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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Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Federal

Last updated 03/18/2024

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 pays 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.

* Requirements around patient location, eligible providers, and in-person visit requirements is currently waived or implementation delayed until January 1, 2025 due to passage of HR 2617.  Policies that have been extended are noted throughout this section.

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Alabama

Last updated 06/18/2024

AL Medicaid reimburses live video for a specific set of …

AL Medicaid reimburses live video for a specific set of services and specific provider types.  See manual for full lists.  Although asynchronous is included in the definition of telehealth and telemedicine, the telemedicine policy makes no further mention of the modality.

Remote patient monitoring is reimbursed for certain conditions and providers and when the service meets certain requirements. An entire chapter of the Medicaid manual is dedicated to remote patient monitoring instructions.

Audio-only is reimbursed currently the same as face-to-face with FQ modifier.

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Alaska

Last updated 06/19/2024

Alaska reimburses for Live Video, Store & Forward & audio-only.  …

Alaska reimburses for Live Video, Store & Forward & audio-only.  They also reimburse for patient-initiated services in some circumstances. It is unclear if they reimburse for remote patient monitoring.

In Sept. 2023, Medicaid updated their telehealth regulations to comply with statute.  They are currently working on telehealth guidance and reviewing their provider manuals.  In the meantime, their Telehealth Coverage and Reimbursement FAQs is meant to answer the most common questions.

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Arizona

Last updated 05/29/2024

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.  See manuals for list of services that can be provided by real-time telehealth, though its not an exclusive list. There are no geographic restrictions for Telehealth; services delivered via Telehealth are covered by AHCCCS in rural and urban regions.

AHCCCS reimburse for store-and-forward for specific specialties and for remote patient monitoring, although restrictions apply.  Audio-only services are covered if a telemedicine encounter is not reasonably available due to the member’s functional status, the member’s lack of technology or telecommunications infrastructure limits, as determined by the provider.

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Arkansas

Last updated 05/27/2024

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 are included in Medicaid’s definition of telemedicine, but there was no specific information found regarding reimbursement of the modalities, with the exception of mobile telemonitoring in the Patient-Led Arkansas Shared Savings Entity (PASSE) Program. Audio-only communication is covered in certain circumstances.

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California

Last updated 06/29/2024

Medi-Cal allows providers to decide what modality, live video, store-and-forward, …

Medi-Cal allows providers to decide what modality, live video, store-and-forward, or audio-only, 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 and 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 Medicare CTBS remote patient monitoring codes and one specific e-consult code.

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Colorado

Last updated 04/25/2024

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. Colorado Medicaid also recently adopted rules to authorize e-consults through the Department’s e-consult platform which allows asynchronous exchanges between primary care and specialty providers.

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Connecticut

Last updated 04/12/2024

CT has enacted temporary laws relative to telehealth, active until …

CT has enacted temporary laws relative to telehealth, active until June 30, 2024, that require reimbursement of synchronous interactions, asynchronous store and forward transfers or remote patient monitoring.  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 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, including those rendered via audio-visual and audio-only  modalities. CT Medicaid has created a Telehealth Information page with FAQs and a CMAP Telehealth Table, which includes the list of procedure codes approved to be rendered via telehealth.

SOURCE: HB 5596 (2021 Session), SB 2 (2022 Session)CT Statute 17b-245e, CT Statute 17b-245g & CT Dept. of Social Services Provider Bulletin 2023-38. REVISED Guidance for Services Rendered via Telehealth. May 2023. (Accessed Apr. 2024).

An additional 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 Statute 17b-245gCT HB 6470 (2021 Session). (Accessed Apr. 2024).

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Delaware

Last updated 04/24/2024

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

Delaware Medical Assistance Program (DMAP) reimburses for medically necessary telehealth services, including any covered State Plan service that would typically be provided to an eligible individual in an in-person setting by an enrolled practitioner. Consistent with January 2024 updates to its Practitioner Provider Manual, in addition to live video coverage, DMAP now reimburses certain store-and-forward and telephonic services, as well as remote physiologic monitoring.

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District of Columbia

Last updated 06/05/2024

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. 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. 2023. (Accessed Jun. 2024).

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Florida

Last updated 06/11/2024

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.  A recently released Medicaid notice to clarify Medicaid policy post-COVID public health emergency states that FL Medicaid will continue to cover store-and-forward and remote patient monitoring services, but will no longer cover audio-only telehealth services.

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Georgia

Last updated 05/24/2024

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.  A new law requires GA Medicaid to cover continuous glucose monitoring.

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Hawaii

Last updated 06/03/2024

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.  Recently passed legislation indicates that Hawaii Medicaid will cover some audio-only delivered services until December 31, 2025.

Additionally, according to Hawaii’s statutory definition of telehealth and limited documentation from Hawaii Medicaid, they appear to be reimbursing for store-and-forward and remote patient monitoring in certain circumstances. Phone calls are allowed for limited circumstances.

Note that in August 2023 a public health emergency (PHE) was declared in Hawaii for the Maui fires.  In response to the PHE, Hawaii has enacted several waivers that impact the Medicaid population and utilize telehealth.  See Hawaii Med-Quest Memo QI-2335A for more details. These waivers will last until the end of the PHE, though Medicaid does have the ability to extend them.

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Idaho

Last updated 02/13/2024

Idaho Medicaid reimburses for live video virtual services (they have …

Idaho Medicaid reimburses for live video virtual services (they have changed the term from “telehealth”), remote patient monitoring and audio-only. The Medicaid program does not reimburse for store-and-forward.

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Illinois

Last updated 02/27/2024

IL Medicaid reimburses for live video telemedicine and telepsychiatry services …

IL Medicaid reimburses for live video telemedicine and telepsychiatry services for specific providers.  Last year, IL Medicaid issued a  provider bulletin specifying that certain Interprofessional Consultation CPT codes are billable for psychiatric services.  IL Medicaid will provide reimbursement for home uterine monitoring, continuous glucose monitoring, and some audio-only services.

The IL Association of Medicaid Health Plans has created a comprehensive billing manual for IL Medicaid Managed Care that includes some information on telehealth policy as it applies to these health plans. The existence of this guide was relayed to IL Medicaid providers by the IL Dept of Healthcare and Family Services in a Provider Notice issued on 11/17/2023.

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Indiana

Last updated 03/21/2024

Indiana Medicaid reimburses for live video telemedicine for certain services …

Indiana Medicaid reimburses for live video telemedicine for certain services and providers and remote patient monitoring (RPM).  Indiana Medicaid does not reimburse for store-and-forward although store-and-forward can still be used to facilitate other reimbursable services.  Certain services may be provided via audio-only and be reimbursed by the program.

 

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Iowa

Last updated 04/22/2024

Iowa Medicaid pays for telehealth, including audio-only interactions, for certain …

Iowa Medicaid pays for telehealth, including audio-only interactions, for certain service codes as long as it meets accepted health care practices and standards.  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.  Asynchronous telehealth for teledentistry is covered.

A list of approved reimbursable codes for telehealth in Iowa Medicaid is available and includes a variety of monitoring codes, such as remote physiologic and therapeutic codes, as well as specific codes covering services provided via phone and store-and-forward (i.e. e-visits).  Additionally, there is a column in the code list that generally identifies codes eligible for audio-only reimbursement.

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Kansas

Last updated 03/04/2024

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.

Telephone evaluation and management services provided by a qualified healthcare professional to an established patient, parent, or guardian is reimbursed for certain codes.

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 03/18/2024

Kentucky’s definition of telehealth includes synchronous and asynchronous technology, remote …

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 reimbursed for certain conditions.

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.

KY Medicaid is required to reimburse for telehealth services and telehealth consultations under certain circumstances, including the RHCs, FQHCs and FQHC look-alikes. Medicaid participating practitioners and home heath 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.

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Louisiana

Last updated 06/04/2024

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 under the Community Choices Waiver.  There is no reference to store-and-forward.  Audio-only specified as allowed for FQHCs and RHCs, and in some other specific services.

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Maine

Last updated 05/20/2024

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.  They also reimburse for store-and-forward, including virtual transfer of health information and remote consultation between a treating provider and specialist.  Telephone evaluation and management services are also reimbursed in certain circumstances, as well as the virtual check-in and interprofessional codes for medication management providers.

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Maryland

Last updated 05/24/2024

Maryland Medicaid covers live video synchronous telehealth, asynchronous telehealth for …

Maryland Medicaid covers live video synchronous telehealth, asynchronous telehealth for limited services, and remote patient monitoring modalities. Until June 30, 2025, legislation also requires coverage of audio-only and telehealth reimbursement parity. See Provider Telehealth website for MD Medicaid overview.

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Massachusetts

Last updated 04/15/2024

MassHealth updated their telehealth policies, effective Oct. 1, 2023 to …

MassHealth updated their telehealth policies, effective Oct. 1, 2023 to align with most COVID era policies.  They now reimburse for live video, asynchronous, and audio-only delivery modalities with certain exceptions for noncovered services.  They state that reimbursement for remote patient monitoring will be announced at a future date.

 

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Michigan

Last updated 04/29/2024

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.  Medicaid reimburses for asynchronous telemedicine services, including store and forward services, interprofessional consultations and remote patient monitoring services under certain circumstances.

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Minnesota

Last updated 06/24/2024

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.  MA is covering audio-only through an expansion of emergency waivers until July 1, 2025.

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Mississippi

Last updated 04/05/2024

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.  Telemedicine, other than remote patient monitoring services and store-and-forward telemedicine services, must be “real-time” audio visual capable.

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Missouri

Last updated 01/20/2024

Missouri Medicaid (HealthNet) will reimburse for services delivered via live …

Missouri Medicaid (HealthNet) 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.

HealthNet is also continuing to allow telephone for telehealth services and continuing to allow quarantined providers and/or providers working from alternate sites or facilities.

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Montana

Last updated 06/03/2024

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

Montana Medicaid reimburses for live video under some circumstances. With the end of COVID, MT Medicaid has specified that there are no requirements for technology used to deliver services via telemedicine/telehealth which can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.  However, still no mention of remote patient monitoring in their telehealth policy.

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

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Nebraska

Last updated 04/10/2024

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.  Passage of LB 400 expanded the Medicaid definition of telehealth to include audio-only, and Medicaid recently released a bulletin and code list that allows audio-only reimbursement for some specific service codes.

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Nevada

Last updated 03/26/2024

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

Nevada Medicaid and the Nevada Check Up (NCU) program reimburse for live video and store-and-forward services under specific conditions. There is no reimbursement for remote patient monitoring.  Audio-only is reimbursed if there is medical necessity and its appropriateness is documented in the patient record.

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New Hampshire

Last updated 03/29/2024

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 regulations that indicate its reimbursed as long as funding and resources are available in the fiscal year.  New Medicaid regulations stipulate that providers are permitted to perform health care services through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media.

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New Jersey

Last updated 05/09/2024

New Jersey Medicaid reimburses for live video under certain circumstances. …

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

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New Mexico

Last updated 06/17/2024

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 05/30/2024

New York Medicaid offers live video, store-and-forward, and remote patient …

New York Medicaid offers live video, store-and-forward, and remote patient monitoring reimbursement. Both the Department of Health and Office of Mental Health have recently adopted final rules making many emergency Medicaid telehealth expansions permanent, including allowances for audio-only coverage. In addition, recently effective legislation requires telehealth reimbursement parity until April 1, 2026 and the Department of Health Announced Medicaid Telehealth Coverage Extended Beyond COVID-19 Public Health Emergency Through 2024. See NY Medicaid Telehealth website for overview of policies and the newly published Medicaid Telehealth Policy Manual for the most current guidance.

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North Carolina

Last updated 03/17/2024

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 06/10/2024

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 provide reimbursement for store-and-forward through online digital evaluation and management services in specific circumstances.  Asynchronous teledentistry is required to be covered by recently passed legislation, and was recently incorporated into the dental provider manual.

Home health telemonitoring is covered though not much detail is provided.

Audio-only is allowed for established patients through Dec. 31, 2024.

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Ohio

Last updated 06/05/2024

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

Ohio Medicaid reimburses for live video telemedicine.  Store-and-forward is only reimbursed for certain communication technology-based service codes.  Certain remote physiologic monitoring codes are reimbursed along with FQHCs being reimbursed through the FFS under clinic provider type 50 for remote patient monitoring.  Audio-only is incorporated into the definition of telehealth in OH Medicaid and is reimbursed for certified community behavioral health centers for CPST and SUD case management.

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Oklahoma

Last updated 03/06/2024

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 (CGM) and Extended Ambulatory Cardiac Monitoring is covered under certain circumstances. OK Medicaid also added a list of codes reimbursable through audio-only after 5/11/23 and allows for reporting of audio-only modifiers FQ and 93.  Newly passed regulations also clarify audio-only requirements and allow FQHCs to bill for audio-only through the FFS rate.

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Oregon

Last updated 03/30/2024

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 05/07/2024

Under bulletins from the Office of Mental Health and Substance …

Under 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.  Reimbursement for interprofessional consultation services were also recently added though store-and-forward may only be utilized as part of the synchronous consultation.

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Puerto Rico

Last updated 03/28/2024

Although the Puerto Rico Department of Health has information regarding …

Although the Puerto Rico Department of Health has information regarding telehealth, including definitions for terms and modalities, its Medicaid program webpage lacks any information on telehealth.  It is likely because Puerto Rico Medicaid is 100% Managed Care, which is operated by Plan Vital.  At this time, there does not appear to be any specific permanent telehealth policy under Plan Vital.

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Rhode Island

Last updated 05/15/2024

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 only located policy indicating RI Medicaid is reimbursing store-and-forward through teledentistry.

An encounter for FQHCS includes a telemedicine visit (telephone-only and tele video services).

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South Carolina

Last updated 05/07/2024

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

South Carolina Medicaid reimburses for live video under certain circumstances. Store-and-forward does not appear to be reimbursed as it does not meet certain established conditions for coverage. However, CPT Code G2010 (remote images submitted by a patient) is listed as reimbursed for established patients.

South Carolina Medicaid reimburses for home health monitoring through the Home Aging Program for some conditions when a patient is eligible. Coverage for certain audio-only codes for particular providers implemented during the public health emergency has been extended through December 31, 2024.

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South Dakota

Last updated 04/02/2024

South Dakota Medicaid provides reimbursement for live video services under …

South Dakota Medicaid provides reimbursement for live video services under some circumstances, and asynchronous teledentistry. Reimbursement is also available for audio-only behavioral heath and Telephonic Evaluation and Management Services with certain conditions.  In October 2023, South Dakota Medicaid added reimbursement for remote patient monitoring services for certain conditions and in certain circumstances.

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Tennessee

Last updated 05/03/2024

A law requires TennCare (Medicaid) reimbursement for telehealth services and …

A law requires TennCare (Medicaid) reimbursement for telehealth services and provider-based telemedicine, which includes store-and-forward.  Remote patient monitoring may be offered by health insurance entities.  Audio-only conversation is allowed for provider based telemedicine for the provision of behavioral health services or healthcare services when other means are unavailable.

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 04/25/2024

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.  Texas Medicaid has two telehealth manuals (which they title “telecommunications services”), one for the general Medicaid program and one specifically for Children with Special Health Care Needs (CSHCN) as well as specific telehealth sections in a variety of other program provider manuals.

Audio-only service deliver is also allowed for behavioral health services under certain circumstances.

 

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Utah

Last updated 06/25/2024

Utah Medicaid recently updated their telehealth provider manual section to …

Utah Medicaid recently updated their telehealth provider manual section to allow reimbursement for services that are clinically appropriate for telehealth, providing examples of such services.  They also allow reimbursement for audio-only services under some conditions.  They state that there is no reimbursement for store-and-forward or remote patient monitoring, though there is reimbursement for interprofessional telephone/internet assessments and management and home telemetry.

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Vermont

Last updated 07/02/2024

Vermont Medicaid reimburses for live video under certain circumstances. Store-and-forward …

Vermont Medicaid reimburses for live video under certain circumstances. Store-and-forward is covered when it is clinically appropriate and medically necessary. DVHA will not reimburse for teleophthalmology or teledermatology by store-and-forward means.  Home health monitoring is considered a Medicaid benefit and is available under certain conditions.  Additionally, audio-only telephone is also required to be reimbursed under certain circumstances.  The Medicaid program has updated their regulations to include reimbursement of audio-only services when clinically appropriate and medically necessary.

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Virgin Islands

Last updated 03/25/2024

Currently there is no permanent policy regarding telehealth and the …

Currently there is no permanent policy regarding telehealth and the Medicaid program, however, legislation was passed for the establishment of a Crisis Intervention and Prevention Services program.  See Medicaid Miscellaneous section for more information.

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Virginia

Last updated 04/22/2024

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. Virtual Check-Ins are also reimbursed.

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)
  • Early Intervention Services
  • Mental Health Services
  • Physician/Practitioner
  • Home Health
  • Psychiatric Services
  • Rehabilitation

See the Provider Manual home page to access all manuals.

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Washington

Last updated 06/19/2024

Telemedicine is covered by the Department. Washington Medicaid (Apple Health) …

Telemedicine is covered by the Department. Washington Medicaid (Apple Health) reimburses for live video, store-and-forward, and remote patient monitoring under certain circumstances. The Department recently began covering audio-only services for specific billing codes as well.

SOURCE: WA Admin. Code Sec. 182-531-0100. WA State Health Care Authority. Medicaid Telemedicine Policy and Billing Guide (Jun. 2024)WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., RPM, p. 102 (Apr. 2024). (Accessed Jun. 2024).

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West Virginia

Last updated 05/15/2024

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

West Virginia Medicaid reimburses for live video under some circumstances. Reimbursement is largely limited to real-time communications, however store-and-forward services may be billed by ophthalmologists and optometrists with certain restrictions. Specific remote patient monitoring codes are also eligible for reimbursement.

Ongoing Telehealth Medicaid Flexibilities until December 31, 2024:

As noted in a 2023 WV Medicaid Provider Newsletter, with the end of the federal Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) have extended telehealth flexibilities until December 31, 2024. West Virginia Medicaid and the WVCHIP will also continue to follow CMS in allowing Telehealth flexibilities until this date. For more information on WV Medicaid COVID Telehealth Policies, see the Medicaid memos located on the WV Medicaid COVID-19 Telehealth Website, which also reference temporary audio-only allowances. In addition, in August 2023 WV Medicaid added an appendix to its Practitioners Services Medicaid Policy Manual Telehealth Section with available codes specific to the PHE Medicaid Telehealth Services Flexibilities – see Policy 519.17 Appendix B.

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Wisconsin

Last updated 04/19/2024

Both synchronous (two-way, real-time, interactive communications) and asynchronous (information stored …

Both synchronous (two-way, real-time, interactive communications) and asynchronous (information stored and forwarded to a provider for later review) services identified under permanent policy may be reimbursed when provided via telehealth (also known as “telemedicine”).  ForwardHealth includes virtual check-in, e-visit options for members to connect with their providers remotely as well as telephone evaluation codes.  Additionally, forward-health reimburses for audio-only when audio-visual telehealth is not possible.  Certain remote patient monitoring reimbursement codes are also now reimbursable. Interprofessional consultations (e-consults) are reimbursable by both the treating and consulting provider under the outlined policy requirements and limitations.

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Wyoming

Last updated 05/13/2024

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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