Medicaid & Medicare

Miscellaneous

Medicaid programs sometimes have additional requirements, such as documentation or privacy requirements that get noted in this Miscellaneous section.  Additionally, Medicaid specific grants, pilots, and workgroups are also included in this section.

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Federal

Last updated 02/28/2021

Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, …

Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate you furnished the billed service as a professional telehealth service from a distant site. As of January 1, 2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method II must submit institutional claims using the GT modifier.

Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay you the appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). If you are located in, and you reassigned your billing rights to, a CAH and elected the Optional Payment Method II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percent of the Medicare PFS facility amount for the distant site service.

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

Medicaid Requirements

Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy and quality of care. States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology.

States are not required to submit a (separate) SPA for coverage or reimbursement of telemedicine services, if they decide to reimburse for telemedicine services the same way/amount that they pay for face-to-face services/visits/consultations.

States must submit a (separate) reimbursement (attachment 4.19-B) SPA if they want to provide reimbursement for telemedicine services or components of telemedicine differently than is currently being reimbursed for face-to-face services.

States may submit a coverage SPA to better describe the telemedicine services they choose to cover, such as which providers/practitioners are; where it is provided; how it is provided, etc. In this case, and in order to avoid unnecessary SPA submissions, it is recommended that a brief description of the framework of telemedicine be placed in an introductory section of the State Plan and then a reference made to telemedicine coverage in the applicable benefit sections of the State Plan. For example, in the physician section it might say that dermatology services can be delivered via telemedicine provided all state requirements related to telemedicine as described in the state plan are otherwise met.

SOURCE: Medicaid.gov.  Telemedicine (Accessed Nov 2020).

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Alabama

Last updated 02/28/2021

All procedure codes billed for telemedicine services must be billed …

Alaska

Last updated 02/28/2021

Documentation requirements for telemedicine consultations include:

  • Statement that the service

Documentation requirements for telemedicine consultations include:

  • Statement that the service was provided using telemedicine
  • The address location of the patient
  • The address location of the provider
  • The method of telemedicine used
  • The names of all persons participating in the telemedicine service and their role in the encounter
  • The inquiry from the requesting provider
  • The consulting provider’s report back to the requesting provider (see policy for more details).

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

Payment to the presenting provider is limited to the rate established for brief evaluation and management of an established patient.

Receiving providers will be reimbursed in the same manner as reimbursement is made for the same service provided through traditional modes of delivery, not to exceed 100 percent of the rate established in state law.

SOURCE: AK Admin Code, Title 7, 145.270. (Accessed Feb. 2021).

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Arizona

Last updated 02/28/2021

Contractors shall promote the use of telehealth to support an …

Contractors shall promote the use of telehealth to support an adequate provider network.

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

Behavioral Health Medical Record Requirements include the requirement for members receiving services via telemedicine, to have copies of electronically recorded information of direct, consultative or collateral clinical interviews.

SOURCE: AZ Medical Policy for AHCCCS.  Ch. 940: Quality Management and Performance Improvement Program. Pg. 5 & 6.  (9/01/2020).  (Accessed Feb. 2021).

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Arkansas

Last updated 02/28/2021

The distant site provider is prohibited from utilizing telemedicine with …

The distant site provider is prohibited from utilizing telemedicine with a patient unless a professional relationship exists between the provider and patient.  See manual for ways to establish the relationship.   A professional relationship is established if the provider performs a face-to-face examination using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination; or if the establishment of a professional relationship is permitted via telemedicine under the guidelines outlined in ASMB regulations.  Telemedicine may be used to establish the professional relationship only for situations in which the standard of care does not require an in-person encounter and only under the safeguards established by the healthcare professional’s licensing board (See ASMB Regulation 38 for these safeguards including the standards of care).  See manual for full list of requirements on establishing a professional relationship.  Special requirements also exist for providing telemedicine services to a minor in a school setting (see manual).

A healthcare provider providing telemedicine services within Arkansas shall follow applicable state and federal laws, rules and regulations regarding:

  1. Informed consent;
  2. Privacy of individually identifiable health information;
  3. Medical record keeping and confidentiality, and
  4. Fraud and abuse.

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).

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

If the PASSE allows the use of telemedicine, the PASSE must document what services the PASSE allows, the settings allowed, and the qualifications for individuals to perform services via telemedicine.

SOURCE: PASSE Program, II-26, (3/1/19).  (Accessed Feb. 2021).

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California

Last updated 02/28/2021

Specific documentation requirements apply to substantiate the corresponding technical and …

Specific documentation requirements apply to substantiate the corresponding technical and professional components of billed CPT or HCPCS codes.  Providers are not required to document a barrier to in-person visit for Med-Cal coverage or to document the cost effectiveness of telehealth or store-and-forward. Providers at the distant site are not required to document cost effectiveness of telehealth to be reimbursed for telehealth or store-and-forward services.  The distant site provider is, however, responsible for billing Medi-Cal for the covered services and supplying the appropriate supporting documentation.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Aug. 2020), Pg. 4. (Accessed Feb. 2021).

Telehealth services and supports are among the services and supports authorized to be included by individual program plans developed for disabled individuals by regional centers that contract with the State Department of Developmental Disabilities.

SOURCE: Welfare and Institutions Code Sec. 4512. (Accessed Feb. 2021).

Medicaid must ensure that all managed care covered services are available and accessible to enrollees of Medicaid managed care plans in a timely manner. Telecommunications technologies can be used as a means to meet time and distance standards in some circumstances.  See statute for details.

SOURCE: CA Welfare and Institutions Code Sec. 14197. (Accessed Feb. 2021). & CA Department of Health Care Services (DHCS).  All Plan Letter 20-003:  Telehealth Services Policy.  Feb. 27, 2020. (Accessed Feb. 2021).

Telehealth services, telephonic services and other specified services must be reimbursed when provided by specific entities during or immediately following an emergency, subject to the Department obtaining federal approval and matching funds. The Department is required to issue guidance for entities to facilitate reimbursement for telehealth or telephonic services in emergency situations by July 1, 2020.

SOURCE: Welfare and Institutions Code Sec. 14132.723 & 724 (AB 1494 – 2019 Legislative Session). (Accessed Feb. 2021).

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Colorado

Last updated 02/28/2021

Services appropriately billed to managed care should continue to be …

Services appropriately billed to managed care should continue to be billed to managed care. All managed care requirements must be met for services billed to managed care. Managed care may or may not reimburse telemedicine costs.

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

Transmissions must be performed on dedicated secure lines or must utilize an acceptable method of encryption adequate to protect the confidentiality and integrity of the transmission. Transmissions must employ acceptable authentication and identification procedures by both the sender and the receiver. Providers of telemedicine services must implement confidentiality procedures that include, but are not limited to:

  • Specifying the individuals who have access to electronic records.
  • Using unique passwords or identifiers for each employee or other person with access to the member records.
  • Ensuring a system to routinely track and permanently record such electronic medical information.
  • Members must be advised of their right to privacy and that their selection of a location to receive telemedicine services in private or public environments is at the member’s discretion.

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

The State Department shall post telemedicine utilization data of the state’s Department website no later than 30 days after the effective date and shall update the data every other month through the state fiscal year 2021-22.

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

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Connecticut

Last updated 02/28/2021

The Commissioner is required to submit a report by Aug. …

The Commissioner is required to submit a report by Aug. 1, 2020 to the joint standing committees of the General Assembly on the categories of health care services in which the department is utilizing telehealth services, in what cities or regions of the state such services are being offered and any cost savings realized by the state by providing telehealth services.

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

Effective for dates of service January 1, 2021 and forward, telemedicine claims should no longer be billed with POS 02.

SOURCE: CT Department of Social Services, Medical Assistance Program, Provider Bulletin 2020-100, Dec. 2020. (Accessed Feb. 2021).

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Delaware

Last updated 02/28/2021

The face-to-face encounter for home health services used to evaluate …

The face-to-face encounter for home health services used to evaluate a patient’s condition and recertify services may take place via telehealth.

SOURCE:  DE Medical Assistance Program.  Home Health Provider Specific Manual, 2/21/20. Sec. 5.2.8,  p. 18. (Accessed Feb. 2021).

Provider manual lays out three different models for prescribing:

  1. First Model:  The distant provider consults with the referring healthcare practitioner (if present during the telemedicine session or by other means) about appropriate medications. The referring provider then executes the prescription locally for the patient.
  2. Second Model:  The consulting provider works with a medical professional at the originating site to provide front line care, including writing prescriptions. This method is common at mental health centers. The medical professional must be available on site to write the prescription exactly as described by the consulting healthcare practitioner.
  3. Third Model:  The consulting healthcare practitioner directly prescribes and sends/calls-in the initial prescription or refill to the patient’s pharmacy.

For stimulants, narcotics and refills, hard copy prescriptions can be written and sent via delivery service to the referring site for the consumer to pick up a couple days after the appointment (see manual for more details).

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 2/21/20. Ch. 16 Telemedicine, Sec. 16.11 p. 83 & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8, p. 13.  (Accessed Feb. 2021). 

Confidentiality, privacy and electronic security standards for telemedicine as well as a contingency plan required of telemedicine sites is listed in the DE Behavioral Health Service Certification and Reimbursement manual.

SOURCE:  DE Medical Assistance Program.  Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. p. 10 (Accessed Feb. 2021).

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District of Columbia

Last updated 02/28/2021

Where an FQHC provides an allowable healthcare service at the …

Where an FQHC provides an allowable healthcare service at the originating or distant site, the FQHC shall be reimbursed the applicable rate (PPS, APM or FFS).  If an FQHC is both the originating and distant site, and both sites render the same healthcare service, only the distant site will be reimbursed.

When DCPS or DCPCS provides any of the allowable healthcare services at the originating or distant site, the provider shall only be reimbursed for distant site healthcare services that are Medicaid eligible and are to be delivered in a licensed education agency.

When an originating site and a distant site are CSAs, and the same provider identification number is used for a serviced delivered via telemedicine, only the distant site provider shall be eligible for reimbursement of the allowable healthcare services described within this section.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.24, 25, 26 & 27. (Accessed Feb. 2021).

See Transmittal for documentation standards for services delivered via telemedicine in DC Medicaid.

SOURCE: DC Medicaid Department of Health Care Finance. Transmittal #20-42: Documentation Standards for Services Delivered Via Telemedicine. Nov. 30, 2020 (Accessed Feb. 2021).

Special reimbursement parameters for FQHCs:

  • When FQHC is originating site:  An FQHC provider must deliver an FQHC-eligible service in order to be reimbursed the appropriate PPS or fee for service (FFS) rate at the originating site;
  • When FQHC is distant site:  An FQHC provider must deliver an FQHC-eligible service* in order to be reimbursed the appropriate PPS or FFS rate; and
  • When FQHC is Originating and Distant Site: In instances where the originating site is an FQHC, the distant site is an FQHC, and both sites deliver a service eligible for the same clinic visit/encounter all-inclusive PPS code, only the distant site will be eligible to be reimbursed for the appropriate PPS rate for an FQHC-eligible service.

SOURCE: Physicians Billing Manual. DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.5. Pg. 67 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 4 (Feb. 2018) (Accessed Feb. 2021).

Telemedicine section also appears in Provider Manuals on:

See regulation and telemedicine guidance for specific technology requirements.

A provider is required to develop a confidentiality compliance plan.

DHCF is required to send a Telemedicine Program Evaluation survey to providers, effective Jan. 1, 2017.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.13, 14 & 15 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 6-7 (Mar. 2020). (Accessed Feb. 2021).

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Florida

Last updated 02/28/2021

Substance Abuse Services

Prior to initiating services utilizing telehealth, providers …

Substance Abuse Services

Prior to initiating services utilizing telehealth, providers shall submit detailed procedures outlining which services they intend to provide. Providers delivering any services by telehealth are responsible for the quality of the equipment and technology employed and are responsible for its safe use. Providers utilizing telehealth equipment and technology must be able meet or exceed the prevailing standard of care. Service providers must meet the following additional requirements:

  • Must be capable of two-way, real-time electronic communication, and the security of the technology must be in accordance with applicable federal confidentiality regulations 45 CFR §164.312;
  • The interactive telecommunication equipment must include audio and high-resolution video equipment which allows the staff providing the service to clearly understand and view the individual receiving services;
  • Clinical screenings, assessments, medication management, and counseling are the only services allowable through telehealth; and
  • Telehealth services must be provided within the state of Florida except for those licensed for outpatient, intervention, and prevention.

SOURCE: FL Admin Code Sec. 65D-30.004.  (Accessed Feb. 2021).

Florida created a Telehealth Advisory Council for purpose of making recommendations to the Governor and the Legislature about telehealth.

The state’s Agency for Health Care Administration, the Department of Health (DOH) and the Office of the Insurance Regulation was also required to survey FL providers on their utilization of telehealth.  Survey results were published in a report in October. 2017.

SOURCE: FL Report on Telehealth Utilization and Accessibility. Dec. 2016 & Expanding Florida’s Use and Accessibility of Telehealth, Telehealth Advisory Council,  Oct. 31, 2017 (Accessed Feb. 2021).

Children’s Medical Services

There is a webpage dedicated to explaining what telemedicine services are to families.

SOURCE: FL Children’s Medical Services:  Special Services for children with special needs.  Telemedicine Services. (Accessed Feb. 2021).

No reimbursement for equipment used to provide telemedicine services.

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

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Georgia

Last updated 02/28/2021

Both the originating site and distant site must document and …

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. Additionally, all electronic documentation must be available for review by the Georgia Department of Community Health, Medicaid Division, Division of Program Integrity and all other applicable divisions of the department.

All transactions must utilize acceptable methods of encryption as well as employ authentication and identification procedures for both the sender and receiver.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.7 & 9 (Oct. 2020). (Accessed Feb. 2021).

 

 

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Hawaii

Last updated 02/28/2021

No Reference Found

No Reference Found

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Idaho

Last updated 02/28/2021

Technical Requirements:

  • Video must be provided in real time with

Technical Requirements:

  • Video must be provided in real time with full motion video and audio.
  • Transmission of voice must be clear and audible
  • Telehealth services that cannot be provided as effectively as in-person services are not covered.
  • Video images must be high quality images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication

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

Provider Requirements

  • Providers at the distant site must disclose to the patient the performing provider’s identity, location, telephone number and Idaho license number.
  • Telehealth providers must have a systematic quality assurance and improvement program for telehealth that is documented, implemented and monitored.

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

Documentation Requirements

The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and that services were delivered via telehealth. The documentation must be of the same quality as is originated during an in-person visit. These documentation requirements are specific to delivery via telehealth and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).

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

Specific documentation requirements apply for telehealth services.  See administrative code …

Specific documentation requirements apply for telehealth services.  See administrative code for details.

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

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Indiana

Last updated 02/28/2021

For patients receiving ongoing telemedicine services, a physician should perform …

For patients receiving ongoing telemedicine services, a physician should perform a traditional clinical evaluation at least once a year, unless otherwise stated in policy. The distant site physician should coordinate with the patient’s primary care physician.

Documentation must be maintained at the distant and originating locations to substantiate the services provided.  It must indicate the services were provided via telemedicine and location of the distant and originating sites.  Documentation is subject to post-payment review.

A provider can use telemedicine to prescribe a controlled substance to a patient who has not been previously examined. Opioids, however, cannot be prescribed via telemedicine, except in cases in which the opioid is a partial agonist (such as buprenorphine) and is being used to treat or manage opioid dependence.

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

The information above applies to Indiana Health Coverage Programs (IHCP) services provided under the fee-for-service (FFS) delivery system. For information about services provided through the managed care delivery system – including Healthy Indiana Plan (HIP), Hoosier Care Connect, or Hoosier Healthwise services – providers must contact the member’s managed care entity (MCE).

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

Prior authorization (PA) is required for all for telehealth services. Telehealth services are indicated for members who require scheduled remote monitoring of data related to the member’s qualifying chronic diagnoses that are not controlled with medications or other medical interventions. Services may be authorized for up to 60 days.  See Telehealth Module for additional requirements.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, p. 7. (Accessed Feb. 2021).

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Iowa

Last updated 02/28/2021

Iowa Medicaid uses the POS 02 code adopted by Medicare.…

Iowa Medicaid uses the POS 02 code adopted by Medicare.

Iowa Medicaid will recognize Modifier 95 – Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System, as informational only.

SOURCE: IA Admin Code, 441-79.1(7)b(1) & 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

Home Health Agencies

The face-to-face encounter may be conducted through …

Home Health Agencies

The face-to-face encounter may be conducted through telehealth, as implemented by the State.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Home Health Agency, p. 29 (Aug. 2020). (Accessed Feb. 2021).

Except when otherwise prohibited by any other provision of law, when the patient consents and has a primary care or other treating physician, the person providing telemedicine services will send within three business days a report to such primary care or other treating physician of the treatment and services rendered to the patient in the telemedicine encounter.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-30 & 2-31 (Jan. 2020). (Accessed Feb. 2021).

Hospice

Service Intensity Add-on (SIA) Payment for hospice care is not covered if provided by a social worker via telephone.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospice, p. 16 (Oct. 2020). (Accessed Feb. 2021).

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Kentucky

Last updated 02/28/2021

The Cabinet for Health and Family Services is required to …

The Cabinet for Health and Family Services is required to do the following:

  • Develop policies and procedures to ensure the proper use and security for telehealth, including but not limited to confidentiality and data integrity, privacy and security, informed consent privileging and credentialing, reimbursement and technology;
  • Promote access to health care provided via telehealth;
  • Maintain a list of Medicaid providers who may deliver telehealth services of Medicaid recipients throughout the Commonwealth;
  • Require that specialty care be rendered by a health care provider who is recognized and actively participating in the Medicaid program; and
  • Require that any required prior authorization requesting a referral or consultation for specialty care be processed by the patient’s primary care provider and that any specialist coordinates care with the patient’s primary care provider.

SOURCE: KY Statute Sec. 205.5591 (2). (Accessed Feb. 2021).

The Cabinet for Health and Family Services cannot require a Medicaid provider to be a part of a telehealth network.

SOURCE: KY Statute Sec. 205.5591 (3). (Accessed Feb. 2021).

For FQHCs and RHCs, a “visit” is defined as occurring in-person or via telehealth.

SOURCE: KY 907 KAR 1:055 (37). (Accessed Feb. 2021).

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Louisiana

Last updated 02/28/2021

Recently Passed Legislation (Now Effective)

The department shall include in …

Recently Passed Legislation (Now Effective)

The department shall include in its Medicaid policies and procedures all of the following information relating to telehealth:

  1. An exhaustive listing of the covered healthcare services which may be furnished through telehealth.
  2. Processes by which providers may submit claims for reimbursement for healthcare services furnished through telehealth.
  3. The conditions under which a managed care organization may reimburse a provider or facility that is not physically located in this state for healthcare services furnished to an enrollee through telehealth.

SOURCE: LA Statute Sec. 46:460.51 (HB 589 – 2020 Session). (Accessed Feb. 2021). 

The beneficiary’s clinical record must include documentation that the service was provided through the use of telemedicine/telehealth.

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 158 (As revised on Sept, 03, 2020). (Accessed Feb. 2021).

FQHC and RHC

Effective August 1, 2019, FQHCs and RHCs must use POS 02 with modifier 95 when billing for telemedicine/telehealth services.

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

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Maine

Last updated 02/28/2021

See manual for information regarding telehealth equipment, technology, security, documentation …

See manual for information regarding telehealth equipment, technology, security, documentation and member choice and education requirements.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.01. p. 9-12. (June 15, 2020). (Accessed Feb. 2021).

The Department is required to report on the utilization of telehealth and telemonitoring services within the MaineCare program annually.

The Department is required to conduct educational outreach to providers and MaineCare members on telehealth and telemonitoring.

SOURCE: ME Statute Sec. 3173-H. (Accessed Feb. 2021). 

Telepharmacy is allowed.

Telepharmacy is a method of delivering prescriptions dispensed by a pharmacist to a remote site. Pharmacies using telepharmacy must follow all applicable State and Federal regulations, including use of staff qualified to deliver prescriptions through telepharmacy.

Providers may dispense prescriptions via tele-pharmacy; pre-authorization is required.  Providers must assure that member counseling is available at the remote site from the dispensing provider or the provider delivering the prescription, and that only qualified staff, deliver prescriptions.

SOURCE: MaineCare Benefits Manual, Pharmacy Services, 10-144 Ch. 2, Sec. 80 p. 5 & 30. 80.01 & 07 (Sept. 1, 2017). (Accessed Feb. 2021).

ME established the ME Telehealth and Telemonitoring advisory group to evaluate difficulties related to telehealth and telemonitoring services and make recommendations to the department to improve it statewide.

SOURCE: ME Statute Sec. 3173-I. (Accessed Feb. 2021).

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Maryland

Last updated 02/28/2021

Expires June 30, 2025:

The Maryland Department of Health shall …

Expires June 30, 2025:

The Maryland Department of Health shall study whether, under the Maryland Medical Assistance Program, substance use disorder services may be appropriately provided through telehealth to a patient in the patient’s home setting.  On or before December 1, 2021, the Maryland Department of Health shall submit a report to the General Assembly that includes findings and recommendations.

SOURCE: HB 1208 & 502 (2020 Session). (Accessed Feb. 2021).

Technology requirements for providers:

  • A camera that has the ability to manually, or under remote control, provider multiple views of a patient with the capability of altering the resolution, focus, and zoom requirements according to the consultation;
  • Have display monitor size sufficient to support diagnostic needs used in the service via telehealth;
  • Bandwidth speed and image resolution sufficient to provide quality video to meet a minimum of 15 frames per second, or higher, as industry standards change;
  • Unless engaging in a telehealth communication with a participant who is deaf or hard of hearing, audio equipment that ensures clear communication and includes echo cancellation;
  • Creates audio transmission with less than 300 millisecond delay;
  • Secure and HIPAA compliant telehealth communication;

A dedicated connection that provides bandwidth only for telehealth communications is preferable for services delivered via telehealth.

All tech staff must be trained in telehealth technology use and HIPAA compliance.

Provider manual outlines various telehealth provider scenarios.

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 3 & 7-8 (Accessed Feb. 2021).

Providers of health care services delivered through telehealth must use video and audio transmission with less than a 300 millisecond delay.  Other minimum technology requirements apply.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.07. (Accessed Feb. 2021). 

Providers may not store at originating or distant site video images or audio portion of telemedicine services for future use.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.08. (Accessed Feb. 2021).

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Massachusetts

Last updated 02/28/2021

Newly Passed Legislation (Now Effective)

Medicaid contracted health insurers, health …

Newly Passed Legislation (Now Effective)

Medicaid contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request.

SOURCE: Massachusetts Senate No. 2984. Section 40 (Accessed Jan. 2021) 

Behavioral Health Services

A provider may prescribe Schedule II controlled substances via telehealth only after conducting an initial in-person examination of the patient. Ongoing in-person examinations are required every three months for the duration of the prescription.

SOURCE: MassHealth All Provider Bulletin 281, p. 2, Jan. 2019. (Accessed Feb. 2021).

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Michigan

Last updated 02/28/2021

No reimbursement for remote access for surgical procedures, and use …

No reimbursement for remote access for surgical procedures, and use of robotics.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1688, Jan. 2021  (Accessed Feb. 2021).

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Minnesota

Last updated 02/28/2021

Clinical Supervision of Outpatient Mental Health Services

Clinical supervision must …

Clinical Supervision of Outpatient Mental Health Services

Clinical supervision must be conducted by a qualified supervisor using individual or group (or both) supervision. Individual or group face-to-face supervision may be conducted via electronic communications that utilize interactive telecommunications equipment that includes at a minimum audio and video equipment for two-way, real-time, interactive communication between the supervisor and supervisee, and meet the equipment and connection standards of telemedicine.

SOURCE: MN Dept. of Human Services, Provider Manual, Clinical Supervision of Outpatient Mental Health Services, 8/4/2016, (Accessed Feb. 2021).  

Early Intensive Developmental and Behavioral Intervention (EIDBI) services

Services must be:

  • Compliant with HIPAA and security requirements and regulation
  • Medically appropriate to the condition and needs of the person and/or family.

Either the person or family must be present via two-way, interactive video while the provider delivers EIDBI telemedicine services.

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

See documentation requirements in rule.

SOURCE: MS Admin. Code 23,

See documentation requirements in rule.

SOURCE: MS Admin. Code 23, Part 225, (Accessed Feb. 2021). 

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Missouri

Last updated 02/28/2021

Recently Passed Legislation

Beginning January 1, 2022, and each year …

Recently Passed Legislation

Beginning January 1, 2022, and each year thereafter, the department shall make publicly available a report that shall include the information submitted under subsection 8 of this section.  The report shall also include, in collaboration with the department of public safety, information about the number of evidentiary collection kits submitted by a person or entity outside of a hospital setting, as well as the number of appropriate medical providers utilizing the training and telehealth services provided by the network outside of a hospital setting.

SOURCE: MO Revised Statute Ch. 192.2520 (Accessed Feb. 2021).

Special documentation requirements apply.

SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 210 (Nov. 25, 2020); MO HealthNet, Physician Manual, Telehealth Services, p. 290 (Nov. 25, 2020)MO HealthNet, Rural Health Clinic, p. 166 (Nov. 24, 2020). (Accessed Feb. 2021).

School-based Therapy Services

Place of service school (03) must be used for services provided in a school or on school grounds. If a school district is providing telehealth services on school grounds, the GT modifier must be used.

SOURCE: MO HealthNet, Therapy Manual, p. 173-174 (Nov. 24, 2020). (Accessed Feb. 2021).

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Montana

Last updated 04/27/2021

Effective January 1, 2017, providers must also use the telehealth …

Effective January 1, 2017, providers must also use the telehealth place of service of 02 for claims. By coding with the GT modifier and the 02 place of service, the provider is certifying that the service was a face-to-face visit provided via interactive audio-video telemedicine.

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).

If a rendering provider’s number is required on the claim for a face-to-face visit, it is required on a telemedicine claim.

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).

Confidentially requirements apply (see manual).

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).

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Nebraska

Last updated 02/28/2021

NE Medicaid does provide an outpatient cardiac rehabilitation program consisting …

NE Medicaid does provide an outpatient cardiac rehabilitation program consisting of physical exercise or conditioning and concurrent telemetric monitoring are considered a valuable therapeutic modality. When a program is provided by a hospital to its outpatients, the service is covered as an outpatient service.

SOURCE: NE Admin. Code Title 471, Sec. 10-006.16(B), p. 48-95 (Accessed Feb. 2021).

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Nevada

Last updated 02/28/2021

No Reference Found

No Reference Found

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New Hampshire

Last updated 02/28/2021

As of December 1, 2013, New Hampshire Medicaid transitioned to …

As of December 1, 2013, New Hampshire Medicaid transitioned to a managed care model of administration under three health plans. These plans each have their own telehealth coverage policy.

SOURCE:  Provider Quick Reference Guide.  (Accessed Feb. 2021).

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New Jersey

Last updated 02/28/2021

See Newsletter for specific documentation, prescribing and technology requirements, as …

See Newsletter for specific documentation, prescribing and technology requirements, as well as requirements to meet the standard of care as a traditional face-to-face visit.

A mental health screener, screening service, or screening psychiatrist subject to the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.) shall not be required to obtain a separate authorization in order to engage in telemedicine or telehealth for mental health screening purposes, and shall not be required to request and obtain a waiver from existing regulations, prior to engaging in telemedicine or telehealth.

An initial face-to-face visit is not required to establish a provider-patient relationship. The provider must review and be familiar with the patient’s history and medical records, when applicable, prior to the provision of any telehealth services.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 3-4 (Accessed Feb. 2021).

New Jersey’s Medicaid program consists of five managed care health plans. Individual telehealth policies may vary between health plans.

SOURCE: NJ Medicaid & Managed Care.  Division of Medical Assistance and Health Services.  (Accessed Feb. 2021).

Psychiatric Services

If a physical evaluation is required as part of a psychiatric assessment, the hosting provider must have a registered nurse available to complete and share the results of the physical evaluation.

NJ Medicaid does not reimburse for any costs associated with the provision of telepsychiatry 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 New Jersey Medicaid.

Additional requirements are listed in the telepsychiatry memo.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013. (Accessed Feb. 2021).

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New Mexico

Last updated 02/28/2021

MCOs must:

  • Promote and employ broad-based utilization of statewide access

MCOs must:

  • Promote and employ broad-based utilization of statewide access to Health Insurance Portability and Accountability Act (HIPAA)-compliant telemedicine service systems including, but not limited to, access to text telephones or teletype (TTYs) and 711 telecommunication relay services;
  • Follow state guidelines for telemedicine equipment or connectivity;
  • Follow accepted HIPAA and 42 CFR part two regulations that affect telemedicine transmission, including but not limited to staff and contract provider training, room setup, security of transmission lines, etc; the MCO shall have and implement policies and procedures that follow all federal and state security and procedure guidelines;
  • Identify, develop, and implement training for accepted telemedicine practices;
  • Participate in the needs assessment of the organizational, developmental, and programmatic requirements of telemedicine programs;
  • Report to HSD on the telemedicine outcomes of telemedicine projects and submit the telemedicine report; and
  • Ensure that telemedicine services meet the following shared values, which are ensuring: competent care with regard to culture and language needs; work sites are distributed across the state, including native American sites for both clinical and educational purposes; and coordination of telemedicine and technical functions at either end of network connection.

The MCO shall participate in project extension for community healthcare outcomes (ECHO), in accordance with state prescribed requirements and standards, and shall:

  • Work collaboratively with HSD, the university of New Mexico, and providers on project ECHO;
  • Identify high needs, high cost members who may benefit from project ECHO participation;
  • Identify its PCPs who serve high needs, high cost members to participate in project ECHO;
  • Assist project ECHO with engaging its MCO PCPs in project ECHO’s center for Medicare and Medicaid innovation (CMMI) grant project;
  • Reimburse primary care clinics for participating in the project ECHO model;
  • Reimburse “intensivist” teams;
  • Provide claims data to HSD to support the evaluation of project ECHO;
  • Appoint a centralized liaison to obtain prior authorization approvals related to project ECHO; and
  • Track quality of care and outcome measures related to project ECHO.

SOURCE:  NM Administrative Code 8.308.9.18. (Accessed Feb. 2021).

There must be an established prescriber-patient relationship to prescribe drugs or medical supplies. This includes prescribing over the Internet, or via other electronic means, based solely on an online questionnaire.  Physicians, psychologists with prescriptive authority, physician assistants and advanced practice nurses may prescribe online during a live video exam. The prescribing clinician must: obtain a medical history, obtain informed consent and generate a medical record.  A physical exam is recorded as appropriate by the telehealth practitioner but the exam may be waived when not normally a part of a typical face-to-face encounter for the services being provided.

SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2019) p. 31 (Accessed Feb. 2021).

 

 

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New York

Last updated 02/28/2021

Subject to federal financial participation and the approval of the …

Subject to federal financial participation and the approval of the director of the budget, the commissioner shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth, as defined in section 2999-cc(4) of the public health law.

SOURCE: Social Services Law Article 367-u. (Accessed Feb. 2021).

Culturally competent translation and/or interpretation services must be provided when the member and distant practitioner do not speak the same language.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 6. (Accessed Feb. 2021).

The patient must be present for telemental health services for Medicaid reimbursement.  Telemental health is also defined as “real-time”.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.4(r4) (Accessed Feb. 2021).

See rule for requirements needed for approval for telemental health services.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.5 & 596.6. (Accessed Feb. 2021).

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North Carolina

Last updated 02/28/2021

Providers shall comply with the following in effect at the …

Providers shall comply with the following in effect at the time the service was rendered:

  • All applicable agreements, federal, state and local laws and regulations including HIPAA and medical retention requirements.
  • All Medicaid’s clinical (medical) coverage policies, guidelines, policies, provider manuals, implementation updates and bulletins published by CMS, DHHS, its divisions or its fiscal contractor(s).

Since telehealth services are considered professional services, a beneficiary and provider relationship may be established via telehealth.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p.3 &  9, Nov. 15, 2020. (Accessed Feb. 2021).

Provider(s) shall comply with the following in effect at the time the service is rendered:

  • All applicable agreements, federal, state and local laws and regulations including the Health Insurance Portability and Accountability Act (HIPAA) and record retention requirements; and
  • All NC Medicaid’s clinical (medical) coverage policies, guidelines, policies, provider manuals, implementation updates, and bulletins published by the Centers for Medicare and Medicaid Services (CMS), DHHS, DHHS division(s) or fiscal contractor(s).

Provider(s) are expected to send documentation of any telehealth services rendered to a beneficiary’s identified primary care provider or medical home within 48 hours of the encounter for medical services (including behavioral health medication management), obtaining required consent when necessary (as per 42 CFR Part 2 for relevant substance use disorder related disclosures). Documentation can be sent by any HIPAA-compliant secure means.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 9-10, Nov. 15, 2020. (Accessed Feb. 2021).

Home Health Services

Telehealth may be implemented for the face-to-face encounter in accordance with 42 CFR 440.70 and clinical coverage policy 1H, Telemedicine and Telepsychiatry.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 3A, Home Health, p. 13, Jan 10, 2020. (Accessed Feb. 2021).

Other

Outpatient Specialized Therapies, Local Education Agencies: See p. 47 of LEA manual. NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 10C, Family Planning Services, p. 47, Jan. 1, 2021. (Accessed Feb. 2021). https://files.nc.gov/ncdma/documents/files/10C_4.pdf

SOURCE: Respiratory Therapy Services: See p. 23 of Respiratory Therapy Services manual. NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 10D, Respiratory Therapy Services, p. 23, Jan. 1, 2021. (Accessed Feb. 2021).

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North Dakota

Last updated 02/28/2021

No Reference Found

No Reference Found

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Ohio

Last updated 02/28/2021

See administrative code for additional provider responsibilities related to HIPAA …

See administrative code for additional provider responsibilities related to HIPAA and other practice standards as well as information about submitting telehealth claims.

SOURCE: OAC 5160-1-18. (Accessed Feb. 2021).

Behavioral Health

No initial in person visit is necessary to initiate services using telehealth modalities. The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.

The provider must have a written policy and procedure describing how they ensure that staff assisting clients with telehealth services or providing telehealth services are adequately trained in equipment usage.

See rule for additional requirements of behavioral health providers utilizing telehealth.

SOURCE: OAC 5122-29-31. (Accessed Feb. 2021).

Opioid Treatment Programs

Telemedical procedures will only be allowed for stable patients for purposes of dose adjustment and routine medical appointments. Telemedical induction of any form of medication assisted treatment will only be allowed in accordance with federal and state standards.

SOURCE: OAC 5122-40-09. (Accessed Feb. 2021).

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Oklahoma

Last updated 02/28/2021

All telehealth activities must comply with Oklahoma Health Care Authority …

All telehealth activities must comply with Oklahoma Health Care Authority (OHCA) policy, and all other applicable State and Federal laws and regulations.

See administrative code for specific documentation requirements.

SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(8) & (f). (Accessed Feb. 2021).

Health Access Networks (HANs) must Facilitate members’ access to all levels of care, including primary, outpatient, specialty, certain ancillary services, and acute inpatient care, within a community or across a broad spectrum of providers across a service region or the state through improved access to specialty care, telehealth, and expended quality improvement strategies.

SOURCE: OK Admin. Code Sec. 317:25-9-2. (Accessed Feb. 2021).

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Oregon

Last updated 02/28/2021

Providers billing for covered telemedicine services are responsible for the …

Providers billing for covered telemedicine services are responsible for the following:

  • Complying with HIPAA and the Authority’s Privacy and Confidentiality Rules and security protections for the patient in connection with the telehealth communication and related records requirements (OAR chapter 943 division 14 and 120, OAR 410-120-1360 and 1380, 42 CFR Part 2, if applicable, and ORS 646A.600 to 646A.628 (Oregon Consumer Identity Theft Protection Act) except as noted in section (7) below;
  • Obtaining and maintaining technology used in telehealth communication that is compliant with privacy and security standards in HIPAA and the Authority’s Privacy and Confidentiality Rules described in subsection (A) except as noted in section (7) below;
  • Developing and maintaining policies and procedures to prevent a breach in privacy or exposure of patient health information or records (whether oral or recorded in any form or medium) to unauthorized persons and timely breach reporting;
  • Maintaining clinical and financial documentation related to telehealth services as required in OAR 410-120-1360 and any program specific rules in OAR Ch 309 and Ch 410;
  • Complying with all federal and state statutes as required in OAR 410-120-1380.

SOURCE: OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Feb. 2021) & OAR 410-141-3566 Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement Requirements. (Effective Ja. 1, 2021). (Accessed March 2021).

Providers billing for covered teledentistry/telehealth services are responsible for (A) through (D) above, as well as:

  • A patient receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request;
  • The patient’s chart documentation shall reflect notification of the right to interactive communication with the distant site dentist;
  • A patient may request to have real time communication with the distant dentist at the time of the visit or within 30 days of the original visit.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

Teledentistry

A patient may request to have real time communication with the distant dentist at the time of the visit or within 30 days of the original visit.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Effective Jan. 1, 2021). (Accessed Feb. 2021).

Providers shall ensure access to health care services for limited English proficient (LEP) and deaf and hard of hearing patients and their families through the use of qualified and certified health care interpreters to provide meaningful language access services as described in OAR 333-002-0040.

SOURCE: OR OAR Sec. 410-120-1990. (Accessed Feb. 2021).

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Pennsylvania

Last updated 02/28/2021

Technology Requirements:

Technology used for telehealth, whether fixed or mobile, …

Technology Requirements:

Technology used for telehealth, whether fixed or mobile, should be capable of presenting sound and image in real-time and without delay. The telehealth equipment should clearly display the participants’ full bodies and their environments. The telehealth equipment must meet any state or federal requirements for the transmission or security of health information.

Providers are responsible to ensure confidentiality and security in the transmission and storage of health information, and to conduct regular reviews, at least annually, of systems used for the delivery of telehealth. Providers must maintain annual and comparative reports of these reviews to be examined by OMHSAS and BH-MCOs upon request. The reports must be retained in a retrievable record, identified by date of review, and include the following information:

  • Technology provider certification(s).
  • Manifest files of the software being utilized.
  • Attestation of systems security checks performed with corresponding results logged on a regular basis.

Confidentiality:

Providers must assure the privacy of the individual receiving services and comply with the Health Insurance Portability and Accountability Act (HIPAA) and other federal and state privacy and confidentiality requirements.

Delivery of Services:

The participant’s medical record must indicate when a service is provided using telehealth including, the start and end time of service.

Quality of Service:

  • The provider using telehealth must maintain written quality protocols for the operation and use of telehealth equipment including the provision of periodic training to ensure that telehealth is provided in accordance with the requirements in this bulletin as well as the provider’s established patient care standards.
  • The providers must maintain a written procedure detailing a contingency plan for transmission failure or other technical difficulties that render the behavioral health service undeliverable.
  • The provider must periodically review, at least annually, its quality protocol and delivery of services through telehealth. The provider must maintain annual and comparative reports of these reviews to be examined by OMHSAS and by the responsible BH-MCOs upon request.

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.2-4, Feb. 20, 2020, (Accessed Feb. 2021).

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Rhode Island

Last updated 02/28/2021

No Reference Found

No Reference Found

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South Carolina

Last updated 02/28/2021

If a beneficiary is a minor child, a parent and/or …

If a beneficiary is a minor child, a parent and/or guardian must present the child for telemedicine services unless otherwise exempted by State or Federal law. The parent and/or guardian need not attend the telemedicine session unless attendance is therapeutically appropriate.

Documentation to substantiate the services provided must be maintained at the referring and consulting locations. A request for a telemedicine service from a referring provider and the medical necessity for the telemedicine service must be documented in the beneficiary’s medical record. The documentation must include an indication that services were rendered via telemedicine and all other Medicaid documentation guidelines apply. The beneficiary has access to all transmitted medical information, with the exception of live interactive video, as there is often no stored data in such encounters.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 30, 31 & 193 (Feb. 2021). (Accessed Feb. 2021).

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South Dakota

Last updated 04/29/2021

Originating sites eligible for reimbursement must bill for the service …

Originating sites eligible for reimbursement must bill for the service using HCPCS Q3014.

All telemedicine services provided at the distant site must be billed with the GT modifier.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 13 (Mar. 2021). (Accessed Apr. 2021).

The initial face-to-face encounter for home health services may occur via telehealth.

SOURCE: SD Medicaid Billing and Policy Manual: Home Health Agency Services, p. 3. (Mar. 2021). (Accessed Apr. 2021).

The telemedicine provider manual lists temporary COVID-19 specific policies. Please reference manual for additional information.

See telemedicine provider manual for specific documentation requirements.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, (Mar. 2021), (Accessed Apr. 2021).

See list of recipients in manual that are eligible for medically necessary services covered in accordance with the limitations of the telemedicine chapter.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 2 (Mar. 2021) (Accessed Apr. 2021).

See manual for documentation requirements for originating and distant sites.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 11-12 (Mar. 2021) (Accessed Apr. 2021).

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Tennessee

Last updated 02/28/2021

No Reference Found

No Reference Found

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Texas

Last updated 02/28/2021

Children’s Health Insurance Program

Allows reimbursement for live video telemedicine …

Children’s Health Insurance Program

Allows reimbursement for live video telemedicine and telehealth services to children with special health care needs.

SOURCE: TX Govt. Code Sec. 531.02162, (Accessed Feb. 2021).

Must use the “95” modifier for telemedicine/telehealth services (except for services that already indicate remote delivery in the description).  See manual for codes that can be billed with the “95” modifier.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 7 and 11 (Feb. 2021). (Accessed Feb. 2021).

The software system used by the distant site and originating site (when patient presenter is used) must allow secure authentication of the distant site provider and the client.

See provider manual for other information security and documentation requirements.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 4. (Feb. 2021). (Accessed Feb. 2021).

Fees for telemedicine, telehealth and home telemonitoring services are adjusted within available funding.

SOURCE: TX Admin Code. 355.7001(g). (Accessed Feb. 2021).

A valid practitioner-patient relationship must exist between the distant site provider and patient.  The relationship exists if the distant site provider meets the same standard of care required for an in-person service.  A relationship is established through: a prior in-person services; a prior telemedicine medical services that meets the delivery modality requirements in TX Occupations Code Sec. 111.005(a)(3); or through the current telemedicine medical service.  The relationship can be established through a call coverage agreement established in accordance with the Texas Medical Board rules.

Distant site providers should provide patients with written notification of the physician’s privacy practices as well as guidance on appropriate follow-up care.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 6 (Feb. 2021). (Accessed Feb. 2021).

A distant site provider may issue a valid prescription as part of a telemedicine medical service. The prescribing physician must be licensed in Texas. If the prescription is for a controlled substance, the prescribing physician must have a current valid U.S. Drug Enforcement Administration (DEA) registration number.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 8 (Feb. 2021). (Accessed Feb. 2021).

Radiation Therapy Services

Teletherapy is covered by Texas Medicaid once per day in an outpatient hospital setting.

SOURCE: TX Medicaid Inpatient and Outpatient Hospital Services Handbook, p. 62 (Feb. 2021). (Accessed Feb. 2021).

All patient health information generated or utilized during a telehealth or telemedicine medical service must be stored by the distant site provider in a patient health record. If the distant site provider stores the patient health information in an electronic health record, the provider should use software that complies with Health Insurance Portability and Accountability Act (HIPAA) confidentiality and data encryption requirements, as well as with HHS rules implementing HIPAA.

Documentation for a service provided via telemedicine must be the same as for a comparable in-person service.

If a patient has a primary care provider who is not the distant site provider and the patient or their parent or legal guardian provides consent to a release of information, a distant site provider must provide the patient’s primary care provider with the following information:

  • A medical record or report with an explanation of the treatment provided by the distant site provider
  • The distant site provider’s evaluation, analysis, or diagnosis of the patient

Unless the telemedicine medical services are rendered to a child in a school-based setting, distant site providers of mental health services are not required to provide the patient’s primary care provider with a treatment summary.  For telemedicine medical services provided to a child in a school-based setting, a notification provided by the telemedicine medical services physician to the child’s primary care provider must include a summary of the service, exam findings, prescribed or administered medications, and patient instructions.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 5 & 8-9. (Feb. 2021). (Accessed Feb. 2021).

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Utah

Last updated 02/28/2021

Psychiatrist service will be covered by all Managed Care Entities …

Psychiatrist service will be covered by all Managed Care Entities (MCE). If a member receiving the service is part of an MCE, then the provider must be enrolled with the member’s MCE in order to receive reimbursement.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).

If the required face-to-face encounter for certain durable medical equipment occurred via telehealth it must be documented.

SOURCE: Utah Medicaid Provider Manual: Durable Medical Equipment, p. 6,  (Jan. 2021).  (Accessed Feb. 2021). 

Home and Community Based New Choices Waiver Services

A non face-to-face medication reminder system using telecommunication device is covered.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services, New Choices Waiver, p. 75,  (Oct.. 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).

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Vermont

Last updated 02/28/2021

A qualified telemedicine and store-and-forward provider must:

  • Meet or exceed

A qualified telemedicine and store-and-forward provider must:

  • Meet or exceed federal and state legal requirements of medical and health information privacy, including HIPAA
  • Provide appropriate informed consent in a language the beneficiary understands. Specific requirements exist.
  • Take appropriate steps to establish the provider-patient relationship and conduct all appropriate evaluations and history of the beneficiary consistent with traditional standards of care.
  • Maintain medical records for all beneficiaries receiving health care services through telemedicine that are consistent with established laws and regulations governing patient health care records.
  • Establish an emergency protocol when care indicates that acute or emergency treatment is necessary for the safety of the beneficiary.
  • Address needs for continuity of care for beneficiaries (e.g., informing beneficiary or designee how to contact provider or designee and/or providing beneficiary or identified providers timely access to medical records).
  • If prescriptions are contemplated, follow traditional standards of care to ensure beneficiary safety in the absence of a traditional physical examination.

Services provided through telehealth are subject to the same prior authorization requirements that exist for the service when not provided through telehealth.

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.5-6), Telehealth, (Accessed Feb. 2021).

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Virginia

Last updated 02/28/2021

Use of telemedicine must be noted in the service documentation …

Use of telemedicine must be noted in the service documentation of the patient record.

The originating site provider or designee must attend the encounter with the member, unless the encounter documentation in the patient record notes the reason staff was not present.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 3-4. (May 2014) & Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. And Limitations, p. 16-17 (Mar. 2020); Psychiatric Services Provider Manual, Covered Svcs, And Limitations pg. 17, (Aug. 2018), (Accessed Feb. 2021).

Telemedicine also available for limited screening under the Governor’s Access Plan for the Seriously Mentally Ill (GAP).

SOURCE: VA Dept. of Medical Assistant Svcs., GAP Manual, p. 3 & 6 (Feb. 2019). (Accessed Feb. 2021).

See Psychiatric Services Provider Manual for requirements around equipment, professional protocols, and confidentiality.

SOURCE: VA Dept. of Medical Assistance Svcs.  Psychiatric Services Provider Manual, Covered Services, pg. 17, (Aug. 2018), (Accessed Feb. 2021).

Dual Eligibles (Medicare and Medicaid)

DMAS established the Commonwealth Coordinated Care program and allows participating plans to reimburse for telehealth for Medicare and Medicaid services as an innovative way to reduce hospital readmissions, reduce ED visits, etc.  Participating plans shall encourage the use of telehealth to promote community living and improve behavioral health services.  Plans shall be permitted to use telehealth in rural and urban settings and reimburse for store-and-forward.  Plans shall also have the ability to cover remote patient monitoring.

SOURCE: 12VAC30-121-70 (B(7)). (Accessed Feb. 2021).

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Washington

Last updated 02/28/2021

Use place of service (POS) 02 to indicate that a …

Use place of service (POS) 02 to indicate that a billed service was furnished as a telemedicine service from a distant site. Distant site practitioners billing for telemedicine services under Critical Access Hospital (CAH) optional payment method must use the GT modifier. Add modifier 95 if the distant site is designated as a nonfacility.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 87-88 (Feb. 2021). (Accessed Feb. 2021).

Additional Documentation Requirements for Telemedicine:

  • Specification of the telehealth modality that was used (e.g., visit was conducted via HIPAA-compliant real-time audio/visual)
  • Verification that telemedicine was clinically appropriate for this service
  • Whether any assistive technologies were used
  • The location of the client
  • The names and credentials (MD, ARNP, RN, PA, CNA, etc.) of all provider personnel involved in the telemedicine visit
  • Consent for care via the modality that was used

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 85-86 (Feb. 2021). (Accessed Feb. 2021).

“If a provider from the originating site performs a separately identifiable service for the client on the same day as telemedicine, documentation for both services must be clearly and separately identified in the client’s medical record.”

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., 87 (Feb. 2021). (Accessed Feb. 2021).

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West Virginia

Last updated 02/28/2021

See manual for equipment standards and requirements.

SOURCE: WV Dept.

See manual for equipment standards and requirements.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).

Additional instructions regarding telehealth standards and billing available in the following manuals:  Licensed Behavioral Health Center Services (Ch. 503); Substance Use Disorder Services (Ch. 504); Behavioral Health Outpatient Services (Ch. 521); Targeted Case Management (Ch. 523). Limited to specific CPT codes.

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); 523.3 Targeted Case Management (Revised Jul. 1, 2016) (Accessed Feb. 2021).

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Wisconsin

Last updated 02/28/2021

The department may not require a certified provider of Medical …

The department may not require a certified provider of Medical Assistance that provides a reimbursable service to obtain an additional certification or meet additional requirements solely because the service was delivered through telehealth, except that the department may require, by rule, that the transmission of information through telehealth be of sufficient quality to be functionally equivalent to face-to-face contact. The department may apply any requirement that is applicable to a covered service that is not provided through telehealth to any service.

SOURCE:  WI Statute Sec. 49.45 (61)(e), (Accessed Feb. 2021).

POS code 02 required.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth.  (Accessed Feb. 2021).

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Wyoming

Last updated

Telehealth services must be properly documented when offered at the …

Telehealth services must be properly documented when offered at the discretion of the provider as deemed medically necessary.

A single pay to provider can bill both the originating site (spoke site) and the distant site provider (hub site) when applicable.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 112-113 (Jan. 2021). (Accessed Feb. 2021).

No reimbursement for:

  • The use or upgrade of technology;
  • Transmission charges;
  • Charges of an attendant who instructs a patient on the use of the equipment or supervises/monitors a patient during the telehealth encounter; or
  • Consults between health professionals.

The GT modifier must be billed by the distant site.

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

Miscellaneous

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