Medicaid & Medicare

Out of State Providers

Telehealth makes it possible for providers to deliver services across state lines if they are properly licensed in the state the patient is located in. Some Medicaid programs have placed restrictions on providers located out-of-state, requiring them to have some sort of an in-state presence, while other states have explicitly allowed out-of-state providers as long as they are licensed in the state and enroll with the Medicaid program.

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Federal

Last updated 02/28/2021

Doctors of Medicine and Osteopathy – The requirement that a …

Doctors of Medicine and Osteopathy – The requirement that a doctor of medicine be legally authorized to practice medicine and surgery by the State in which he/she performs his/her services means a physician is licensed to practice medicine and surgery. (Similar regulations exist for other types of practitioners, see manual).

SOURCE:  Medicare General Information, Eligibility and Entitlement, Chapter 5 – Definitions, Updated 11/2/2018, Sec. 70, p. 31-32.  (Accessed Feb. 2021).

Items and services furnished outside the United States are excluded from coverage (with exceptions for beneficiaries traveling in Canada and emergency situations).

Payment may not be made for a medical service (or a portion of it) that was subcontracted to another provider or supplier located outside the United States. For example, if a radiologist who practices in India analyzes imaging tests that were performed on a beneficiary in the United States, Medicare would not pay the radiologist or the U.S. facility that performed the imaging test for any of the services that were performed by the radiologist in India.

SOURCE:  Medicare Benefit Policy Manual, Chapter 16 – General Exclusions from Coverage, Revised 11/6/14, Sec. 60, p. 24.  (Accessed Feb. 2021).

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Alabama

Last updated 06/08/2021

Providers must have an Alabama license and be enrolled as …

Providers must have an Alabama license and be enrolled as a provider with the Alabama Medicaid Agency.

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

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Alaska

Last updated 07/29/2021

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Arizona

Last updated 05/17/2021

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Arkansas

Last updated 02/28/2021

A healthcare provider treating patients in Arkansas through telemedicine shall …

A healthcare provider treating patients in Arkansas through telemedicine shall be fully licensed or certified to practice in Arkansas and is subject to the rules of the appropriate state licensing or certification board. This requirement does not apply to the acts of a healthcare provider located in another jurisdiction who provides only episodic consultation services.

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

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California

Last updated 02/28/2021

Provider must be licensed in CA, enrolled as a Medi-Cal …

Provider must be licensed in CA, 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.

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

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Colorado

Last updated 02/28/2021

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Connecticut

Last updated 06/30/2021

Effective Now Until June 30, 2023

The following providers in …

Effective Now Until June 30, 2023

The following providers in another state or territory of the United States or the District of Columbia, that provide telehealth services pursuant to his or her authority under any relevant order issued by the Commissioner of Public Health, and maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers, are considered a telehealth provider:

  • Physician
  • Physician assistant
  • Physical therapist or physical therapist assistant
  • Chiropractor
  • Naturopath
  • Podiatrist
  • Occupational therapist or occupational therapy assistant
  • Optometrist
  • Registered nurse or advanced practice registered nurse
  • Psychologist
  • Marital and family therapist
  • Clinical social worker
  • Master social worker
  • Alcohol and drug counselor
  • Professional counselor
  • Dietitian-nutritionist
  • Speech and language pathologist
  • Respiratory care practitioner
  • Audiologist
  • Pharmacist
  • Paramedic
  • Nurse-midwife
  • Dentist
  • Behavior analyst
  • Genetic counselor
  • Music therapist
  • Art therapist
  • Athletic trainer

Any Connecticut entity, institution or health care provider that engages or contracts with a telehealth provider that is licensed, certified or registered in another state or territory of the United States or the District of Columbia to provide health care or other health services shall verify the credentials of such provider in the state in which he or she is licensed, certified or registered, ensure that such a provider is in good standing in such state, and confirm that such provider maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers.

The Commissioner of Public Health may temporarily waive, modify or suspend any regulatory requirements adopted by the Commissioner of Public Health or any boards or commissions as the Commissioner of Public Health deems necessary to reduce the spread of COVID-19 and to protect the public health for the purpose of providing residents of this state with telehealth services from out-of-state practitioners.

SOURCE: HB 5596 (2021 Session) (Accessed June 2021).

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Delaware

Last updated 07/09/2021

The Distant site provider must be located within the continental …

The Distant site provider must be located within the continental US and enrolled in the DE Medicaid program or in a DE Medicaid Managed Care Organization to be reimbursed for services.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 5/20/21. Ch. 16.2.4.1 & 16.5.7 Telemedicine pg. 77 & 81. (Accessed July 2021).

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District of Columbia

Last updated 02/28/2021

For healthcare services rendered outside of the District, the provider …

For healthcare services rendered outside of the District, the provider of the services shall meet any licensure requirements of the jurisdiction in which the patient is physically located.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.9. (Accessed Feb. 2021).

“For services rendered outside of the District, providers shall meet any licensure requirements of the jurisdiction where he/she is physically located and the jurisdiction where the patient is physically located.”

SOURCE: Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9. P.65. (Accessed Feb. 2021).

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Florida

Last updated 07/17/2021

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Georgia

Last updated 07/26/2021

Out-of-state providers may be licensed under the Interstate Medical Licensure …

Out-of-state providers may be licensed under the Interstate Medical Licensure Compact.  Providers should see the Georgia Composite Medical Board for additional information.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 7 (July 2021). (Accessed July 2021).

 

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Hawaii

Last updated 06/17/2021

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Idaho

Last updated 02/28/2021

Providers of telehealth services must be licensed by the Idaho …

Providers of telehealth services must be licensed by the Idaho Board of Medicine, Board of Nursing, or in the case of therapeutic consultation and crisis intervention for children’s developmental disabilities services, providers must meet staff qualifications.

Please refer to Idaho Administrative Code for additional information.

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  Jan. 19, 2021, Section 8.9.1 p. 123,Idaho Medicaid Provider Handbook. Agency Professional July 11, 2019. Section 1.4.6 p. 10 & IDAPA 16.03.09 Sec.855. (Accessed Feb. 2021).

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Illinois

Last updated 02/28/2021

For medical services, the provider rendering the service at the …

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.

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

SOURCE: IL Handbook for Practitioners Rendering Medical Services, Chapter 200, 220.5.7 p. 26, (Sept. 2020); & Handbook for Encounter Clinic Services 210.2.2 pg. 17-18 (Aug. 2016). (Accessed Feb. 2021).

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Indiana

Last updated 02/28/2021

Out-of-state providers can perform telemedicine services without fulfilling the out-of-state …

Out-of-state providers can perform telemedicine services without fulfilling the out-of-state prior authorization requirement if they have the subtype “telemedicine” attached to their enrollment.

The Provider must be enrolled with a rendering or billing provider classification and be one of the following types:

  • Advanced practice registered nurse
  • Physician assistant
  • Podiatrist
  • Optometrist
  • Physician

The provider must have a license issued from the Indiana Professional Licensing Agency (IPLA) with the Telemedicine Provider Certification.

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

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Iowa

Last updated 02/28/2021

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Kansas

Last updated 02/28/2021

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Kentucky

Last updated 05/26/2021

KY Medicaid program shall require a telehealth provider to be …

KY Medicaid program shall require a telehealth provider to be licensed in Kentucky, or as allowed under the standards and provisions of a recognized interstate compact, in order to receive reimbursement for telehealth services.

SOURCE: KY Statute Sec. 205.5591, as amended by HB 140 (2021 Session). (Accessed May 2021).

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Louisiana

Last updated 02/28/2021

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Maine

Last updated 02/28/2021

Healthcare Providers must be licensed or certified in the state …

Healthcare Providers must be licensed or certified in the state of Maine.

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

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Maryland

Last updated 02/28/2021

If you are rendering services via telehealth with a participant …

If you are rendering services via telehealth with a participant located in Maryland, then you are considered to be practicing in Maryland; therefore, you must be licensed in Maryland and are subject to your professional board’s licensure requirements.

It is your responsibility to ensure that you meet the Board licensure requirements. This includes consulting with the professional board in the state where the patient physically is located as well as where the provider is physically located. Failure to comply with licensure requirements involving services delivered via telehealth will likely have implications beyond Maryland Medicaid’s telehealth purview.

SOURCE:  MD Medicaid Telehealth Program FAQs. p. 2, Updated April 2020. (Accessed Feb. 2021).

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Massachusetts

Last updated 02/28/2021

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Michigan

Last updated 02/28/2021

Telemedicine services must be provided by a health care professional …

Telemedicine services must be provided by a health care professional who is licensed, registered or otherwise authorized to engage in his or her health care profession in the state where the patient is located.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 535, Jan. 2021 (Accessed Feb. 2021).  

Behavioral Health Therapy

Providers of telepractice services must be currently certified by the Behavior Analyst Certification Board (BACB), be a QBHP, be fully licensed in MI as a fully licensed psychologist, or be a practitioner who holds a limited license and is under the direction of a licensed psychologist.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 483, Jan. 2021 (Accessed Feb. 2021).

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Minnesota

Last updated 02/28/2021

Out-of-state coverage policy applies to services provided via telemedicine. See …

Mississippi

Last updated 02/28/2021

For teleradiology, consulting and referring provider is a licensed physician …

For teleradiology, consulting and referring provider is a licensed physician (or PA or NP for referring providers) who must be licensed in the state within the United States in which he/she practices.

SOURCE: MS Admin. Code 23, Part 225, Rule 3.1. (Accessed Feb. 2021).

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Missouri

Last updated 02/28/2021

Payment cannot be made to any financial institutions, telemedicine providers, …

Montana

Last updated 02/28/2021

Providers must be licensed in the state of Montana.

Any …

Providers must be licensed in the state of Montana.

Any out of state distance providers must be licensed in the State of Montana and enrolled in Montana Healthcare Programs in order to provide telemedicine services to Montana Healthcare Programs members. Providers must contact the Montana Department of Labor and Industry to find out details on licensing requirements for their applicable professional licensure.

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 08/02/2021

Payment in fee-for-service and Managed Care may be approved for …

Payment in fee-for-service and Managed Care may be approved for services provided outside Nebraska in the following situations:

  • When an emergency arises from accident or sudden illness while a client is visiting in another state and the client’s health would be endangered if medical care is postponed until the client returns to Nebraska;
  • When a client customarily obtains a medically necessary service in another state because the service is more accessible; and
  • When the client requires a medically necessary service that is not available in Nebraska.

Prior authorization is required for out-of-state services.  See regulation for procedures

Out-of-State telehealth services are covered if the telehealth services otherwise meet the regulatory requirements for payment for services provided outside Nebraska and:

  • When the distant site is located in another state and the originating site is located in Nebraska; or
  • When the Nebraska client is located at an originating site in another state, whether or not the provider’s distant site is located in or out of Nebraska.

SOURCE: NE Admin. Code Title 471 Sec. 1-002.02(E) & 1-004.11, p. 3 & 10.  (Accessed Aug. 2021).

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Nevada

Last updated 07/28/2021

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New Hampshire

Last updated 07/26/2021

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New Jersey

Last updated 07/21/2021

A psychiatrist or psychiatric APN may be off-site, but must …

A psychiatrist or psychiatric APN may be off-site, but must be licensed in the State of New Jersey.

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

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New Mexico

Last updated 07/19/2021

When the originating site is in New Mexico and the …

When the originating site is in New Mexico and the distant site is outside New Mexico, the distant-site provider at the distant site must be licensed in New Mexico for telemedicine, or meet federal requirements for Indian Health Service or tribal contract facilities.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Jul. 2021).

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New York

Last updated 07/15/2021

“Distant site” means a site at which a telehealth provider …

“Distant site” means a site at which a telehealth provider is located while delivering health care services by means of telehealth. Any site within the United States or United States’ territories is eligible to be a distant site for delivery and payment purposes.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Jul. 2021).

A distant site must be located within any of the fifty United States or United States’ territories where a telehealth provider is located when delivering health care services by means of telehealth.

The originating site must be located within the fifty United States or United States’ territories.

Practitioners providing services via telehealth must be licensed or certified, currently registered in accordance with NYS Education Law or other applicable law, and enrolled in NYS Medicaid.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 3 & 6. (Accessed Jul. 2021).

The distant site must possess a current, valid license, permit, or limited permit to practice in New York State.

Psychiatrists and nurse practitioners in psychiatry may deliver services from a site located within the United States, including from a space in a place of residence approved by the Office of Mental Health; and

Mental health practitioners may deliver services from a site located within the State of New York, including from a space in a place of residence approved by the Office of Mental Health.

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

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North Carolina

Last updated 07/12/2021

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North Dakota

Last updated 07/08/2021

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Ohio

Last updated 07/06/2021

Mental Health Services Provided by Agencies

Provider must have a …

Mental Health Services Provided by Agencies

Provider must have a physical location in Ohio or have access to a physical location in Ohio where individuals may opt to receive in person services rather than telehealth services.

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

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Oklahoma

Last updated 06/29/2021

The provider must be contracted with SoonerCare and appropriately licensed …

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.

Providers and/or patients 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. (Accessed Jun. 2021).

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Oregon

Last updated 06/30/2021

The Authority may expand network capacity through remote care and …

The Authority may expand network capacity through remote care and telehealth services provided across state lines.

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

A provider located in a state other than Oregon whose services are rendered in that state shall be licensed and otherwise certified by the proper agencies in the state of residence as qualified to render the services. Certain cities within 75 miles of the Oregon border may be closer for Oregon residents than major cities in Oregon, and therefore, these areas are considered contiguous areas, and providers are treated as providing in-state services.  See rule for additional requirements.

SOURCE: OR OAR 410-120-1180 (Accessed Jun. 2021).

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Pennsylvania

Last updated 06/19/2021

Out-of-state practitioners providing treatment using telehealth to Pennsylvania residents must …

Out-of-state practitioners providing treatment using telehealth to Pennsylvania residents must meet the licensing requirements established by the Pennsylvania Department of State to provide services in the Commonwealth.

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin OMHSAS-20-20, p.3, Feb. 20, 2020, (Accessed Jun. 2021).

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Rhode Island

Last updated 06/25/2021

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South Carolina

Last updated 06/19/2021

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South Dakota

Last updated 04/29/2021

The out-of-state prior authorization requirement does not apply if the …

The out-of-state prior authorization requirement does not apply if the recipient is located in South Dakota at the time of the service and the provider is located outside of the State. If the service otherwise requires a prior authorization, the provider is still required to obtain prior authorization prior to providing the service.

The distant site provide does not need an out-of-state prior authorization for services delivered via telemedicine. If the service otherwise requires a prior authorization, the provider is still required to obtain prior authorization prior to providing the service.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 & 14 (Mar. 2021). (Accessed Apr. 2021).

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Tennessee

Last updated 06/14/2021

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Texas

Last updated 06/07/2021

An out-of-state physician who is a distant site provider may …

An out-of-state physician who is a distant site provider may provide episodic telemedicine medical services without a Texas medical license as outlined in Texas Statute and Regulation.

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, pg. 6 (Jun. 2021). (Accessed Jun. 2021).

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Utah

Last updated 06/09/2021

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Vermont

Last updated 06/02/2021

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Virginia

Last updated 05/31/2021

Newly enrolling out-of-state physicians who enter on their enrollment application …

Newly enrolling out-of-state physicians who enter on their enrollment application a service address that is within 50 miles of the Virginia border may be enrolled as in-state providers.

SOURCE:  VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 2-3. (May. 2014) (Accessed May 2021).

Out-of-state physicians must enroll with DMAS contractors to utilize telemedicine in the Medicaid program.

All providers utilizing telemedicine and billing for services must be enrolled with DMAS. All coverage requirements described in the DMAS provider manuals apply when the service is delivered via telemedicine.

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. 2-3. (May. 2014) & VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16-17 (Mar. 2020) (Accessed May 2021).

Providers must have the appropriate required license from the Department of Behavioral Health and Developmental Services (http://www.dbhds.virginia.gov/) and enrolled with Magellan. These providers are considered as remote providers.

SOURCE:  VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 6. (May. 2014), (Accessed May 2021).

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Washington

Last updated 05/11/2021

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West Virginia

Last updated 05/24/2021

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Wisconsin

Last updated 05/18/2021

Out-of-state providers who do not have border status enrollment with …

Out-of-state providers who do not have border status enrollment with WI Medicaid are required to obtain prior authorization (PA) before providing services.  WI Medicaid is prohibited from paying providers located outside of the US, the District of Columbia and its territories.

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

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Wyoming

Last updated 05/12/2021

If the provider is an out-of-state, non-enrolled provider and renders …

If the provider is an out-of-state, non-enrolled provider and renders services to a Medicaid client, the provider may choose to enroll in the Medicaid Program and submit the claim according to Medicaid billing instructions, or bill the client.  Out-of-state providers furnishing services within the state on a routine or extended basis must meet all of the certification requirements of the State of Wyoming. The provider must enroll in Medicaid prior to furnishing services.

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).

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 33 & 117 (Apr. 2021)Institutional Manual, pg. 33 & 112, (Apr. 2021)Tribal Provider Manual, pg. 34 & 114, (Apr. 2021), (Accessed May 2021).

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Medicaid & Medicare

Out of State Providers

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