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.

Click the map to scroll down to the state

Federal

Last updated 01/19/2022

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.  Mental health is the biggest exception (and also includes an allowance for audio-only service delivery).  However, there are requirements for in-person visits at regular increments.  See below for further details.

CMS also pay for traditional services delivered via store-and-forward in Alaska and Hawaii telehealth demonstration pilots.  Additionally, they 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 05/20/2022

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 May 2022).

Alabama Medicaid reimburses for live video under some circumstances.  The Agency also covers an origination site fee. The provider shall maintain appropriately trained staff, or employees,
familiar with the recipient’s treatment plan, immediately available in-person to the recipient receiving a telemedicine service to attend to any urgencies or emergencies that may occur during the session.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Services (p. 28-17), Apr. 2022. (Accessed May 2022).

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 (p. 32).  Apr. 2022. (Accessed May 2022).

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Alaska

Last updated 06/02/2022

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 03/20/2022

AHCCCS covers all major forms of telehealth services. Asynchronous (also …

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Mar. 2022).

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, (1/22/2022), pg. 47 & 49; AHCCCS Medical Policy Manual Section 320-I Telehealth. p. 2.; IHS/Tribal Provider Billing Manual, p. 50 & 52 (1/22/2022), (Accessed Mar. 2022)

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Arkansas

Last updated 03/08/2022

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. Audio-only communication is covered in certain circumstances.

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California

Last updated 01/17/2022

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 01/10/2022

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 02/07/2022

CT passed a new temporary law, active until June 30, …

CT passed a new temporary law, active until June 30, 2023, that requires reimbursement of synchronous interactions, asynchronous store and forward transfers or remote patient monitoring, as well as audio-only if the provider is in-network under certain circumstances.  After the law expires the law will revert back to what is CT’s ‘permanent statute’ section, unless new legislation is passed before that time that further amends the law.

Based on a previous law and permanent statute, Connecticut Medicaid is also 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 though provider bulletins do indicate coverage and reimbursement for some services. For audio-only services, while permanent policy does 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 5596 (2021 Session)CT Statute 17b-245e, (Accessed Feb. 2022).

An additional new law requires reimbursement of audio-only telehealth under certain circumstances and reimbursement for services provided by means of telehealth to the same extent as if the service was provided in person.

SOURCE: CT HB 6470 (2021 Session), CT Statute 17b-245g. (Accessed Feb. 2022).

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Delaware

Last updated 03/28/2022

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 02/22/2022

Medicaid is required to cover healthcare services appropriately delivered through …

Medicaid is required to cover healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person. Medicaid enrolled providers are eligible to deliver telemedicine services at the same rate as in-person consultations. Under recently adopted regulations and guidance, Medicaid is also now covering audio-only telehealth. Medicaid continues to not cover asynchronous telehealth or remote patient monitoring, and billing manuals still reference an exclusion of audio-only in addition to e-mail and fax.

Source: DC Code 31-3863; DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.2. & 910.13.; Telemedicine Provider Guidance, Jan. 7, 2022. (Accessed Feb. 2022).

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Florida

Last updated 02/11/2022

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 03/21/2022

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 03/22/2022

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 02/04/2022

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 03/14/2022

IL Medicaid reimburses for live video telemedicine and telepsychiatry services …

IL Medicaid reimburses for live video telemedicine and telepsychiatry services for specific providers.  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 and some audio-only services.

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Indiana

Last updated 04/07/2022

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.

Changes that were made by recently passed Senate Bill 3 have not yet been transferred into the state’s Medicaid Telemedicine and Telehealth Reference Module, including prohibitions around restricting originating and distant sites.  However, Indiana Medicaid did announce changes to their policies in Bulletin 202142 and BT202145.  Both the Module and Bulletins are listed in the policy finder because both items are still publicly accessible on IN Medicaid’s website. However, it appears that the information in the Bulletins overrides the Module information in cases where it conflicts.

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Iowa

Last updated 03/29/2022

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 06/13/2022

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 03/15/2022

The Medicaid program and managed care are required to reimburse …

The Medicaid program and managed care are required to reimburse for services delivered through telehealth.  The department is required to promulgate administrative regulations to establish requirements for telehealth coverage and reimbursement, which shall be equivalent to the coverage for the same service provided in person unless the telehealth provider and the Medicaid program or a Medicaid managed care organization contractually agree to a lower reimbursement rate for telehealth services, or the department establishes a different reimbursement rate.

Kentucky’s definition of telehealth includes synchronous and asynchronous technology, remote patient monitoring technology, and audio-only encounters.  Store-and-forward is reimbursed by KY Medicaid under certain circumstances and remote patient monitoring is not considered an eligible telehealth service for reimbursement although included as part of KY’s glossary (see reference below).

Medicaid-participating practitioners and home health agencies are strongly encouraged to use audio-only encounters as a mode of delivering telehealth services only when no other approved mode of delivering telehealth services is available.

 

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system;

and

    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 (Accessed Mar. 2022).

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Louisiana

Last updated 03/24/2022

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 02/09/2022

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 01/25/2022

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.  Recently passed legislation requires expanded coverage of asynchronous and remote patient monitoring modalities. Until June 30. 2023, the legislation also requires coverage of audio-only and telehealth reimbursement parity.

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Massachusetts

Last updated 03/22/2022

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

Massachusetts passed 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.  MassHealth recently issued a bulletin largely aligning the state’s telehealth policy with the COVID era policies with certain exceptions through Dec. 31, 2022.  The update provides for reimbursement of live video with certain limitations, and modifiers for billing asynchronous and audio-only services.  It is indicated that RPM will be addressed in an upcoming bulletin.

 

 

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Michigan

Last updated 01/17/2022

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.  A new bulletin effective Aug. 1, 2021 Medicaid reimburses for asynchronous telemedicine services, including store and forward services, interprofessional telephone/internet/electronic health record consultations and remote patient monitoring services under certain circumstances. Michigan Medicaid uses the terms “telemedicine” and “telepractice”.

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Minnesota

Last updated 03/28/2022

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

Minnesota Medicaid provides reimbursement for live video, store-and-forward and telemonitoring through their Medical Assistance (MA) program for certain providers when patients are located at specific originating sites.  Many of their individual programs have their own unique requirements for telehealth reimbursement.  Under a new law, MA is covering audio-only through an expansion of emergency waivers until June 30, 2023.

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Mississippi

Last updated 01/13/2022

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.  The requirement for a telepresenter is waived during a state of emergency when the patient’s residence is the originating site.  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 01/11/2022

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 03/30/2022

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.

Telehealth services must be reimbursed at the same rate of payment as services delivered in person.

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Nebraska

Last updated 03/26/2022

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.  Recent passage of LB 400 expands the Medicaid definition of telehealth to include audio-only in specific circumstances however no further information has been provided regarding reimbursement on a permanent basis.

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Nevada

Last updated 01/02/2022

Nevada’s state plan is required to entail reimbursement for telehealth …

Nevada’s state plan is required to entail reimbursement for telehealth and paid at the same rate, except for audio-only interaction.  Although the requirement is altered at various points after the state of emergency is terminated.

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 06/09/2022

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 Jun. 2022).

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New Jersey

Last updated 04/12/2022

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 03/14/2022

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.  They will also reimburse for limited professional services delivered by telephone without video.

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New York

Last updated 04/07/2022

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 and the Office of Mental Health released telepsychiatry guidance in November 2019.

Additional guidance has been released since, however they currently appear to just be tied to the COVID-19 emergency. New York Medicaid has indicated intention to make emergency Medicaid telehealth expansions, including audio-only coverage, permanent.

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North Carolina

Last updated 03/23/2022

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 04/05/2022

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 03/31/2022

Ohio Medicaid reimburses for live video telemedicine.  Store-and-forward and remote …

Ohio Medicaid reimburses for live video telemedicine.  Store-and-forward and remote patient monitoring are only reimbursed for certain communication technology-based service codes.

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Oklahoma

Last updated 04/07/2022

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.  Continuous glucose monitoring is reimbursed by Medicaid.  Continuous Glucose Monitoring (CGM) is covered under certain circumstances.

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Oregon

Last updated 01/20/2022

OR Health Authority covers telehealth and telemedicine services. The definitions …

OR Health Authority covers telehealth and telemedicine services. The definitions of which encompass video conferencing, store-and-forward imaging, streaming media including services with information transmitted via landlines, and wireless communications, including the Internet and telephone networks. Services must be culturally and linguistically appropriate.

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Pennsylvania

Last updated 04/07/2022

Under newly revised bulletins from the Office of Mental Health …

Under newly revised bulletins from the Office of Mental Health and Substance Abuse Services and PA Medical Assistance, they now offer live video reimbursement to a wide range of licensed providers, and patient locations, and audio-only in situations when the beneficiary does not have video capability or an urgent medical situation.   PA Medicaid does not consider store-and-forward or remote patient monitoring to fall under the definition of telemedicine.

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Rhode Island

Last updated 02/10/2022

The Rhode Island Medical Assistance Program reimburses for some specific …

The Rhode Island Medical Assistance Program reimburses for some specific codes via live-video.  A newly passed law requires Medicaid provide coverage of telemedicine, which includes live video, store-and-forward and remote patient monitoring. CCHP has not located documentation from RI Medicaid that they are implementing the store-and-forward and remote patient monitoring pieces yet.

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South Carolina

Last updated 03/22/2022

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 01/26/2022

South Dakota Medicaid provides reimbursement for live video services under …

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

Except for behavioral health services delivered by a Substance Use Disorder Agency, Community Mental Health Center or Independent mental Health Practitioner when the patient does not have access to face-to-face audio/visual telemedicine technology, South Dakota discontinued coverage of telephonic and audio only services that were covered on a temporary basis. The department will be bringing forth an administrative rules package in the coming months that is intended to enable certain services to be provided via telephone or other audio-only modalities on a permanent basis.

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Tennessee

Last updated 04/10/2022

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

TennCare reimburses for live video only for crisis-related services. A law 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 04/11/2022

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.

The Commission is required to develop and implement a system that ensures behavioral health services may be provided using an audio-only platforms.

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Utah

Last updated 02/22/2022

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 (Jan. 2022). (Accessed Feb. 2022).

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

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 22 (Jan. 2022).  (Accessed Feb. 2022).

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Vermont

Last updated 03/11/2022

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.  Additionally, audio-only telephone is also required to be reimbursed under certain circumstances.

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Virginia

Last updated 04/08/2022

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

Virginia Medicaid reimburses for live video, store-and-forward, remote patient monitoring and certain audio-only codes 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.

VA Medicaid recently moved the telehealth-specific content they had in their individual provider manuals into a ‘telehealth supplement’.  Manuals that formerly included telehealth content now direct providers towards the telehealth supplement.  Provider manuals that incorporate the supplement include:

  • Addiction and Recovery Treatment Services (ARTS)
  • Mental Health Services
  • Early Intervention Services
  • Physician/Practitioner
  • Home Health
  • Psychiatric Services
  • Residential Treatment Services

See the Provider Manual home page to access all manuals.

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Washington

Last updated 04/11/2022

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. 89, 92 (Apr. 2022); (Accessed Apr. 2022).

Telemedicine is covered by the Department.

SOURCE: WA Admin. Code Sec. 182-531-0100. (Accessed Apr. 2022).

Effective July 1, 2022, the Department plans to begin covering audio-only services under the definition of telemedicine.

SOURCE: WA State Health Care Authority, Medicaid Provider Bulletin, Audio-Only Telemedicine (Apr. 2022). (Accessed Apr. 2022).

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West Virginia

Last updated 04/12/2022

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 03/25/2022

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

Newly passed statute requires Wisconsin’s Medicaid program to provide coverage for Telehealth services, as defined under 42 USC 1395m (m) (4) (F), remote physiologic monitoring, remote evaluation of pre-recorded patient information, brief communication technology-based services, care management services delivered through telehealth and any other telehealth or communication technology-based services.

ForwardHealth has revamped their Medicaid reimbursement policy to allow certain CPT/HCPCS codes to be reimbursable via telehealth under certain circumstances.  Audio-only is also allowed when audio-visual telehealth is not possible.  Certain remote patient monitoring reimbursement codes are also now reimbursable.

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Wyoming

Last updated 01/17/2022

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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