Medicaid & Medicare

Overview

Medicare and each Medicaid program are different in how they approach and reimburse telehealth delivered services. This section provides a brief overview of each program’s policies before jumping into the details.

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Federal

Last updated 02/28/2021

CMS reimburses for live video under certain circumstances and for …

CMS reimburses for live video under certain circumstances and for specific services when the patient is in a rural area and at a specified originating site with a few exceptions.  They also pay for traditional services delivered via store-and-forward in Alaska and Hawaii telehealth demonstration pilots.  Additionally, they also define communication technology-based services separately and provide reimbursement for those services when delivered via live video, asynchronously as well as remote physiologic monitoring depending on the applicable code’s description. However, as communication technology-based services are not considered “telehealth” by CMS, they are not under the same statutory restrictions telehealth-delivered services face.  More details are provided below.

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Alabama

Last updated 02/28/2021

Live video telemedicine services are covered for limited specialties and …

Live video telemedicine services are covered for limited specialties and under special circumstances.  Telephone consultations are not authorized.

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

Alabama Medicaid reimburses for live video under some circumstances.  The Agency also covers an origination site fee.  For all telemedicine services, an appropriately trained staff member, or employees familiar with the patient’s treatment plan must be immediately available in-person to the patient.

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

They make no reference to store-and-forward reimbursement, but the program reimburses for In-Home Monitoring through the Alabama Coordinated Health Network program for diabetes and Chronic Heart failure, although it’s not considered to fall under the telemedicine program.

SOURCE: AL Medicaid Management Information System Provider Manual, Primary Care Physician (40-38).  Jan. 2021. (Accessed Feb. 2021).

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Alaska

Last updated 02/28/2021

Alaska reimburses for Live Video, Store & Forward & Remote …

Alaska reimburses for Live Video, Store & Forward & Remote Patient Monitoring, although some restrictions apply.

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Arizona

Last updated 02/28/2021

Arizona Health Care Cost Containment System (AHCCCS) covers medically necessary, …

Arizona Health Care Cost Containment System (AHCCCS) covers medically necessary, non-experimental, and cost-effective Telehealth services provided by AHCCCS-registered providers. There are no geographic restrictions for Telehealth; services delivered via Telehealth are covered by AHCCCS in rural and urban regions. They reimburse for store-and-forward for specific specialties and for remote patient monitoring, although restrictions apply. Arizona’s Medicaid program uses an integrated managed care model with a fee-for-service delivery system for Alaska Native/American Indian populations and limited emergency services.

All services provided via telehealth must be medically necessary, non-experimental and cost-effective services.  Services are billed by the individual provider (located at the distant site).  Tele-presenter services are not billable.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Manual, Ch. 10: Individual Practitioner Services, (10-46 & 48), (07/01/2020); AHCCCS Medical Policy Manual Section 320-I Telehealth (08/01/19). p. 2. (Accessed Feb. 2021);  IHS/Tribal Provider Billing Manual (8/48 & 50), (07/14/2020). (Accessed Feb. 2021).; AHCCCS, AHCCCS Fact Sheet: What is AHCCCS Managed Care? (n.d.) (Accessed Feb. 2021)

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Arkansas

Last updated 02/28/2021

Arkansas Medicaid reimburses for live video when the telemedicine service …

Arkansas Medicaid reimburses for live video when the telemedicine service is comparable to an in-person service.  Store-and-forward and remote patient monitoring is included in Medicaid’s definition of telemedicine, but there was no specific information found regarding reimbursement of the modalities.

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California

Last updated 02/28/2021

Medi-Cal allows providers to decide what modality, live video or …

Medi-Cal allows providers to decide what modality, live video or store-and-forward, will be used to deliver eligible services to a Medi-Cal enrollee as long as the service is covered by Medi-Cal and meets all other Medi-Cal guidelines, policies, can be properly provided via telehealth, and meets the procedural and definition components of the appropriate CPT or HCPCS code.  Additional requirements apply for specific programs (such as FQHCs/RHCS and Indian Health Services).  Medi-Cal also reimburses for one specific e-consult code.

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Colorado

Last updated 02/28/2021

Colorado Medicaid reimburses for live video for medical and mental …

Colorado Medicaid reimburses for live video for medical and mental health services.  They also provide reimbursement for remote patient monitoring for patients with certain chronic conditions.  Colorado Medicaid requires a member to be present and participating in a telemedicine service, excluding the possibility of utilizing store-and-forward, except in the case of teledentistry for an interim therapeutic restoration.

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Connecticut

Last updated 02/28/2021

Connecticut Medicaid is required to cover telemedicine services for categories …

Connecticut Medicaid is required to cover telemedicine services for categories of health care that the commissioner determines are appropriate, cost effective and likely to expand access to medically necessary services where there is a clinical need for those services to be provided by telehealth or for Medicaid recipients for whom accessing appropriate health care services poses an undue hardship.  The CT Medicaid Program manuals do not mention reimbursement for telemedicine but does indicate that while they do not provide reimbursement for behavioral health services provided electronically or over the phone, there is an exception for case management behavioral health services for clients age eighteen and under.

There is no reference to remote patient monitoring.

SOURCE:  HB 6001 (2020 Session), (Accessed Feb. 2021).

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Delaware

Last updated 02/28/2021

Delaware Medical Assistance Program (DMAP) reimburses for medically necessary telemedicine …

Delaware Medical Assistance Program (DMAP) reimburses for medically necessary telemedicine services delivered via live video for certain providers and for patients at specific sites.  DMAP does not reimburse for store-and-forward and makes no reference to remote patent monitoring.

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District of Columbia

Last updated 02/28/2021

Medicaid shall cover and reimburse for healthcare services appropriately delivered …

Medicaid shall cover and reimburse for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person.  Although this law was amended to expand reimbursement to store-and-forward and remote patient monitoring, it was not funded under an approved budget and financial plan and therefore did not go into effect.

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

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Florida

Last updated 02/28/2021

FL Medicaid reimburses for real time interactive telemedicine according to …

FL Medicaid reimburses for real time interactive telemedicine according to administrative code, however there is no indication of reimbursement in any Medicaid Manual.  No reference was found in regards to reimbursement for store-and-forward or remote patient monitoring.

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Georgia

Last updated 02/28/2021

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward …

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward is not reimbursable as interactive telecommunications is a condition of payment; however, GA Medicaid will reimburse for the technical component of x-rays, ultrasounds, etc. as well as store-and-forward teledentistry. There is no reference to remote patient monitoring.

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Hawaii

Last updated 02/28/2021

Hawaii Medicaid (Med-QUEST) reimburses for live video.  Although their statute …

Hawaii Medicaid (Med-QUEST) reimburses for live video.  Although their statute prohibits HI Medicaid from placing any restrictions on originating sites, regulations creating restrictions on the types or originating site eligible for reimbursement and their geographic location still exist in Hawaii Rules.  HI indicated in a memo that a state plan amendment was approved that allows for the changes in Hawaii Medicaid policy based on the statutory requirements, but it did not provide any specifics on removing the originating site or geographic restrictions currently present in HI rules.

Additionally, according to Hawaii’s statutory definition of telehealth, they should also be reimbursing for store-and-forward and remote patient monitoring, however CCHP has yet to find any documentation from Hawaii Medicaid that they are reimbursing for these modalities.

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Idaho

Last updated 02/28/2021

Idaho Medicaid reimburses for live video telehealth for certain providers …

Idaho Medicaid reimburses for live video telehealth for certain providers and for specific services.  There is no reference to store-and-forward or remote patient monitoring.

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Illinois

Last updated 02/28/2021

IL Medicaid reimburses for live video telemedicine and telepsychiatry services …

IL Medicaid reimburses for live video telemedicine and telepsychiatry services for specific providers.  A recent law change required them to expand reimbursement to other behavioral health professions beginning in Jan. 2019.  Although IL definitions of telemedicine and telehealth encompass store-and-forward there is no mention of store-and-forward reimbursement.  IL Medicaid will provide reimbursement for home uterine monitoring.

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Indiana

Last updated 02/28/2021

Indiana Medicaid reimburses for live video telemedicine for certain services …

Indiana Medicaid reimburses for live video telemedicine for certain services and providers.  Indiana Medicaid does not reimburse for store-and-forward although store-and-forward can still be used to facilitate other reimbursable services.  Indiana Medicaid defines telehealth as including remote patient monitoring (RPM) services and reimburses home health agencies for RPM for patients with diabetes, congestive heart failure and COPD.

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Iowa

Last updated 02/28/2021

Iowa Medicaid pays for telehealth as long as it meets …

Iowa Medicaid pays for telehealth as long as it meets accepted health care practices and standards.  The Medicaid program does not have a definition for telehealth, and therefore it is unknown if the term encompasses store-and-forward or remote patient monitoring. Managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawki) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

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Kansas

Last updated 02/28/2021

Kansas Medicaid covers live video telemedicine for certain services.  Additionally, …

Kansas Medicaid covers live video telemedicine for certain services.  Additionally, they also cover remote patient monitoring that is in real-time through home health agencies and with prior authorization.

All insurers (including Medicaid) must cover medically necessary services, subject to the terms and conditions of the contract. Medicaid specifically must provide reimbursement for speech language pathology services and audiology services.

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Kentucky

Last updated 02/28/2021

KY Medicaid is required to reimburse for covered services provided …

KY Medicaid is required to reimburse for covered services provided to a Medicaid recipient through telehealth. The Department must establish requirements for telehealth coverage and reimbursement which are equivalent to the coverage for the same service provided in-person unless the telehealth provider and the Medicaid program contractually agree to a lower reimbursement rate for telehealth services, or the Department establishes a different reimbursement rate.

KY Medicaid and any Medicaid managed care organization are restricted from doing the following:

  • Requiring a Medicaid provider to be physically present with a Medicaid recipient, unless the provider determines that it is medically necessary to perform those services in-person;
  • Requiring prior authorization, medical review or administrative clearance for telehealth that would not be required if a service were provided in-person;
  • Requiring a Medicaid provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in-person;
  • Require demonstration that it is necessary to provide services to a Medicaid recipient through telehealth;
  • Restrict or deny coverage of telehealth based solely on the communication technology or application used to deliver the telehealth service; OR
  • Require a Medicaid provider to be part of a telehealth network.

SOURCE: KY Revised Statutes. 205.5591. (Accessed Feb. 2021).

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Louisiana

Last updated 02/28/2021

Live video telemedicine is covered for distant site providers enrolled …

Live video telemedicine is covered for distant site providers enrolled in Louisiana Medicaid.  There is no reimbursement for the originating site.  Activity and sensor monitoring, health status monitoring and medication dispensing and monitoring are forms of remote patient monitoring that are covered by Louisiana Medicaid.  There is no reference to store-and-forward.

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Maine

Last updated 02/28/2021

Maine Medicaid (MaineCare) reimburses for live video telehealth under certain …

Maine Medicaid (MaineCare) reimburses for live video telehealth under certain conditions, and remote patient monitoring for patients with certain risk factors.  Although their definition of telehealth is broad enough to include of store-and-forward, there is no mention of store-and-forward reimbursement within their policies.

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Maryland

Last updated 02/28/2021

Maryland Medicaid covers live video telehealth conducted by specific providers …

Maryland Medicaid covers live video telehealth conducted by specific providers and in specific originating sites.  Although the Medicaid program does not reimburse for store-and-forward, dermatology, ophthalmology and radiology are excluded from the definition of store-and-forward.  Maryland Medicaid does reimburse for remote patient monitoring for patients with certain chronic conditions and exhibiting certain risk factors.

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Massachusetts

Last updated 02/28/2021

Massachusetts introduced major revisions to the state’s Medicaid telehealth policy …

Massachusetts introduced major revisions to the state’s Medicaid telehealth policy that took effect in January 2021 and established coverage for health care services, and parity for behavioral health services.  Massachusetts has also revised its definition of telehealth in statute. Even though the new definition of telehealth includes remote patient monitoring, there is not yet evidence that Medicaid is implementing RPM reimbursement at this time. Additionally, MA Medicaid Bulletins do not yet reflect the expansions to telehealth reimbursement made in law, with the latest one on permanent policy being dated January 2019. Based on official Massachusetts’s government public releases related to the new law, the MassHealth telehealth expansion of primary care and chronic disease management will expire in two years.

SOURCE: Massachusetts Office of Governor. (Accessed Feb. 2021). 

 

 

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Michigan

Last updated 02/28/2021

Michigan Medicaid reimburses for live video telemedicine for certain healthcare …

Michigan Medicaid reimburses for live video telemedicine for certain healthcare professionals, for patients located at certain originating sites for specific services.  There is no reimbursement for store-and-forward or remote patient monitoring.

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Minnesota

Last updated 02/28/2021

Minnesota Medicaid provides reimbursement for live video and store-and-forward through …

Minnesota Medicaid provides reimbursement for live video and store-and-forward through their Medical Assistance program for certain providers when patients are located at specific originating sites.  Many of their individual programs have their own unique requirements for telemedicine reimbursement.  Additionally, tele-home-care (remote monitoring) is reimbursed with prior authorization under Home Care Services and the Elderly Waiver (EW) and Alternative Care (AC) program, but specific reimbursement criteria is not listed.

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Mississippi

Last updated 02/28/2021

Mississippi Medicaid reimburses certain providers for live video telehealth when …

Mississippi Medicaid reimburses certain providers for live video telehealth when there is a telepresenter with the patient.  They also reimburse for store-and-forward teleradiology, and for remote patient monitoring for patients with certain chronic conditions.

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Missouri

Last updated 02/28/2021

Missouri Medicaid will reimburse for services delivered via live video.  …

Missouri Medicaid will reimburse for services delivered via live video.  They will also reimburse for some tele-dentistry asynchronous services and remote patient monitoring for specific conditions.

 

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Montana

Last updated 04/27/2021

Montana Medicaid reimburses for live video under some circumstances. There …

Montana Medicaid reimburses for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring based on the definition for telemedicine.

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Nebraska

Last updated 02/28/2021

Nebraska Medicaid reimburses for live video, store-and-forward, and remote patient …

Nebraska Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under some circumstances. Reimbursement for store-and-forward is only specified for teleradiology.

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Nevada

Last updated 02/28/2021

Nevada Medicaid and the Nevada Check Up (NCU) program reimburses …

Nevada Medicaid and the Nevada Check Up (NCU) program reimburses for live video and store-and-forward services under specific conditions. There is no reimbursement for remote patient monitoring.

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New Hampshire

Last updated 02/28/2021

New Hampshire Medicaid follows the Center for Medicare and Medicaid …

New Hampshire Medicaid follows the Center for Medicare and Medicaid Services requirements and Federal regulations for the use of telehealth and telemedicine. Reimbursement is available for live video under some circumstances. New Hampshire statute has a definition for store-and-forward and remote patient monitoring, and states that the Medicaid program shall provide reimbursement for all modes of telehealth, including video and audio, audio-only, or other electronic media provided by medical providers to treat all members for all medically necessary services.  It states that primary care, remote patient monitoring and substance use disorder services shall only be covered in the event that the patient has already established care at an originating site via face-to-face in-person service, with a few exceptions.  Statute does not prohibit the Medicaid program from providing coverage for only those services that are medically necessary and subject to all other terms and conditions of the coverage.

SOURCE: NH Revised Statutes 167:4-d (Accessed Feb. 2021).

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New Jersey

Last updated 02/28/2021

New Jersey Medicaid reimburses for live video and remote patient …

New Jersey Medicaid reimburses for live video and remote patient monitoring under certain circumstances. Store-and-forward is not explicitly included in reimbursement; however, it could be covered within the definition of telemedicine. Individual Medicare managed care plans may have their own individual policies regarding telehealth and telemedicine.

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New Mexico

Last updated 02/28/2021

New Mexico Medicaid reimburses for live video telehealth at the …

New Mexico Medicaid reimburses for live video telehealth at the same rate as when services are provided in-person as well as store-and-forward.  There is no reference to remote patient monitoring.

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New York

Last updated 02/28/2021

New York Medicaid offers live video reimbursement and some reimbursement …

New York Medicaid offers live video reimbursement and some reimbursement for store-and-forward and home health services. The New York State Department of Health released a Medicaid telehealth expansion in 2019. The guidance states that other state offices will be updating guidances and regulation to reflect the changes made, however no other office has released updates at the time of this report.

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North Carolina

Last updated 02/28/2021

NC Medicaid reimburses for medically necessary telehealth services via live …

NC Medicaid reimburses for medically necessary telehealth services via live video, remote patient monitoring, audio-only and other virtual communications modalities outlined in its updated telehealth clinical coverage policies.

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North Dakota

Last updated 02/28/2021

North Dakota reimburses for live video telemedicine for most services, …

North Dakota reimburses for live video telemedicine for most services, with a few exceptions.  They do not provide reimbursement for store-and-forward and no reference was found for remote patient monitoring.

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Ohio

Last updated 02/28/2021

Ohio Medicaid reimburses for live video telemedicine.  They do not …

Ohio Medicaid reimburses for live video telemedicine.  They do not provide reimbursement for store-and-forward or remote patient monitoring.

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Oklahoma

Last updated 02/28/2021

SoonerCare reimburses for live video telehealth. Store-and-Forward and Remote Patient …

SoonerCare reimburses for live video telehealth. Store-and-Forward and Remote Patient Monitoring must be compensable by the Oklahoma Health Care Authority (OHCA) in order to be reimbursed.

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Oregon

Last updated 02/28/2021

As of January 1, 2021, Oregon Health Authority covers medically …

As of January 1, 2021, Oregon Health Authority covers medically necessary and appropriate physical, behavioral and oral health services within Oregon Health Plan (OHP) covered benefit plans.

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Pennsylvania

Last updated 02/28/2021

The Pennsylvania Medical Assistance Program provides reimbursement for live-video under …

The Pennsylvania Medical Assistance Program provides reimbursement for live-video under some circumstances. There is no reimbursement available for store-and-forward or remote patient monitoring.

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Rhode Island

Last updated 02/28/2021

The Rhode Island Medical Assistance Program reimburses for some live-video …

The Rhode Island Medical Assistance Program reimburses for some live-video services and provides no reimbursement for store-and-forward or remote patient monitoring.

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South Carolina

Last updated 02/28/2021

South Carolina Medicaid reimburses for live video under certain circumstances. …

South Carolina Medicaid reimburses for live video under certain circumstances. Store-and-forward is not reimbursed as it does not meet established conditions for the use of telemedicine. South Carolina Medicaid reimburses for home health monitoring through the Home Aging Program for some conditions when a patient is eligible.

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South Dakota

Last updated 04/29/2021

South Dakota Medicaid provides reimbursement for live video and audio-only …

South Dakota Medicaid provides reimbursement for live video and audio-only services under some circumstances. Reimbursement is not provided for store-and-forward or remote patient monitoring services.

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Tennessee

Last updated 02/28/2021

TennCare reimburses for live video only for crisis-related services. A …

TennCare reimburses for live video only for crisis-related services. A law recently passed that requires reimbursement for additional telehealth services and provider-based telemedicine, which includes store-and-forward.  Remote patient monitoring may be offered by health insurance entities.

TennCare services are offered through managed care entities. Each MCO has its own telehealth policy. Coverage and reimbursement for live video and store-and-forward may vary between MCOs.

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Texas

Last updated 02/28/2021

Texas Medicaid reimburses for live video and store-and-forward in some …

Texas Medicaid reimburses for live video and store-and-forward in some circumstances. Home telemonitoring is reimbursable for some conditions when a provider is approved to deliver those services.

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Utah

Last updated 02/28/2021

Utah Medicaid reimburses for medically necessary, non-experimental and cost-effective services …

Utah Medicaid reimburses for medically necessary, non-experimental and cost-effective services via live video telehealth, and does not reference store-and-forward modality in their policy.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, P. 48 (Jul. 2020). (Accessed Feb. 2021).

Home telemetry for outpatient long-term cardiac monitoring is allowable with prior authorization under certain conditions.

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Jan. 2021).  (Accessed Feb. 2021).

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Vermont

Last updated 02/28/2021

Vermont Medicaid reimburses for live video under certain circumstances. Home …

Vermont Medicaid reimburses for live video under certain circumstances. Home health monitoring is considered a Medicaid benefit and is available under certain conditions. An administrative rule indicates store-and-forward is reimbursed for teledermatology and teleophthalmology, but a recent Medicaid Manual has contradictory information.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101), Telehealth, (Accessed Feb. 2021).

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Virginia

Last updated 02/28/2021

Virginia Medicaid reimburses for live video, store-and-forward, and remote patient …

Virginia Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under certain circumstances. Plans participating in the Medicare-Medicaid Demonstration Waiver are permitted to use store-and-forward and remote patient monitoring in rural and urban locations and to provide reimbursement for services.

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Washington

Last updated 02/28/2021

Washington Medicaid (Apple Health) reimburses for live video, limited store-and-forward, …

Washington Medicaid (Apple Health) reimburses for live video, limited store-and-forward, and remote patient monitoring under some circumstances.

Client must be present and participating in telemedicine visit.  Clients under the Family Planning Only – Pregnancy Related program, Family Planning Only program (formerly TAKE CHARGE), First Steps, and School Based Health Care Service program are eligible for telemedicine through fee-for-service.

MCO’s cover the delivery of care via telemedicine. Follow the MCO’s policy and billing requirements.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 84-85 (Feb. 2021); (Accessed Feb. 2021).

Telemedicine is covered by the Department.

SOURCE: WA Admin. Code Sec. 182-531-0100. (Accessed Feb. 2021).

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West Virginia

Last updated 02/28/2021

West Virginia Medicaid reimburses for live video under some circumstances. …

West Virginia Medicaid reimburses for live video under some circumstances. Reimbursement is only made for real-time communications, therefore there is no reimbursement for store-and-forward or remote patient monitoring.

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Wisconsin

Last updated 02/28/2021

Newly passed statute requires Wisconsin’s Medicaid program to provide coverage …

Newly passed statute requires Wisconsin’s Medicaid program to provide coverage for any benefit delivered via interactive video. ForwardHealth is also required to provide reimbursement for remote patient monitoring, asynchronous telehealth and other communication-based technology covered by Medicare.  However, ForwardHealth currently allows for only certain covered services to be provided via telehealth via interactive telehealth, specifically excludes store-and-forward from coverage and does not mention remote patient monitoring.

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Wyoming

Last updated 04/27/2021

Wyoming Medicaid reimburses for live video under some circumstances. There …

Wyoming Medicaid reimburses for live video under some circumstances. There is no reference to store-and-forward or remote patient monitoring reimbursement.

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Medicaid & Medicare

Overview

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