL Dept. of Healthcare and Family Svcs. Handbook for Practitioners. Ch. 200, p. 25, & Handbook for Podiatrists, F-200, p. 28 (Oct. 2016)(Accessed Feb. 2020).

For medical services, the provider rendering the service at the distant site can be a physician, physician assistant, podiatrist or advanced practice nurse, who is licensed by the State of Illinois or by the state where the patient is located.

SOURCE: Handbook for Podiatrists, F-200, 220.6.2 p. 27 (Oct. 2016). (Accessed Feb. 2021);


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

There is reimbursement for originating site facility fees.

Eligible facilities include:

  • Physician’s office;
  • Podiatrist’s office
  • Local health departments
  • Community mental health centers
  • Outpatient hospitals

SOURCE: IL Handbook for Practitioners Rendering Medical Services, Ch. 200, p. 25 (Sept. 2020) & PractitionerHandbookPolicyPhysicianAssistantChangesFinal.pdf  Handbook for Podiatrists, F-200, p. 27 (Oct. 2016). (Accessed Feb. 2021).

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Indiana

Last updated 02/28/2021

POLICY

Indiana Code requires reimbursement for video conferencing for FQHCs, …

POLICY

Indiana Code requires reimbursement for video conferencing for FQHCs, Rural Health Clinics, Community Mental Health Centers, Critical Access Hospitals and a provider determined by the office to be eligible, providing a covered telemedicine service.

SOURCE: IN Code, 12-15-5-11 (Accessed Feb. 2021).

The Indiana Health Coverage Programs (IHCP) covers telemedicine services, including medical exams and certain other services normally covered by Medicaid.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct 1, 2019, p.1. (Accessed Feb. 2021).   

In any telemedicine encounter, there will be the following:

  • A distant site;
  • An originating site;
  • An attendant to connect the patient to the provider at the distant site; and
  • A computer or television monitor at the distant and originating sites to allow the patient to have real-time, interactive; and face-to-face communication with the distant provider via IATV technology.

The patient must be physically present and participating in the visit.

SOURCE: IN Admin. Code, Title 405, 5-38-3 & 4.IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p.1 & 2. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

All services that are available for reimbursement when delivered as telemedicine are subject to the same limitations and restrictions as they would be if not delivered by telemedicine.

There is a specific telemedicine Services Codes list accessible on the Indiana Medicaid website with CPT codes that are reimbursable when the services are rendered via telemedicine at the distant site and billed with modifier 95 and POS code 02.  Use of GT modifier is optional.

Although reimbursement for ESRD-related services is permitted in the telemedicine setting, the IHCP requires at least one monthly visit for ESRD-related services to be a traditional clinical encounter to examine the vascular access site.

FQHCs/RHCs:  FQHCs and RHCs may bill for telemedicine services if the service rendered is considered a valid FQHC/RHC encounter and a covered telemedicine service.  Other requirements and billing instructions are included in the manual.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 3-4. (Accessed Feb. 2021).  

IHCP does not reimburse the following provider types for telemedicine:

  • Ambulatory surgical centers;
  • Outpatient surgical services;
  • Home health agencies or services (For information about home health agency reimbursement for telehealth services, see the Telehealth Services section);
  • Radiological services;
  • Laboratory services;
  • Long-term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled;
  • Anesthesia services or nurse anesthetist services;
  • Audiological services;
  • Chiropractic services;
  • Care coordination services;
  • Durable medical equipment, and home medical equipment providers
  • Optical or optometric services;
  • Podiatric services;
  • Physical therapy services;
  • Transportation services;
  • Services provided under a Medicaid home and community-based services waiver.
  • Provider to provider consultations

SOURCE: IN Admin. Code, Title 405, 5-38-4 ; IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 2. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

The distant site physician or practitioner must determine if it is medically necessary for a medical professional to be at the originating site.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 2. & IN Admin. Code, Title 405, 5-38-4(2). (Accessed Feb. 2021).

Federally qualified health centers and rural health centers are eligible distant sites as long as services meet both the requirements of a valid encounter and a covered telemedicine service as defined in the IHCP’s telemedicine policy.  See manual for special billing instructions.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 4. (Accessed Feb. 2021).  

Provider types listed under Services Not Reimbursed (under Eligible Services/Specialties section) are not eligible to be reimbursed for telemedicine.

SOURCE: IN Admin. Code, Title 405, 5-38-4(5). (Accessed Feb. 2021).

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

  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Community mental health centers
  • Critical access hospitals
  • A provider, as determined by the office to be eligible, providing a covered telemedicine service

SOURCE: IN Admin Code, 405 5-38-4(3)IN Code 12-15-5-11.  (Accessed Feb. 2021).


ELIGIBLE SITES

Services may be rendered in an inpatient, outpatient or office setting.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 2. (Accessed Feb. 2021). 

Federally qualified health centers and rural health clinics acting as the originating site may be reimbursed if it is medically necessary for a medical professional to be with the member, and the service provided includes all components of a valid encounter code.  See manual for billing requirements.

All components of the service must be provided and documented, and the documentation must demonstrate medical necessity. All documentation is subject to post-payment review.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 4-5. (Accessed Feb. 2021).

Separate reimbursement for a provider at the originating site is payable only if that provider’s presence is medically necessary. Documentation must be maintained in the patient’s medical record to support the need for the provider’s presence at the originating site during the visit. Such documentation is subject to post-payment review. If a healthcare provider’s presence at the originating site is medically necessary, billing of the appropriate evaluation and management code is permitted.

SOURCE (hub-spoke provider reimbursement): IN Admin. Code, Title 405, 5-38-4 & IN Medicaid Telemedicine and Telehealth Module,Oct. 1, 2019, p. 2. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Healthcare Common Procedure Coding System (HCPCS) code Q3014 – Telehealth originating site facility fee, billed with modifier 95, is reimbursable for providers that render services via telemedicine at the originating site.

FQHCs/RHCs:  Separate reimbursement for merely serving as the originating site is not available to FQHCs and RHCs. When the presence of a medical professional is not medically necessary at the originating site, neither the facility fee, as billed by HCPCS code Q3014, nor the facility-specific PPS rate is available, because the requirement of a valid encounter is not met.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 4 & 5. (Accessed Feb. 2021).

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Iowa

Last updated 02/28/2021

POLICY

Department of Human Services is required to adopt rules …

POLICY

Department of Human Services is required to adopt rules to provide telehealth coverage under Medicaid.  Such rules must provide that in-person contact between a health care professional and a patient is not required as a prerequisite for payment.

SOURCE: IA Senate File 505 (2015), Sec. 12(23), pg. 32-33. (Accessed Feb. 2021). 

An in-person contact between a health care professional and a patient is not required as a prerequisite for payment for otherwise-covered services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services are provided. Health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement.

SOURCE: IA Admin Code Sec. 441, 78.55 (249A). (Accessed Feb. 2021).

Managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawki) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

SOURCE: IA Hawki Benefits. (Accessed Feb. 2021).  

Crisis Response Services and Subacute Mental Health Services.

Payment shall be made for time spent in face-to-face services with the member.  “Face-to-face” means services in-person or using telehealth in conformance with the federal Health Insurance Portability and Accountability Act (HIPAA) privacy rules.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Crisis Response Services, p. 3 & 19, May 1, 2018, p. 19; Subacute Mental Health Services.  May 1, 2018, p. 9. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


ELIGIBLE PROVIDERS

The following providers may serve as the distant site provider:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Nurse-Midwives
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists
  • Clinical Psychologists
  • Clinical Social Workers
  • Federally Qualified Health Centers
  • Behavioral Health Service Providers
    • Licensed Independent Social Workers
    • Licensed Master Social Workers
    • Licensed Marital and Family Therapists
    • Licensed Mental Health Counselors
    • Certified Alcohol and Drug Counselors

SOURCE:  Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Feb. 2021).


ELIGIBLE SITES

The following locations may serve as the originating site:

  • The offices of physicians and other practitioners (psychologists, social workers, behavioral health providers, habilitation services providers, and advanced registered nurse practitioners (ARNPs)).
  • Hospitals
  • Critical Access Hospitals
  • Community Mental Health Centers
  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Area Education Agencies (AEAs) and Local Education Agencies

SOURCE:  Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Originating sites are paid a facility fee for telehealth services. FQHCs and RHCs would not bill Q3014 as a separate service because reimbursement for the related costs would occur through the annual cost settlement process.

SOURCE:  Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Feb. 2021).

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Kansas

Last updated 02/28/2021

POLICY

Insurers (including Medicaid) cannot exclude from coverage a service …

POLICY

Insurers (including Medicaid) cannot exclude from coverage a service solely because the service is provided through telemedicine, rather than in-person contact or based upon the lack of a commercial office for the practice of medicine, when such service is delivered by a healthcare provider.

SOURCE: KS Statute Ann. § 40-2,213(b).  (Accessed Feb. 2021). 

Services provided through telemedicine must be medically necessary and are subject to the terms and conditions of the individual’s health benefits plan.

Payment or reimbursement of covered healthcare services delivered through telemedicine is the payment or reimbursement for covered services that are delivered through personal contact.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p.  2-30 (Jan. 2020). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Eligible services:

  • Office visits;
  • Individual psychotherapy;
  • Pharmacological management services.

The consulting or expert provider at the distant site must bill with the 02 place of service code.  The GT modifier is no longer required.

See manual for list of acceptable CPT codes.  Telemedicine will be reimbursed at the same rate as face-to-face services.

KMAP does not recognize CPT Codes 99241-99245 and 99251-99255.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-29 (Jan. 2020) & FQHC/RHC, 8-13 (Feb. 2021), (Accessed Feb. 2021) & KS Dept. of Health and Environment, Kansas Medical Assistance Program, RHC/FQHC Fee-for-Service Provider Manual, Benefits & Limitations. (Accessed Feb. 2021).

Mental health assessment can be delivered by a nonphysician at a professional level and delivered either face-to-face or through telemedicine. Consultation with a physician or other providers to assist with the individual’s specific crisis may be billed either as face-to-face or via Telemedicine.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Mental Health, p. 8-10, 8-18 (Jan. 2021). (Accessed Feb. 2021). 

Speech-language pathologists and audiologists licensed by KDADS may provide services via telemedicine. See manual for specific codes for eligible telemedicine services. Services must be provided via real-time, interactive (synchronous) audio-video telecommunication equipment that is compliant with HIPAA. Codes not appearing on the list are not covered via telemedicine.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-27 & 2-28 (Jan. 2020). (Accessed Feb. 2021).

Kansas Medicaid does not authorize the use of telemedicine in the delivery of any abortion procedure.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31 (Jan. 2020). (Accessed Feb. 2021). 

Autism Service

Parent support and training as well as Family Adjustment Counseling can be provided via telemedicine, telehealth, or other modes of video distance monitoring methods that adhere to all required HIPPA guidelines and meet the state standards for telemedicine delivery methods.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Autism Services, p. 8-5 & 8-8 (May 2019). (Accessed Feb. 2021). 

Intellectual/Developmentally Disabled Services

All functional assessments must be conducted in-person at a location of the individual’s choosing, or, if available, through the use of real-time interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

SOURCE: KS Dept. of Health and Environment, Provider Manual, HCBS Intellectual/Developmentally Disabled, p. I-1 (Mar. 2019). (Accessed Feb. 2021). 

Substance Use Disorder directs providers to General Benefits manual telemedicine section.

SOURCE: KS Dept. of Health and Environment, Provider Manual, Substance Use Disorder, p. 8-10, (Jan. 21, 2020), (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Telemedicine and telehealth services may be delivered by a healthcare provider, which includes:

  • Physicians
  • Licensed Physician Assistants
  • Licensed Advanced Practice Registered Nurses
  • Other persons licensed, registered, certified, or otherwise authorized to practice by the behavioral sciences regulatory board.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-29 (Jan. 2020). (Accessed Feb. 2021). 

Speech-language pathologists and audiologists licensed by the Kansas Department for Aging and Disability Services (KDADS) may also furnish appropriate and medically necessary services within their scope of practice via telemedicine. Services must be provided via real-time, interactive (synchronous) audio-video telecommunication equipment that is compliant with HIPAA.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-27 (Jan. 2020); Early Childhood Intervention Fee-for-Service Provider Manual, p. 8-2 (Jan. 2021) ; Local Education Agency Services, p. 8-7 (Jan. 2020); & Rehabilitative Therapy Services, p. 8-4, (Oct. 2020). (Accessed Feb. 2021).

Providers who are not RHC or FQHC providers and are acting as the distant site will be reimbursed in accordance with a percentage of the Physician Fee Schedule and not an encounter rate.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-12, (Jan. 2021), (Accessed Feb. 2021).


ELIGIBLE SITES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

The originating site, with the beneficiary present, may bill code Q3014 for the originating site fee with the appropriate POS code.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-29 (Jan. 2020). & KS Dept. of Health and Environment, Kansas Medical Assistance Program, RHC/FQHC Fee-for-Service Provider Manual, Benefits & Limitations. (Accessed Feb. 2021).

 

 

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Kentucky

Last updated 02/28/2021

POLICY

Kentucky Medicaid will reimburse for a “telehealth consultation”, which …

POLICY

Kentucky Medicaid will reimburse for a “telehealth consultation”, which includes live video.

Reimbursement shall not be denied solely because an in-person consultation between a provider and a patient did not occur.

SOURCE: KY Revised Statutes § 205.559. (Accessed Feb. 2021).

The department must reimburse an eligible telehealth care provider for a telehealth service in an amount that is at least 100 percent of the amount for a comparable in-person service. A managed care plan may establish a different rate for telehealth reimbursement via contract.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Telehealth service means any service that is provided by telehealth that is one of the following:

  • Event
  • Encounter
  • Consultation, including a telehealth consultation
  • Visit
  • Store-and-forward transfer
  • Referral
  • Treatment

A service is not reimbursed if:

  • It is not medically necessary;
  • The equivalent service is not covered by the department if provided in a face-to-face setting; or
  • The provider is not enrolled, participating, or in good standing with the Medicaid program, is on an excluded or terminated provider list, or is an excluded individual or entity, as listed on the US Office of Inspector General List.

Reimbursement is not made for services that are not:

  • Medically necessary;
  • Compliant with administrative regulation;
  • Applicable to this administrative regulation; or
  • Compliant with state or federal law.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

A “telehealth care provider” is a Medicaid provider who is:

  • Currently enrolled as a Medicaid provider;
  • Participating as a Medicaid provider;
  • Operating within the scope of the provider’s professional licensure; and
  • Operating within the provider’s scope of practice.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Feb. 2021).

Eligible providers for services NOT in a Community Mental Health Center:

  • A psychiatrist;
  • A licensed clinical social worker directly employed by a psychiatrist if the psychiatrist also interacts with the recipient during the encounter;
  • A psychologist with a license and a doctorate degree in psychology directly employed by a psychiatrist if the psychiatrist also interacts with the recipient during the encounter;
  • A licensed professional clinical counselor directly employed by a psychiatrist if the psychiatrist also interacts with the recipient during the encounter;
  • A licensed marriage and family therapist directly employed by a psychiatrist if the psychiatrist also interacts with the recipient during the encounter;
  • A physician;
  • An APRN;
  • Speech-language pathologist;
  • Occupational therapist;
  • Physical therapist;
  • Licensed dietitian or certified nutritionist; or
  • Registered nurse or dietitian

Eligible providers for services in a Community Mental Health Center:

  • A psychiatrist;
  • A physician;
  • Psychologist with a license in accordance with KRS 319.010(6);
  • A licensed marriage and family therapist;
  • A licensed professional clinical counselor;
  • A psychiatric medical resident;
  • A psychiatric registered nurse;
  • A licensed clinical social worker;
  • An advanced practice registered nurse

Restrictions apply for all professionals.

SOURCE: KY State Plan Amendment. Attachment 3.1-B. Approved 3/9/2011 (Accessed Feb. 2021).


ELIGIBLE SITES

Place of service is anywhere the patient is located at the time a telehealth service is provided, and includes telehealth services provided to a patient at home or office, or a clinic, school or workplace.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No Reference Found

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Louisiana

Last updated 02/28/2021

POLICY

Louisiana Medicaid only reimburses the distant site for services …

POLICY

Louisiana Medicaid only reimburses the distant site for services provided via telemedicine. Reimbursement for services provided by telemedicine/telehealth is at the same level as services provided in person.

Covered services must be identified on claims submissions by appending the modifier “95” to the applicable procedure code and indicate Place of Service (POS) 02. Both the correct POS and modifier must be present on the claim to receive reimbursement.

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 151-152 (As revised on Sept. 03, 2020). (Accessed Feb. 2021).

Louisiana Medicaid services provided via an interactive audio and video telecommunications system shall be identified on claim submissions by appending the HIPPA compliant POS or modifier to the appropriate procedure code, in line with current policy.

SOURCE: LA Admin. Code 50: I.503, (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Recently Passed Legislation (Now Effective)

The department shall periodically review policies regarding Medicaid reimbursement for telehealth services to identify variations between permissible reimbursement under that program and reimbursement available to healthcare providers under the Medicare program.

The department may modify its administrative rules, policies, and procedures applicable to Medicaid reimbursement for telehealth services as necessary to provide for a reimbursement system that is comparable to that of the Medicare program for those services.

SOURCE:  LA Statute Sec. 1255.1 (HB 589 – 2020 Session). (Accessed Feb. 2021). 

When otherwise covered, services located in the Telemedicine appendix of the CPT manual, or its successor, may be reimbursed when provided by telemedicine/telehealth. In addition, other specified services may be reimbursed when provided by telemedicine/telehealth and these services are explicitly noted in this manual.

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 151. (Sept. 3, 2020). (Accessed Feb. 2021).

Behavioral Health Services

Family psychotherapy, individual psychotherapy, and medication management services may be reimbursed when provided via telecommunication technology.

SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 6 (As revised on Aug. 04, 2020). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

The distant site provider must be enrolled as a Louisiana Medicaid provider to receive reimbursement for covered services.

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 151 (As revised on Sept. 03, 2020). (Accessed Feb. 2021). 

Behavioral Health

“Healthcare provider,” as used herein, means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution licensed or certified by this state to provide health care or professional services as a physician assistant, hospital, nursing home, registered nurse, advanced practice registered nurse, licensed practical nurse, psychologist, medical psychologist, social worker, or licensed professional counselor.

SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 7 (As revised on Aug. 04, 2020). (Accessed Feb. 2021).

Reimbursement for FQHCs will be set at the all-inclusive prospective payment rate on file for the date of service.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (Jan. 10, 2020). (Accessed Feb. 2021). 

FQHC manual refers to provider manual for billing instructions.

SOURCE: LA Dept. of Health and Hospitals, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.4, pp. 6, 07/14/2020. (Accessed Feb. 2021).


ELIGIBLE SITES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Louisiana Medicaid only reimburses the distant site provider.

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 151 (As revised on Sept. 03, 2020). (Accessed Feb. 2021).

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Maine

Last updated 02/28/2021

POLICY

If the Member is eligible for the underlying covered …

POLICY

If the Member is eligible for the underlying covered service to be delivered, and if delivery of the covered service via telehealth is medically appropriate, as determined by the health care provider, the member is eligible for telehealth services.

No reimbursement for communication between health care providers when the member is not present at the originating site, except as specified in the provider manual.

No reimbursement for communications solely between health care providers and members when such communications would not otherwise be billable, except as specified in the provider manual.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 3 & 9. (June 15, 2020). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Any medically necessary MaineCare Covered Service may be delivered via Interactive Telehealth Services, provided the following requirements are met:

  1. The Member is otherwise eligible for the Covered Service, as described in the appropriate section of the MaineCare Benefits Manual; and
  2. The Covered Service delivered by Interactive Telehealth Services is of comparable quality to what it would be were it delivered in person.

There is a specific list of telehealth specific codes and reimbursement rates provided in the manual.

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

Non-Covered services include:

  • Medical equipment, supplies, orthotics and prosthetics
  • Personal care aide
  • Pharmacy services for prescribed drugs
  • Assistive technology services (for certain applicable sections, see manual)
  • Non-emergency medical transportatio
  • Services that require physical contact
  • Any service medically inappropriate for telehealth services.

See manual for details of the exclusions.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 4-5, 7-9. (June 15, 2020). (Accessed Feb. 2021).

The Department of Health and Human Services shall, no later than September 30, 2020, amend its rule Chapter 101: MaineCare Benefits Manual, Chapter I, Section 4, Telehealth and Chapter 101: MaineCare Benefits Manual, Chapter II, Section 13, Targeted Case Management Services to provide for reimbursement of case management services delivered through telehealth to targeted populations.

NOTE: As of Feb. 2021, these documents do not yet reflect this change.

SOURCE:  LD 1974 (2020 Session). (Accessed Feb. 2021).

A multitude of services are listed as being allowed either face-to-face or through telehealth in the behavioral health services manual.

SOURCE:  MaineCare Benefits Manual, Behavioral Health Services, 10-44 Ch. II, Sec. 65, pgs. 51-52 (Aug. 19, 2020). (Accessed Feb. 2021).

Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations

Telemedicine may be utilized as clinically appropriate, according to the standards described in Chapter I, Section 4 of the MaineCare Benefits Manual.

SOURCE: MaineCare Benefits Manual, Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations, 28.08, Ch. 101, Ch. II, Sec. 28, p. 12, (9/23/19), (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

A health care provider is an individual or entity licensed or certified under the laws of the state of Maine to provide medical, behavioral health, and related services to MaineCare Members. Health Care Providers must be enrolled as MaineCare Providers in order to be reimbursed for services.

A health care provider must also be:

  • Acting within the scope of his or her license
  • Enrolled as a MaineCare provider; and
  • Otherwise eligible to deliver the underlying Covered Service

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.03., p 1 & 4. (June 15, 2020). (Accessed Feb. 2021). 

If approved by HRSA and the state, a FQHC, RHC, or IHC may serve as the provider site and bill under the encounter rate.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 13. (June 15, 2020). (Accessed Feb. 2021).


ELIGIBLE SITES

The Originating (Member) Site will usually be a Health Care Provider’s office, but it may also be the Member’s residence, provided the proper equipment is available for Telehealth Services.

FQHCs, RHCs or IHCs may be originating sites.

The Health Care Providers at the Receiving and Originating Sites may be part of the same organization. In addition, a Health Care Provider at the Originating (Member) Site may bill MaineCare and receive payment for Telehealth Services if the service is provided by a qualified professional who is under a contractual arrangement with the Originating (Member) Site.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4., p. 2 & 13 & 14. (June 15, 2020). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

A facility fee is provided to a health care provider at the originating site.

An originating facility fee may only be billed in the event that the originating site is in a healthcare provider’s facility.

An Originating Facility Fee may not be billed for a Telephonic Service.

When an FQHC or RHC serves as the originating site, the facility fee is paid separately from the center or clinic all-inclusive rate.

The Department does not reimburse a transmission fee.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 2, 9, 13. (June 15, 2020). (Accessed Feb. 2021).

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Maryland

Last updated 02/28/2021

POLICY

Reimbursement for telehealth is required for services appropriately delivered …

POLICY

Reimbursement for telehealth is required for services appropriately delivered through telehealth and may not exclude from coverage a health care service solely because it is through telehealth.

SOURCE: Insurance Code 15-139 (Accessed Feb. 2021). 

To the extent authorized by federal law or regulation, the provisions of § 15–139(c) through (f) (see reference above) of the Insurance Article relating to coverage of and reimbursement for health care services delivered through telemedicine shall apply to the Program and managed care organizations in the same manner they apply to carriers.

The Department may require providers to submit a registration form to include information required for the processing of telehealth claims.

SOURCE: MD General Health Code Sec. 15-105.2 (Accessed Feb. 2021).

Managed Care

MCOs shall provide coverage for medically necessary telemedicine services.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.67.06.31. (Accessed Feb. 2021).

Maryland Medicaid provides a telehealth program that employs a “hub-and-spoke” model. This model involves real-time interactive communication between the originating and distant sites via a secure, two-way audiovisual telecommunication system. The “telepresenter,” physically located at the originating site with the participant, facilitates the telehealth communication between the participant and distant site provider by arranging, moving, or operating the telehealth equipment.

SOURCE: MD Medicaid Telehealth Program. Telehealth Program Manual, p. 1. Updated April 2020. (Accessed Feb. 2021).

Mental Health

The Department shall grant approval to a telemental health provider to be eligible to receive State or federal funds for providing interactive telemental health services if the provider meets requirements of this chapter and for outpatient mental health centers; or if the telemental heath provider is an individual psychiatrist.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.03. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Covered Services – Somatic and behavioral health services:  Providers must contact the participant’s Healthchoice MCO or behavioral health ASO with questions regarding prior authorization requirements for telehealth services.

SOURCE: MD Medicaid Telehealth Program. Telehealth Program Manual, p. 2. Updated April 2020. (Accessed Feb. 2021).

The Department, under the Telehealth Program, covers medically necessary services covered by the Maryland Medical Assistance Program rendered by a distant site provider that are:

  • Distinct from services provided by the originating site provider;
  • Able to be delivered using technology-assisted communication; and
  • Clinically appropriate to be delivered via telehealth.

Services must be provided via telehealth to the same extent and standard of care as services provided in person; and as determined by the providers licensure or credentialing board, services performed via telehealth must be within the scope of a provider’s practice.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.04. (Accessed Feb. 2021).

Services should be billed with the GT modifier.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.10. (Accessed Feb. 2021).

Mental Health Eligible Services:

  • Diagnostic interview;
  • Individual therapy
  • Family therapy
  • Group therapy, up to 8 individuals
  • Outpatient evaluation and management
  • Outpatient office consultation
  • Initial inpatient consultation
  • Emergency department services

SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.09. (Accessed Feb. 2021).

Subject to the limitations of the State budget, the medical assistance program shall provide mental health services appropriately delivered through telehealth to a patient in the patient’s home setting.

SOURCE: MD General Health Code Sec.15.103 (HB 1208 & SB 502 – 2020 Session). (Accessed Feb. 2021).

Effective Immediately, expires June 30, 2025:

On or before Dec. 1, 2020, the Department shall apply to the Centers for Medicare and Medicaid Services for an amendment to any of the state’s 1115 waivers necessary to implement a pilot program to provide services to program recipients regardless of the program recipient’s location at the time telehealth services are provided.  Chronic condition case management services will be available through the pilot.  The Department shall collect outcomes data on recipients of telehealth services under the pilot program to evaluate the effectiveness of the pilot program and submit a report to the Department on or before Dec. 1, 2020 and every 6 months after that.

SOURCE: MD General Health Code Sec.15.141.2 (HB 1208 & 502-2020 Session), (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Expires in three years at the end of September 30, 2021

The Department may specify by regulation the types of health care providers eligible to receive reimbursement for health care services.  If the Department specifies by regulation the types of health care providers eligible to receive reimbursement, the types of health care providers shall include:

  • Primary care providers; and
  • Psychiatrists, and psychiatric nurse practitioners who are providing assertive community treatment or mobile treatment services to program recipients located in a home or community-based setting.

The health services provided by a psychiatrist or a psychiatric nurse practitioner must be equivalent to the same health care service when provided through in-person consultation.

* Effective Sept. 30, 2021, psychiatrists and nurse practitioners are removed from the eligible health care provider list above.

SOURCE:  MD General Health Code Sec. 15-105.2(b)(4)(ii) (Accessed Feb. 2021).

Effective October 7, 2019, all distant site providers enrolled in Maryland Medicaid may provide services via telehealth as long as telehealth is a permitted delivery model within the rendering provider’s scope of practice. Providers should consult their licensing board prior to rendering services via telehealth.

Telehealth providers must be enrolled in the Maryland Medical Assistance Program before rendering services via telehealth.

Only providers who are HIPAA compliant and meet Technical Requirements may bill for services rendered via telehealth.

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual, p. 1-3. Updated April 2020. (Accessed Feb. 2021).

Distant Site Providers may render services via telehealth within the provider’s scope of practice.

SOURCE:  Code of Maryland Admin. Regs. Sec. 10.09.49.06. (Accessed Feb. 2021).

Distant site providers may use secure space/areas in the provider’s home to engage in telehealth. Telehealth providers must meet the minimum requirements for privacy as well as the minimum requirements for technology.

Other permitted places of service from where to deliver services via telehealth include: school, office, inpatient hospital, outpatient hospital, emergency room, nursing facility, independent clinic, Federally Qualified Health Center (FQHC), community mental health center, non-residential substance abuse treatment facility, end-stage renal disease treatment facility, public health clinic.

SOURCE:  MD Medicaid Telehealth Program FAQs. p. 1, Updated April 2020. (Accessed Feb. 2021).

Mental Health

Eligible Providers:

  • Outpatient mental health centers
  • Telemental health providers who are individual psychiatrists.

Telemental health providers may be private practice, part of a hospital, academic, health or mental health care system.  Public Mental Health System (PMHS) approved community-based providers or individual practitioners may engage in agreements with TMH providers for services.  Fee-for-service reimbursement shall be at an enhanced rate, as stipulated by the Department, provided all applicable provisions of this chapter are met and funds are available.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.03 & Sec. 10.21.30.04. (Accessed Feb. 2021).


ELIGIBLE SITES

Eligible originating sites:

  • College or university student health or counseling office
  • Community-based substance use disorder provider
  • Deaf or hard of hearing participant’s home or any other secure location approved by the participant and provider
  • Elementary, middle, high or technical school with a supported nursing, counseling or medical office
  • Local health department
  • FQHC
  • Hospital, including emergency department
  • Nursing facility
  • Private office of a physician, physician assistant, psychiatric nurse practitioner, nurse practitioner, or nurse midwife
  • Opioid treatment program
  • Outpatient mental health center
  • Renal dialysis center; or
  • Residential crisis services site

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual, p. 2. Updated April 2020. & Code of Maryland Admin. Regs. Sec. 10.09.49.06. (Accessed Feb. 2021).

A school may still serve as the originating site for a telehealth interaction if the service is performed outside of an SBHC with an FQHC or local health department sponsor.

Schools are permitted to act as originating sites under Medicaid telehealth Program regulations. All distant site providers enrolled in Maryland Medicaid may provide services via telehealth as long as telehealth is a permitted delivery model within the rendering provider’s scope of practice. Providers should consult their licensing board prior to rendering services via telehealth.

SOURCE:  MD Medicaid Telehealth Program FAQs. p. 1-2, Updated April 2020 & School-based Health Center Provider Manual, p. 23, Revised Sept. 14, 2020. (Accessed Feb. 2021).

Subject to the limitations of the State budget, the medical assistance program shall provide mental health services appropriately delivered through telehealth to a patient in the patient’s home setting.

SOURCE: MD General Health Code Sec.15.103 (HB 1208 & SB 502 – 2020 Session), (Accessed Feb. 2021).

Mental Health

Eligible Originating Sites:

  • County government offices appropriate for private clinical evaluation services;
  • Critical Access Hospital;
  • Federally Qualified Health Center;
  • Hospital;
  • Outpatient mental health center;
  • Physician’s office;
  • Rural Health Clinic;
  • Elementary, middle, high, or technical school with a supported nursing, counseling or medical office; or
  • College or university student health or counseling office.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

The Telehealth Program serves Medicaid participants regardless of geographic location within Maryland.

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. p. 1, Updated April 2020. (Accessed Feb. 2021).

Mental Health

To be eligible a beneficiary must reside in one of the designated rural geographic areas or whose situation makes person-to-person psychiatric services unavailable.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05. (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

Hospital Billing Instructions

Facility charges related to the use of telemedicine services. This revenue code is payable for dates of service 10/1/13 forward.

SOURCE:  Maryland Dept. of Health Medical Assistance, UB04 Hospital Billing Instructions, 4/23/2020, p. 93 (Accessed Feb. 2021).

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Massachusetts

Last updated 02/28/2021

POLICY

Newly Passed Legislation (Now Effective)

The division and its …

POLICY

Newly Passed Legislation (Now Effective)

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth.

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.

Coverage that reimburses a provider with a global payment shall account for the provision of telehealth services to set the global payment amount.  See services section below for behavioral health services specific requirements for payment.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Feb. 2021) 

Telehealth is a modality of treatment, not a separate covered service. Providers are not required to deliver services via telehealth.

The bulletin does not apply to services under the Children’s Behavioral Health Initiative (CBHI) program, which may continue to be delivered via all modalities currently authorized in applicable program specifications.

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Newly Passed Legislation (Now Effective)

Health Care Services

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Feb. 2021) 

Behavioral Health Services

The division shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health services delivered via in-person methods; provided, that this subsection apply to providers of behavioral health services covered as required (see text for applicable behavioral health providers).

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Feb. 2021) 

The division of medical assistance shall ensure that rates of payment for in-network providers for telehealth services provided in pursuant to MA law (see text) are not less than the rate of payment for the same service delivered via in-person methods.

Source: Massachusetts Senate No. 2984. Section 68 (Accessed Feb. 2021)

Community Health Centers, Community Mental Health Centers, and Outpatient Substance Use Disorder providers (provider types 20, 26 and 28) may deliver the following covered services via telehealth:

  • All services specified in 101 CMR 306.00 et seq.; and
  • The outpatient services specified in the following categories:
  • Opioid Treatment Services: Counseling;
  • Ambulatory Services: Outpatient Counseling; Clinical Case Management; and
  • Services for Pregnant/Postpartum Clients: Outpatient Services

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Feb. 2021). 

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

SOURCE: MassHealth Transmittal Letter CHC-113, p. 6-11 & 6-12, Feb. 2020. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Newly Passed Legislation (Now Effective)

Coverage shall not be limited to services delivered by third-party providers.

SOURCE: Massachusetts Senate No. 2984. Section 40 para. 632 (Accessed Feb. 2021)


ELIGIBLE SITES

Newly Passed Legislation (Now Effective)

A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth; provided, however, that a patient may decline receiving services via telehealth in order to receive in-person services.

SOURCE: Massachusetts Senate No. 2984. Section 40 para. 655 (Accessed Feb. 2021)


GEOGRAPHIC LIMITS

A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth.

SOURCE: Massachusetts Senate No. 2984. Section 40  (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

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Michigan

Last updated 02/28/2021

POLICY

MDHHS requires a real time interactive system at both …

POLICY

MDHHS requires a real time interactive system at both the originating and distant site, allowing instantaneous interaction between the patient and health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary or there is an imminent health risk justifying immediate medical need for services.

Source: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1688. Jan. 2021 (Accessed Feb. 2021). 

Assertive Community Treatment Program

All telepractice interactions shall occur through real-time interactions between the ACT consumer and the physician/nurse practitioner/clinical nurse specialist from their respective physical location. Psychiatric services are the only ACT services that are approved to be provided in this manner.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 355-356 Jan. 2021 (Accessed Feb. 2021)


ELIGIBLE SERVICES/SPECIALTIES

Michigan Medicaid reimburses for the following service categories via live video:

  • ESRD-related services
  • Behavior change intervention
  • Behavioral Health and/or Substance Use Disorder Treatment
  • Education Services, Telehealth
  • Inpatient consultations
  • Nursing facility subsequent care
  • Office or other outpatient consultations
  • Office or other outpatient services
  • Psychiatric diagnostic procedures
  • Subsequent hospital care
  • Training service – Diabetes (see Diabetes Self-Management Education Training Program section in Hospital Chapter specific program requirements)

Where face-to-face visits are required (such as ESRD and nursing facility related services), the telemedicine service may be used in addition to the required face-to-face visit but cannot be used as a substitute. There must be at least one face-to-face hands-on visit (i.e., not via telemedicine) by a physician, physician’s assistant or advanced practice registered nurse per month to examine the vascular site for ESRD services. The initial visit for nursing facility services must be face-to-face.

Providers at the distant site can only bill services listed in the Telemedicine Services database.

Procedure codes and modifier information is contained in the MDHHS Telemedicine Services Database.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1688- 1689, Jan. 2021 (Accessed Feb. 2021).  

Speech-Language and Audiology Services

Speech, language and hearing services may be reimbursed. Requires an annual referral from a physician.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1784, Jan. 2021 (Accessed Feb. 2021). 

Assertive Community Treatment Program

The telepractice modifier, 95, must be used in conjunction with ACT encounter reporting code H0039 when telepractice is used.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 355 Jan. 2021 (Accessed Feb. 2021). 

Telepractice for BHT Services

Telepractice services must be prior authorized.  Telepractice must be obtained through real-time interaction between the child’s physical location (patient site) and the provider’s physical location (provider site). Telepractice services are provided to patients through hardwire or internet connection. It is the expectation that providers, facilitators, and staff involved in telepractice are trained in the use of equipment and software prior to servicing patients, and services provided via telepractice are provided as part of an array of comprehensive services that include in-person visits and assessments with the primary supervising BHT provider. Qualified providers of behavioral health services are able to arrange telepractice services for the purposes of teaching the parents/guardians to provide individualized interventions to their child and to engage in behavioral health clinical observation and direction (i.e. increase oversight of the provision of services to the beneficiary to support the outcomes of the behavioral plan of care developed by the primary supervising BHT provider).

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 482-483 Jan. 2021 (Accessed Feb. 2021). 

Child Therapy

A child mental health professional may provide child therapy on an individual or group basis with a family-driven, youth-guided approach. Telepractice/Telehealth is approved for Individual Therapy or Family Therapy using approved children’s

evidence-based practices (i.e., Trauma Focused Cognitive Behavioral Therapy, Parent Management Training-Oregon, Parenting Through Change) and utilizes the GT modifier when reporting the service.  Qualified providers of children’s evidence-based practices have completed their training in the model, its implementation via telehealth, and are able to provide the practice with fidelity.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 338, Oct. 1, 2020 (Accessed Feb. 2021). 

Psychiatric Collaborative Care Model (CoCM) Services

Provider care management services provided by a Behavioral Health Care Manager can be provided in a non-face-to-face interaction. Weekly consults with the psychiatric consultant may also be non-face-to-face. Non-face-to-face weekly to monthly follow-up by the behavioral health care manager that must include monthly screening with validated rating scale, monitoring of goals and/or medication, and may include recommended evidence-based therapies.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 1682-1683, Jan. 2021  (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Tribal 638 facilities that elect to operate under the Tribal FQHC alternative payment methodology (APM) must update their provider enrollment information in CHAMPS by selecting the “Tribal FQHC” subspecialty. Tribal FQHCs can change their enrollment status in CHAMPS at any time.

Distant site services provided by qualified Medicaid-enrolled practitioners may be covered when the qualified practitioner is employed by the clinic or working under the terms of a contractual agreement with the clinic. Tribal FQHCs must maintain all practitioner contracts and provide them to MDHHS upon request. Refer to the Practitioner chapter of the Medicaid Provider Manual for additional information on distant site providers. Telemedicine service(s) provided at the distant site that qualify as a face-to-face visit may generate the AIR payment.

SOURCE: MI Medical Services Administration Bulletin MSA 20-60, pg. 2-3 Sept. 1, 2020 (Accessed Feb. 2021)

Physicians and practitioners are eligible to be distant site providers.

SOURCE: Dept. of Health and Human Services Medicaid Provider Manual, p. 1689, Jan. 2021 (Accessed Feb. 2021). 

Telepractice for BHT Services

Qualified providers include:

  • Board certified behavior analysts
  • Board certified assistant behavior analysts
  • Licensed psychologists
  • Limited licensed psychologists
  • Qualified behavioral health professionals

Occupational, physical and speech therapists are not included in this policy.

A facilitator trained in telepractice technology must be physically present with the patient during the entire telepractice session.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 483 Jan. 2021 (Accessed Feb. 2021). 

Medication Therapy Management (MTM)

In the event that the beneficiary is unable to physically access a face-to-face care setting, an eligible pharmacist may provide MTM services via telepractice.  Services must be provided through hardwire or internet connection.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1613, Jan. 2021 (Accessed Feb. 2021).

Prepaid Inpatient Health Plans/Community Mental Health (PIHP/CMH) can be either originating or distant sites. Practitioners must meet the provider qualifications for the covered service provided via telemedicine.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 346, Jan. 2021 (Accessed Feb. 2021).

Speech-Language and Audiology Services

Eligible providers:

  • A fully licensed speech-language pathologist
  • Licensed Audiologist in Michigan
  • Speech language pathologist and/or audiology candidate under the direction of a qualified SLP or audiologist. All documentation must be reviewed and signed by the appropriately licensed SLP or licensed audiologist.
  • A limited licensed speech language pathologist under the direction of a fully licensed SLP or audiologist. All documentation must be reviewed and signed by the appropriately licensed supervising SLP or licensed audiologist.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1784, Jan. 2021 (Accessed Feb. 2021).  

Federally Qualified Health Centers/ Rural Health Centers

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

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 671 & 1747 Jan. 2021 (Accessed Feb. 2021). 

Child Therapy

A child mental health professional may provide child therapy on an individual or group basis with a family-driven, youth-guided approach. It is the expectation that providers involved in telepractice/telehealth are trained in the use of equipment and software prior to servicing children/families.

SOURCE:  MI Dept. of Health and Human Services Medicaid Provider Manual, p. 340, Jan. 2021 (Accessed Feb. 2021).

School-Based Services and Caring 4 Students Providers

Telepractice specifically applies to the SBS and C4S programs.  See bulletin for requirements.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-15, Behavioral Health Telepractice, May 5, 2020 (Accessed Feb. 2021).


ELIGIBLE SITES

Newly Passed Legislation (Effective Now)

Beginning October 1, 2020, telemedicine services are covered under the medical assistance program and Healthy Michigan program if the originating site is an in-home or in-school setting, in addition to any other originating site allowed in the Medicaid provider manual or any established site considered appropriate by the provider.

SOURCE: MI Compiled Laws Sec. 400.105h. (HB 5416 – 2020 Session). (Accessed Feb. 2021).

Tribal 638 Facilities

Tribal FQHCs are eligible to receive all-inclusive rate (AIR) reimbursement for clinic services provided outside of the four walls of the facility, including telemedicine and services provided by contracted employees.

SOURCE: MI Medical Services Administration Bulletin MSA 20-60, Sept. 1, 2020 (Accessed Feb. 2021)

Eligible originating sites:

  • County mental health clinics or publicly funded mental health facilities;
  • Federally Qualified Health Centers;
  • Hospitals (inpatient, outpatient, or Critical Access Hospitals);
  • Physician or other providers’ offices, including medical clinics;
  • Hospital-based or CAH-based Renal Dialysis Centers;
  • Rural Health Clinics;
  • Skilled nursing facilities;
  • Tribal Health Centers

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1689. Jan. 2021 (Accessed Feb. 2021). 

Speech-Language and Audiology Services

The patient site may be located within the school, at the patient’s home or any other established site deemed appropriate by the provider.

The room must be free from distractions so as not to interfere with the telepractice session.  A facilitator must be trained in the use of the telepractice technology and physically present at the patient site during the entire telepractice session to assist the patient at the direction of the SLP or audiologist.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1784, Jan. 2021 (Accessed Feb. 2021). 

Prepaid Inpatient Health Plans/Community Mental Health (PIHP/CMH) can be either originating or distant sites.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 346, Jan. 2021 (Accessed Feb. 2021).

Behavioral Health Therapy

Eligible patient site:

  • Center
  • Clinic
  • Patient’s home
  • Any other established site deemed appropriate by the provider

Room must be free of distractions.  A trained facilitator must be physically present at the patient site during the entire telepractice session.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 483, Jan. 2021 (Accessed Feb. 2021). 

Federally Qualified Health Centers/ Rural Health Centers

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

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 671 & 1747, Jan. 2021 (Accessed Feb. 2021). 

School-Based Services and Caring 4 Students Providers

Allowable telepractice originating sites include the school, the beneficiary’s home, or any other established site deemed appropriate by the provider. It must be a room free from distractions so as not to interfere with the telepractice session.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-15, Behavioral Health Telepractice, May 5, 2020 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Originating site may bill for a facility fee. MDHHS will reimburse the originating site provider the lesser of charge or the current Medicaid fee screen.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 273, Jan. 2021 (Accessed Feb. 2021).

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Minnesota

Last updated 02/28/2021

POLICY

Medical assistance covers medically necessary services and consultations delivered …

POLICY

Medical assistance covers medically necessary services and consultations delivered by a licensed health care provider via telemedicine in the same manner as if the service was delivered in-person.  Coverage is limited to three telemedicine services per week per enrollee. Telemedicine services are paid at the full allowable rate.

SOURCE: MN Statute Sec. 256B.0625, Subdivision 3b(a) (Accessed Feb. 2021).

  • The limit of coverage of three telemedicine services per enrollee per calendar week does not apply if:
  • The telemedicine services are for the treatment and control of tuberculosis; and
  • The telemedicine services are provided in a manner consistent with the recommendations and best practices specified by the Centers for Disease Control and Prevention and the commissioner of health.

SOURCE: MN Statute Sec 256B.0625, Subdivision 3b. (Accessed Feb. 2021). 

Minnesota’s Medical Assistance program reimburses live video for fee-for-service programs.

To be eligible for reimbursement, providers must self-attest that they meet the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine form.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telemedicine), As revised Jan. 28, 2020. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Examples of eligible services:

  • Consultations
  • Telehealth consults: emergency department or initial inpatient care
  • Subsequent hospital care services with the limitation of one telemedicine visit every 30 days per eligible provider
  • Subsequent nursing facility care services with the limitation of one telemedicine visit every 30 days
  • End-stage renal disease services
  • Individual and group medical nutrition therapy
  • Individual and group diabetes self-management training with a minimum of one hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training
  • Smoking cessation
  • Alcohol and substance abuse (other than tobacco) structured assessment and intervention services

Two-way interactive video consultation in an emergency room (ER) may be billed when no physician is in the ER and the nursing staff is caring for the patient at the originating site. The ER physician bills the ER CPT codes with place of service 02.

Telemedicine consults are limited to three per calendar week per patient.  Payment is not available for sending materials to a recipient, other provider or facility.  See Live Video Policy section above for exception or tuberculosis control and treatment.

Non-covered services:

  • Electronic connections that are not conducted over a secure encrypted website as specified by the Health Insurance Portability & Accountability Act of 1996 Privacy & Security rules (e.g., Skype)
  • Prescription renewals
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Non-clinical communication
  • Communication via telephone, email or facsimile
  • Day treatment
  • Partial hospitalization programs
  • Residential treatment services
  • Case management face-to-face contact

In addition, Minnesota also has the following general requirements for its telemedicine policy:

  • Out-of-state coverage policy applies to services provided via telemedicine
  • Payment will be made for only one reading or interpretation of diagnostic tests such as x-rays, lab tests and diagnostic assessments
  • Payment is not available to providers for sending materials to members, other providers or facilities

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telemedicine), As revised Jan. 28, 2020. (Accessed Feb. 2021).

Mental Health Services

Mental health services that are otherwise covered by medical assistance as direct face-to-face services may be provided via two-way interactive video. Use of two-way interactive video must be medically appropriate to the condition and needs of the person being served. Reimbursement is at the same rates and under the same conditions that would otherwise apply to the service. The interactive video equipment and connection must comply with Medicare standards in effect at the time the service is provided.

SOURCE: MN Statute Sec. 256B.0625, Subd. 46 (Accessed Feb. 2021). 

MHCP covers medically necessary mental health services delivered by a health care provider via telemedicine.

SOURCE: MN Dept. of Human Services, Provider Manual, Telemedicine Delivery of Mental Health Services, Revised 10/19/2018, (Accessed Feb. 2021).

Assertive Community Treatment and Intensive Residential Treatment Services

Physician services, whether billed separately or included in the rate, may be delivered by telemedicine when it is used to provide intensive residential treatment services.

SOURCE:  MN Statute Sec 256B.0622, subdivision 8(e) (Accessed Feb. 2021).

Individualized Education Program (IEP)

Telemedicine coverage applies to a child or youth who is MA eligible, has an IEP and the service provided is identified in the IEP. Whether the originating site is a home or school must be documented in the child’s health record.  Limited to three visits per week per child or youth.

To be eligible for reimbursement, the school or school district must self-attest that the telemedicine services provided by the professional provider either employed by or contracted by the school meet all of the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine (DHS-6806) (PDF).

Non-Covered Services:

  • Evaluation or assessments that are less effective than if provided in-person, face-to-face
  • Supervision evaluations or visits
  • Personal care assistants
  • Nursing services
  • Transportation services
  • Electronic connections that are conducted over a website that is not secure and encrypted as specified by the Health Insurance Portability & Accountability Act of 1996 Privacy & Security rules (for example, Skype)
  • Prescription renewals
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Non-clinical communication
  • Communication via telephone, email or fax

Use 02 place of service code. See IEP manual for specific documentation and billing requirements.

SOURCE: MN Dept. of Human Svcs., Provider Manual, IEP Services, Revised 4/10/2020 (Accessed Feb. 2021).

Mental Health Services

Providers authorized to provide mental health services may conduct the same services via telemedicine, except:

  • Children’s day treatment
  • Partial hospitalization programs
  • Mental health residential treatment services
  • Case management services delivered to children

Providers should bill with the place of service code 02.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Telemedicine Delivery of Mental Health Services, Revised 10/19/18 Accessed Feb. 2021).

Alcohol and Drug Abuse Services

Individual, non-residential treatment is the only substance use disorder service reimbursed when delivered via telemedicine.

Non-covered Services:

  • Electronic connections that are not conducted over a secure encrypted web site as specified by the Health Insurance Portability & Accountability Act of 1996 (e.g., Skype)
  • Prescription renewals
  • Scheduling a test or appointment
  • Reporting test results
  • Non-clinical communication
  • Communication via telephone, email or facsimile

Limited to three telemedicine services per week per recipient.  Payment is not available to providers for sending materials. See manual for documentation requirements.  Use the GT modifier.

SOURCE: Substance Use Disorder Telemedicine, Oct. 19, 2017 (Accessed Feb. 2021).

Dental

MHCP allows payment for teledentistry services.  Reimbursement for teledentistry is the same as face-to-face encounters. See list of codes, documentation and billing requirements in provider manual.  A provider must self-attest to meet all the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for telemedicine.

Covered Services (See manual for exact CDT codes):

  • Periodic oral evaluation (with an established patient)
  • Limited oral exam
  • Oral evaluation for a patient under 3 years of age
  • Comprehensive oral evaluation (new or established patient)
  • Intraoral radiographic imaging
  • Bitewing radiographic imaging
  • Intraoral—occlusal radiographic image
  • Panoramic radiographic imaging
  • Medical dental consultation

SOURCE (Dental): MN Dept. of Human Svcs., Provider Manual, Dental Svcs. Dec. 24, 2020 (Accessed Feb. 2021).

Early Intensive Developmental and Behavioral Intervention (EIDBI) EIDBI services

Telemedicine is an option for Early Intensive Developmental and Behavioral Intervention (EIDBI) EIDBI services.  Either the person or his/her family must be present via two-way interactive video while the provider delivers EIDBI telemedicine services. Use 02 place of service code.

Eligible services include:

  • Comprehensive multi-disciplinary evaluation
  • Coordinated care conference
  • Family/caregiver training and counseling
  • Individual treatment plan (ITP) development and progress monitoring
  • Observation and direction

EIDBI Benefits grid also lists adaptive behavioral treatment by protocol and group adaptive behavior treatment by protocol.   See grid for more information.

SOURCE: MN Dept. of Human Svcs., EIDBI Services Benefits billing grid, January 2021 (Accessed Jan. 2021) & MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telemedicine Services.  July 1, 2020. (Accessed Feb. 2021).

Medical assistance covers medically necessary EIDBI services and consultations delivered by a licensed health care provider via telemedicine, in the same manner as if the service or consultation was delivered in person.

SOURCE:  MN Statute Sec. 256B.0949, Subdivision. 13. (Accessed Feb. 2021).

Rehabilitation Services

MHCP allows payment for some rehabilitation services through telemedicine.  Physical and occupational therapists, physical and occupational therapists assistants, speech-language pathologists and audiologists may use telemedicine to deliver certain covered rehabilitation therapy services that they can appropriately deliver via telemedicine. Service delivered by this method must meet all other rehabilitation therapy service requirements and providers must adhere to the same standards and ethics as they would if the service was provided face-to-face.  Must use GT or GQ modifiers.  Providers must self-attest that they meet all of the conditions of MHCP telemedicine policy by completing the “Provider Assurance Statement for Telemedicine”.   When submitting claims for telemedicine services, use place-of-service code 02 to certify that the services meets the telemedicine requirements. The GQ modifier is required when billing for services via asynchronous telecommunication systems.

Limited to three sessions per week per member.  Payment not available for sending materials to a recipient, other providers or other facilities. Payment is made only for one reading or interpretation of diagnostic tests such as x-rays, lab tests, and diagnostic assessments.

Noncovered services:

  • Electronic connections that are not conducted over a secure encrypted website as specified by HIPAA
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Non-clinical communication
  • Communication via telephone, email or fax

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Sept. 18, 2020 (Accessed Feb. 2021).

Medication Therapy Management Services (MTMS)

Under certain circumstances MTMS can be delivered via interactive video.  See section on “eligible sites” for more information.  To be eligible providers must submit a provider assurance statement, use equipment compliant with HIPAA (see manual for details) and use the GT modifier and 02 POS code.

Noncovered services:

  • Encounters by telephone or by email
  • Encounters in skilled nursing facilities

SOURCE: MN Dept. of Human Svcs., Provider Manual, Medication Therapy Management Svcs. Mar. 8, 2018 (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Providers must use the place of service code 02.

Eligible providers:

  • Physician
  • Nurse practitioner
  • Physician assistant
  • Nurse midwife
  • Clinical nurse specialist
  • Registered dietitian or nutrition professional
  • Dentist, dental hygienist, dental therapist, advanced dental therapist
  • Mental health professional, when following requirements and service limitations
  • Pharmacist
  • Certified genetic counselor
  • Podiatrist
  • Speech therapist
  • Physical therapist
  • Occupational therapist
  • Audiologist
  • Public health nursing organizations

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telemedicine), As revised Jan. 28, 2020. (Accessed Feb. 2021).

Medical assistance covers medically necessary services and consultations delivered by a licensed health care provider via telemedicine, which includes a licensed health care provider under section 62A.671, subdivision 6, a community paramedic as defined under section 144E.001, subdivision 5f, or a mental health practitioner defined under section 245.462, subdivision 17, or 245.4871, subdivision 26, working under the general supervision of a mental health professional, and a community health worker who meets the criteria under subdivision 49, paragraph (a).

SOURCE: MN Statute Sec. 256B.0625, Subd. 3b. (Accessed Feb. 2021).

Individualized Education Program (IEP)

Eligible providers include the following:

  • Charter schools
  • Education districts
  • Intermediate districts
  • Public school districts
  • Tribal schools (schools that receive funding from the Bureau of Indian Affairs-BIA)
  • Service cooperatives
  • Special education cooperatives
  • State academies

SOURCE: MN Dept. of Human Svcs., Provider Manual, IEP Services, Revised April 10, 2020. (Accessed Feb. 2021).

Early Intensive Developmental and Behavioral Intervention (EIDBI) EIDBI services

Eligible Providers:

  • Physician
  • Nurse practitioner
  • Clinical psychologist
  • Clinical social worker
  • Speech therapist
  • Physical therapist
  • Occupational therapist.

Mental health practitioners working under the supervision of a mental health professional are also eligible.  A comprehensive multi-disciplinary evaluation provider, qualified supervising professional, (Level I or Level II) EIDBI provider may apply to provide EI DBI services via telemedicine if they meet the qualifications and complete the Telemedicine Assurance Statement.

SOURCE: MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telemedicine Services.  July 1, 2020.  (Accessed Feb. 2021).

Mental Health Services

All providers eligible to deliver mental health services may deliver the same eservices via telemedicine.  See manual for specific requirements a provider must follow when delivering services via telemedicine.  The following services may not be conducted via telemedicine:

  • Children’s day treatment
  • Partial hospitalization programs
  • Mental health residential treatment services
  • Case Management services delivered to children

SOURCE: MN Dept. of Human Svcs., Provider Manual, Telemedicine Delivery of Mental Health Services, Revised 10/19/18 (Accessed Feb. 2021).

Alcohol and Drug Abuse Services

All providers eligible to deliver the same services they are authorized to provide via telemedicine as long as they self-attest to meeting all of the conditions of the MHCP telemedicine policy by completing the Provider Assurance Statement for Telemedicine.  Individual, non-residential treatment is the only substance use disorder service currently reimbursed via telemedicine.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Substance Use Disorder Telemedicine, Oct. 19, 2017 (Accessed Feb. 2021).

Rehabilitation Services

Eligible providers:

  • Speech-language pathologists
  • Physical therapists
  • Physical therapist assistants
  • Occupational therapists
  • Occupational therapy assistants
  • Audiologists

Physical therapist assistants and occupational therapy assistants providing services via telemedicine must follow the same supervision policy as indicated in “Rehabilitation Service Practitioners”.  No distant site limitations beyond provider types.   Providers must self-attest that they meet all of the conditions of MHCP telemedicine policy by completing the “Provider Assurance Statement for Telemedicine”.  See manual for documentation requirements. When submitting claims for telemedicine services, use place-of-service code 02 to certify that the services meets the telemedicine requirements. The GQ modifier is required when billing for services via asynchronous telecommunication systems.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Sept. 18, 2020 (Accessed Feb. 2021).


ELIGIBLE SITES

Authorized originating sites include:

  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Critical access hospital (CAH)
  • Rural health clinic (RHC) and Federally Qualified Health Center (FQHC)
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility (SNF)
  • End-stage renal disease (ESRD) facilities
  • Community mental health center
  • Dental clinic
  • Residential facilities, such as a group home and assisted living, shelter or group housing
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)
  • School
  • Correctional facility-based office
  • Mobile Stroke Unit

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services, As revised Jan. 28, 2020. (Accessed Feb. 2021). 

Individualized Education Program (IEP)

Eligible originating sites, the location of the child or youth at the time the service is provided.  Document in the child’s health record:

  • Home
  • School

SOURCE: MN Dept. of Human Svcs., Provider Manual, Individualized Education Program, April 10, 2020 (Accessed Feb. 2021).

Medication Therapy Management Services (MTMS)

Qualified members who must travel more than twenty miles for enrolled MHCP MTMS provider may have the services delivered via interactive video to an ambulatory care site in which there is no enrolled MTMS provider in the local trade area.  Services must meet the following criteria:

  • Both the patient site and the pharmacist site must be located in a pharmacy, clinic, hospital or other ambulatory care site;
  • The origination site must meet the MTMS privacy and space requirements except that the space would need to seat only two people comfortably;
  • Qualified members may have the service delivered via interactive video to their residence if the service is performed during a covered home care visit by an MHCP enrolled provider;
  • The pharmacist provider’s site must be located in a pharmacy, clinic, hospital or other ambulatory care site.

See manual for privacy, equipment and reimbursement requirements.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Medication Therapy Management Svcs. Mar. 8, 2018 (Accessed Feb. 2021).

Alcohol and Drug Abuse Services

Eligible originating sites:

  • Substance abuse disorder treatment facility (residential or outpatient)
  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Withdrawal management facility
  • Drug court office
  • Correctional facility-based office (including jails)
  • School
  • Community mental health center (CCBHC)
  • Residential facility such as a group home and assisted living
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)

SOURCE: MN Dept. of Human Svcs., Provider Manual, Substance Use Disorder Telemedicine, Oct. 19, 2017 (Accessed Feb. 2021).

Dental

Affiliate practice or originator within Minnesota Board of Dentistry defined scope of practice must be present at originating site:

  • Dentist
  • Advanced dental therapists
  • Dental therapists
  • Dental hygienists
  • Licensed dental assistants
  • Other licensed health care professionals

SOURCE: MN Dept. of Human Svcs., Provider Manual, Dental Svcs. December 24, 2020 (Accessed Feb. 2021).

Rehabilitation Services

Eligible originating sites:

  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Critical access hospital (CAH)
  • Rural health clinic (RHC) and Federally Qualified Health Center (FQHC)
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility (SNF)
  • End-stage renal disease (ESRD) facilities
  • Community mental health center
  • Dental clinic
  • Residential facilities, such as a group home and assisted living
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)
  • School

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Sept. 18, 2020 (Accessed Feb. 2021).

Tribal Facilities

Outpatient telemedicine services are reimbursable at the IHS outpatient reimbursement rate when provided through a tribal facility.  An encounter for a tribal or IHS facility means a face-to-face visit between a member eligible for MA and any health professional at or through an IHS or tribal service location for the provision of MA covered services within a 24-hour period ending at midnight.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Tribal and Federal Indian Health Svcs., Nov. 22, 2019 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

Medication Therapy Management Services (MTMS)

Qualified members who must travel more than twenty miles for enrolled MHCP MTMS provider may have the services delivered via interactive video to an ambulatory care site in which there is no enrolled MTMS provider in the local trade area.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Medication Therapy Management Svcs. Mar. 8, 2018 (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

Early Intensive Developmental and Behavioral Intervention (EIDBI) EIDBI services

MHCP does not reimburse for connection charges or origination, set-up or site fees.

SOURCE: MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telemedicine Services. July 1, 2020. (Accessed Feb. 2021).

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Mississippi

Last updated 02/28/2021

POLICY

Mississippi Medicaid and private payers are required to provide …

POLICY

Mississippi Medicaid and private payers are required to provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation.

SOURCE: MS Code Sec. 83-9-351. (Accessed Feb. 2021). 

Providers of telehealth services must be an enrolled Mississippi Medicaid provider acting within their scope-of-practice and license or medical certification or Mississippi Department of Health (MDSH) certification and in accordance with state and federal guidelines, including but not limited to, authorization of prescription medications at both the originating and distant site. The Division of Medicaid requires that providers utilize telehealth technology sufficient to provide real-time interactive communications that provide the same information as if the telehealth visit was performed in-person. Equipment must also be compliant with all applicable provisions of the Health Insurance Portability and Accountability Act (HIPAA).

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.2B (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

The Division of Medicaid covers medically necessary telehealth services as a substitution for an in-person visit for consultations, office visits, and/or outpatient visits when all the required medically appropriate criteria is met which aligns with the description of the Current Procedural Terminology (CPT) evaluation and management (E&M) and Healthcare Common

Procedure Coding System (HCPCS) guidelines.

Noncovered Services:

  • Telehealth service that is not covered in an in-person setting
  • Telehealth services in the inpatient setting;
  • Installation or maintenance of telehealth hardware, software and/or equipment, videotapes, and transmissions.
  • Early and periodic screening, diagnosis, and treatment (EPSDT) well child visits through telehealth.
  • Physician visits for non-established beneficiaries, and/or level VI or V visits.
  • The following modalities, which MS Medicaid does not consider telehealth:  telephone conversation, chart review, electronic mail messages, facsimile transmission, internet services for online medical evaluations, or communication through social media;
  • Any other communication made in the course of usual business practices including, but not limited to calling in a prescription refill, or performing a quick virtual triage.
  • The installation or maintenance of any telecommunication devices or systems.

The Division of Medicaid reimburses all providers delivering a medically necessary telehealth service at the distant site at the current applicable MS Medicaid fee for the service provided. The provider must include the appropriate modifier on the claim indicating the service was provided through telehealth.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.3-1.5 (Accessed Feb. 2021).

The Division of Medicaid covers medically necessary health services to eligible Medicaid beneficiaries as specified in the State Plan. If a service is not covered in an in-person setting, it is not covered if provided through telehealth.

Telehealth service must be delivered in a real-time communication method that is:

  • Live;
  • Interactive; and
  • Audiovisual

SOURCE: State of Mississippi. State Plan Under Title XIX of the Social Security Act. Medical Assistance Program. Attachment 3.1A. 3/31/15.  (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Any enrolled Medicaid provider may provide telehealth services at the originating site.  The following enrolled Medicaid providers may provide telehealth services at the distant site:

  • Physicians,
  • Physician assistants,
  • Nurse practitioners,
  • Psychologists,
  • Licensed Clinical Social Workers (LCSW),
  • Licensed Professional Counselors (LPCs),
  • Board Certified Behavior Analysts or Board-Certified Behavior Analyst Doctorals
  • Community Mental Health Centers (CMHCs)
  • Private Mental Health Centers

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.3(B). (Accessed Feb. 2021).

During a state of emergency, beneficiaries may seek treatment utilizing telehealth services from a distant site provider not listed under Medicaid’s allowed distant site providers.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.7. (Accessed Feb. 2021).


ELIGIBLE SITES

The Division of Medicaid reimburses the provider at the originating site the Mississippi Medicaid telehealth originating site facility fee for telehealth services per completed transmission, in addition to a separately identifiable covered service if performed (see facility fee section).

The division of Medicaid covers telehealth services at an originating site when the telepresenter meets certain requirements.  Requirements include:

  • Is a Mississippi Medicaid provider, or employed by a Mississippi Medicaid provider and directly supervised by the provider or an appropriate employee of the provider if the medical personnel’s license or certification requires supervision,
  • Is trained to use the appropriate technology at the originating site,
  • Is able to facilitate comprehensive exams under the direction of a distant site practitioner who is, or is employed by, a Mississippi Medicaid provider.
  • Must remain in the exam room for the entirety of the exam unless otherwise directed by the distant site provider for the appropriate treatment of the beneficiary, and
  • Must act within the scope of their practice, license, or certification.

SOURCE: MS Admin Code Title 23, Part 225, Rule 1.1 & 1.5. (Accessed Feb. 2021). 

During a state of emergency, beneficiaries may seek treatment utilizing telehealth services from an originating site not listed in the Medicaid State Plan, including the beneficiary’s residence.

When the beneficiary receives services in the home, the requirement for a telepresenter to be present may be waived.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.7. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

The Division of Medicaid reimburses the enrolled Medicaid provider at the originating site the Mississippi Medicaid telehealth originating site facility fee for telehealth services per completed transmission in addition to reimbursement for a separately identifiable covered service if performed.

The following providers are eligible to receive the originating site facility fee for telehealth services per transmission when the telepresenter meets certain requirements (see eligible site section):

  • Office of a physician or practitioner,
  • Outpatient hospital, including a Critical Access Hospital (CAH),
  • Rural Health Clinic (RHC),
  • Federally Qualified Health Center (FQHC),
  • Community Mental Health/Private Mental Health Center,
  • Therapeutic Group Home,
  • Indian Health Service Clinic, and
  • School-based clinic.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.5(A). (Accessed Feb. 2021). 

An originating site fee is covered in the following originating sites:

  • Office of a physician or practitioner;
  • Outpatient Hospital (including a Critical Access Hospital (CAH));
  • Rural Health Clinic (RHC);
  • Federally Qualified Health Center (FQHC);
  • Community Mental Health/Private Mental Health Centers;
  • Therapeutic Group Homes;
  • Indian Health Service Clinic; or
  • School-based clinic.

SOURCE: State of Mississippi. State Plan Under Title XIX of the Social Security Act. Medical Assistance Program. Attachment 3.1-A. 3/31/15.  (Accessed Feb. 2021). & MS Admin. Code Title 23, Part 225, Rule. 1.5(A). (Accessed Feb. 2021).

Facility fee provided per completed transmission.

SOURCE: State of Mississippi. State Plan Under Title XIX of the Social Security Act. Medical Assistance Program. Attachment 4.19-B. 3/31/15.  (Accessed Feb. 2021).

RHCs and FQHCs acting in the role of a telehealth originating site provider with no other separately identifiable service being provided will only be paid the telehealth originating site fee per completed transmission and will not receive reimbursement for an encounter.

Source: State of Mississippi. State Plan Under Title XIX of the Social Security Act. Medical Assistance Program. Attachment 4.19-B, Rural Health Centers & Federally Qualified Health Center. 6/30/16. (Accessed Feb. 2021).

The Division of Medicaid reimburses a RHC a fee per completed transmission, for telehealth services provided by the RHC acting as the originating site provider, which meets the requirements in Miss. Admin. Code Part 225, Chapter 1, effective January 1, 2015. The RHC may not bill for an encounter visit unless a separately identifiable service is performed. The originating site facility fee will be paid at the existing fee-for-service rate.

SOURCE: MS Admin. Code Title 23, Part 212, Rule. 1.4. (Accessed Feb. 2021).

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Missouri

Last updated 02/28/2021

POLICY

Services provided through telehealth must meet the standard of …

POLICY

Services provided through telehealth must meet the standard of care that would otherwise be expected should such services be provided in person. Prior to the delivery of telehealth services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the school year.

SOURCE: MO HealthNet, Physician Manual, 13.69A p. 289 (Nov. 25, 2020), Provider Manual, Rural Health Clinics, Section 13, p. 165 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 209 (Nov. 24, 2020). (Accessed Feb. 2021).

The department of social services shall reimburse providers for services provided through telehealth if such providers can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in-person.  Reimbursement for telehealth services shall be made in the same way as reimbursement for in-person contact; however, consideration shall also be made for reimbursement to the originating site.

SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Services provided through telehealth must meet the standard of care that would otherwise be expected should such services be provided in person. Use the appropriate CPT code for the service along with place of service 02 (telehealth). Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

SOURCE: MO HealthNet, Physician Manual,13-69A p. 289-290 (Nov. 25, 2020), MO HealthNet, Provider Manual, Rural Health Clinics, Section 13, p. 166 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 209-210 (Nov. 24, 2020). (Accessed Feb. 2021).

Comprehensive Substance Abuse Treatment & Rehabilitation (CSTAR) Program

Medication services may be provided via telehealth.

SOURCE: MO HealthNet, CSTAR Manual, 13.14(K)(4) p. 200 (Nov. 24, 2020), (Accessed Feb. 2021).

Community Psych Rehab Program

Several services are covered if delivered via telehealth. See manual for specific services.

SOURCE: MO HealthNet, Community Psych Rehab Program Manual, p. 239. (Nov. 24, 2020), (Accessed Feb. 2021).

Home Health

The telehealth may be used in the “face-to-face” requirement of an encounter.

SOURCE: MO HealthNet, Home Health Manual, p. 168. (Nov. 24, 2020), (Accessed Feb. 2021).

Dentistry

Some teledentistry is covered. See manual for codes.

SOURCE: MO HealthNet, Dental Manual, p. 262. (Nov. 24, 2020). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. To be reimbursed for telehealth services health care providers treating patients in this state, utilizing telehealth, must be fully licensed to practice in this state and be enrolled as a MO HealthNet/ MHD provider prior to rendering services.

SOURCE: MO HealthNet, Physician Manual, 13.69B p. 288-290 (Nov. 25, 2020), Provider Manual, Rural Health Clinics, Section 13, p. 165-166 (Nov. 25, 2020) & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Nov. 24, 2020). (Accessed Feb. 2021).

RHCs must bill with their non-RHC provider number when they are the originating site to receive the facility fee. RHCs may bill with either their non-RHC provider number or their RHC provider number when they are the distant site.  The provider will use the appropriate procedure code for the service along with place of service 02 (Telehealth). Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. To be reimbursed for telehealth services health care providers treating patients in this state, utilizing telehealth, must be fully licensed to practice in this state and be enrolled as a MHD provider prior to rendering services.

SOURCE: MO HealthNet, Rural Health Clinic, p. 166 (Nov. 25, 2020). (Accessed Feb. 2021). 

Anesthesiologist monitoring telemetry in the operating room is a non-covered service.

SOURCE: MO HealthNet, Physician Manual, p. 213 (Nov. 25, 2020). (Accessed Feb. 2021).

Reimbursement to the health care provider delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided. Use the appropriate CPT code for the service along with place of service 02 (telehealth).

Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

SOURCE:  MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Nov. 24, 2020), (Accessed Feb. 2021).

Reimbursement to the health care provider delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.

SOURCE: MO HealthNet, Physician Manual,13-69A p. 290 (Nov. 25, 2020), & MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Nov. 24, 2020). (Accessed Feb. 2021).

RHCs may bill with either their non-RHC provider number or their RHC provider number. The provider will use the appropriate procedure code for the service along with place of service 02 (Telehealth).

Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

SOURCE: MO HealthNet, Provider Manual, Rural Health Clinics, Section 13, p. 166 (Nov. 25, 2020) (Accessed Feb. 2021).


ELIGIBLE SITES

The department shall not restrict the originating site through rule or payment so long as the provider can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in-person.

SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Feb. 2021). 

No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient’s medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in-person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.

SOURCE: MO Revised Statute Sec. 191.1145(6). (Accessed Feb. 2021).  

RHCs must bill with their non-RHC provider number (or when the distant site, the RHC provider number can also be used) when they are the originating site to receive the facility fee.

Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

SOURCE: MO HealthNet, Rural Health Clinic, p. 165 (Nov. 25, 2020). (Accessed Feb. 2021). 

The originating site is where the MO HealthNet participant receiving the telehealth service is physically located.  The originating site and distant site can be billed by the same provider for the same date of service as long as the distant site is not located in the originating site facility.

SOURCE: MO Department of Social Services. Provider Bulletin. Vol. 40, No. 47. Feb. 2, 2018. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

Payment for services rendered via telehealth shall not depend on any minimum distance requirement between the originating and distant site.

SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

Providers can bill Q3014 for the telehealth originating site facility fee.

SOURCE: MO Department of Social Services. Provider Bulletin. Vol. 40, No. 47. Feb. 2, 2018. (Accessed Feb. 2021). 

FQHCs and RHCs are eligible for an originating site facility fee. Special billing instructions apply to FQHC providers.

SOURCE: MO Department of Social Services. Provider Bulletin. Vol 41, No. 44. Mar. 5, 2019. (Accessed Feb. 2021).

The originating site is only eligible to receive a facility fee for the Telehealth service. Claims should be submitted with HCPCS code Q3014 (Telehealth originating site facility fee). Procedure code Q3014 is used by the originating site to receive reimbursement for the use of the facility while Telehealth services are being rendered.

SOURCE: MO HealthNet, Physician Manual, 13.69A p. 290 (Nov. 25, 2020); MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Nov. 24, 2020). (Accessed Feb. 2021).

RHCs must bill with their non-RHC provider number to receive reimbursement for a facility fee for the Telehealth services when operating as the originating site. Claims must be submitted with HCPCS code Q3014 (Telehealth originating site facility fee).

SOURCE: Provider Manual, Rural Health Clinics, Section 13, p. 166 (Nov. 25, 2020). (Accessed Feb. 2021).

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Montana

Last updated 04/27/2021

POLICY

MT Medicaid reimburses for medically necessary telemedicine services to …

POLICY

MT Medicaid reimburses for medically necessary telemedicine services to eligible members.  Providers must be enrolled as Montana Healthcare Programs providers and be licensed in the state of Montana.

Telemedicine should not be selected when face-to-face services are medically necessary. Members should establish relationships with primary care providers who are available on a face-to-face basis.

The originating and distant providers may not be within the same facility or community. The same provider may not be the “pay to” for both the originating and distance provider.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Healthy Montana Kids

Services provided by telemedicine are allowed for non-surgical medical services and behavioral health outpatient services.

SOURCE: MT Children’s health Insurance Plan, Healthy Montana Kids (HMK). Evidence of Coverage (Nov. 2017), p. 24 & 30. (Accessed Feb. 2021). 

Telehealth services are available for Physical, Occupational and Speech Therapy when ordered by a physician or mid-level practitioner. The order is valid for 180 days. All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable so long as such services are medically necessary and clinically appropriate for delivery via telemedicine/telehealth.

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services program (EPSDT) covers all medically necessary services for children age 20 and under. Therapy services for children are not restricted to a specific number of hours or units as long as the therapy services are restorative, not maintenance. All other applicable requirements apply.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Therapies Manual, Covered Services (Mar. 2020). (Accessed Apr. 2021). 

School-Based Services

Telehealth services are allowed for Physical Therapy, Occupational Therapy and Speech Therapy. All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable so long as such services are medically necessary and clinically appropriate for delivery via telemedicine/telehealth.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance PRograms Manual, School-Based Services Manual (Mar. 2020). (Accessed Apr. 2021).

The availability of services through telemedicine in no way alters the scope of practice of any health care provider; or authorizes the delivery of health care services in a setting or manner not otherwise authorized by law.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Telemedicine (Feb. 2020). (Accessed Apr. 2021).

Home Health Services

A face to face encounter may occur through telehealth.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Senior and Long Term Care Division, Community Services Bureau, Home Health Policy Manual. Apr. 1, 2019. pg. 1, (Accessed Apr. 2021).

Durable Medical Equipment

Face-to-face assessments of the patient by the prescriber can be performed using telemedicine.

SOURCE:  MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Durable Medical Equipment, Prosthetics, Orthotics, and Medical Supplies (DMEPOS) Manual (Dec. 2020). (Accessed Apr. 2021).


ELIGIBLE PROVIDERS

Providers must be enrolled as Montana Healthcare Programs providers and be licensed in the State of Montana in order to:

  • Treat a Montana Healthcare Programs member; and
  • Submit claims for payment to Montana Healthcare Programs

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Telemedicine (Feb. 2020). (Accessed Apr. 2021).


ELIGIBLE SITES

Telemedicine can be provided in a member’s residence; the distance provider is responsible for the confidentiality requirements. See Facility/Transmission fee section for list of eligible originating sites for facility fee.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).


GEOGRAPHIC LIMITS

The originating and distant providers may not be within the same facility or community. The same provider may not be the pay to for both the originating and distance provider.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr 2021).


FACILITY/TRANSMISSION FEE

The following provider types can bill the originating site fee:

  • Outpatient hospital
  • Critical access hospital*
  • Federally qualified health center*
  • Rural health center*
  • Indian health service*
  • Physician
  • Psychiatrist
  • Mid-levels
  • Dieticians
  • Psychologists
  • Licensed clinical social worker
  • Licensed professional counselor
  • Mental health center
  • Chemical dependency clinic
  • Group/clinic
  • Public health clinic
  • Family planning clinic

*Reimbursement for Q3014 is a set fee and is paid outside of both the cost to charge ratio and the all-inclusive rate.

Originating site providers must include a specific diagnosis code to indicate why a member is being seen by a distance provider and this code must be requested from the distance site prior to billing for the telemedicine appointment.

The originating site provider may also, as appropriate, bill for clinical services provided on-site the same day that a telemedicine originating site service is provided. The originating site may not bill for assisting the distant site provider with an examination, including for any services that would be normally included in a face-to-face visit.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr. 2021).

No reimbursement for infrastructure or network use charges.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Billing Procedures (Sep. 2017). (Accessed Apr. 2021).

FQHCs and RHCs can bill a telehealth originating site code if applicable.

SOURCE: MT Dept. of Public Health and Human Svcs, Medicaid and Medical Assistance Programs Manual, Rural Health Clinics & Federally Qualified Health Center, Billing Procedures (Jan, 2020). (Accessed Apr 2021).

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Nebraska

Last updated 02/28/2021

POLICY

Nebraska Medicaid provides coverage for telehealth at the same …

POLICY

Nebraska Medicaid provides coverage for telehealth at the same rate as in-person services when the technology meets industry standards and is HIPAA compliant.

Medicaid will reimburse a consulting health care provider if the following are met:

  • After obtaining and analyzing the transmitted information, the consulting provider reports back to the referring health care practitioner;
  • The consulting health care practitioner must bill for services using the appropriate modifier;
  •  Payment is not made to the referring health care practitioner who sends the medical documentation. Reimbursement is at the same rate as in-person services.
  • Practitioner consultation is not covered for behavioral health when the client has an urgent psychiatric condition requiring immediate attention by a licensed mental health practitioner.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.08-.09, Ch. 1, p. 9.  (Accessed Feb. 2021).

In-person contact is not required for reimbursable services under the Medicaid program, subject to reimbursement policies developed.  This policy also applies to managed care plans who contract with the Department only to the extent that:

  • Services delivered via telehealth are covered and reimbursed under the fee-for-service program and
  • Managed care contracts are amended to add coverage of services delivered via telehealth and appropriate capitation rate adjustments are incorporated.

Reimbursement shall, at a minimum, be set at the same rate as a comparable in-person consult and the rate must not depend on the distance between the health care practitioner and the patient.

The department shall establish rates for transmission cost reimbursement for telehealth consultations, considering, to the extent applicable, reductions in travel costs by health care practitioners and patients to deliver or to access health care services and such other factors as the department deems relevant. Such rates shall include reimbursement for all two-way, real-time, interactive communications, unless provided by an Internet service provider, between the patient and the physician or health care practitioner at the distant site which comply with the federal Health Insurance Portability and Accountability Act of 1996 and rules and regulations adopted thereunder and with regulations relating to encryption adopted by the federal Centers for Medicare and Medicaid Services and which satisfy federal requirements relating to efficiency, economy, and quality of care.

SOURCE: NE Revised Statutes Sec. 71-8506. (Accessed Feb. 2021).

Children’s Behavioral Health
A trained staff member must be immediately available to a child receiving telehealth behavioral health services.  This requirement may be waived by a legal guardian and in cases where there is a threat that the child may harm themselves or others, a safety plan must be developed before the telehealth interaction takes place.

SOURCE: NE Admin. Code Title 471, Sec. 1-004.05, Ch. 1, p. 8. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Federally Qualified Health Centers & Rural Health Clinics

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

SOURCE: NE Admin. Code Title 471, Sec. 29-004.05, Ch. 29, p. 5. & NE Admin. Code Title 471, Sec. 34-007, Ch. 34, Manual Letter #11-2010. (Accessed Feb. 2021).

Assertive Community Treatment (ACT)

ACT Team Interventions may be provided via telehealth when provided according to certain regulations.

SOURCE: NE Admin. Code Title 471 Sec. 35-013.11, Ch. 35, p. 26.  (Accessed Feb. 2021).

Indian Health Service (IHS) Facilities

Telehealth services may be used to conduct a face-to-face visit (encounter) for the provision of medically necessary Medicaid-defined services in an IHS or Tribal facility within a 24-hour period ending at midnight, as documented in the client’s medical record.

SOURCE: NE Admin. Code Title 471 Sec. 11-001, Ch. 11, p. 1. (Accessed Feb. 2021).

Services for Individuals with Developmental Disabilities

Providers may conduct observations for the development, modification, evaluation, or implementation of a behavioral support plan in-person or by telehealth.

SOURCE: NE Admin. Code Title 403 Sec. 004.04, Ch. 4, p. 5 & Sec. 004.04, Ch. 5, p. 5  (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Nebraska Medicaid-enrolled providers licensed, registered, or certified to practice in Nebraska are eligible for reimbursement.

SOURCE: NE Rev. Statute, 71-8503(2) (Accessed Feb. 2021).


ELIGIBLE SITES

Health care practitioners must assure that the originating sites meet the standards for telehealth, including providing a place where the client’s right for confidential and private services is protected.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.03, Ch. 1, p. 8.  (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Telehealth services and transmission costs are covered by Medicaid when:

  • The technology used meets industry standards;
  •  The technology is Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant; and
  • The telehealth technology solution in use at both the originating and the distant site must be sufficient to allow the health care practitioner to appropriately complete the service billed to Medicaid

An originating site fee is paid to the Medicaid-enrolled facility hosting the client.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.06 & 1-004.010, Ch. 1,. 8 & 10.  (Accessed Feb. 2021).

Federally Qualified Health Centers & Rural Health Clinics

Telehealth transmission cost related to non-core services will be the lower of:

  • The provider’s submitted charge; or
  • The maximum allowable amount

SOURCE:  NE Admin. Code Title 471, Sec. 29-004.05A, Ch. 29, Manual Letter #11-2010, p. 5 & NE Admin. Code Title 471, Sec. 34-007.01, Ch. 34, Manual Letter #11-2010, p. 6. (Accessed Feb. 2021).

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Nevada

Last updated 02/28/2021

POLICY

Services provided via telehealth must be clinically appropriate and …

POLICY

Services provided via telehealth must be clinically appropriate and within the health care professional’s scope of practice as established by its licensing agency. Services provided via telehealth have parity with in-person health care services. Health care professionals must follow the appropriate Medicaid Services Manual (MSM) policy for the specific service they are providing.

  • Photographs must be specific to the patient’s condition and adequate for rendering or confirming a diagnosis or a treatment plan. Dermatologic photographs (e.g., photographs of a skin lesion) may be considered to meet the requirement of a single media format under this instruction.
  • Reimbursement for the DHCFP covered telehealth services must satisfy federal requirements of efficiency, economy and quality of care.
  • All participating providers must adhere to requirements of the Health Insurance Portability and Accountability Act (HIPAA). The DHCFP may not participate in any medium not deemed appropriate for protected health information by the DHCFP’s HIPAA Security Officer.

Telehealth services follow the same prior authorization requirements as services provided in-person. Utilization of telehealth services does not require prior authorization. However, individual services may require prior authorization when delivered by telehealth.

End Stage Renal Disease requires at least one in-person visit to examine the vascular access site by the provider, indicated in the medical records. Interactive audio/video telecommunications systems may be used for providing additional visits.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403, p. 1; 3403.5, p. 3; & 3403.7, p. 4 (Jul. 27, 2017). (Accessed Feb. 2021).

Effective December 1, 2015, telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice to provide services that can be appropriately provided via telehealth.  The telecommunications system used must be an interactive audio and video system. Standard telephones, facsimile machines or electronic mail do not meet this criteria.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (May 20, 2020). (Accessed Feb. 2021).

Medicaid Managed Care plans must include coverage for services provided through telehealth to the same extent as through provided in-person or by other means.

Medicaid Managed Care plans shall not:

  • Require an enrollee to establish an in-person relationship with a provider or provide any additional consent to or reason for obtaining services through telehealth as a condition to providing the coverage;
  • Require a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license;
  • Refuse to provide coverage for telehealth because of the type of the distant site or originating site in which the provider/enrollee provides/receives services via telehealth; or
  • Require covered services to be provided through telehealth as a condition of providing coverage for such services.

A Medicaid Managed Care plan may not require an enrollee to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in-person.

Medicaid Managed Care plans are not required to:

  • Ensure that covered services are available to an enrollee through telehealth at a particular originating site
  • Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care; or
  • Enter into a contract with any provider of health care or cover any service if the insurer is not otherwise required by law to do so.

SOURCE: NV Revised Statute Sec. 695G.162. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Telehealth services are covered in:

  • Physician Office Services
  • Podiatry
  • Community Paramedicine Services
  • Medical Nutrition Therapy

SOURCE: NV Dept. of Health and Human Svcs., Section 603.2, p. 3; 603.7, p. 20; 604.2, p. 2; & 608.2, p. 3 (Jan. 1, 2020) (Accessed Feb. 2021).

A licensed professional operating within the scope of their practice under state law may provide the following Telehealth services for Medicaid recipients:

  • Annual wellness visits;
  • Diabetic outpatient self-management;
  • Documented psychiatric treatment in crisis intervention (e.g., threatened suicide); and
  • Office or other outpatient visits

SOURCE: NV Dept. of Health and Human Svcs., SOURCE: NV Dept. of Health and Human Svcs., Provider Type 20 (Physician), 40 (Osteopath) and 77 (APRN) Billing Guide, pg. 9 (5/4/20). (Accessed Feb. 2021).

Services NOT Covered:

Basic skills training and peer-to-peer services provided by a Qualified Behavioral Assistant

  • Personal care services provided by a Personal Care Attendant
  • Home Health Services provided by a RN, occupational therapist, physical therapist, speech therapist, respiratory therapist, dietician or Home Health Aide
  • Private Duty Nursing services provided by a RN

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403.6, p. 3 (Jul. 27, 2017). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p.1 (May 20, 2020) (Accessed Feb. 2021).

Indian Health Services and Tribal Clinics should follow the guidelines in the Telehealth Chapter 3400.

SOURCE: Nevada Dept. of Health and Human Svcs., Medicaid Services Manual, Indian Health Services and Clinics, pg. 1, (5/1/20), (Accessed Feb. 2021).

A distant site provider must be an enrolled Medicaid provider.

Licensed Clinical Psychologist (LCP), Licensed Clinical Social Worker (LCSW) and clinical staff employed and determined by a state mental health agency to meet established class specification qualifications of a Mental Health Counselor, Clinical Social Worker or Psychological Assistant may bill and receive reimbursement for psychotherapy (via a HIPAA-compliant telecommunication system), but may not seek reimbursement for medical evaluation and management services.

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

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 1-2, 3403.2, p. 2 & Section 3403.5, p. 2 (Jul. 27, 2017). (Accessed Feb. 2021).


ELIGIBLE SITES

In order to receive coverage for a telehealth facility fee, the originating site must be an enrolled Medicaid provider.

If a patient is receiving telehealth services at an originating site not enrolled in Medicaid, the originating site is not eligible for a facility fee from the DHCFP. Examples of this include, but are not limited to, cellular devices, home computers, kiosks and tablets.

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

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 1-2, (Jul. 27, 2017). (Accessed Feb. 2021).

Eligible sites:

  • Office of provider
  • Critical Access Hospital (CAH)
  • Rural Health Clinic (RHC)
  • Federally Qualified Health Center (FQHC)
  • Hospital
  • End Stage Renal Disease (ESRD) Facility
  • Skilled Nursing Facility (SNF)
  • Community Mental Health Centers (CMHC)
  • Indian Health Services/Tribal Organization/Urban Indian Organization
  • School-Based Health Centers
  • Schools
  • Family Planning Clinics
  • Public Health Clinics
  • ·Comprehensive Outpatient Rehabilitation Facilities
  • Community Health Clinics (State Health Division)
  • Special Children’s Clinics
  • Human Immunodeficiency Virus (HIV) Clinics
  • Therapy offices
  • Chiropractic offices
  • Emergency Medical Services (EMS) performing Community Paramedic Services
  • Recipient’s smart phone (no facility fee)
  • Recipient’s home computer (no facility fee)

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1-2 (May 20, 2020) (Accessed Feb. 2021).

Specific encounter service limits apply for distant site providers at Indian Health Service, Tribal clinics, or Tribal FQHCs. See billing guide for Nevada AI/AN providers.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines, Indian Health Services (IHS) and Tribal Clinics, p. 1. (05/01/2020) (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

The originating site must be located in the state of Nevada.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 p. 1-2, (Jul. 27, 2017). (Accessed Feb. 2021).

A Medicaid Managed Care Organization may not refuse to provide coverage of telehealth services because where the distant or originating site providing/receiving services via telehealth is located.

SOURCE: NV Revised Statute Sec. 695G.162.  (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

Originating site is qualified to receive a facility fee if they are an enrolled Medicaid provider. If a patient is receiving telehealth services at a site not enrolled in Medicaid, the originating site is not eligible to receive a facility fee.

Facilities that are eligible for encounter reimbursement may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1, p. 1-2 (Jul. 27, 2017). (Accessed Feb. 2021).

A facility fee is not billable if the telecommunication system used is a recipient’s smart phone or home computer.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 2 (May 20, 2020) (Accessed Feb. 2021).

Some provider types that may bill for an originating site facility fee include:

  • Some Special Clinic provider types
  • Some Applied Behavior Analysis provider types
  • Therapists
  • Chiropractors
  • Providers at End-Stage Renal Disease Facilities

SOURCE: NV Dept. of Health and Human Svcs. Announcement 1048 & 1202. (Accessed Feb. 2021).

Sites eligible for an originating site facility fee include:

  • Office of provider
  • Critical Access Hospital (CAH)
  • Rural Health Clinic (RHC)
  • Federally Qualified Health Center (FQHC)
  • Hospital
  • End Stage Renal Disease (ESRD) Facility
  • Skilled Nursing Facility (SNF)
  • Community Mental Health Centers (CMHC)
  • Indian Health Services/Tribal Organization/Urban Indian Organization
  • School-Based Health Centers
  • Schools
  • Family Planning Clinics
  • Public Health Clinics
  • Comprehensive Outpatient Rehabilitation Facilities
  •  Community Health Clinics (State Health Division)
  • Special Children’s Clinics
  • Human Immunodeficiency Virus (HIV) Clinics
  • Therapy offices
  • Chiropractic offices
  • Emergency Medical Services (EMS) performing Community Paramedic Services

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1-2 (May 20, 2020) (Accessed Feb. 2021).

If the originating site is enrolled as a Nevada Medicaid provider, they may bill HCPCS code Q3014. If the telecommunication system used is a recipient’s smart phone or home computer, the facility fee may not be billed.

SOURCE: Nevada Dept. of Health and Human Services, School Health Services, pg. 67 (8/6/20), (Accessed Feb. 2021).

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New Hampshire

Last updated 02/28/2021

POLICY

The Medicaid program shall provide coverage and reimbursement for …

POLICY

The Medicaid program shall provide coverage and reimbursement for health care services provided through telemedicine on the same basis as the Medicaid program provides coverage and reimbursement for health care services provided in person.

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.

NH Medicaid is required by statute to cover Medicaid-covered services provided within the scope of practice of a physician or other health care provider as a method of delivery of medical care. The appropriate application of telehealth services provided by physicians and other health care providers is determined by the department based on the Centers for Medicare and Medicaid Services regulations, and also includes persons providing psychotherapeutic services.

NH Medicaid is not prohibited from providing coverage for only those services that are medically necessary and subject to all other terms and conditions of the coverage.

Telemedicine services for primary care, remote patient monitoring and substance use disorder services are covered only when the patient has established care at an originating site via face-to-face in-person service.  Exceptions include:

  • The provider is a Department of Veteran Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration pursuant to 21 U.S.C. section 831(h);
  • The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;
  • The patient is being treated by, and is physically located in a doorway as defined in RSA 167:4-d, II(c);
  • The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or
  • The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f)

SOURCE: NH Revised Statutes 167:4-d (HB 1623 – 2020 Session) (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

“Telehealth services” shall comply with 42 C.F.R. section 410.78, except for 42 C.F.R. section 410.78(b)(4).  This sections limits telehealth services to specific CPT/HCPCS codes.

New Hampshire Medicaid is required by statute to provide coverage for Medicaid-covered services provided within the scope of practice of a physician or other health care provider.  It must be an appropriate application of telehealth services, as determined by the department based on CMS regulations and also includes psychotherapeutic services.

Primary care, remote patient monitoring & substance use disorder shall only be covered in the event that the patient has already established care at an originating site via face-to-face in-person service.  Exceptions include:

  • The provider is a Department of Veteran Affairs (VA) practitioner or VA-contracted practitioner not required to obtain a special registration pursuant to 21 U.S.C. section 831(h);
  • The patient is being treated by, and is physically located in a correctional facility administered by the state of New Hampshire or a New Hampshire county;
  • The patient is being treated by, and is physically located in a doorway as defined in RSA 167:4-d, II(c);
  • The patient is being treated by and is physically located in a state designated community mental health center pursuant to RSA 135; or
  • The patient is being treated by, and physically located in, a hospital or clinic registered in a manner fully consistent with 21 U.S.C. section 823(f)and

By which an individual shall receive medical services from a physician or other health care provider who is an enrolled Medicaid provider without in-person contact with that provider.

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.  The combined amount of reimbursement that the Medicaid program allows for the compensation to the distant site and the originating site shall not be less that the total amount allowed for health care services provided in person.

With written consent of the patient receiving medication assisted treatment through telehealth services provided under this section, the health care provider shall provide notification of the patient’s medication assisted treatment to the doorway.

The department shall adopt rules to carry out this section.

SOURCE: NH Revised Statutes 167:4-d (HB 1623 – 2020 Session) (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

“Telehealth services” shall comply with 42 C.F.R. section 410.78, except for 42 C.F.R. section 410.78(b)(4).  This sections limits providers that can be reimbursed for telehealth to the following:

  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Nurse-midwife
  • Clinical psychologist and clinical social worker (may not seek payment for medical evaluation and management services)
  • Registered dietician or nutrition professional
  • Certified registered nurse anesthetist

Medical providers below 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. Medical providers include, but are not limited to, the following:

Physicians and physician assistants, governed by RSA 329 and RSA 328- D;

  • Advanced practice nurses, governed by RSA 326-B and registered nurses under RSA 326-B employed by home health care providers
  • Midwives
  • Psychologists
  • Allied Health Professionals
  • Dentist
  • Mental health practitioners
  • Community mental health providers employed by community mental health programs
  • Alcohol and other drug use professionals
  • Dietitians
  • Professionals certified by the national behavior analyst certification board or persons performing services under the supervision of a person certified by the national behavior analyst certification board.

SOURCE: NH Revised Statutes 167:4-d & 42 CFR Sec. 410.78(b)(2) & Centers for Medicare and Medicaid Services. Medicare Learning Network Booklet, p. 6-9. (March 2020). (Accessed Feb. 2021).


ELIGIBLE SITES

There shall be no restriction on eligible originating or distant sites for telehealth services. An originating site means the location of the member at the time the service is being furnished via a telecommunication system. A distant site means the location of the provider at the time the service is being furnished via a telecommunication system.

SOURCE: NH Revised Statutes Annotated, 167:4-d, (NH HB 1623, 2020 Session), (Accessed Feb. 2021).

“Originating site” means the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including, but not limited to, a health care provider’s office, a hospital, or a health care facility, or the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center, or the patient’s workplace.

SOURCE: NH Revised Statutes 167:4-d (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

New Hampshire Medicaid does not follow 42 CFR 410.78(b)(4), listing geographic and site restrictions on originating sites.

SOURCE: NH Revised Statutes 167:4-d (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

New Hampshire Medicaid complies with the Centers for Medicare and Medicaid Service requirements for telehealth. Based on the Medicare requirements, originating sites are eligible for a facility fee.

SOURCE: NH Revised Statutes 167:4-d & Centers for Medicare and Medicaid Services. Medicare Learning Network Booklet, p. 10. (March 2020). (Accessed Feb. 2021).

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New Jersey

Last updated 02/28/2021

POLICY

The State Medicaid and NJ FamilyCare programs shall provide …

POLICY

The State Medicaid and NJ FamilyCare programs shall provide coverage and payment for health care services delivered to a benefits recipient through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey.  Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate.

The State Medicaid and NJ FamilyCare programs may limit coverage to services that are delivered by participating health care providers, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.

The commissioner will apply for a State Plan amendment as necessary to implement this.

SOURCE: NJ Statute C.30:4D-6k. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

The offsite provider is responsible for determining that the billable service meets all required standards of care. If the provider cannot meet that standard of care via telehealth, the provider shall notify the patient to seek a face-to-face appointment. When a physical evaluation is required, the telehealth provider may utilize an individual licensed to provide physical evaluations (e.g. RN) who is onsite.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 2 (Accessed Feb. 2021).

Psychiatric Services

Telepsychiatry may be utilized by mental health clinics and/or hospital providers of outpatient mental health services to meet their physician related requirements including but not limited to intake evaluations, periodic psychiatric evaluations, medication management and/or psychotherapy sessions for clients of any age.

Before any telepsychiatry services can be provided, each participating program must establish policies and procedures, regarding elements noted in the newsletter, such as confidentiality requirements, technology requirements and consent.

Mental health clinics and hospital providers are limited to billing for services permitted by the Division of Medical Assistance and Health Services.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013. (Accessed Feb. 2021).

For the Screening and Outreach Program, the psychiatric assessment maybe completed through the use of telepsychiatry, provided that the screening service has a Division-approved plan setting forth its policies and procedures for providing a psychiatric assessment via telepsychiatry that meets the following criteria (see regulation).

SOURCE: NJAC 10:31-2.3. (Accessed Feb. 2021).

A provider may use interactive, real-time, two-way audio in combination with asynchronous store-and-forward technology, without video communication, if the provider has determined that the provider is able to meet the accepted standard of care provided if the visit was face-to-face.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 2. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

  • Psychiatric Services
  • Psychiatrist
  • Psychiatric Advanced Practice Nurse

The practitioner may be offsite but must be a practitioner currently licensed to practice within the State of New Jersey.  When consumers receiving telepsychiatry services are under the care of a multidisciplinary treatment team, the psychiatrist or psychiatric APN providing telepsychiatry services must have regular communication with them and be available for consultation.

The clinician cannot bill for services directly.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013. (Accessed Feb. 2021).


ELIGIBLE SITES

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

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 2 (Accessed Feb. 2021).

Psychiatric Services

A patient must receive services at the mental health clinic or outpatient hospital program and the mental health clinic/hospital must bill for all services under their Medicaid provider number. The clinician cannot bill for services directly.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013 (Accessed Feb. 2021).


GEORAPHIC SITES

No Reference Found


FACILITY/TRANSMISSION FEE

All costs associated with the provision of telehealth services, including but not limited to the contracting of professional services and the telecommunication equipment, are the responsibility of the provider and are not directly reimbursable by NJFC.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 4 (Accessed Feb. 2021).

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New Mexico

Last updated 02/28/2021

POLICY

New Mexico Medicaid will reimburse for professional services at …

POLICY

New Mexico Medicaid will reimburse for professional services at the originating-site and the distant-site at the same rate as when the services are furnished without the use of a telecommunication system.

SOURCE: NM Administrative Code 8.310.2.12(M). (Accessed Feb. 2021).

Telemedicine is also covered by NM Managed Care.

SOURCE: NM Medical Assistance Division Managed Care Policy Manual, p. 311. Oct. 2020.  (Accessed Feb. 2021).

Applied Behavior Analysis

Telemedicine applies to multiple Family Sets joining each other in a virtual meeting. MAD encourages AP agencies to use this delivery system to meet the needs of Family Set members who cannot attend during regular business hours groups. A parent who travels for work, could easily keep engaged by participating in during their lunch or dinner time.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Feb. 2021).

Managed Care Program

The benefits package includes telemedicine services.  See Admin. Code 8.308.9.18 for requirements of MCOs related to telemedicine services.

SOURCE: NM Admin Code Sec. 8.309.4.16 & 8.308.9.18. (Accessed Feb. 2021).

Provision of telemedicine services does not require that a certified Medicaid healthcare provider be physically present with the patient at the originating site unless the telemedicine consultant at the distant site deems it necessary.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Effective Oct. 1, 2019 the agency’s telehealth and teleconsultation services fee schedule rates are set at 90% of the Medicare fee schedule and are effective for services provided on or after that date.

SOURCE: NM State Plan Amendment.  Attachment 4.19B.  (2/19/20). (Accessed Feb. 2021).

Applied Behavior Analysis

MAD pays for telemedicine communication system per recipient/per service for the delivery of ABA services.  See manual for specific services and supervision requirements.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 12, (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

No Reference Found


ELIGIBLE SITES

School-based services provided via telemedicine are covered.

SOURCE: NM Administrative Code 8.320.6.13(I). (Accessed Feb. 2021).

An interactive telehealth communication system must include both interactive audio and video, and be delivered on a real-time basis at both the originating and distant sites. The originating site can be any medically warranted site.  Coverage for services rendered through telemedicine shall be determined in a manner consistent with Medicaid coverage for health care services provided through in-person consultation.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Reimbursement is made to the originating site for an interactive telemedicine system fee at the lesser of the following:

  • Provider’s billed charge;
  • Maximum allowed by MAD for the specific service or procedure.

A telemedicine originating-site communication fee is also covered if the eligible recipient was present at and participated in the telemedicine visit at the originating site and the system in use meets the definition of a telemedicine system.

SOURCE: NM Administrative Code 8.310.2.12 M (4) & (5). (Accessed Feb. 2021).

Indian Health Services

Originating Site Fee:

  • A telemedicine originating site fee is covered when the requirements of 8.310.2 NMAC are met;
  • Both the originating and distant sites may be IHS or tribal facilities at two different locations or if the distant site is under contract to the IHS or tribal facility and would qualify to be an enrolled provider;
  • A telemedicine originating site fee is not payable if the telemedicine technology is used to connect an employee or staff member of a facility to the eligible recipient being seen at the same facility;

However, even if the service does not qualify for a telemedicine originating site fee, the use of telemedicine technology may be appropriate thereby allowing the service provided to meet the standards to qualify as an encounter by providing the equivalent of face-to-face contact.

SOURCE: NM Administrative Code 8.310.12.12. (Accessed Feb. 2021).

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New York

Last updated 02/28/2021

POLICY

Reimbursement policy applies to fee-for-service and Medicaid Managed Care …

POLICY

Reimbursement policy applies to fee-for-service and Medicaid Managed Care plans.

New York reimburses for two-way electronic audio-visual communications to delivery clinical health care services to a patient at an originating site by a telehealth provider located at a distant site. The totality of the communication of information exchanged between the physician or other qualified health care practitioner and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via face-to-face interaction.

Telehealth should not be used by a provider if it may result in any reduction to the quality of care required to be provided to a Medicaid member or if such service could adversely impact the member.

NY Medicaid does not reimburse for telehealth used solely for the convenience of the practitioner when a face-to-face visit is more appropriate and/or preferred by the member.

New York Medicaid does not reimburse the acquisition, installation, and maintenance of telecommunication devices or systems.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 1-4. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Federally Qualified Health Centers (FQHCs)

FQHCs that have “opted into” Ambulatory Patient Groups (APGs) should follow the billing guidance outlined for sites billing under APGs.

FQHCs that have not opted into APGs:

  • When services are provided via telemedicine to a patient located at an FQHC originating site, the originating site may bill only the FQHC offsite services rate code (4012) to recoup administrative expenses associated with the telemedicine encounter.
  • When a separate and distinct medical service, unrelated to the telemedicine encounter, is provided by a qualified practitioner at the FQHC originating site, the originating site may bill the Prospective Payment System (PPS) rate in addition to the FQHC offsite services rate code (4012).
  • If a provider who is onsite at an FQHC is providing services via telemedicine to a member who is in their place of residence or other temporary location, the FQHC should bill the FQHC off-site services rate code (4012) and report the applicable modifier (95 or GT) on the procedure code line.
  • If the FQHC is providing services as a distant site provider, the FQHC may bill their PPS rate.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 11. (Accessed Feb. 2021).

Telemental Health Services may be authorized by the office for licensed or designated services provided by Telemental Health Practitioners.

Under the Medicaid program, Telemental Health Services are covered when medically necessary and under the following circumstances:

  • The person receiving services is located at the originating/spoke site and the Telemental Health Practitioner is located at the distant/hub site;
  • The person receiving services is present during the encounter;
  • The request for Telemental Health Services and the rationale for the request are documented in the individual’s clinical record;
  • The clinical record includes documentation that the encounter occurred; and
  • The Telemental Health Practitioner at the distant/hub site is (1) authorized in New York State; (2) practicing within his/her scope of specialty practice; (3) affiliated with the originating/spoke site facility; and (4) if the originating/spoke site is a hospital, credentialed and privileged at the originating/spoke site facility.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.5 & 596.7 (Accessed Feb. 2021).

Teledentistry

There is no reimbursement for synchronous teledental encounter code D9995.  Payment will be for the procedures rendered.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2020, page 83 & Medicaid Update, ‘Billing Telehealth as a Teledental Encounter’, Jan. 2020, Vol. 36, No. 1, pg. 83 (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Providers who may deliver telemedicine services include:

  • Licensed physician
  • Licensed physician assistant
  • Licensed dentist
  • Licensed nurse practitioner
  • Licensed registered professional nurse (only when such nurse is receiving patient- specific health information or medical data at a distant site by means of RPM)
  • Licensed podiatrist
  • Licensed optometrist
  • Licensed psychologist
  • Licensed social worker
  • Licensed speech language pathologist or audiologist
  • Licensed midwife
  • Physical Therapists
  • Occupational Therapists
  • Certified diabetes educator
  • Certified asthma educator
  • Certified genetic counselor
  • Hospital (including residential health care facilities serving special needs populations)
  • Home care services agency
  • Hospice
  • Credentialed alcoholism and substance abuse counselor
  • Providers authorized to provide services and service coordination under the early intervention program
  • Clinics licensed or certified under Article 16 of the MHL certified and non-certified day and residential programs funded or operated by the OPWDD
  • Care manager employed by or under contract to a health home program, patient centered medical home, office for people with developmental disabilities Care Coordination Organization (CCO), hospice or a voluntary foster care agency certified by the office of children and family services
  • Or any other provider as determined by the Commissioner. (in Public Health Law only)

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc & NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 5-6. (Accessed Feb. 2021).

Telemental Health

Services are authorized for telemental health practitioners.  ‘Telemental health practitioner’ means a physician, nurse practitioner in psychiatry, psychologist, mental health counselor, social worker, marriage and family therapist, creative arts therapist, or psychoanalyst who is providing Telemental Health Services from a distant or hub site.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(q) & 596.5(a) (Accessed Feb. 2021).

Home Telehealth

Subject to the approval of the state director of the budget, the commissioner may authorize the payment of medical assistance funds for demonstration rates or fees established for home telehealth services and subject to federal financial participation shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth as defined in Section 2999-cc.

SOURCE: NY Statute, Social Services Law SOS §367-u.  (Accessed Feb. 2021).

Teledentistry

Dentists providing services via telehealth must be licensed and currently registered in accordance with NYS Education Law or other applicable law and enrolled in NYS Medicaid. Telehealth services must be delivered by dentists acting within their scope of practice.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2020, page 81 (Accessed Feb. 2021).

Originating and Distant sites must be located within the fifty United States or United States’ territories and may include:

  • Facilities licensed under Article 28 of the Public Health Law (PHL): hospitals, nursing homes and diagnostic and treatment centers;
  • Facilities licensed under Article 40 of the PHL: hospice programs;
  • Facilities as defined in subdivision 6 of Section 1.03 of the Mental Hygiene Law (MHL): clinics certified under Articles 16, 31 and 32;
  • Certified and non-certified day and residential programs funded or operated by the Office of People with Developmental Disabilities (OPWDD);
  • Private physician or dentist offices located within the State of New York;
  • Adult care facilities licensed under Title 2 of Article 7 of the Social Security Law (SSL);
  • Public, private and charter elementary and secondary schools located within the State of New York;
  • School-age child care programs located within the State of New York;
  • Child daycare centers located within the State of New York; and,
  • The member’s place of residence in New York State, or other temporary location in or out of state.

SOURCE:  Dental Procedure Manual. 1/1/20. P. 81 (Accessed. Feb. 2021).


ELIGIBLE SITES

The distant site is any secure location within the fifty United States or United States’ territories where the telehealth provider is located while delivering health care services by means of telehealth.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 3. (Accessed Feb. 2021).

Telemental Health

The recipient can be physically located at a provider site licensed by the office, or the recipient’s place of residence or other temporary location withing or outside the state of New York.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.5(a) (Accessed Feb. 2021).

Originating include:

  • Facilities licensed under Article 28 of the Public Health Law (PHL): hospitals, nursing homes and diagnostic and treatment centers;
  • Facilities licensed under Article 40 of the PHL: hospice programs;
  • Facilities as defined in subdivision 6 of Section 1.03 of the Mental Hygiene Law (MHL): clinics certified under Articles 16, 31 and 32;
  • Certified and non-certified day and residential programs funded or operated by the Office of People with Developmental Disabilities (OPWDD);
  • Private physician or dentist offices located within the State of New York;
  • Adult care facilities licensed under Title 2 of Article 7 of the Social Security Law (SSL);
  • Public, private and charter elementary and secondary schools located within the State of New York;
  • School-age child care programs located within the State of New York;
  • Child daycare centers located within the State of New York; and,
  • The member’s place of residence in New York State, or other temporary location in or out of state.

SOURCE: NY Public Health Law Article 29 – G Section 2999- cc & Dental Procedure Manual. 1/1/20. P. 81 (Accessed. Feb. 2021).

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 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 Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Outpatient departments, clinics, and emergency rooms serving as originating sites may only bill a facility fee using CPT code Q3014, to recoup administrative expenses associated with the telemedicine encounter. Outpatient departments, clinics, and emergency rooms must bill a facility fee through Ambulatory Patient Groups.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 8-10. (Accessed Feb. 2021).

The originating site can bill for administrative expenses only when a telemental health service connection is being provided and a qualified mental health professional is not present at the originating site with the patient at the time of the encounter.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.7(e) (Accessed Feb. 2021).

Only one clinic payment will be made when both the originating site and the distant site are part of the same provider billing entity. In such cases, only the originating site should bill Medicaid for the telemedicine encounter.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 8. (Accessed Feb. 2021).

 

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North Carolina

Last updated 02/28/2021

POLICY

All telehealth services must be provided over a secure …

POLICY

All telehealth services must be provided over a secure HIPAA compliant technology with live audio and video capabilities including (but not limited to) smart phones, tablets and computers.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 8, Nov. 15, 2020. (Accessed Feb. 2021).

The beneficiary must be enrolled in either the NC Medicaid program or the NC Health Choice Program.  Provider(s) shall verify each Medicaid or NCHC beneficiary’s eligibility each time a service is rendered.  The Medicaid beneficiary may have service restrictions due to their eligibility category that would make them ineligible for this service.  For example, to participate in the NC Health Choice Program, a beneficiary must be between 6 and 18 years old, although there is an exception if the child falls under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirement for Medicaid beneficiaries under 21 years of age.  See manual for details.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, Nov. 15, 2020. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

A range of services may be delivered via telehealth, virtual communication, and remote patient monitoring to Medicaid and NCHC beneficiaries. All telehealth, virtual communication, and remote monitoring services must be delivered in a manner that is consistent with the quality of care provided in-person.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 6, Nov. 15, 2020. (Accessed Feb. 2021).

Medicaid or NCHC shall cover procedures, products, and services related to this policy when they are medically necessary, and:

  • The procedure, product, or service is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the beneficiary’s needs;
  • The procedure, product, or service can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide; and
  • The procedure, product, or service is furnished in a manner not primarily intended for the convenience of the beneficiary, the beneficiary’s caretaker, or the provider.

Services NOT Covered

  • The beneficiary does not meet the eligibility requirements;
  • The beneficiary does not meet the criteria listed above;
  • The procedure, product, or service duplicates another provider’s procedure, product, or service; or
  • The procedure, product, or service is experimental, investigational, or part of a clinical trial.

See p. 5 of manual for specific criteria that must be met before a telehealth service can be rendered to a NC Medicaid beneficiary.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 5-7, Nov. 15, 2020. (Accessed Feb. 2021) & NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 7-8, Jan. 1, 2021. (Accessed Feb. 2021).

Additional Criteria not covered under NC Health Choice

Except as otherwise provided for eligibility, fees, deductibles, copayments, and other cost sharing charges, health benefits coverage provided to children eligible under the Program shall be equivalent to coverage provided for dependents under North Carolina Medicaid Program except for the following:

  • No services for long-term care.
  • No nonemergency medical transportation.
  • No EPSDT.
  • Dental services shall be provided on a restricted basis in accordance with criteria adopted by the Department to implement this subsection.

Unless otherwise required for a specific service, Medicaid and NCHC shall not require prior approval for 1H, Telehealth, Virtual Communications and Remote Patient Monitoring. Prior authorization or an initial in-person examination is not required in order to receive care via telehealth, virtual patient communication, or remote patient monitoring; however, when establishing a new relationship with a patient via these modalities, the provider shall meet the prevailing standard of care and complete all appropriate exam requirements and documentation dictated by relevant CPT or HCPCS coding guidelines.

Special provisions apply for the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program.  See manual.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 5-8, Nov. 15, 2020. (Accessed Feb. 2021).

Telehealth, including:

  • office or other outpatient services and office and inpatient consultation codes; and
  • hybrid telehealth visit with supporting home visit codes.

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.

Virtual patient communications must be transmitted between a patient and provider, or between two providers, in a manner that is consistent with the CPT code definition for those services. Provider(s) shall follow all applicable HIPAA rules.

Hybrid Telehealth awith Supporting Home Visit (Hybrid Model)

Eligible providers may conduct telehealth visits with a supporting home visit by a delegated staff member (“hybrid model”) with new or established patients, for a range of scenarios including (but not limited to):

  • Chronic Disease Management: Providers shall use the home visit codes in this policy with appropriate modifiers.
  • Perinatal Care: Providers shall only use the home visit codes in this policy with appropriate modifiers if they are not billing the pregnancy global package codes. Providers billing the pregnancy global package codes shall refer to clinical coverage policy 1E-5, Obstetrical Services at https://medicaid.ncdhhs.gov/ for billing guidance for this model.

Well-child services are not eligible to be delivered via the hybrid model. See manual for additional requirements.

FQHCs, FQHC-Lookalikes, and RHCs may utilize this hybrid model but shall not bill the home visit codes in table C.1.; FQHCs, FQHC-Lookalikes and RHCs may bill their core service code (T1015) and an originating site facility fee (Q3014) for hybrid model visits to reflect the additional cost of the delegated staff person attending the beneficiary’s home. To be reimbursed for the originating site facility fee, all of the following requirements must be met for each home visit:

  • The assistance delivered in the home must be given by an appropriately trained delegated staff person.
  • The fee must be billed for the same day that the home visit is conducted.
  • HCPCS code Q3014 must be appended with the GT modifier and billed with a place of service ‘12’ to designate that the originating site was the home.
  • The core service code (T1015) must be billed separately from the originating site facility fee code (Q3014).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 13-14, Nov. 15, 2020. (Accessed Feb. 2021).

See Attachment A of manual for billable codes (p. 12).

When the GT modifier is appended to a code billed for professional services, the service is paid at the allowed amount of the fee schedule.

  • For hospitals, this is a covered service for both inpatient and outpatient and is part of the normal hospital reimbursement methodology.
  • Reimbursement for these services is subject to the same restrictions as face-to-face contacts (such as; place of service, allowable providers, multiple service limitations, prior authorization).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 6, 8 & 18, Nov. 15, 2020. (Accessed Feb. 2021).

Outpatient Behavioral Health

NC Medicaid covers a range of outpatient behavioral health services via audio-visual and audio-only modalities. See Outpatient Behavioral Health manual for criteria and covered services (p.

Medicaid and NCHC shall not cover Outpatient Behavioral Health Services for the following:

  • sleep therapy for psychiatric disorders;
  • when services are not provided in-person or in accordance with Attachment A.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 4-8, Jan. 1, 2021. (Accessed Feb. 2021).

FQHCs/RHCs

Certain FQHC or RHC providers may bill NC Medicaid for core services delivered via telehealth. Services must meet NC Medicaid’s definition of core services. See p.  NC Medicaid Clinical Coverage Policy No: 1D-4 for core visit services.

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. 7, Dec. 1, 2020. (Accessed Feb. 2021).

Teledentistry

Synchronous real-time dentistry is covered through D9995.

SOURCE: NC Div. of Medical Assistance. Medicaid Bulletin. p. 22, Jan. 2018. (Accessed Feb. 2021).

Office Based Opioid Treatment (OBOT)

Telemedicine and telepsychiatry services may be used for the medical or counseling portions of OBOT services providing they are in accordance with NC Medicaid clinical coverage policy 1H, Telemedicine and Telepsychiatry. If telemedicine is utilized for the medical management portion of OBOT services, the beneficiary shall be located at a facility where a physical exam can be conducted by a nurse practitioner, physician assistant, or MD at the time of the telemedicine visit.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1A-41, Office-Based Opioid Treatment, p. 12, Dec. 12, 2019. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

To be eligible to bill for procedures, products, and services related to this policy, providers shall

  • Meet Medicaid or NCHC qualifications for participation;
  • Be currently Medicaid or NCHC enrolled; and
  • Bill only for procedures, products, and services that are within the scope of their clinical practice, as defined by the appropriate licensing entity.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 9, Nov. 15, 2020. (Accessed Feb. 2021) & NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 13, Jan. 1, 2021. (Accessed Feb. 2021).

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

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

Eligible providers that can bill for telehealth services:

  • Physicians;
  • Nurse practitioners;
  • Psychiatric Nurse Practitioner
  • Certified nurse midwives;
  • Physician’s assistants; and
  • Clinical pharmacist practitioners

NC Medicaid permits all of the above provider types to bill for virtual communication services and RPM except for clinical pharmacist practitioners.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, 13-16, Nov. 15, 2020. (Accessed Feb. 2021).

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Medically necessary services will be provided in the most economic mode, as long as the treatment made available is similarly efficacious to the service requested by the beneficiary’s physician, therapist, or other licensed practitioner; the determination process does not delay the delivery of the needed service; and the determination does not limit the beneficiary’s right to a free choice of providers.

EPSDT does not require the state Medicaid agency to provide any service, product or procedure:

  • that is unsafe, ineffective, or experimental or investigational.
  • that is not medical in nature or not generally recognized as an accepted method of medical practice or treatment.

Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may bill for telehealth, virtual communication, and remote patient monitoring services if the service follows core service billing requirements as outlined in clinical coverage policy 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 4 & 12, Nov. 15, 2020. (Accessed Feb. 2021).

In addition to physicians, the following provider types may bill NC Medicaid for outpatient behavioral health services via telehealth:

  • Licensed Psychologist
  • Licensed Psychological Associate (LPA)
  • Licensed Professional Counselor (LPC)
  • Licensed Clinical Mental Health Counselor (LCMHC)
  • Licensed Professional Counselor Associate (LPCA) or Licensed Clinical Mental Health Counselor Associate (LCMHCA)
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Clinical Social Worker Associate (LCSWA)
  • Licensed Marriage and Family Therapist (LMFT) h. Licensed Marriage and Family Therapist Associate
  • Licensed Clinical Addiction Specialist (LCAS)
  • Licensed Clinical Addiction Specialist – Associate (LCSA-A)
  • Licensed Physician Assistant (PA)

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 13, Jan. 1, 2021. (Accessed Feb. 2021).

FQHCs/RHCs

Eligible providers include all core service providers as defined in Section 3.2.1 of the FQHC/RHC clinical policy, which includes physicians, physician assistants, nurse practitioners, nurse midwives, clinical psychologists, clinical social workers, licensed psychological associates, licensed clinical mental health counselors, licensed marriage and family therapists, advance practice nurse specialists, clinical nurse specialists, and licensed clinical addiction specialists.

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 Feb. 2021).


ELIGIBLE SITES

The Originating Site is the location in which the beneficiary is located, which may be health care facilities, schools, community sites, the home, or wherever the beneficiary may be at the time they receive services via telehealth, virtual communications, or remote patient monitoring. There are no restrictions on originating sites.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, 13-16, Nov. 15, 2020. (Accessed Feb. 2021).

When the originating site is a hospital, the originating site facility fee must be billed with RC780 and Q3014.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 17, Nov. 15, 2020. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

There are no restrictions on the originating or distant sites.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, Nov. 15, 2020. (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

Any Medicaid enrolled provider who provides a beneficiary with access to audio and visual equipment in order to complete a telehealth encounter may bill for a facility fee when their office or facility is the site at which the beneficiary is located when the service is provided and the distant site provider is at a different physical location. Skilled nursing facilities (SNF) shall not bill an originating site facility fee when the SNF Medical Director or a beneficiary’s attending physician is conducting a telehealth visit.

Providers must bill Q3014 for the originating site facility fee.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 9 & 16, Nov. 15, 2020. (Accessed Feb. 2021).

FQHCs, FQHC-Lookalikes and RHCs may bill their core service code (T1015) and an originating site facility fee (Q3014) for hybrid model visits to reflect the additional cost of the delegated staff person attending the beneficiary’s home. To be reimbursed for the originating site facility fee, all of the following requirements must be met for each home visit:

1.       The assistance delivered in the home must be given by an appropriately trained delegated staff person.

2.       The fee must be billed for the same day that the home visit is conducted.

3.       HCPCS code Q3014 must be appended with the GT modifier and billed with a place of service ‘12’ to designate that the originating site was the home.

4.       The core service code (T1015) must be billed separately from the originating site facility fee code (Q3014).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 13-16, Nov. 15, 2020. (Accessed Feb. 2021) & 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 Feb. 2021).

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North Dakota

Last updated 02/28/2021

POLICY

The totality of the communication of the information exchanged …

POLICY

The totality of the communication of the information exchanged between the physician or other qualified healthcare professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 149, (Jan. 2021), (Accessed Feb. 2021).

Indian Health Services

Coverage and payment of services provided through telemedicine is on the same basis as those provided through face-to-face contact.

SOURCE: North Dakota Department of Human Services: General Information for Providers. North Dakota Medicaid and Other Medical Assistance Programs.  (Jan. 2021) P. 70 (Accessed Feb. 2021).

Teledentistry

Synchronous teledentistry is reimbursable and reported in addition to other ND Medicaid-covered procedures provided to the patient, when applicable. Dentists and dental offices must report the appropriate CDT Code for these procedures.

The patient record must include the CDT codes that reflect the teledentistry encounter. ND Medicaid reimburses for CDT code D9995 once per date of service. Submissions must be billed using place of service code 02. Service authorization is not required for CDT code D9995.

SOURCE:  North Dakota Department of Human Services: Teledentistry Policy. (July 2019).  (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Qualified services for telemedicine must:

  • Maintain actual visual contact (face-to-face) between the practitioner and patient.
  • Be medically appropriate and necessary with supporting documentation included in the patient’s clinical medical record.
  • Be provided via secure and appropriate equipment to ensure confidentiality and quality in the delivery of the service.
  • The service must be provided using a HIPAA compliant platform.

See manual for appropriate coding.

All service limits set by ND Medicaid apply to telemedicine services.

Except for non-covered services noted below, telemedicine can be used for services covered by Medicaid, and otherwise allowed, per CPT, to be rendered via telemedicine.

Noncovered Services:

  • Therapies provided in a group setting
  • Store and Forward
  • Targeted Case Management for High Risk Pregnant Women and Infants
  • Targeted Case Management for Individuals in need of Long-Term Care Services

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 149-50, (Jan. 2021), (Accessed Feb. 2021).

Medication Therapy Management (MTM)

Tele-pharmacy or telehealth is allowed for reimbursement with real time audio and visual conferencing.  Both the origination site (where the recipient is located) and the distant site (where the MTM provider is located) must be in the state of North Dakota.  The origination site must meet privacy and space requirements.

SOURCE: ND Div. of Medical Assistance, Medication Therapy Management Provider Manual, p. 2 & 7, (May 2019), (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Payment will be made only to the distant practitioner during the telemedicine session. No payment is allowed to a practitioner at the originating site if his/her sole purpose is the presentation of the patient to the practitioner at the distant site.

Payment is made for services provided by licensed professionals enrolled with ND Medicaid and within the scope of practice per their licensure only.

Telemedicine services provided by an Indian Health Service (IHS) facility or a Tribal 638 Clinic functioning as the distant site, are reimbursed at the All-Inclusive Rate (AIR), regardless whether the originating site is outside the “four walls” of the facility or clinic.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 149-150, (Jan. 2021), (Accessed Feb. 2021).


ELIGIBLE SITES

Payment will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 150, (Jan. 2021), (Accessed Feb. 2021).

Health Services billed by schools can be delivered via telemedicine; however, no originating site fee is allowed. See Services Rendered via Telemedicine chapter for additional information.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 73, (Jan. 2021), (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Payment will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians or other technology or personnel utilized in the performaNDe of the telemedicine service.

Payment will be made only to the distant practitioner during the telemedicine session. No payment is allowed to a practitioner at the originating site if his/her sole purpose is the presentation of the patient to the practitioner at the distant site.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 149-50, (Jan. 2021), (Accessed Feb. 2021).

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Ohio

Last updated 02/28/2021

POLICY

Ohio Medicaid covers live video telemedicine for certain eligible …

POLICY

Ohio Medicaid covers live video telemedicine for certain eligible providers wherever the covered individual is located.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021. & OAC 5160-1-18.  (Accessed Feb. 2021).

The department of Medicaid is required to establish standards for Medicaid payment for health care services the department determines are appropriate to be covered when provided as telehealth services.

SOURCE: OH Revised Code, Sec. 5164.95.(B) (Accessed Feb. 2021).

Inmates of a penal facility or a public institution are not eligible for reimbursement for telehealth services.

SOURCE: OH Admin Code 5160-1-18(E). (Accessed Feb. 2021).

Teledentistry

The department is required to establish standards for Medicaid payment for services provided through teledentistry.

SOURCE: OH Revised Code, Sec. 5164.951. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See Medicaid guidance document and appendix to new rule 5160-1-18 for eligible services for telehealth delivery on or after November 15, 2020.

If the practitioner site does not bill the Ohio Department of Medicaid (ODM) directly (i.e., holds a contractual agreement with the practice), the patient site or practice who holds the contractual agreement may instead bill for the service delivered using telehealth.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Feb. 2021).

The following services are eligible for payment when delivered through telehealth from the practitioner site:

  • When provided by a patient centered medical home, or behavioral health providers, evaluation and management of a new patient described as “office or other outpatient visit” with medical decision making not to exceed moderate complexity.
  • Evaluation and management of an established patient described as “office or other outpatient visit” with medical decision making not to exceed moderate complexity.
  • Inpatient or office consultation for a new or established patient when providing the same quality and timeliness of care to the patient other than by telehealth is not possible
  • Mental health or substance use disorder services described as “psychiatric diagnostic evaluation” or “psychotherapy”
  • Remote evaluation of recorded video or images submitted by an established patient.
  • Virtual check-in by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient.
  • Online digital evaluation and management service for an established patient.
  • Remote patient monitoring.
  • Audiology, speech-language pathology, physical therapy, and occupational therapy services, including services provided in the home health setting.
  • Medical nutrition services.
  • Lactation counseling provided by dietitians.
  • Psychological and neuropsychological testing.
  • Smoking and tobacco use cessation counseling.
  • Developmental test administration.
  • Limited oral evaluation.
  • Hospice services.
  • Private duty nursing services.
  • State plan home health services.
  • Dialysis related services.
  • Services under the specialized recovery services (SRS) program as defined in rule 5160-43-01 of the Administrative Code.
  • Notwithstanding paragraph (D)(2) of this rule, behavioral health services covered under Chapter 5160-27 of the Administrative Code.
  • Optometry services.

SOURCE: OH Admin Code 5160-1-18(D). (Accessed Feb. 2021).

Behavioral Health

The following are the services that may be provided via telehealth:

  • General services
  • CPST service
  • Therapeutic behavioral services and psychosocial rehabilitation service
  • Peer recovery services
  • SUD case management service
  • Crisis intervention service
  • Assertive community treatment service
  • Intensive home-based treatment service

Individuals receiving residential and withdrawal management substance use disorder services or mental health day treatment service may receive any of the component services listed above through telehealth.

SOURCE: OAC 5122-29-31. (Accessed Feb. 2021).

Outpatient hospital behavioral health services (OPHBH)

Hospitals are eligible to provide outpatient behavioral health services via telehealth to the extent they appear on the OPHBH fee schedule.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021. (Accessed Feb. 2021).

Federally Qualified Health Center and Rural Health Clinics

Medical nutrition therapy and lactation services rendered by eligible FQHC and RHC practitioners will be paid under the PPS.

Group therapy will continue to be paid through FFS as a covered non-FQHC/RHC service under the clinic provider type 50 (using ODM’s payment schedules).

Services under the Specialized Recovery Services (SRS) program are not currently covered FQHC or RHC services.

Dental

Dentists may provide a limited problem-focused oral exam (CDT D0140) or periodic oral evaluation (D0120) through telehealth during this state of emergency.  Dental services furnished through telehealth at FQHCs are covered under 5160-1-18 and are paid as covered FQHC dental services.

Hospice

Hospice services can be provided using telehealth when clinically appropriate.

Home Health Services

Home health services, the RN assessment service and the RN consultation service can be provided using telehealth when clinically appropriate.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Feb. 2021).

Recently Adopted Rule – Nursing Facilities

In accordance with rule 5160-1-18 of the Administrative Code, physician visits may be provided via telehealth.

SOURCE: Ohio Administrative Code 5160-3-19(4). (Accessed Feb. 2021).

Recently Adopted Rule – Hospice

Hospice providers that deliver any component of services via telehealth will add the GT modifier on those claims, in addition to the appropriate procedure code above. Ohio Department of Medicaid will allow telehealth services to be provided where in-person visits are mandated. Services billed with T2044 and T2045 are not eligible to be provided via telehealth.

SOURCE: Ohio Administrative Code 5160-56-06. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Eligible providers:

  • Physician, Psychiatrist, Ophthalmologist
  • Podiatrist
  • Psychologist
  • Physician Assistant
  • Dentist
  • Advanced Practice Registered Nurses:
    • Clinical Nurse Specialist
    • Certified Nurse Midwife
    • Certified Nurse Practitioner
  • Licensed Independent Social Worker
  • Licensed Independent Chemical Dependency Counselor, Supervised practitioners, trainees, residents, and interns
  • Licensed Independent Marriage and Family Therapist (in billing guide only)
  • Licensed Professional Clinical Counselor (in billing guide only)
  • Dietitians
  • Audiologist, speech-language pathologist, speech-language pathology aides, audiology aides, and individuals holding a conditional license
  • Occupational and physical therapist and occupational and physical therapist assistants
  • Speech-Language Pathologist
  • Home health aide and hospice aides (in admin code only)
  • Private duty registered nurse or licensed practical nurse in a home health or hospice setting.
  • Medicaid school program (MSP) practitioners
  • Behavioral health practitioners (in admin code only)
  • Optometrists
  • Other practitioners if specifically authorized in rule promulgated under Agency 5160 of the Administrative Code.

Types of providers able to bill: Rendering practitioners listed above, except:

  • Supervised practitioners
  • Occupational therapy assistant
  • Physical therapist assistant
  • Speech-language pathology and audiology aides
  • Individuals holding a conditional license
  • Registered Nurses (RN) and Licensed Practical Nurses (LPN) working in a hospice or home health setting

Other providers able to bill include:

  • Professional Medical or Dental Group
  • Federally Qualified Health Center
  • Rural Health Clinic
  • Ambulatory health care clinics
  • Outpatient hospitals on behalf of licensed psychologists and independent practitioners not eligible to separately bill when practicing in an outpatient hospital setting.
  • Medicaid school program (MSP)
  • Private duty  or non-Agency nurses
  • Pharmacies (submitted on a professional claim)
  • Home health and hospice agencies (in admin code only)
  • Behavioral health providers (in admin code only)
  • Hospitals operating an outpatient hospital behavioral health program (in admin code only)

Practitioners unable to bill:

  • Supervised practitioners, trainees, residents, and interns
  • Occupational therapist assistant
  • Physical therapist assistant
  • Speech-language pathology aides, audiology aides, and individuals holding a conditional license

Outpatient Hospitals

Hospital providers are eligible to bill for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill a professional claim. Ohio Medicaid will pay according to the Enhanced Ambulatory Patient Grouping (EAPG) pricing as described in OAC rule 5160-2-75.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021 & OH Administrative Code 5160-1-18 & 5160-2-75.  (Accessed Feb. 2021).

Federally Qualified Health Center and Rural Health Clinics

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

Nursing Facilities

Nursing facilities (NF) are reimbursed for all telehealth related services through the NF per diem rate. Nursing Facilities do not bill for the telehealth related services they provide. Per the telehealth rule 5160-1-18, physicians and other eligible providers may bill for the services they provide to nursing facility residents from the practitioner’s site in accordance with the rule.  When nursing facilities provide telehealth related services to their residents, they report the costs they incur for those services on the Medicaid NF cost report.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Feb. 2021).

Recently Adopted Rule – Optometrist

A provider of telehealth services who practices in the state shall be licensed by the board. Telehealth may be delivered in a variety of ways, including, but not limited to, those models listed in this rule. Synchronous is a real time interaction between the provider and patient that may occur via encrypted audio and video transmission over telecommunication links including, but not limited to, videoconferencing.

SOURCE: Ohio Administrative Code 4725-25-01. (Accessed Feb. 2021).

Recently Adopted Rule – Hospice

Hospice providers that deliver any component of services via telehealth will add the GT modifier on those claims, in addition to the appropriate procedure code above. Ohio Department of Medicaid will allow telehealth services to be provided where in-person visits are mandated.

SOURCE: Ohio Administrative Code 5160-56-05. (Accessed Feb. 2021).


ELIGIBLE SITES

“Patient site” is the physical location of the patient at the time a health care service is provided through the use of telehealth.

A modifier as identified in Appendix B of this rule if the physical location of the patient is one of the following locations:

  • The patient’s home (including homeless shelter, assisted living facility, group home, and temporary lodging);
  • School;
  • Inpatient hospital;
  • Outpatient hospital;
  • Nursing facility;
  • Intermediate care facility for individuals with an intellectual disability.

The “practitioner site” is the physical location of the treating practitioner at the time a health care service is provided through the use of telehealth.

SOURCE: OAC 5160-1-18. (Accessed Feb. 2021).

Medicaid covered individuals can access telehealth services wherever they are located. Locations include, but are not limited to:

  • Patient’s home
  • School
  • Temporary Housing
  • Homeless shelter
  • Group Home
  • Hospital
  • Inpatient hospital
  • Intermediate care facility for individuals with intellectual disability (ICF/IID)

Penal facility or public institution such as a jail or prison are excluded places of service.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

There is no limitation on the practitioner or patient site.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021.  (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

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Oklahoma

Last updated 02/28/2021

POLICY

SoonerCare (Oklahoma’s Medicaid program) reimburses for live video when:…

POLICY

SoonerCare (Oklahoma’s Medicaid program) reimburses for live video when:

  • Provider is contracted with SoonerCare and appropriately licensed
  • The GT modifier is billed

Proper documentation of services rendered to include: service rendered, location at which service was rendered, and that service was provided via telehealth. (Documentation of services must follow all other SoonerCare documentation guidelines as well.)

SOURCE: OK Health Care Authority, Telehealth. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

OHCA has discretion and final authority to approve or deny telehealth services based on agency and/or SoonerCare members’ needs.  See Medicaid Telehealth webpage for a link to a full list of eligible CPT Codes for Medical and Behavioral Health Services.  Services provided by telehealth must be billed with the appropriate modifier.

SOURCE: OK Admin. Code Sec. 317:30-3-27 & Health Care Authority, Providers, Telehealth. (Accessed Feb. 2021).

A telehealth service is subject to the same SoonerCare program restrictions, limitations, and coverage which exist for the service when not provided through telehealth; provided, however, that only certain telehealth codes are reimbursable by SoonerCare. For a list of the SoonerCare-reimbursable telehealth codes, refer to the OHCA’s Behavioral Health Telehealth Services and Medical Telehealth Services, available on OHCA’s website, www.okhca.org.

Where there are established service limitations, the use of telehealth to deliver those services will count towards meeting those noted limitations. Service limitations may be set forth by Medicaid and/or other third-party payers.

SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Feb. 2021).

Physical, Occupational and Speech and Hearing Services

For physical therapy, occupational therapy, and/or speech and hearing services that are provided in a primary or secondary school setting, but that are not school-based services (i.e., not provided pursuant to an IEP), providers must adhere to all State and Federal requirements relating to prior authorization and prescription or referral.

SOURCE: OK Admin. Code Sec. 317:30-3-27(d). (Accessed Feb. 2021).

Behavioral Health

See SoonerCare behavioral health fee schedule for reimbursable telemedicine services.

SOURCE:  Oklahoma Health Care Authority, Behavioral Health Services Reimbursable via telemedicine. Updated July 18, 2018. (Accessed Feb. 2021).

Psychiatric services performed via telemedicine are subject to the requirements found in Oklahoma Administrative Code (OAC) 317:30-3-27.

SOURCE: OK Admin. Code Sec. 317:30-5-11 – Psychiatric services. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

To participate, a provider must:

  • Be contracted with SoonerCare and appropriately licensed
  • Bill for services using the appropriate modifier (GT)
  • Maintain documentation of services, to include: service rendered, location at which service was rendered, and that service was provided via telemedicine. (Documentation of services must follow all other SoonerCare documentation guidelines as well.)

SOURCE: Oklahoma Health Care Authority, Telehealth. (12/03/20).  (Accessed Feb. 2021).

The provider must be contracted with SoonerCare and appropriately licensed or certified, in good standing. Services that are provided must be within the scope of the practitioner’s license or certification. If the provider is outside of Oklahoma, the provider must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.

SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(3). (Accessed Feb. 2021).

Certain outpatient behavioral health services are only reimbursed when provided by a licensed psychiatrist, certified mobile crisis team or an inpatient psychiatric facility.

SOURCE:  Oklahoma Health Care Authority, Behavioral Health Services Reimbursable via telemedicine. Updated July 18, 2018. (Accessed Feb. 2021).

Indian Health Service/Tribal 638

An I/T/U encounter means a face to face or telehealth contact between a health care professional and an IHS eligible SoonerCare member for the provision of medically necessary Title XIX or Title XXI covered services through an IHS or Tribal 638 facility or an urban Indian clinic within a 24-hour period ending at midnight, as documented in the patient’s record.

SOURCE: OK Admin. Code Sec. 317:30-5-1098. I/T/U outpatient encounters. (Accessed Feb. 2021).


ELIGIBLE SITES

The medical or behavioral health related service must be provided at an appropriate site for the delivery of telehealth services. An appropriate telehealth site is one that has the proper security measures in place; the appropriate administrative, physical, and technical safeguards should be in place that ensures the confidentiality, integrity, and security of electronic protected health information. The location of the room for the encounter at both ends should ensure comfort, privacy, and confidentiality. Both visual and audio privacy are important, and the placement and selection of the rooms should consider this. Appropriate telehealth equipment and networks must be used considering factors such as appropriate screen size, resolution, and security. Providers and/or members may provide or receive telehealth services outside of Oklahoma when medically necessary; however, prior authorization may be required.

SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(3). (Accessed Feb. 2021).

School Setting

In order for OHCA to reimburse medically necessary telehealth services provided to SoonerCare members in a primary or secondary school setting, all of the requirements in (c) above must be met, with the exception of (c)(5), as well as all of the requirements shown below, as applicable.  There are special consent and notification requirements for school-based sites.  See Oklahoma Code.

Physical therapy, occupational therapy, and/or speech and hearing services that are provided in a primary or secondary school setting, but that are not school-based services (i.e., not provided pursuant to an IEP), providers must adhere to all State and Federal requirements relating to prior authorization and prescription or referral.

SOURCE: OK Admin. Code Sec. 317:30-3-27(d). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.

SOURCE: OK Admin. Code Sec. 317:30-3-27(e)(4). (Accessed Feb. 2021).

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Oregon

Last updated 02/28/2021

POLICY

Services can be synchronous (using audio and video, video …

POLICY

Services can be synchronous (using audio and video, video only or audio only) or asynchronous (using audio and video, audio, or text-based media) and may include transmission of data from remote monitoring devices. Communications may be between providers, or be between one or more providers and one or more patients, family members /caregivers /guardians).

SOURCE: OAR 410-141-3566, Health Systems Division: Medical Assistance, Oregon Health Plan, Telehealth Service and Reimbursement Requirements. (Accessed Feb. 2021) & OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

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. See OAR for billing requirements.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Feb. 2021).

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

SOURCE: OR OAR 410-133-0040, Health Systems Division: Medical Assistance Programs, School-Based Health Services (Accessed Feb. 2021).

Coordinated Care Organizations

CCOs shall provide reimbursement for telehealth services and reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided via telemedicine at the same reimbursement rate as if it were provided in person. This requirement does not supersede the CCOs direct agreement(s) with providers, including but not limited to, alternative payment methodologies, quality and performance measures or Value Based Payment methods described in the CCO contract. However, nothing either in this requirement or within CCO direct agreement(s) with providers referenced herein supersedes any federal or state requirements with regard to the provision and coverage of health care interpreter services.

SOURCE: OR Administrative Rules. Rule 410-141-3566. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

Teledentistry is allowed. All billing requirements apply to all modalities (live video, store and forward, remote patient monitoring and mobile communication devices). Payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.  The dentist who completes diagnosis and treatment planning and the oral evaluation documents these services using the traditional CDT codes, and also reports D9995 or D9996 as appropriate. An assessment-D0191 is a limited inspection performed to identify possible signs of oral or systemic disease, malformation or injury, and the potential need for referral for diagnosis and treatment. This code may be billed using the modality of teledentistry:

  • When D0191 is reported in conjunction with an oral evaluation (D0120-D0180) using teledentistry, D0191 shall be disallowed even if done by a different provider;
  • The assessment and evaluation may not be billed or covered by both the originating site dental care provider and a distant site dentist using the modality of teledentistry, even if due to store-and-forward review, if the dates of services are on different days.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

Behavioral Health

Behavioral health services identified as allowable for telephonic delivery are listed in the fee schedule. See fee schedule for list of covered telehealth services.

For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person.

SOURCE: OR OAR 410-12-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Feb. 2021) & Oregon Health Authority, OHP Fee-for-Service Fee Schedule, Behavioral Health, (10/30/20). (Accessed Feb. 2021).

School Based Health Services

Oregon Health Authority reimburses for all the same covered services outlined in OAR 410-133-0080 when furnished through telehealth (See OAR 410-133-0080):

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.

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 Feb. 2021).

Reproductive Health Access Program

Covered services provided by telehealth technology may be billed to the RH Program, as appropriate. The CVR must indicate that the visit was conducted via telehealth. All telehealth visits must adhere to applicable state and federal telehealth regulations.

SOURCE: OR OAR 333-004-3110, RH Access Fund Billing and Claims (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Telehealth providers shall meet the following requirements:

  1. Shall be enrolled with the Authority as an Oregon Health Plan (OHP) provider, per 410-120-1260.
  2. Shall provide services via telehealth that are within their respective certification or licensing board’s scope of practice and comply with telehealth requirements including, but not limited to:
    1. Documenting patient and provider agreement of consent to receive services;
    2. Allowed physical location of provider and patient;
    3. Establishing or maintaining an appropriate provider-patient relationship.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

Dentists providing Medicaid services must be licensed to practice dentistry within the State of Oregon or within the contiguous area of Oregon and must be enrolled as a Health Systems Division (Division) provider.  Providers billing covered teledentistry/telehealth services are responsible for complying with specific standards.  See rule for teledentistry/telehealth services requirements for providers billing.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

See rule for requirements for providers billing behavioral health services.

SOURCE: OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health). (Accessed Feb. 2021).

School Based Health Services

Must be provided by a licensed practitioner/clinician employed by or contracted by an Oregon public school district or Education Service District, enrolled with Oregon Health Authority (OHA) as a “school medical (SM)” provider with authority to provide SBHS to Oregon Medicaid beneficiaries. Must also be performed by or under a supervising licensed practitioner/clinician within the scope of practice governed by their licensing board, who meet the federal requirements as described in medically qualified staff in OAR 410-133-0120, and who hold a current and valid license without restriction from a state licensing board where the provider is located. See OAR 410-133-0140 for additional provider requirements.

SOURCE: OR OAR 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Definitions (Accessed Feb. 2021) & OAR 410-133-0140, School-Based Health Services, School Medical Provider Enrollment Provisions.

CCOs shall provide reimbursement for telehealth services and reimburse Certified and Qualified Health Care Interpreters (HCIs) for interpretation services provided via telemedicine at the same reimbursement rate as if it were provided in person. This requirement does not supersede the CCOs direct agreement(s) with providers, including but not limited to, alternative payment methodologies, quality and performance measures or Value Based Payment methods described in the CCO contract. However, nothing either in this requirement or within CCO direct agreement(s) with providers referenced herein supersedes any federal or state requirements with regard to the provision and coverage of health care interpreter services.

SOURCE: OAR 410-141-3566, (Accessed Feb. 2021).


ELIGIBLE SITES

The patient may be in the community or in a health care setting.

The provider may be in any location in which appropriate privacy can be ensured.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

School-Based Health Services

Telehealth may occur between an alternate site such as the child/student’s home, childcare facility, or other public education programs and settings, and the distant site setting of the practitioner/clinician. 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 & 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Definitions (Accessed Feb. 2021).

The originating site may bill a CDT code only if a separately identifiable service is performed within the scope of practice of the practitioner providing the service. The service must meet all criteria of the CDT code billed.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Effective Jan. 1, 2021). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

The originating site code Q3014 is covered only when the patient is present in an appropriate health care setting and receiving

services from a provider in another location.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. C-1. (02/01/21). (Accessed Feb. 2021).

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Pennsylvania

Last updated 02/28/2021

POLICY

For FQHCs & RHCs

Telepsychiatry Services – Only applicable …

POLICY

For FQHCs & RHCs

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

SOURCE: PA PROMISe, 837 Professional/CMS-1500 Claim Form, Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Apr. 22, 2014). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See listing for reimbursable procedure codes when the service is provided via interactive telecommunication technology.

SOURCE: PA Department of Human Services, Medical Assistance Program Fee Schedule for Consultations Performed Using Interactive Telecommunication Technology, p. 3 (May 23, 2012), (Accessed Feb. 2021) & PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, Attachment A, Feb. 20, 2020, (Accessed Feb. 2021).

Psychiatric Outpatient Clinics, Psychiatric Partial Hospitalization Programs, and Drug & Alcohol Outpatient Clinics can bill for specified services provided by psychiatrists, licensed psychologists, CRNPs, PAs, LCSWs, LPCs, and LMFTs in the FFS delivery system. See Attachment A in cited bulletin for a list of procedure codes for services that may be provided using telehealth in the FFS delivery system. Providers must use the appropriate procedure codes and modifiers to identify that the service was delivered using telehealth.

Interpretive services, including sign language, must be provided as necessary.

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.3-4, Feb. 20, 2020, (Accessed Feb. 2021).

PA Medical Assistance Program has a fee schedule that lists codes eligible to be performed using interactive telecommunication technology.

SOURCE: PA Department of Public Welfare, Fee Schedule for Consultations Performed Using Interactive Telecommunication Technology.  May 23, 2012, (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

In the FFS delivery system, psychiatrists, psychologists, CRNPs and PAs certified in mental health, LCSWs, LPCs, and LMFTs can provide services using telehealth in Psychiatric Outpatient Clinics, Psychiatric Partial Hospitalization Programs, and Drug & Alcohol Outpatient Clinics.

Psychiatric Outpatient Clinics, Psychiatric Partial Hospitalization Programs, and Drug & Alcohol Outpatient Clinics can bill for specified services provided by psychiatrists, licensed psychologists, CRNPs, PAs, LCSWs, LPCs, and LMFTs in the FFS delivery system. See Attachment A in cited bulletin for a list of procedure codes for services that may be provided using telehealth in the FFS delivery system. Providers must use the appropriate procedure codes and modifiers to identify that the service was delivered using telehealth.

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.2 & 4, Feb. 20, 2020, (Accessed Feb. 2021).

Pennsylvania Medicaid will provide reimbursement for live video to all Medicaid enrolled physician specialists.

Eligible Providers (fee for service):

  • Physicians
  • Certified registered nurse practitioners
  • Certified nurse midwives

Providers under a managed care system should contact the appropriate managed care organization.

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Feb. 2021).

Telepsych services delivered in FQHCs and RHCs require providers to have a service description approved by the Office of Mental Health and Substance Abuse Services and the service must be deliverable through the managed care option. Telepsych services are limited to psychologists and psychiatrists.

SOURCE:  PA PROMISe, 837 Professional/CMS-1500 Claim Form, Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Apr. 22, 2014). (Accessed Feb. 2021).


ELIGIBLE SITES

Telehealth cannot be utilized to deliver services to individuals in their homes, unless services are being delivered as part of Assertive Community Treatment (ACT), Dual Diagnosis Treatment Team (DDTT), or Mobile Mental Health Treatment (MMHT) services and only if staff trained in the use of the telehealth equipment and protocols to provide operating support and staff trained to provide in-person clinical intervention are present.

In the FFS delivery system, psychiatrists, psychologists, CRNPs and PAs certified in mental health, LCSWs, LPCs, and LMFTs can provide services using telehealth in Psychiatric Outpatient Clinics, Psychiatric Partial Hospitalization Programs, and Drug & Alcohol Outpatient Clinics.  BH-MCOs may allow additional provider settings to utilize telehealth.

Originating site must have staff trained in telehealth equipment and protocols to provide operating support and staff trained and available to provide in-person clinical intervention, if needed. If ACT, DDTT, or MMHT services are being provided in the home, staff trained in the use of the telehealth equipment and protocols to provide operating support and staff trained to provide in-person clinical intervention if needed must be present.

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.2-3, Feb. 20, 2020, (Accessed Feb. 2021).

A patient is allowed to access a telemedicine consultation at any enrolled office of the referring provider as well as any other participating physicians, certified registered nurse practitioner, or certified nurse midwife (i.e. other than the referring provider).

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

Providers are reminded that services should be rendered face-to-face whenever practical and appropriate. Some situations providers may consider when determining if the use of telecommunication technology to provide a consultation is practical and appropriate include, but are not limited to, the recipient’s medical condition would make it dangerous to travel, the recipient must travel more than 60 minutes in a rural area or 30 minutes in an urban area, or there are no available openings with an appropriate physician specialist located within the travel limits within a timeframe appropriate to treat the recipient’s condition.

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

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Rhode Island

Last updated 02/28/2021

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

Rhode Island Medicaid’s fee …

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

Rhode Island Medicaid’s fee schedule lists several telehealth service CPT codes for outpatient visits and limited emergency department inpatient telehealth consultations under procedure/professional services.

SOURCE: RI Department of Health. Medicaid Fee Schedule Rates. (Accessed Feb. 2021).

Reimbursement is available for initial inpatient telehealth consultation and follow-up inpatient telehealth consultation.

SOURCE: RI Department of Health. Medicaid Fee Schedule Rates. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

No Reference Found


ELIGIBLE SITES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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South Carolina

Last updated 02/28/2021

POLICY

South Carolina Medicaid will reimburse for live video and …

POLICY

South Carolina Medicaid will reimburse for live video and covers telemedicine when the service is medically necessary and under the following circumstances:

  • The medical care is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the beneficiary’s need; and
  • The medical care can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 29 (Feb. 2021) (Accessed Feb. 2021).

If there are technological difficulties in performing a medical assessment or problems in a beneficiaries’ understanding of telemedicine, face-to-face care must be provided instead.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 28 (Feb. 2021) (Accessed Feb. 2021).

Telemedicine equipment and transmission must permit encrypted transmission and the speed and image resolution must be technically sufficient to support the service billed. Staff involved in a telemedicine visit must be trained in the use of the telemedicine equipment and component in its operation.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 30 (Feb. 2021) (Accessed Feb. 2021).

Reimbursement to the health professional delivering the medical service is the same as the current fee schedule amount for the service provided. See appropriate professional manuals for CPT codes. Codes must be billed along with the telemedicine GT modifier.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 215 (Feb. 2021) (Accessed Feb. 2021).

Telepsychiatry

To qualify for reimbursement, interactive audio and video equipment that permits two-way real-time or near real-time communication with the client, consultant, interpreter, and referring clinician.

Additional requirements include:

  • Reimbursement requires the “real-time” presence of a client.
  • Reimbursement is available for psychiatric diagnosis assessment with Medicaid and medical evaluation and management codes.
    GT modifier must be used when billing the for telepsychiatric services.
  • All equipment must operate at a minimum communication transfer rate of 384 kbps.
  • Telepsychiatry reimbursement is not available for the following MH services; injectable, NS, CI Individual Family, Group and Multiple FP and Psychological Testing which require “hands on” encounters, Mental Health Assessment by Non-Physician and SPD.

SOURCE: SC Health and Human Svcs. Dept. Community Mental Health Services Provider Manual, p. 20. (Jan. 2020). (Accessed Feb. 2021). 


ELIGIBLE SERVICES/SPECIALTIES

Eligible services include consultation, diagnostic, and treatment services:

• Office or other outpatient visits;
• Inpatient consultation;
• Individual psychotherapy;
• Psychiatric diagnostic interview examination;
• Neurobehavioral status examination;
• Electrocardiogram interpretation and report only;
• Echocardiography.

Services provided by allied health professionals are not covered.

Telemedicine services are not an expansion of covered services, but an option for the delivery of certain covered services.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 28, 30 & 157 (Feb. 2021) (Accessed Feb. 2021).

Local education manual refers providers to the physician Services Provider Manual for information regarding coverage and billing for telemedicine.

SOURCE: SC Health and Human Svcs. Dept. Local Education Provider Manual, p. 29, (Nov. 2020), (Accessed Feb. 2021).

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.

SOURCE: SC Health and Human Svcs. Dept., Medicaid Targeted Case Management Provider Guide, p. 20 (Jan. 2020), (Accessed Feb. 2021).

Telepsychiatry
Psychiatric Diagnostic assessment with medical services to assess or monitor the client’s psychiatric and/or physiological status may be provided via live video telepsychiatry. See manual for specific requirements.

SOURCE:  SC Health and Human Svcs. Dept. Community Mental Health Services Provider Manual, p. 20 (Jan. 2020). (Accessed Feb. 2021). 

Autism Spectrum Disorder
Telehealth is not covered.

SOURCE: SC Health and Human Svcs. Autism Spectrum Disorder Provider Manual, p. 19 (Jan. 2020). (Accessed Feb. 2021).

Dental Telephonic or Telehealth Encounters
SCDHHS will reimburse enrolled dentists for the provision of triage and care coordination when provided via telephonic or telehealth interaction for patients with urgent or emergent dental issues, regardless of the patient’s location. Dentists should bill for these services using Current Dental Terminology (CDT) Procedure code D9992. Reimbursement for D9992 will be allowed once per thirty (30) days per provider, provider location or billing entity for either a new or an established patient.

Reimbursement for the telephonic services described above is available if the interaction with a Healthy Connections Medicaid member includes at least one telephonic component between patient and provider or provider and provider. Interactions that also include video interaction may also be billed, but other forms of electronic communication, such as email and instant and text messaging, are not eligible for reimbursement. To qualify for reimbursement, the interactions must include the necessary audio and video components, of sufficient quality and resolution, to provide the care that is being billed.

SOURCE: SC Health and Human Svcs. Dental Services Provider Manual. (Oct. 2020), Pg. 77. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Distant site eligible, reimbursed providers:

  • Physicians;
  • Nurse practitioners;
  • Physician Assistants.

Distant (consultant) sites must be located in the SC Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 28-29. (Feb. 2021) (Accessed Feb. 2021).

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

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 215. (Feb. 2021). (Accessed Feb. 2021).


ELIGIBLE SITES

Eligible originating (referring) sites:

  • Practitioner offices;
  • Hospitals (inpatient and outpatient);
  • Rural Health Clinics;
  • Federally Qualified Health Centers;
  • Community Mental Health Centers;
  • Public Schools;
  • Act 301 Behavioral Health Centers.

Referring sites (also known as originating sites) must be located in the South Carolina Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border.

SOURCE: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 28 (Feb. 2021) (Accessed Feb. 2021).

Local Education Agency Manual refers providers to the Physician Manual Policy.

SOURCE: Local Education Manual, p. 29. (Nov. 2020). (Accessed Feb. 2021).

An appropriate certified or licensed health care professional at the referring site is required to present (patient site presenter) the beneficiary to the physician or practitioner at the consulting site and remain available as clinically appropriate.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 30 (Feb. 2021) (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

Distant (consultant) sites must be located in the SC Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 28. (Feb. 2021) (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

The referring site is only eligible to receive a facility fee for telemedicine services. Claims are submitted with HCPCS code. If a provider from the referring site performs a separately identifiable service for the beneficiary on the same day as telemedicine, documentation for both services must be clearly and separately identified in the beneficiary’s medical record, and both services are eligible for full reimbursement.

RHCs and FQHCs are eligible to receive a facility fee for telemedicine services when operating as the referring site. They may not bill the encounter code if these are the only services being rendered.

Hospital providers are eligible to receive a facility fee for telemedicine when operating as the referring site. Claims must be submitted with the appropriate telemedicine revenue code.

SOURCE: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 215 (Feb. 2021). (Accessed Feb. 2021). 

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South Dakota

Last updated 04/29/2021

POLICY

Services provided via telemedicine are subject to the same …

POLICY

Services provided via telemedicine are subject to the same service requirements and limitations as in-person services.

These coverage requirements apply for telemedicine services in SD Medicaid:

  • The provider must be properly enrolled;
  • Services must be medically necessary;
  • The recipient must be eligible; and
  • If applicable, the service must be prior authorized.

Providers must bill for services at their usual and customary charge. Providers are reimbursed the lesser of their usual and customary charge or the fee schedule rate.  Reimbursement for distant site telemedicine services is limited to the individual practitioner’s professional fees or the encounter rate if the service qualifies as an FQHC/RHC or IHS/Tribal 638 clinic service. The maximum allowable amount for services provided via telemedicine is the same as services provided in-person.

See Appendix of manual for complete list of CPT codes, but please note that current version of this manual includes services that are only being covered on a temporary basis.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 3-4 & 12 (Mar. 2021) (Accessed Apr. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See manuals for specific CPT codes in Appendix.  Services not specifically listed as covered in the procedure code table in the Appendix are considered non-covered.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 11, 14-16 (Mar. 2021) (Accessed Apr. 2021).

Community health worker services can be provided via telemedicine.

SOURCE: SD Medicaid Billing and Policy Manual: Community Health Worker, pg. 8, (Mar. 2021). (Accessed Apr. 2021).

Speech language pathologist services can be provided via telemedicine for adults, in schools, and for infants ages 0-3.

SOURCE: SD Medicaid Billing and Policy Manual:  Birth to Three Non-School District Providers, p. 3, (Jan. 2021), School Districts, pg. 4, (Apr. 2021), & Therapy Services (Dec. 2020). (Accessed Apr. 2021)

Psychotherapy is allowed to be provided via telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Independent Mental Health Practitioners, pg. 13, (Dec. 2020), (Accessed Apr. 2021). 

An encounter for the initial ordering of durable medical equipment may occur through telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Durable Medical Equipment, Prosthetics, Orthotics and Supplies, pg. 2. Dec. 2020. (Accessed Apr. 2021).

Speech therapy services may be provided via telemedicine after an initial face-to-face contact and once every 90 days thereafter.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Mar. 2021). (Accessed Apr. 2021).

A face-to-face encounter for physician recertification for hospice may occur via telemedicine.

SOURCE: SD Medicaid Billing and Policy Manual: Hospice, p. 2 (Dec. 2020), (Accessed Apr. 2021).

Telemedicine consultations are covered as outpatient hospital services.

SOURCE: SD Medicaid Billing and Policy Manual: Outpatient Hospital Services, p. 2 (Dec. 2020), (Accessed Apr. 2021).

Community health worker services can be provided via telemedicine.

SOURCE: SD Medicaid Billing and Policy Manual: Community Health Worker, p. 8 (Mar. 2021), (Accessed Apr. 2021).

Psychotherapy is allowed to be provided via telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Independent Mental Health Practitioners, p. 13, (Dec. 2020), (Accessed Apr. 2021).


ELIGIBLE PROVIDERS

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

  • Certified Social Worker (PIP or PIP Candidate)
  • Clinical Nurse Specialist
  • Community Health Worker
  • Community Mental Health Centers (CMHC)
  • Diabetes Education Programs
  • Dietitians
  • Federally Qualified Health Centers (FQHC)
  • Indian Health Services Clinics
  • Licensed Marriage and Family Therapists
  • Licensed Professional Counselor (MH or working toward MH designation)
  • Nurse Practitioners
  • Nutritionists
  • Physicians
  • Physician Assistants
  • Podiatrists
  • Psychologist
  • Rural Health Clinic (RHC)
  • Speech Language Pathologists
  • Substance Use Disorder Agencies
  • Tribal 638 facilities

* Audiologists, occupational therapists, physical therapists and optometrists are listed as temporarily allowed during COVID-19 PHE in the provider manual, but are not permanent eligible providers.

Unless prohibited by law or regulation the distant site location may be a provider’s home. South Dakota Medicaid does not require the distant site location be listed on their provider enrollment record. All services provided via telemedicine at a distant site must be billed with the GT modifier in the first modifier position to indicate the service was provided via telemedicine.

South Dakota Medicaid does not have additional requirements regarding the distant site location other than the same community limitation stated in this manual.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1 & 4 (Mar. 2021). (Accessed Apr. 2021).

Speech therapy services may be provided via telemedicine once an initial in-person contact has been completed. An in-person contact must occur every 90 days thereafter. The telemedicine service must be provided by means of “real-time” interactive telecommunications system. The recipient (patient) and provider cannot be in the same community.

SOURCE: SD Medicaid Billing and Policy Manual: Therapy Services, pg. 7, Dec. 2020, (Accessed Apr. 2021).

Indian Health Services and Tribal 638 Providers

IHS/Tribal 638s may also provide distant site telemedicine services. When an IHS provider is the originating site and an IHS contract provider is the distant site, IHS should submit a claim for both the originating site facility fee and the distant site telemedicine services. The contracted distant site provider may not submit a claim for the service. The services rendered by the contracted provider are reimbursed through their contract with IHS.

“Encounter,” a face-to-face or telemedicine contact between a health care professional and a Medicaid recipient for the provision of Medicaid or CHIP services through an IHS or Tribal 638 facility within a 24-hour period ending at midnight.

SOURCE: SD Medicaid Billing and Policy Manual:  IHS and Tribal 638 Providers, p. 5 & 12-13, (Apr. 2021), (Accessed Apr. 2021).


ELIGIBLE SITES

Originating sites listed in the eligible provider section are eligible to receive a facility fee for each completed telemedicine transaction for a covered distant site telemedicine service. Sites not listed may also serve as an originating site but are not eligible for a facility fee reimbursement. Originating site are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the telemedicine service. Originating sites must be enrolled with South Dakota Medicaid.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1 & 3 (Mar. 2021). (Accessed Apr. 2021).

FQHC/RHCs are eligible to serve as an originating site for telemedicine services. An originating site is the physical location of the Medicaid recipient at the time the service is provided a home can be an originating site but is not eligible for reimbursement.

SOURCE: SD Medicaid Billing and Policy Manual:  FQHC and RHC Services, pg. 6, 14, (Dec. 2020)  (Accessed Apr. 2021).

Indian Health Services and Tribal 638 Providers

IHS and Tribal 638 facilities s are eligible to serve as an originating site for telemedicine services.

SOURCE: SD Medicaid Billing and Policy Manual:  IHS and Tribal 638 Providers, p. 5, (Apr. 2021), (Accessed Apr. 2021).


GEOGRAPHIC LIMITS

An originating site may not be located in the same community as the distant site, unless the originating site is a nursing facility; or telemedicine is being utilized primarily to reduce the risk of exposure of the provider, staff, or others to infection.

If telemedicine is being used primarily to reduce the risk of exposure to infection, the originating site would generally be expected be a recipient’s home or another site ineligible to bill an originating site facility fee.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 3 (Mar. 2021) (Accessed Apr. 2021).


FACILITY/TRANSMISSION FEE

Certain originating sites are eligible for a facility fee and are:

  • Office of a physician or practitioner
  • Outpatient Hospital
  • Critical Access Hospital
  • Rural Health Clinic
  • Federally Qualified Health Center
  • Indian Health Services Clinic
  • Community Mental Health Center
  • Substance use disorder agency
  • Nursing Facilities
  • Schools

The originating site may not be located in the same community as the distant site unless the originating site is a nursing facility.

Originating site are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the telemedicine service.

A recipient’s home is not eligible for reimbursement of an originating site facility fee.

For group services with multiple recipients in the same originating site location, only one originating site fee is billable per physical location of the recipients. For Division of Behavioral Health block grant contract providers, the originating site fee should only be billed to Medicaid if the group includes both Medicaid recipients and individuals ineligible for Medicaid.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 2-3; 11, 13. (Mar. 2021). (Accessed Apr. 2021).

Skilled Nursing Facility and Nursing Facility Services

The telemedicine originating site fee is reimbursed at the lesser of the provider’s usual and customary charge and the fee for HCPCS code Q3014 listed on the Physician Services Fee Schedule.  The telemedicine originating site fee must be billed using revenue code 780.

SOURCE: SD Medicaid Billing and Policy Manual: Skilled Nursing Facility and Nursing Facility Services, p. 10, (Dec. 2020), (Accessed Apr. 2021).

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Tennessee

Last updated 02/28/2021

POLICY

Health insurance entities (including managed care organizations) participating in …

POLICY

Health insurance entities (including managed care organizations) participating in the medical assistance program are required to provide coverage for telehealth (which includes live video) delivered services in a manner that is consistent with the health insurance policy or contract provided for in-person services. Any provisions not stipulated in the telehealth services section of the insurance code shall be governed by the terms and conditions of the health insurance contract.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002(e) & (g). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to the effective date of this act by the federal centers for Medicare and Medicaid services.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, “medically necessary” means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5- 144; and

For all other healthcare services, “medically necessary” means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

  • In accordance with generally accepted standards of medical practice;
  • Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
  • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease excluding any costs paid pursuant to subsection (i).

SOURCE: TN Code Annotated, Sec. 56-7-1002 & HB 8002 (2020 Session), (Accessed Feb.2021). 

A health insurance entity shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine and shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient.  They shall also reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

This section does not require a health insurance entity to provide coverage or reimbursement for healthcare services delivered by means of provider-based telemedicine (which includes store-and-forward) if the applicable health insurance policy would not provide coverage or reimbursement for the same healthcare services if delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1003 & HB 8002 (2020 Session), (Accessed Feb. 2021).

Mental Health & Substance Abuse Services

TennCare will reimburse for live video for crisis-related services or an assessment for emergency admission by an in-patient psychiatric facility.

Please see Telecommunications Guidelines for policy guidance.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 46 & 56, (2017) (Accessed Feb. 2021).

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4 &, (2012) (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

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

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

SOURCE: TN Code Annotated, Sec. 56-7-1003 & HB 8002 (2020 Session), (Accessed Feb. 2021).


ELIGIBLE SITES

Qualified Sites

  • Office of a healthcare services provider (an individual acting within the scope of a valid license issued pursuant to title 63 or any state-contracted crisis service provider employed by a facility licensed under title 33);
  • A hospital licensed under title 68;
  • A facility recognized as a rural health clinic under federal Medicare regulations;
  • A federally qualified health center;
  • A school clinic staffed or at a public elementary or secondary school appropriately staffed and equipped; or
  • Any facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002(a)(5) & (7)(A)(ii). (Accessed Feb. 2021).

“Qualified site” means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

SOURCE: TN Code Annotated, Sec. 56-7-1003 & HB 8002 (2020 Session), (Accessed Feb. 2021).

Mental Health & Substance Abuse Services

Crisis service providers may connect from:

  • Emergency departments;
  • Jails;
  • Detention centers; and
  • Other similar locations

All telehealth sites shall ensure that telehealth equipment is located in a space conducive to a clinical environment.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 46 & 50, (2017) (Accessed Feb. 2021) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4 & 8, (2012) (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

Reimbursement and coverage must be provided for telehealth services without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002(d)(2) & (e). (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to the effective date of this act by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002 & HB 8002 (2020 Session), (Accessed Feb. 2021). 

 

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Texas

Last updated 02/28/2021

POLICY

Synchronous audiovisual interaction is reimbursable under Texas Medicaid fee-for-service.…

POLICY

Synchronous audiovisual interaction is reimbursable under Texas Medicaid fee-for-service.

SOURCE: TX Medicaid Telecommunication Services Handbook, Feb. 2021, p. 7 (Feb. 2021) (Accessed Feb. 2021).

Provider reimbursement for telemedicine services must be at the same rate as Medicaid reimburses for the same in-person medical service.  A request for reimbursement may not be denied solely because an in-person medical service between a physician and a patient did not occur.  The commission may not limit a physician’s choice of platform for providing a telemedicine medical service or telehealth service by requiring that the physician use a particular platform to receive reimbursement for the service.

SOURCE: TX Govt. Code Sec. 531.0217(d). (Accessed Feb. 2021).

Texas Medicaid managed care organizations (MCOs) are prohibited from denying reimbursement for covered services solely because they are delivered remotely. MCOs must consider reimbursement for all medically necessary Medicaid-covered services that are provided using telemedicine or telehealth and must consider clinical effectiveness and cost-effectiveness to determine whether a telemedicine or telehealth visit is appropriate.

Texas Medicaid MCOs must consider reimbursement for all services that are currently a Medicaid benefit when they are provided using telemedicine or telehealth, including the procedure codes that are identified in certain tables in the handbook (see handbook).

All other medically necessary Medicaid-covered services that are provided using telemedicine or telehealth must also be considered for reimbursement. Texas Medicaid MCOs cannot deny, limit, or reduce reimbursement for a covered health-care service or procedure based on the provider’s choice of telecommunications platform to provide the service or procedure using telemedicine or telehealth.  Providers should refer to individual MCO policies for additional coverage information.

A valid practitioner-patient relationship must exist between the distant site provider and the patient receiving telemedicine services. A valid practitioner-patient relationship exists between the distant site provider and the patient if:

  • The distant site provider meets the same standard of care required for and in-person service.
  • The relationship can be established through:
  • A prior in-person service.
  • A prior telemedicine medical service that meets the delivery modality requirements specified in Texas Occupations Code §111.005(a)(3).
  • The current telemedicine medical service.

SOURCE: TX Medicaid Telecommunication Services Handbook, Feb. 2021, p. 5-6 (Accessed Feb. 2021)

Eligible distant site providers are reimbursed in the same manner as their other professional services.

SOURCE: TX Admin. Code, Title 1 Sec. 355.7001, (Accessed Feb. 2021).

Telemedicine:  Texas health and human services agencies that administer a part of Medicaid are required to provide Medicaid reimbursement for a telemedicine service initiated or provided by a physician. Reimbursement is provided only for a telemedicine medical service initiated or provided by a physician.

A request for reimbursement may not be denied solely because an in-person medical service between a physician and a patient did not occur. Medicaid cannot limit a physician’s choice of platform for providing a telemedicine or telehealth service by requiring the use of a particular platform to receive reimbursement.

Medicaid reimbursement is provided to a physician for a telemedicine medical service provided by the physician, even if the physician is not the patient’s primary care physician or provider, if:

  • The physician is an authorized health care provider under Medicaid;
  • The patient is a child who receives the services in a primary or secondary school-based setting; and
  • The parent or legal guardian of the patient provides consent before the services is provided;

SOURCE: TX Govt. Code Sec. 531.0217. (SB – 670). (Accessed Feb. 2021)

Telehealth:  Before receiving a telehealth service, the patient must receive an initial evaluation for the same diagnosis or condition by a physician or other qualified healthcare professional licensed in Texas which can be performed in-person or as a telemedicine visit that conforms to 22 TAC Ch. 174.  A patient receiving telehealth services must be evaluated annually by a physician or other healthcare professional (in-person or via a telemedicine visit) to determine if the patient has a continued need for the service.  If the patient is receiving the telehealth services to treat a mental health diagnosis or condition, the patient is not required to receive an initial evaluation.

SOURCE: TX Admin. Code, Title 1, Sec. 354.1432(2) (Accessed Feb. 2021).

Preventive health visits under Texas Health Steps (THSteps) are not benefits if performed using

telemedicine medical services. See provider manual for special rules for Texas Health Steps program.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 7 (Feb. 2021), (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Telemedicine & Telehealth

Texas Medicaid reimburses for telemedicine and telehealth codes specified in the TX Medicaid Provider Procedures Manual. See individual manuals for reimbursable services provided through telehealth.

More than one medically necessary telemedicine or telehealth service may be reimbursed for the same date and same place of service if the services are billed by providers of different specialties.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4, 7, & 11, (Feb. 2021). (Accessed Feb. 2021).

Texas Medicaid MCOs must consider reimbursement for all services that are currently a Medicaid benefit when they are provided using telemedicine or telehealth, including the procedure codes that are identified in the tables of subsection 3.3.4 *, “Telemedicine Benefits for FQHCs” and subsection 3.4.8 *, “Distant-Site Telehealth Benefits for FQHCs” in this handbook.  All other medically necessary Medicaid-covered services that are provided using telemedicine or telehealth must also be considered for reimbursement.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 5. (Feb. 2021). (Accessed Feb. 2021).

Telemedicine

Texas Medicaid reimburses for live video for the following services provided through telemedicine:

  • Consultations;
  • Office or other outpatient visits;
  • Psychiatric diagnostic interviews;
  • Pharmacologic management;
  • Psychotherapy;
  • Data transmission

SOURCE: TX Admin. Code, Title 1, Sec. 354.1432(1). (Accessed Feb. 2021).

Certain outpatient mental health services may be provided by distant site providers through telemedicine or telehealth when billed with modifier 95.

Mental health services delivered through telemedicine or telehealth do not require a patient site presenter unless the patient is experiencing a mental health emergency.

Prescribing of certain MAT medications may be done via telemedicine presuming all other applicable state and federal laws are followed.  With the exception of prescribing MAT medications via telemedicine, SUD treatment services may not be delivered via telemedicine or telehealth.

SOURCE:  TX Medicaid Behavioral Health and Case Management Svcs. Handbook, p. 25 & 73-74, (Dec. 2020). (Accessed Feb. 2021).

THSteps preventive medical checkups are not a benefit under telemedicine or telehealth.

SOURCE:  TX Medicaid Children’s Services Handbook, p. 175, (Feb. 2021), (Accessed Feb. 2021).

Use of telemedicine medical services is not permitted for the treatment of a client for chronic pain with scheduled drugs. However, telemedicine medical service is permitted to be used in the treatment of acute pain with scheduled drugs.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8, (Feb. 2021). (Accessed Feb. 2021).

School based telehealth services, SHARS telehealth services and early childhood intervention telehealth services are allowed for certain codes and certain circumstances.  See ‘Eligible Provider’ section below or provider manual for more details.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 12, (Feb. 2021). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Telemedicine eligible distant site providers are enrolled as a Texas Medicaid provider and are a:

  • Physician
  • Clinical Nurse Specialist (CNS)
  • Nurse Practitioner (NP)
  • Advanced Practice Registered Nurse (APRNs) (in administrative code only)
  • Physician Assistant (PA)
  • Certified Nurse Midwife (CNM)
  • Federally Qualified Health Center (FQHC)

A distant site provider is the physician, or PA, NP or CNS who is supervised by and has delegated authority from a licensed Texas physician who uses telemedicine to provide health care services in Texas. Hospitals may also serve as the distant site provider.

Distant site providers that provide mental health services must be appropriately licensed or certified in Texas, or be a qualified mental health professional-community services (QMHP-CS).

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 6, (Feb. 2021). (Accessed Feb. 2021) & TX Admin Code. Title 1, Sec. 355.7001.

Telehealth eligible distant site providers listed in both Administrative Code & Telecommunications Medicaid Manual

  • Licensed professional counselors
  • Licensed marriage and family therapist (LMFT)
  • Licensed clinical social worker (LCSW) (including Comprehensive Care Program social workers)
  • Licensed psychologist
  • Licensed psychological associate
  • School Health and Related Services (SHARS)

Telehealth eligible distant sites listed in Administrative Code only:

  • Durable medical equipment suppliers

Telehealth eligible distant sites listed in Telecommunications Medicaid Manual only:

  • Early Childhood Intervention (ECI)
  • Provisionally licensed psychologist
  • Licensed dietician
  • CCP providers (occupational therapist, speech-language pathologist)
  • Home health agency
  • Post-doctoral psychology fellows and pre-doctoral psychology interns under a psychologist supervision
  • FQHC

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 10 (Feb. 2021) & TX Admin Code. Title 1, Sec. 355.7001 (Accessed Feb. 2021).

School-Based Telehealth Services

Occupational Therapist (OT) and Speech Therapist (ST) providers may be reimbursed for telehealth services delivered to children in school-based settings with the following criteria:

  • Reimbursement for OT and ST providers is only available when the patient site is a school-based setting.
  • Children receiving telehealth services rendered by OT and ST providers must be eligible for these services through Texas Health Steps comprehensive Care Program (CCP).
  • All medical necessity criteria and prior authorization requirements for in-person OT and ST services apply when services are delivered to children in school-based settings.
  • Services provided to a patient on public school or open-enrollment charter school premises are only permitted when delivered before or after school hours.

All other prior authorization, reimbursement, and billing guidelines that are applicable to in-person services will also apply when OT and ST services are delivered as telehealth services.

Licensed clinical social workers (LCSW), licensed professional counselors (LPC), licensed marriage and family therapists (LMFT), and psychologist providers may be reimbursed for telehealth services in school-based settings.

Children receiving telehealth services rendered by LCSW, LPC, LMFT, and psychologist providers must be eligible for these services through Texas Health Steps CCP or through SHARS.

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 11 (Feb. 2021) & Telehealth Services Benefit Policy Update, p. 2 Effective Aug. 1, 2019. (Accessed Feb. 2021).

Early Childhood Intervention

Effective for dates of service on or after March 1, 2020, telehealth services delivered remotely to children who are eligible for the Early Childhood Intervention (ECI) Program and Medicaid will become a benefit for ECI providers.

Services can be billed with modifiers for occupational therapy (OT) services, speech therapy (ST) services, acute OT or ST services.

SOURCE:  TX Medicaid News Item, “Telehealth Services Will Become a Benefit for Early Childhood Intervention Providers Effective March 1, 2020,” Jan. 6, 2020 & TX Medicaid Telecommunication Services Handbook, p. 11 (Dec 2020),  (Accessed Feb. 2021).

FQHCS

See p. 9 of Telecommunication Services Handbook for allowed procedure codes for telemedicine services furnished by FQHCs.

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 11 (Feb. 2021). (Accessed Feb. 2021).

A visit is a face-to-face, telemedicine, or telehealth encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, certified nurse-midwife, visiting nurse, a qualified clinical psychologist, clinical social worker, other health professional for mental health services, dentist, dental hygienist, or an optometrist. Encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit, except where one of the following conditions exist:

  • After the first encounter, the patient suffers illness or injury requiring additional diagnosis or treatment; or
  • The FQHC patient has a medical visit and an “other” health visit, as defined in paragraph (13) of this subsection.

A medical visit is a face-to-face, telemedicine, or telehealth encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, certified nurse midwife, or visiting nurse. An “other” health visit includes, but is not limited to, a face-to-face, telemedicine, or telehealth encounter between an FQHC patient and a qualified clinical psychologist, clinical social worker, other health professional for mental health services, a dentist, a dental hygienist, an optometrist, or a Texas Health Steps Medical Screen.

SOURCE:  Texas Admin Code Title 1, Sec. 355.8261.


ELIGIBLE SITES

Telemedicine/Telehealth eligible originating (patient) sites:

  • An established medical site
  • A state mental health facility
  • State supported living centers.

SOURCE: TX Admin. Code, Title 1, Sec. 354.1432(1)(C) (Accessed Feb. 2021).

A patient site is the place where the client is physically located. A client’s home may be the patient site for telemedicine medical services.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 8 & 12 (Feb. 2021), (Accessed Feb. 2021).

School-Based Telemedicine Services

Telemedicine medical services provided in a school-based setting by a physician, even if the physician is not the client’s primary care physician or provider, are benefits if all of the following criteria are met:

  • The physician is an authorized health-care provider enrolled in Texas Medicaid.
  • The client is a child who is receiving the service in a primary or secondary school-based setting.
  • The parent or legal guardian of the client provides consent before the service is provided.
  • Telemedicine medical services provided in a school-based setting are also a benefit if the physician delegates provision of services to a nurse practitioner, clinical nurse specialist, or physician assistant, as long as the nurse practitioner, clinical nurse specialist, or physician assistant is working within the scope of their professional license and within the scope of their delegation agreement with the physician.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 9 (Feb. 2021), (Accessed Feb. 2021).

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

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

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 9 & 12. (Feb. 2021), (Accessed Feb. 2021).

TX Medicaid is required to reimburse school districts or open enrollment charter schools for telehealth services delivered by a health professional even if the specialist is not the patient’s primary care provider if the school district or charter school is an authorized health care provider under Medicaid and the parent or guardian of the patient consents.

A health professional is defined as:

  • Licensed, registered certified, or otherwise authorized by Texas to practice as a social worker, occupational therapist or speech language pathologist
  • Licensed professional counselor
  • Licensed marriage and family therapist
  • Licensed specialist in school psychology.

SOURCE: TX Government Code Sec. 531.02171. (Accessed Feb. 2021).

Services may take place in a school-based setting if:

  • The physician is an authorized health care provider under Medicaid;
  • The patient is a child who receives the service in a primary or secondary school-based setting;
  • The parent or legal guardian of the patient provides consent before the service is provided; and
  • A health professional is present with the patient during treatment.

SOURCE: TX Admin. Code, Title 1, Sec. 355.7001(f); & TX Admin. Code, Title 1, Sec. 354.1432(1)(G). (Accessed Feb. 2021).

School-Based Telehealth Services

Occupational therapists and speech therapists may be reimbursed for telehealth services delivered to children in school-based settings if the patient is eligible for those services through Texas Health Steps-Comprehensive Care Program (CCP). Services delivered to a patient on public or open-enrollment charter school premises may only be delivered before or after school hours.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 11 (Feb. 2021). (Accessed Feb. 2021).

School Health and Related Services (SHARS)

Schools that participate in the SHARS program may be reimbursed for telehealth OT and ST services delivered to children in school-based settings with the following criteria:

  • Children who are eligible for OT and ST services through SHARS may receive additional therapy through Texas Health Steps-CCP if medical necessity criteria is met.
  • OT and ST services provided by school districts through SHARS can be delivered during school hours.

SOURCE:  TX Medicaid Telecommunication Services Handbook, p. 11 (Feb. 2021) & Telehealth Services Benefit Policy Update, p. 2 Effective Aug. 1, 2019. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Patient-site providers that are enrolled in Texas Medicaid may only be reimbursed for the facility fee using procedure code Q3014. Procedure code Q3014 is payable to NP, CNS, PA, physicians, and outpatient hospital providers. Charges for other services that are performed at the patient site may be submitted separately. Procedure code Q3014 is not a benefit if the patient site is the client’s home.

SOURCE: TX Admin. Code, Title 1 Sec. 355.7001(d) & TX Medicaid Telecommunication Services Handbook, p. 9. (Feb. 2021). (Accessed Feb. 2021). 

Patient Site

FQHCs may be reimbursed the facility fee (procedure code Q3014) as an add-on procedure code that should not be included in any cost reporting that is used to calculate a PPS or APPS per visit encounter rate.

To receive reimbursement for more than one facility fee for the same client on the same date of service, an FQHC must submit documentation of medical necessity that indicates that the client needed multiple distant-site provider consultations. An FQHC can use a signed letter from the client’s treating health-care provider at the FQHC to document the client’s medical need for receiving multiple distant-site provider consultations on the same date of service. The letter must state that the client suffered an illness or injury that required additional diagnosis or treatment by a distant-site provider.

If an FQHC is eligible for payment of both an encounter fee and a facility fee for the same client on the same date of service, the FQHC must submit a claim for the facility fee separate from the claim that was submitted for the encounter.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 9 (Feb. 2021), (Accessed Feb. 2021).

 

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Utah

Last updated 02/28/2021

POLICY

Providers are eligible for reimbursement for telemedicine services under …

POLICY

Providers are eligible for reimbursement for telemedicine services under Utah’s Medical Assistance Program.

SOURCE: UT Code Annotated Sec. 26-18-13. (Accessed Feb. 2021).

Utah Medicaid covers medically necessary, non-experimental and cost-effective services provided via telehealth.

Limitations:

  • Must be HIPAA compliant
  • Must comply with Utah Health Information Network Standards for Telehealth

CMS 1500 Professional Claims- Provider must indicate that the service(s) were provided via telehealth by indicating Place of Service 02 on the CMS 1500 claim form with the service’s usual billing codes.

UB-04 Institutional Claims- Providers must indicate that the service(s) were provided via telehealth by appending the GT modifier to the UB-04 institutional claim form with the service’s usual billing codes.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 & 50 (Jul. 2020). (Accessed Feb. 2021).

Covered services may be delivered by means of telemedicine, as clinically appropriate, including consultation, evaluation and management services, mental health services, substance use disorder services and telepsychiatric consultations. Must comply with privacy and security measures set forth by HIPAA and with Utah Health Information Network standards for telehealth. These standards provide a uniform standard of billing for claims and encounters delivered via telehealth.

The Department pays the lesser of the amount billed or the rate on the fee schedule. A provider shall not charge the Department a fee that exceeds the provider’s usual and customary charges for the provider’s private pay patients.

SOURCE: UT Admin. Code R414-42-3, R414-42-4, & R414-42-5 (Accessed Feb. 2021).


ELIGIBLE SPECIALTIES/SERVICES

Eligible services include but are not limited to:

  • Consultation services
  • Evaluation and management services
  • Mental health services
  • Substance use disorder services
  • Teledentistry
  • Telepsychiatric consultations

See manual for high level list of services that can be delivered via telemedicine.

Rural health clinic and federally qualified health clinic services may be delivered via telemedicine.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48-49 (Jul. 2020) & Utah Medicaid Provider Manual: Rural Health Clinics and Federally Qualified Health Centers Services. p.3 (Jan. 2019). (Accessed Feb. 2021).

The Medicaid program is required to reimburse for telemedicine services at the same rate the Medicaid program reimburses for other health care services (includes managed care plans). The Medicaid program is required to reimburse for telepsychiatric consultations at a rate set by the Medicaid program.

SOURCE: UT Code 26-18-13.5.(3) (Accessed Feb. 2021).

Telepsychiatric consultations between a physician and a board-certified psychiatrist are a covered service. See Medicaid Information Bulletin for specific CPT codes to bill.

SOURCE: Medicaid Information Bulletin. Jul. 2018. Sec. 18-67. (Accessed Feb. 2021).

Teledentistry services are limited to certain CPT codes.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).

Rehabilitative Mental Health and Substance Use Disorder

Services may be provided via telemedicine when clinically appropriate.

The scope of rehabilitative behavioral health services includes the following:

  • Psychiatric Diagnostic Evaluation
  • Mental Health Assessment by a Non-Mental Health Therapist
  • Psychological Testing
  • Psychotherapy with Patient and/or Family Member
  • Family psychotherapy with Patient Present and Family Psychotherapy without Patient Present
  • Group Psychotherapy and Multiple Family Group Psychotherapy
  • Psychotherapy for Crisis
  • Psychotherapy with Evaluation and Management (E/M) Services
  • Evaluation and Management (E/M) Services (Pharmacologic Management)
  • Therapeutic Behavioral Services
  • Psychosocial Rehabilitative Services
  • Peer Support Services
  • SUD Services in Licensed SUD Residential Treatment Programs
  • Assertive Community Treatment (ACT)
  • Mobile Crisis Outreach Teams (MCOT)

SOURCE: Utah Medicaid Provider Manual: Rehabilitative Mental Health and Substance Use Disorder Services. P. 9-10 (Jan. 2021) (Accessed Feb.2021).


ELIGIBLE PROVIDERS

The distant site provider may participate in the telehealth interaction from any appropriate location.

Psychiatrists are limited to reporting certain CPT codes.

Rural health clinic and federally qualified health clinic services may be delivered via telemedicine.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49-51 (Jul. 2020). (Accessed Feb. 2021).


ELIGIBLE SITES

It is acceptable to use telehealth to facilitate contact directly between a member and a provider. Services can be provided between a member and a distant site provider when a member is in their home or other location of their choice.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth services.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 (Jul. 2020), (Accessed Feb. 2021).

Home and Community Based Services Autism Waiver

For those clients living outside of the Wasatch Front, the BCBA may use tele-health for the supervision time. In-person visits should be used for those clients living inside the Wasatch Front.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services Autism Waiver, p. 10, (Jan. 2016).  (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

The provider at the originating site receives no additional reimbursement for the use of telemedicine.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 50 (Jul. 2020) & R414-42-4.(3). (Accessed Feb. 2021).

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Vermont

Last updated 02/28/2021

POLICY

Health insurance plans (including Medicaid) must provide coverage for …

POLICY

Health insurance plans (including Medicaid) must provide coverage for health care service delivered through telemedicine by a health care provider at a distant site to a patient at an originating site to the same extent that the plan would cover the services if they were provided through in-person consultation.

An originating site is the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including a health care provider’s office, a hospital, or a health care facility, or the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center or patient’s workplace.

A distant site is the location of the health care provider delivering services through telemedicine at the time the services are provided.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k & Title 18 Sec. 9361 (2017). (Accessed Feb. 2021).

Covered services must be clinically appropriate for delivery through telemedicine and be medically necessary.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Feb. 2021).

Providers should refer to Health Care Administrative Rule 3.101 on Telehealth for requirements.  Information contained in rule will not be repeated in the provider manual.

All professional claims (CMS-1500 form) with services billed for telemedicine must have POS 02. Modifier GT should not be used on professional services.

All facility claims (UB-04 form) must include modifier GT on any telemedicine services delivered via interactive audio and/or video.

Revenue code 780, Telemedicine – is reimbursable when billed with the appropriate HCPCS code. Pricing is the current Level II price on for the HCPCS code billed on the claim.

SOURCE: VT Agency of Human Services. General Billing and Forms Manual. Sec. 5.3.52, p. 88; 97 (Nov. 23, 2020). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Services delivered shall:

  • Include any service that a provider would typically provide to a beneficiary in a face-to-face setting,
  • Adhere to the same program restrictions, limitations, and coverage that exist for the service when not provided through telemedicine, and
  • Be reimbursed at the same rate as the service being provided in a face-to-face setting

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Feb. 2021).

All providers are required to follow correct coding rules, including application of modifiers, and only bill for services within their scope of practice that can be done via telemedicine.  All claims must use POS 02.

SOURCE: VT Agency of Human Services. General Billing and Forms Manual. Sec. 5.3.52, p. 88, (Nov. 23, 2020). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

A distant site is the location of the health care provider delivering services through telemedicine at the time the services are provided.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k.(Accessed Feb. 2021).

Must be provided by a provider who is working within the scope of his or her practice and enrolled in Vermont Medicaid.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.3), Telehealth, (Accessed Feb. 2021).


ELIGIBLE SITES

An originating site is the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including a health care provider’s office, a hospital, or a health care facility, or the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center or patient’s workplace.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k & Title 18 Sec. 9361 (2017). (Accessed Feb. 2021).

The originating site may include the beneficiary’s home or another nonmedical setting (e.g., school, workplace), a health care provider’s office, a facility, or a hospital.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.1), Telehealth, (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Originating facility site providers (patient site) may be reimbursed a facility fee (Q3014).  Facility fees will not be reimbursed if the provider is employed by the same entity as the originating site. GT modifier should not be used on Q3014.

SOURCE: VT Agency of Human Services. General Billing and Forms Manual. Sec. 5.3.52, p. 88, (Nov. 23, 2020). (Accessed Feb. 2021).

Substance Use Disorder

In order to facilitate the use of telemedicine in treating substance use disorder, when the originating site is a health care facility, the Department of Vermont Health Access is required to reimburse the health care provider at the distant site and the health care facility at the originating site for services rendered, unless the providers at both the distant and originating sites are employed by the same entity.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k 2B(h), (Accessed Feb. 2021).

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Virginia

Last updated 02/28/2021

POLICY

All coverage requirements described in the DMAS Provider Manuals …

POLICY

All coverage requirements described in the DMAS Provider Manuals apply when the service is delivered via telemedicine. The use of telemedicine must be noted in the service documentation of the patient record.

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16 (Mar. 2020) (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Telemedicine is available for selected services and limited provider types.

SOURCE: VA Dept. of Medical Assistance Svcs.  General Information.  All Manuals, Feb. 2019, (Accessed Feb. 2021).

All coverage requirements described in the DMAS Provider Manuals apply when the service is delivered via telemedicine. The use of telemedicine must be noted in the service documentation of the patient record.  Eligible telemedicine codes are listed in the manual in two tables.

See manual for non-covered services.

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16-18 (Mar. 2020) & Billing Instructions, pg. 20 (5/1/17), (Accessed Feb. 2021).

See billing information for specific codes.

Eligible services include:

  • Evaluation and management
  • Psychiatric care
  • Specialty medical procedures such as echocardiography and obstetric ultrasound
  • Speech therapy
  • Radiology procedures

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 3. (May. 2014). (Accessed Feb. 2021).

Speech therapy is reimbursable for a speech-language pathologist at a remote location and a qualified school aide with the child during a tele-practice session.

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Local Education Agency Provider Manual, Covered Svcs. and Limitations, p. 11 (Jul. 2018). (Accessed Feb. 2021).

Community Mental Health Rehabilitative Services

A Comprehensive Needs Assessment meeting DMAS telemedicine standards is allowed for:

  • Psychosocial rehabilitation
  • Partial hospitalization
  • Intensive Community Treatment
  • Crisis intervention

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Community Mental Health Rehabilitative Services, Covered Svcs. and Limitations, p. 18 (May. 2019). (Accessed Feb. 2021).

Telemedicine is reimbursable for psychiatric evaluation in crisis stabilization services when coordinated with an outpatient provider and billed as physician or outpatient psychiatric services, however telemedicine is not allowed for services billed under Crisis Stabilization.

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Community Mental Health Rehabilitative Services, Covered Svcs. and Limitations, p. 49-50 (May. 2019). (Accessed Feb. 2021).

Durable Medical Equipment (DME) and Supplies

The face-to-face encounter to qualify for DME may occur through telehealth.

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Durable Medical Equipment and Supplies Manual, Covered Svcs. and Limitations, p. 8 (10/20/20). (Accessed Feb. 2021).

Opioid Treatment Services

Services can be provided face-to-face or by telemedicine according to DMAS policy regarding telemedicine.  MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telemedicine.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Covered Svcs and Limitations p. 7 & 34. (Dec. 2017). (Accessed Feb. 2021).

MAT for Opioid Use Disorder

Prescribing controlled substances for the treatment of addiction delivered via telemedicine must include a qualified provider and a telepresenter located at the originating site, as well as a qualified prescribing provider located at the remote site. Psychotherapy and SUD counseling may also be provided via telemedicine by a qualified provider who is a credentialed addiction treatment professional as defined in this memorandum and DMAS ARTS Provider Manual.  See manual for eligible MAT codes.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p. 3-4. (Accessed Feb. 2021). 

Residential Treatment Service

An assessment for residential referrals can be completed face-to-face or through telemedicine.  See Medicaid manual for DMAS policy.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Residential Treatment Services, Covered Services and Limitations, p. 5 & 33 (1/9/21), (Accessed Feb. 2021).

Vision Manual

CPT codes that are recognized by DMAS are listed.  Codes include:

  • Consultations
  • Office visits
  • Individual psychotherapy
  • Psychiatric diagnostic interview examination
  • Pharmacologic management
  • Colostomy
  • Obstetric ultrasound
  • Echocardiography, fetal
  • Cardiography interpretation and report only
  • Echocardiography

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Vision Manual, Billing Instructions, p. 23 (Jul. 2015), (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Eligible providers:

  • Physicians
  • Nurse practitioners
  • Nurse midwives
  • Psychiatrist
  • Clinical psychologist
  • Clinical nurse specialists
  • Clinical social worker
  • Professional counselor
  • Psychiatric clinical nurse specialist
  • Psychiatric nurse practitioner
  • Marriage and family therapist/counselor
  • School psychologist
  • Substance abuse treatment practitioner
  • Local Education Agency (billing speech therapy)
  • Federally Qualified Health Center Providers
  • Appropriately licensed behavioral health and developmental services providers enrolled with Magellan.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Federally Qualified Health Centers Coverage of Telemedicine. (Mar. 2019) & Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May. 2014) (Accessed Feb. 2021).

Medication Assisted Treatment

The Member is located at an approved originating site with the Medicaid enrolled telepresenter. The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p.4. (Accessed Feb. 2021). 


ELIGIBLE SITES

Eligible originating sites locations:

  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospitals
  • Nursing Facilities
  • Health Department Clinics
  • Renal Units (dialysis centers)
  • Community Services Boards (mental health-intellectual disability provider)
  • Residential Treatment Centers

All listed providers are considered eligible originating site providers.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Federally Qualified Health Centers Coverage of Telemedicine, p. 1 (Mar. 2019) & Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 6. (May 2014) (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services.  Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 2. (May. 2014) (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

Reimburses a facility fee.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May. 2014) & VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Billing Instructions, p. 22 (May 2017); Vision Manual, Billing Instructions, p. 24 (Jul. 2015). (Accessed Feb. 2021).

Medication Assisted Treatment

The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p.4. (Accessed Feb. 2021).

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Washington

Last updated 02/28/2021

POLICY

Fee-for-service clients are eligible for medically necessary covered health …

POLICY

Fee-for-service clients are eligible for medically necessary covered health care services delivered via telemedicine. The referring provider is responsible for determining and documenting that telemedicine is medically necessary. The referring provider is responsible for determining and documenting medical necessity.

As a condition of payment, the client must be present and participating in the telemedicine visit.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 85 (Feb. 2021).  (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Physician-Related Services

WA Medicaid covers telemedicine when it is a substitute for an in-person face-to-face hands-on encounter for only those services specifically listed in the telemedicine section of the manual.

The agency reimburses medically necessary covered services through telemedicine when the service is provided by a Washington Apple Health (Medicaid) provider and is within their scope of practice.  Place of service 02 to indicate the service was furnished as a telemedicine service from the distant site.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 85 & 87 (Feb. 2021).  (Accessed Feb. 2021).

School Based Services

In order for a school district to receive reimbursement for telemedicine, the provider furnishing services through telemedicine must be enrolled as a servicing provider under the school district’s ProviderOne account. Services provided by nonlicensed school staff must be billed under the supervising provider’s NPI in ProviderOne.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School-Based Health Services, p. 33 (Oct. 2020).  (Accessed Feb. 2021).

Applied Behavior Analysis (ABA) for Clients Age 20 and Younger

Eligible telemedicine services:

  • Program supervision when the child is present
  • Family training, which does not require the child’s presence

The LBA may use telemedicine to supervise the CBT’s delivery of ABA services to the client, the family, or both. LBAs who use telemedicine are responsible for determining if telemedicine can be performed without compromising the quality of the parent training, or the outcome of the ABA therapy treatment plan.

See ABA Treatment fee schedule for telemedicine billing instructions.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Applied Behavior Analysis for Clients 20 and Younger, p. 33 (Feb. 2021) & WAC 182-531A-1200. (Accessed Feb. 2021).

Behavioral Health

Behavioral health administrative services organizations and managed care organizations who have a contract with the department shall reimburse a provider for behavioral health services provided to a covered person who is under 18 years old through telemedicine or store-and-forward if:

  • The behavioral health administrative services organization or managed care organization provides coverage for behavioral health services when provided in-person; and
  • The service is medically necessary

SOURCE: Revised Code of WA Sec. 71.24.335(1). (Accessed Feb. 2021).

Teledentistry

Teledentistry can be delivered through a synchronous or asynchronous method.  The agency covers teledentistry as a substitute for an in-person, face-to-face, hands-on encounter when medically necessary, within the scope of practice of the performing agency-contracted providers, and Department of Health teledentistry guidelines.

A dentist or authorized dental provider may delegate allowable tasks to Washington State Registered Dental Hygienists and Expanded Function Dental Assistants through teledentistry.  Delegation of tasks must be under general supervision. Teledentistry does not meet the definition of close supervision.

See manual for acceptable CPT codes.

SOURCE: WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 67-68. (Mar. 2021). (Accessed Feb. 2021).

Mental Health Services

Drug monitoring must be provided during a face-to-face visit with the client, unless it is part of a qualified telemedicine visit.

SOURCE: WA State Health Care Authority, Medicaid Provider. Mental Health Services, p. 47. Jan. 2021, (Accessed Feb. 2021).

Abortion

Medical abortion services provided via telemedicine to a client who does not receive ultrasound(s) and laboratory studies from the medical abortion provider are not eligible for the HCPCS S0199 bundled payment.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 213 (Feb. 2021).  (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Rural Health Clinics (RHCs) & FQHCs

RHCs & FQHCs are authorized to serve as an originating site for telemedicine services. RHCs and FQHCs may receive the encounter rate when billing as a distant site provider if the service being billed is encounter eligible. Clients enrolled in an agency-contracted MCO must contact the MCO regarding whether or not the plan will authorize telemedicine coverage.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Rural Health Clinics, p. 44, Jan. 2021; Federally Qualified Health Centers, p. 64. (Accessed Feb. 2021).

School Based Health Care Services

Under the SBHS program, HCA pays for services provided through telemedicine as outlined in this billing guide. Licensed providers, licensed assistants, compact license holders, interim permit holders, and non-licensed school staff practicing under the supervision of a licensed provider may provide SBHS through telemedicine.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based-Health Care Services, p. 32, Oct. 2020. (Accessed Feb. 2021). 

Tribal Health Program

An encounter can be conducted face-to-face or via real-time telemedicine.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Tribal Health Program, p. 17, Jan. 2021, (Accessed Feb. 2021).


ELIGIBLE SITES

Approved Originating Sites

  • Clinics;
  • Community mental health center/chemical dependency settings;
  • Dental offices;
  • Federally qualified health center;
  • Home or any location determined appropriate by the individual receiving the service;
  • Hospitals—inpatient or outpatient;
  • Neurodevelopmental centers;
  • Physician’s or other health professional’s office;
  • Renal dialysis centers, except an independent renal dialysis center;
  • Rural health clinic;
  • Schools; or
  • Skilled nursing facility

Originating site (referring) providers are responsible for determining and documenting that telemedicine is medically necessary.

SOURCE: WAC 182-531-1730.(3) & WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 86 (Feb. 2021). (Accessed Feb. 2021). 

School-Based Health Care Services (SBHS)

When the originating site is a school, the school district must submit a claim on behalf of both the originating and distant site.  The location of the student and provider must be documented.  The SBHS program allows the following approved originating sites:

  • The school
  • The home, daycare, or any location determined appropriate by the students or parents

See manual for specific scenarios and appropriate modifiers.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 33-34 (Oct. 2020), (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Facility fees are available for originating sites, except inpatient hospitals, skilled nursing facilities, homes or other locations determined appropriate by the individual receiving service. Eligible originating sites explicitly listed for the facility fee include:

  • Hospital outpatient
  • Critical access hospitals
  • FQHCs and RHCs
  • Physicians or other health professional office
  • Other settings, when approved as an originating site

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 86-87 (Feb. 2021). (Accessed Feb. 2021).

FQHCs and Rural Health Clinics that serve as an originating site for telemedicine services are paid an originating site facility fee. Charges for the originating site facility fee may be included on a claim, but the originating site facility fee may not be included on the cost report.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide Rural Health Clinics, p. 44, Jan. 2021 & Federally Qualified Health Centers, p. 64 (Jan. 2021))  (Accessed Feb. 2021).

School-Based Health Care Services (SBHS)

When the originating site is a school, the school district will receive a telemedicine fee per completed telemedicine transmission.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 33 (Oct. 2020), (Accessed Feb. 2021).

Dental Related Services

The facility fee is included in the CPT code.  There is no separate facility fee for teledentistry.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental Services, p. 67 (Mar. 2021).  (Accessed Feb. 2021).

Abortion

When telemedicine is used to provide HCPCS S0199 bundled services, HCA does not pay any additional originating facility fees.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 213 (Feb. 2021).  (Accessed Feb. 2021).

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West Virginia

Last updated 02/28/2021

POLICY

To utilize Telehealth, providers must document that the service …

POLICY

To utilize Telehealth, providers must document that the service was rendered under that modality. When filing a claim, the provider must bill the service code with Place of Service code 02. West Virginia Medicaid covers and reimburses Telehealth services that are identified in designated polices as appropriate to be rendered through this modality.

West Virginia Medicaid does not limit Telehealth services to members in non-metropolitan statistical professional shortage areas as defined by the Centers for Medicare and Medicaid Services (CMS) Telehealth guidance.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Mar. 1 ,2020.) (Accessed Feb. 2021).

Federally Qualified Health Center and Rural Health Clinic Services:

The member must be able to see and interact with the off-site provider at the time services are provided via telehealth.  Services provided via videophone or webcam are not covered.

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.) (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See the applicable chapters of the WV BMS Policy Manual for more detail on specific services, including whether telehealth is an accepted modality to render the service. If not indicated as available, telehealth should be considered a non-covered modality to render the service.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. Revised Mar. 1, 2020.  (Accessed Feb. 2021).

School-based health services manual refers to the Telehealth Chapter (519.17) of the practitioner manual, and lists under each code in the manual whether or not it is eligible for telehealth.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–538 School-Based Health Services. Revised Aug. 1, 2019 (Accessed Feb. 2021).

Targeted case management can be conducted through telemedicine with the exception of the required 90 day face-to-face encounter with the targeted case manager.

SOURCE: WV Dept. of Health and Human Svcs., Medicaid Provider Manual, Chapter 523: Targeted Case Management, p. 13 (Jul. 1, 2016), (Accessed Feb. 2021).

WV Medicaid encourages providers to render services via telehealth in the Behavioral Health Clinic Services program and for substance use disorder (SUD) waiver services.  Under each code in the manuals, it lists whether or not the service is eligible for telehealth.

SOURCE: WV Dept. of Health and Human Service Medicaid Provider Manual, Chapter—503.12 Licensed Behavioral Health Center Services (Jul. 15, 2018); 504.10 Substance Use Disorder Services (Jul. 1, 2019); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Authorized distant site providers include:

  • Physicians;
  • Physician Assistants (PA);
  • Advanced Practice Registered Nurses (APRN)/Nurse Practitioners (NP)
  • Certified Nurse Midwife (CNM);
  • Clinical Nurse Specialists (CNS);
  • Community Mental Health Center (CMHC);
  • Licensed Behavioral Health Center (LBHC);
  • Licensed Psychologists (LP) and Supervised Psychologist (SP);
  • Licensed Independent Clinical Social Worker (LICSW); and
  • Licensed Professional Counselor (LPC)

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).

FQHC and RHC may only serve as a distant site for Telehealth services provided by a psychiatrist or psychologist and are reimbursed at the encounter rate.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) & WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter 522 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 9. (Jul. 1, 2019) (Accessed Feb. 2021).


ELIGIBLE SITES

Authorized originating sites:

  • Offices of physicians or practitioners;
  • Hospitals;
  • Critical Access Hospitals (CAH);
  • Rural Health Clinics (RHCs);
  • Federally Qualified Health Centers (FQHCs);
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites);
  • Skilled Nursing Facilities (SNF);
  • Licensed behavioral health centers
  • Community Mental Health Centers (CMHC);
  • School-Based Health Service sites; and
  • Homes of members who are receiving treatment of substance abuse and/or mental health disorders via telehealth as identified in Chapters 503, 504, 521, 522, and 538 of the WV BMS Policy Manual.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

WV Medicaid does not limit telehealth services to members in non-metropolitan statistical professional shortage areas as defined by CMS telehealth guidance.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

An originating site must bill the appropriate telehealth originating site code (Q3014) unless the originating site is the home of the member. , However facility fees are not covered.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. Revised Mar. 1, 2020 (Accessed Feb. 2021).

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Wisconsin

Last updated 02/28/2021

POLICY

Statute requires reimbursement for any benefit that delivered via …

POLICY

Statute requires reimbursement for any benefit that delivered via interactive telehealth that is a covered benefit under Medicaid as provided by the department by rule.  The ForwardHealth provider manual currently only allows for certain covered services to be provided via live video telehealth.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth.  (Accessed Feb. 2021). 


ELIGIBLE SERVICES/SPECIALTIES

Statute requires reimbursement for any benefit that delivered via interactive telehealth that is a covered benefit under Medicaid.

Reimbursement must be provided for a consultation pertaining to a Medicaid recipient conducted through interactive telehealth between a certified provider of Medical Assistance and the recipient’s treating provider that is certified under medical assistance, except as provided by the Department by Rule.

Except as provided by the department by rule, Medicaid must cover all Medicare covered services.  However, the Department may not cover or provide reimbursement for services that are first covered under the Medicare program after July 1, 2019 until the date that is one year after the date the service is covered under the Medicare program or the date the secretary explicitly approves the service as a Medical Assistance covered service, whichever is earlier.

The Department shall provide reimbursement under the Medical Assistance program for the following:  Except as provided by the department by rule, services that are covered under the Medicare program under 42 USC 1395 et seq. for which the federal department of health and human services provides Medical Assistance federal financial participation and that are any of the following:

  • Telehealth services;
  • Remote physiologic monitoring,
  • Remote evaluation of prerecorded patient information,
  • Brief communication technology-based services,
  • Care management services delivered through telehealth;
  • Any other telehealth or communication technology-based services.

Any service not specified can be eligible if specified by the Department.  The Department is required to promulgate rules specifying any services that are reimbursable.  They may also exclude services from reimbursement.

SOURCE: WI Statute Sec. 49.45 (61). (Accessed Feb. 2021).

ForwardHealth only covers telehealth delivery of individual services. For those procedure codes that can be used for either individual or group services, providers may not submit claims for telehealth delivery of group services. Allowable providers may be reimbursed, as appropriate, for the following services (and applicable procedure codes) provided through telehealth.  See Manual for covered telehealth CPT and HCPCS codes.

ForwardHealth reimburses providers for telestroke services.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Allowable providers:

  • Audiologists
  • Individual mental health and substance abuse practitioners not in a facility certified by the DQA (Division of Quality Assurance)
  • Nurse midwives
  • Nurse practitioners
  • Ph.D. psychologists
  • Physician assistants
  • Physicians
  • Psychiatrists
  • Professionals providing services in mental health or substance abuse programs certified by the DQA

Ancillary Providers

Claims for services provided via telehealth by distant site ancillary providers should be billed under the supervising physician’s NPI using the lowest appropriate level office or outpatient visit procedure code or other appropriate CPT code for the service performed.  These services must be provided under the direct on-site supervision of a physician who is located at the same physical site as the ancillary provider and must be documented in the same manner as services that are provided face to face.

Pediatric and Health Professional Shortage Area-Eligible Services

Claims for services provided via telehealth by distant site providers may additionally qualify for pediatric (services for members 18 years of age and under) or HPSA-enhanced reimbursement.

Tribal FQHCs and RHCs

They may serve as originating site and distant site providers for telehealth services.  See manual for details.

Tribal FQHCs and RHCs may report services provided via telehealth on the cost settlement report when the FQHC or RHC served as the distant site and the member is an established patient of the tribal FQHC or RHC at the time of the telehealth service.

Services billed with modifier GT (modifier indicating telehealth) will be considered under the PPS reimbursement method for non-tribal FQHCs. Billing HCPCS procedure code T1015 (Clinic visit/encounter, all-inclusive) with a telehealth procedure code will result in a PPS rate for fee-for-service encounters.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. (Accessed Feb. 2021).

Community Health Centers (CHCs)

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

Services billed with modifier GT (modifier indicating telehealth) will be considered under the PPS reimbursement method for non-tribal FQHCs. Billing HCPCS procedure code T1015 (Clinic visit/encounter, all-inclusive) with a telehealth procedure code will result in a PPS rate for fee-for-service encounters.

SOURCE: WI ForwardHealth Online Handbook. Telehealth for Community Health Centers. (Accessed Feb. 2021).


ELIGIBLE SITES

For DOS on or after March 1, 2020, ForwardHealth will allow coverage of telehealth for any originating site. However, only the following originating sites will be eligible for a facility fee reimbursement:

  • Hospitals, including emergency departments
  • Office/clinic
  • Skilled nursing facility

The following entities are also listed as allowable originating sites specifically:

  • Community Health Centers (CHC)
  • Federally Qualified Health Centers (FQHC)
  • Rural Health Clinics (RHC)

Telehealth services that are medical in nature and would otherwise be coded as an office visit or consultation evaluation and management visit are covered for members residing in a skilled nursing facility.

Community Health Centers, Tribal FQHCs and RHCs

The originating site facility fee is not a tribal FQHC or RHC reportable encounter on the cost report. Any reimbursement for the originating site facility fee must be reported as a deductive value on the cost report.

For CHCs, originating site services should be billed, but no reimbursement will be issued as all costs for providing originating site services have already been incorporated into the PPS rates for CHCs. Claims billed by CHCs for originating site services may be used for future rate setting purposes.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth & Telehealth for Community Health Centers (Accessed Feb. 2021).

The department may not limit coverage or reimbursement of a service provided under par. (b) or (c) based on the location of the Medical Assistance recipient when the service is provided.

SOURCE: WI Statute Sec. 49.45 (61). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Reimbursement for facility fee using HCPCS procedure code Q3014. Modifier GT should not be included with procedure code Q3014.

An originating site facility fee is not a tribal FQHC or RHC reportable encounter.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. (Accessed Feb. 2021).

CHCs should submit claims for originating site services on a professional claim form with HCPCS procedure code Q3014 (Telehealth originating site facility fee) and a POS code that represents where the member is located during the service. Modifier GT should not be included with procedure code Q3014 for originating site services to be considered under the PPS reimbursement method. ForwardHealth will not separately reimburse the CHC for originating site services because all costs for providing originating site services have already been incorporated into the PPS rates for CHCs. However, claims billed by CHCs for originating site services may be used for future rate setting purposes, and CHC costs associated with telehealth services may be reported for change in scope adjustment consideration.

SOURCE: WI ForwardHealth Online Handbook, Telehealth for Community Health Centers. (Accessed Feb. 2021).

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Wyoming

Last updated 02/28/2021

POLICY

Reimbursement is made for exams performed via a real-time …

POLICY

Reimbursement is made for exams performed via a real-time interactive audio and video telecommunications system. The quality must be sufficient enough to assure the accuracy of the assessment, diagnosis, and visible evaluation of symptoms and potential medication side effects. A medical professional is not required to be present with the client at the originating site unless medically indicated. See manual for additional billing requirements.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 113-114 (Jan. 2021). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See manual for billing examples.

Quality assurance/improvement activities relative to telehealth delivered services need to be identified, documented and monitored. An evaluation process must also be instituted.

Documentation must indicate the visit took place via telehealth and must clearly identify the location of the hub and spoke sites.

Group psychotherapy is not a covered service.

For ESRD-related services, at least one face-to-face “hands on” visit must be furnished each month to examine the vascular access site by a qualified provider.

The same procedure codes and rates apply for telehealth as in person.  The modifier GT is used to identify the professional telehealth service.  Services must be medically necessary, follow generally accepted standards of care and be a service covered by Medicaid.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 114-116 (Jan. 2021). (Accessed Feb. 2021).

Diabetes Prevention Program (DPP)

The first session of a DPP program cannot be performed via telehealth, but sessions 2-16 can be.  The GT modifier should be used.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, Bulletin:  Introducing Medicaid’s Diabetes Prevention Program.  12/19.  (Accessed Feb.  2021).


ELIGIBLE SITES

Each site will be able to bill for their own services as long as they are an enrolled Medicaid provider (this includes out-of-state Medicaid providers). Providers shall not bill for both the spoke and hub site; unless, the provider is at one location and the client is at a different location even though the pay to provider is the same.

The Originating Site or Spoke site is the location of an eligible Medicaid client at the time the service is being furnished via telecommunications system occurs.

Authorized originating sites:

  • Hospitals;
  • Physician or practitioner offices (includes medical clinics);
  • Psychologists or neuropsychologists offices;
  • Community mental health or substance abuse treatment centers (CMHC/SATC);
  • Advanced practice nurses with specialty of psychiatry/mental health offices;
  • Office of a Licensed Mental Health Professional;
  • Federally Qualified Health Centers;
  • Rural Health Clinics;
  • Skilled nursing facilities;
  • Indian Health Services Clinics;
  • Hospital-based or Critical Access Hospital-based renal dialysis centers (including satellites). Independent renal dialysis facilities are not eligible originating sites;
  • Development Center;
  • Family Planning Clinics;
  • Public Health Offices

A medical professional is not required to be present at the originating site, unless medically indicated.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 112-113 (Jan. 2021), WY Division of Healthcare Financing Tribal Provider Manual, pg. 112, (Jan. 2021) & Institutional Provider Manual pg. 110. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Providers are not allowed to bill Q3014 for the originating site when the originating site is the client’s home. This applies to when the client uses personal telephone or computer while at an authorized originating site or when the client is at any location that is not listed below:

  • Hospitals
  • Office of a physician or other practitioner (this includes medical clinics)
  • Office of a psychologist or neuropsychologist
  • Community mental health or substance abuse treatment center (CMHC/SATC)
  • Office of an advanced practice nurse (APN) with specialty of psych/mental health
  • Office of a Licensed Mental Health Professional (LCSW, LPC, LMFT, LAT)
  • Federally Qualified Health Center (FQHC)
  • Rural Health Clinic (RHC)
  • Skilled nursing facility (SNF)
  • Indian Health Services Clinic (IHS)
  • Hospital-based or Critical Access Hospital-based renal dialysis centers (including satellites).
  • Independent Renal Dialysis Facilities are not eligible originating sites
  • Developmental Center
  • Family Planning Clinics
  • Public Health Offices

SOURCE: WY Medicaid Bulletin, Telehealth Providers Originating Site. 12/10/20. (Accessed Feb. 2021).

Yes, for originating site fees.

No reimbursement for transmission fees.

Providers cannot bill for Q3014 if clients used their own equipment, such as personal phones or computers.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 114-115 (Jan. 2021). (Accessed Feb. 2021).

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Medicaid & Medicare

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