Medicaid & Medicare

Store-and-Forward

Store-and-Forward is the electronic transmission of medical information to a practitioner, usually a specialist, who uses the information to evaluate the case or render a service outside of a real-time or live interaction. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.  In many states, the definition of telemedicine and/or telehealth stipulates that the delivery of services must occur in “real time,” automatically excluding store-and-forward as a part of telemedicine and/or telehealth altogether.  Other states have exceptions and limitations on what will or won’t be reimbursed, or identify store-and-forward and reimburse for it as communication technology-based services (CBTS).

See overview of states with store-and-forward reimbursement >
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Federal

Last updated 02/28/2021

POLICY

Asynchronous store-and-forward technologies means the transmission of a patient’s …

POLICY

Asynchronous store-and-forward technologies means the transmission of a patient’s medical information from an originating site to the physician or practitioner at the distant site. The physician or practitioner at the distant site can review the medical case without the patient being present. An asynchronous telecommunications system in single media format does not include telephone calls, images transmitted via facsimile machines and text messages without visualization of the patient (electronic mail). Photographs visualized by a telecommunications system must be specific to the patient’s medical condition and adequate for furnishing or confirming a diagnosis and or treatment plan. Dermatological photographs, for example, a photograph of a skin lesion, may be considered to meet the requirement of a single media format under this provision.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

For Federal telemedicine demonstration programs conducted in Alaska or Hawaii only, Medicare payment is permitted for telehealth when asynchronous store and forward technologies, in single or multimedia formats, are used as a substitute for an interactive telecommunications system.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

In the case of any Federal telemedicine demonstration program conducted in Alaska or Hawaii, the term “telecommunications system” includes store-and-forward technologies that provide for the asynchronous transmission of health care information in single or multimedia formats.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

You must use an interactive audio and video telecommunications system that permits real-time communication between you at the distant site, and the beneficiary at the originating site.  Transmitting medical information to a physician or practitioner who reviews it later is permitted only in Alaska or Hawaii Federal telemedicine demonstration programs.

If you performed telehealth services “through an asynchronous telecommunications system”, add the telehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99201 GQ). You are certifying the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 11 (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

For Telehealth Demonstration Projects Only:

The term “telehealth service” means professional consultations, office visits, and office psychiatry services (identified as of July 1, 2000, by HCPCS codes 99241–99275, 99201–99215, 90804–90809, and 90862 (and as subsequently modified by the Secretary)), and any additional service specified by the Secretary.  The Secretary shall establish a process that provides, on an annual basis, for the addition or deletion of services (and HCPCS codes), as appropriate.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

Medicare Part B pays for covered telehealth services included on the telehealth list when furnished by an interactive telecommunications system if certain conditions are met, except that for the duration of the Public Health Emergency as defined in § 400.200 of this chapter, Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management and end stage renal disease related services included in the monthly capitation payment furnished by an interactive telecommunications system if certain conditions are met.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

Changes to the list of Medicare telehealth services are made through the annual physician fee schedule rulemaking process. During the Public Health Emergency for the COVID-19 pandemic, as defined in § 400.200 of this chapter, we will use a sub-regulatory process to modify the services included on the Medicare telehealth list during the Public Health Emergency taking into consideration infection control, patient safety, and other public health concerns resulting from the emergency. A list of the services covered as telehealth services under this section is available on the CMS website.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

See page 7-10 of the Telehealth Medicare Learning Network Factsheet for a full list of permanently eligible codes.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p. 7-10 (Accessed Feb. 2021).

List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth is available on the CMS website, including temporary codes during the public health emergency.

SOURCE:  Centers for Medicare and Medicaid Services. List of Telehealth Services.  (Accessed Feb. 2021).

The Secretary shall pay to a physician or practitioner located at a distant site that furnishes a telehealth service to an eligible telehealth individual an amount equal to the amount that such physician or practitioner would have been paid under this title had such service been furnished without the use of a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021). 

The physician or practitioner at the distant site must be licensed to furnish the service under State law. The physician or practitioner at the distant site who is licensed under State law to furnish a covered telehealth service may bill, and receive payment for, the service when it is delivered via a telecommunications system.

The practitioner at the distant site is one of the following:

  • A physician
  • A physician
  • A nurse practitioner
  • A clinical nurse specialist
  • A nurse-midwife
  • A clinical psychologist
  • A clinical social worker
  • A registered dietitian or nutrition professional
  • A certified registered nurse anesthetist

SOURCE: 42 CFR Sec. 410.78 & Medicare Learning Network Factsheet. Telehealth Services, p. 6 (Accessed Feb. 2021).

Eligible Sites:

  • The office of a physician or practitioner.
  • A critical access hospital
  • A rural health clinic
  • A Federally qualified health center
  • A hospital
  • A hospital-based or critical access hospital- based renal dialysis center (including satellites).
  • A skilled nursing facility
  • Rural emergency hospital
  • A community mental health center
  •  A renal dialysis facility for purposes of individuals with end-stage renal disease getting home dialysis.
  • The home of an individual, but only for purposes of individuals with end-stage renal disease getting home dialysis or telehealth services to treat substance use disorder or individuals with co-occurring mental health disorders, or mental health disorders under certain circumstances.

SOURCE:  Social Security Act, Sec. 1834(m) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5 & 42 CFR Sec. 410.78.  (Accessed Feb. 2021).

The originating site and geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke, as determined by the Secretary.

With respect to telehealth services for acute stroke, the term “originating site” shall include any or critical access hospital, any mobile stroke unit, or any other site determined appropriate by the Secretary, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m) & Medicare Learning Network Factsheet. Telehealth Services, p. 5.  (Accessed Feb. 2021).

Providers qualify as originating sites, regardless of location, if they were participating in a Federal telemedicine demonstration project approved by (or getting funding from) the U.S. Department of Health & Human Services as of December 31, 2000.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 4 (Accessed Feb. 2021). https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf

Communication Technology-Based Services (CTBS)

CMS makes separate payment for remote evaluation of recorded video and/or images submitted by the patient. The code, G2010 describes remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

HCPCS code G2010 may be billed only for established patients. The follow-up with the patient could take place via phone call, audio/video communication, secure text messaging, email, or patient portal communication.

SOURCE CY 2019 Final Physician Fee Schedule. CMS, p. 31-40.

Online digital evaluation services (e-visit) are reimbursable for physicians and qualified non-physician health care professionals.  These are non-face-to-face codes that describe patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.

SOURCE CY 2020 Final Physician Fee Schedule. CMS, p. 799.

Interprofessional consultations are reimbursable by CMS as part of their CTBS services (CPT codes include 99451, 99452, 99446, 99447, 99448, and 99449). Cost sharing will apply. These interprofessional services may be billed only by practitioners that can bill Medicare independently for evaluation and management services.  Includes telephone and internet assessments.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40.

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes communication technology-based services (Includes the Brief Communication Technology-Based Service, Remote Evaluation of Pre-Recorded Patient Information) to an RHC or FQHC patient. RHCs and FQHCs receive payment for communication technology-based services or remote evaluation services when an RHC or FQHC practitioner provides at least 5 minutes of communications-based technology or remote evaluation services to a patient who has been seen in the RHC or FQHC within the previous year.

G0071 should be billed for both services.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, & Virtual Communication Services RHCs and FQHCs FAQs, December 2019, (Accessed Feb. 2021). 

RHCs and FQHCs are not eligible for reimbursement of interprofessional consultation services, as only practitioners that can bill Medicare independently for evaluation and management services are eligible.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40.


GEOGRAPHIC LIMITS

For asynchronous store and forward telecommunications technologies, the only originating sites are Federal telemedicine demonstration programs conducted in Alaska or Hawaii.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

For Telehealth Demonstration Projects Only:

The term “originating site” means only those sites described below:

  • In an area that is designated as a rural health professional shortage area under section 332(a)(1)(A) of the Public Health Service Act
  • In a county that is not included in a Metropolitan Statistical Area; or
  • From an entity that participates in a Federal telemedicine demonstration project that has been approved by (or receives funding from) the Secretary of Health and Human Services as of December 31, 2000.

The geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of the home dialysis monthly ESRD-related visit, at a hospital-based or critical access hospital-based renal dialysis center, a renal dialysis facility, or the home.

Additional exceptions exist for treatment of acute stroke and substance use disorder (see below).

SOURCE:  Social Security Act, Sec. 1834(m) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5.  (Accessed Feb. 2021).

Treatment of stroke telehealth services

The geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke, as determined by the Secretary.

With respect to telehealth services to treat acute stroke, the term “originating site” shall include any hospital or critical access hospital, any mobile stroke unit, or any other site determined appropriate by the Secretary, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

Substance Use Disorder

The geographic requirements shall not apply with respect to telehealth services furnished on or after July 1, 2019, to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or cooccurring mental health disorder, as determined by the Secretary, or, on or after the first day after the end of the emergency period described in section 1135(g)(1)(B), subject to subparagraph (B), to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder, as determined by the Secretary at any originating site except a renal dialysis facility.

Requirements for mental health services furnished through telehealth

Payment may not be made under this paragraph for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this title:

  • within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and
  • during subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

These requirements do not apply to services:

  • Under this paragraph (with respect to telehealth services furnished to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder); or
  • Under this subsection without application of this paragraph.

SOURCE:  Social Security Act, Sec. 1834(m) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 (Accessed Feb. 2021).

Originating sites must be:

  • Located in a health professional shortage area (as defined under section 332(a)(1)(A) of the Public Health Service Act that is either outside of a Metropolitan Statistical Area (MSA) as of December 31st of the preceding calendar year or within a rural census tract of an MSA as determined by the Office of Rural Health Policy of the Health ReSOURCEs and Services Administration as of December 31st of the preceding calendar year, or
  • Located in a county that is not included in a Metropolitan Statistical Area as defined in section 1886(d)(2)(D) of the Act as of December 31st of the preceding year, or
  • An entity participating in a Federal telemedicine demonstration project that has been approved by, or receive funding from, the Secretary as of December 31, 2000, regardless of its geographic location.

The geographic requirements specified above do not apply to the following telehealth services:

  • Home dialysis monthly ESRD-related clinical assessment services furnished on or after January 1, 2019, at a hospital-based or critical access hospital-based renal dialysis center, a renal dialysis facility, or the home; and
  • Services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
  • Services furnished on or after July 1, 2019 to an individual with a substance use disorder diagnosis, for purposes of treatment of a substance use disorder or a co-occurring mental health disorder.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2021).

The Health ReSOURCEs and Services Administration (HRSA) decides HPSAs, and the Census Bureau decides MSAs. To see a potential Medicare telehealth originating site’s payment eligibility, go to HRSA’s Medicare Telehealth Payment Eligibility Analyzer.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 4 (Accessed Feb. 2021).

Communication Technology-Based Services (CTBS)

Geographic limits do not apply to Communication Technology-Based Services.


TRANSMISSION FEE

Eligible originating sites are eligible for a facility fee equal to:

  • for the period beginning on October 1, 2001, and ending on December 31, 2001, and for 2002, $20; and
  • for a subsequent year, the facility fee specified in subclause (I) or this subclause for the preceding year increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) for such subsequent year.

No facility fee shall be paid under this subparagraph to an originating site that is the home.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

Treatment of Acute Stroke:  No facility fee shall be paid to an originating site with respect to a telehealth service if the originating site does not otherwise meet the requirements for an originating site, including geographic requirements.

SOURCE:  Social Security Act, Sec. 1834(m).  (Accessed Feb. 2021).

HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC for the separately billable Part B originating site facility fee. The originating site facility fee does not count toward the number of services used to determine payment for partial hospitalization services when a CMHC serves as an originating site.

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

Communication Technology-Based Services (CTBS)

No originating site or transmission fee for Communication Technology-Based Services.

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Alabama

Last updated 06/08/2021

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Alaska

Last updated 07/29/2021

POLICY

Alaska Medicaid will reimburse for Store & Forward telehealth, …

POLICY

Alaska Medicaid will reimburse for Store & Forward telehealth, which is defined as the “provider sends digital images, sounds, or previously recorded video to a consulting provider at a different location.  The consulting provider reviews the information and reports back his or her analysis.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services (1/2/19); Mental Health Physician Clinic (1/2/2019); Physician Services (5/13), (Accessed July 2021).

The department will pay for medical services furnished through telemedicine applications as an alternative to traditional methods of delivering services to Medicaid recipients. For the provider to receive payment, the provider’s use of telemedicine applications must comply with the standards for services delivered under the Medicaid program and for the medical services provided by the type of provider, including provisions that affect the efficiency, economy and quality of service; and coverage limitations.  Store-and-forward services must be provided through the transference of digital images, sounds, or previously recorded video from one location to another to allow a consulting provider to obtain information, analyze it, and report back to the referring provider.

SOURCE:  Alaska Admin Code. Title 7, Sec. 110.620 & 625. (Accessed July 2021).


ELIGIBLE SERVICES/SPECIALTIES

A consulting provider may send data he/she has received during a store-and-forward telemedicine consultation to another consulting provider (with equal or greater scope of practice as determined by his/her occupational license or level of expertise within their field of specialty).

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Audiology Services (6/12); Autism Services (6/12); Chiropractic Services (6/12); Community Behavioral Health Clinic Services (6/12); Direct-Entry Midwives Services (6/12); EPSDT (6/12); Family Planning (6/12); FQHC/RHC (6/12); Imaging Services (6/12); Independent Laboratory (6/12); Mental Health Physician Clinic (6/12); Nutrition (6/12); Physician (6/12); Private Duty Nursing (6/12); Psychologist (6/12); Podiatry (6/12); School-Based Services (6/12); Residential Behavioral Rehabilitation Services (6/12); Therapies (6/12); Vision (6/12) (Accessed July 2021).

Eligible services:

  • Initial or one follow-up office visit;
  • Consultation made to confirm diagnosis;
  • A diagnostic, therapeutic or interpretive service;
  • Psychiatric or substance abuse assessments;
  • Psychotherapy; or
  • Pharmacological management services on an individual recipient basis.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); & Physician Services (5/13) & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. May 8, 2020. (Accessed July 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.

SOURCE: AK Admin. Code, Title 7, 110.635(b). (Accessed July 2021).

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Arizona

Last updated 05/17/2021

POLICY

Asynchronous (store-and-forward) is “transmission of recorded health history (e.g. …

POLICY

Asynchronous (store-and-forward) is “transmission of recorded health history (e.g. pre-recorded videos, digital data, or digital images, such as x-rays and photos) through a secure electronic communications system between a practitioner, usually a specialist, and a member or other practitioner, in order to evaluate the case or to render consultative and/or therapeutic services outside of a synchronous (real-time) interaction. As compared to a real-time member care, synchronous care allows practitioners to assess, evaluate, consult, or treat conditions using secure digital transmission services, data storage services, and software solutions.”

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 1-2). Oct. 2019; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10/47-48), (02/17/2021) & IHS/Tribal Provider Billing Manual, (8/49), (07/14/2020). (Accessed May 2021).

AHCCCS will reimburse for store-and-forward in their fee-for-service program for certain services.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Professional and Technical Services, (10-46), (2/17/2021) & IHS/Tribal Provider Billing Manual, (8/48-49), (2/17/2021). (Accessed May 2021).

Two HCPCS codes used for a Virtual check-in with physicians via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image. Virtual check-ins are initiated by the patient and may be performed via multiple technology modalities including telephone, secure text messaging, email, or use of a patient portal. The two HCPCS codes are included in the 2020/2021 Fee Schedule.

  • G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
  • G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 435. (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

The following services are covered via asynchronous telehealth (store-and-forward):

  • Behavioral Health
  • Cardiology
  • Dermatology
  • Infectious Disease
  • Neurology
  • Ophthalmology
  • Pathology
  • Radiology

Covered behavioral health services can include, but are not limited to:

  • Diagnostic consultation and evaluation,
  • Psychotropic medication adjustment and monitoring,
  • Individual and family counseling, and
  • Case management.

Covered behavioral health services via asynchronous telehealth can include Naturalistic Observation Diagnostic Assessment (NODA).

SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Professional and Technical Services, (10-47 & 49), (2/17/2021) & IHS/Tribal Provider Billing Manual, (8/48-50), (2/17/2021). (Accessed May 2021).

AHCCS Medical Policy Manual

  • AHCCCS only covers store-and-forward for the following:
  • Dermatology
  • Radiology
  • Ophthalmology
  • Pathology
  • Neurology
  • Cardiology
  • Behavioral Health
  • Infectious Disease
  • Allergy/Immunology

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


GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth. Services delivered via telehealth are covered by AHCCCS in rural and urban regions.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2), Oct. 2019.; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-46) & IHS/Tribal Provider Billing Manual, (8/48), (2/17/2021). (Accessed May 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

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Arkansas

Last updated 02/28/2021

POLICY

Store-and-forward technology is the transmission of a patient’s medical …

POLICY

Store-and-forward technology is the transmission of a patient’s medical information from a healthcare provider at an originating site to a healthcare provider at a distant site.

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

Although store-and-forward is included in Medicaid’s definition of telemedicine, no information was found regarding reimbursement of store-and-forward.

Patient-Led Arkansas Shared Savings Entity (PASSE) Program
Virtual providers can use secure web-based communication to remotely monitor and evaluate the patient’s functional and health status.

SOURCE: PASSE Program. P. II-9, (3/1/19). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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California

Last updated 02/28/2021

POLICY

“Asynchronous store-and-forward” means the transmission of a patient’s medical …

POLICY

“Asynchronous store-and-forward” means the transmission of a patient’s medical information from an originating site to the health care provider at a distant site.  Consultations via asynchronous electronic transmission initiated directly by patients, including through mobile phone applications, are not covered under this policy.

“E-consults” fall under the auspice of store-and-forward.  E-consults are asynchronous health record consultation services that provide an assessment and management service in which the patient’s treating health care practitioner (attending or primary) requests the opinion and/or treatment advice of another health care practitioner (consultant) with specific specialty expertise to assist in the diagnosis and/or management of the patient’s health care needs without patient face-to-face contact with the consultant.  E-consults between health care providers are designed to offer coordinated multidisciplinary case reviews, advisory opinions and recommendations of care.  E-consults are permissible only between health care providers.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 1. (Accessed Feb. 2021).

Family PACT

Family PACT telehealth policy mirrors the fee-for-service policy.

SOURCE:  CA Department of Health Care Services.  Family Planning, Access, Care and Treatment Program.  Benefits Manual.  Aug. 2020, Pg. 6. (Accessed. Feb. 2021).  

Managed Care

Existing Medi-Cal covered services may be provided via a telehealth modality (includes store-and-forward) if certain conditions are met (as outlined in fee-for-service manual).

SOURCE: CA Department of Health Care Services (DHCS).  All Plan Letter 19-009:  Telehealth Services Policy.  Oct. 16, 2019. (Accessed Feb. 2021).  

Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC)

Store-and-forward covered for specific specialties for established patients, with the exception of a homeless, homebound or a migratory or seasonal worker (HHMS).  E-consult is not covered.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 11-12.  (Accessed Feb. 2021).  

Indian Health Services, Memorandum of Understanding Agreement (IHS-MOA)

Store-and-forward covered for specific specialties for established patients, with the exception of a homeless patient.  E-consult is not covered.

SOURCE: CA Department of Health Care Services (DHCS).  Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual.  Aug. 2020. Pg. 9.  (Accessed Feb. 2021). 

Local Education Agency:  Speech Therapy

Only interactive telehealth can be billed with modifier 95.

SOURCE:  CA Department of Health Care Services (DHCS).  Local Education Agency (LEA) Telehealth.  Aug. 2020. Pg. 3.  (Accessed Feb. 2021). 

Dental Services

The Department of Health Care Services has opted to permit the use of teledentistry (includes store-and-forward) as an alternative modality for the provision of select dental services.

SOURCE:  CA Department of Health Care Services (DHCS).  Denti-Cal Manual.  Nov. 2020. Pg. 4-14.  (Accessed Feb. 2021). 


ELIGIBLE SERVICES/SPECIALTIES

Modifier GQ must be used for Medi-Cal covered benefits or services, including, but not limited to, teleophthalmology, teledermatology, teledentistry and teleradiology, delivered via asynchronous store and forward telecommunications systems, including through e-consult. Only the service(s) rendered from the distant site must be billed with modifier GQ.

Medi-Cal covered benefits or services, identified by CPT or HCPCS codes and subject to all existing Medi-Cal coverage and reimbursement policies, including any treatment authorization request requirements, may be provided via a telehealth modality if all of the following are satisfied:

  • The treating health care provider at the distant site believes that the benefits or services being provided are clinically appropriate based upon evidence-based medicine and/or best practices to be delivered via telehealth;
  • The benefits or services delivered via telehealth meet the procedural definition and components of the CPT or HCPCS code(s), as defined by the American Medical Association, associated with the Medi-Cal covered service or benefit, as well as any extended guidelines as described in this section of the Medi-Cal provider manual; and
  • The benefits or services provided via telehealth meet all laws regarding confidentiality of health care information and a patient’s right to his or her medical information.

Certain types of benefits or services that would not be expected to be appropriately delivered via telehealth include, but are not limited to, benefits or services that are performed in an operating room or while the patient is under anesthesia, require direct visualization or instrumentation of bodily structures, involve sampling of tissue or insertion/removal of medical devices and/or otherwise require the in-person presence of the patient for any reason.

E-consult code 99451 in conjunction with the GQ modifier (indicating store-and-forward) is reimbursed. For e-consult the following requirements must be met for distant and originating site providers:

  • Originating Site Providers must create and maintain the following:
    • A record that the e-consult is the result of patient care that has occurred or will occur and relates to ongoing patient management; and
    • A record of a request for an e-consult by the health care provider at the originating site
  • Distant Site providers must create and maintain the following:
    • A record of the review and analysis of the transmitted medical information with written documentation of the date of service and time spent; and
    • A written report of case findings and recommendations with conveyance to the originating site.

See manual for instances when e-consult is not reimbursable.

If more than one contact or encounter is required to complete the e-consult request, the entirety of the service and cumulative discussion and review time should be reported only once using CPT code 99451.  E-consults are not applicable for FQHCs, RHCs, or IHS-MOA clinics.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020), Pg. 6, 8, 9-10. (Accessed Feb. 2021).

Medi-Cal covers an ‘e-visit’ which are communications between a patient and their provider through an online patient portal. A Treatment Authorization Request is required.  See manual for applicable codes.

SOURCE:  CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 2 & 10. (Accessed Feb. 2021).

Managed Care

Electronic consultations (e-consults) are permissible using CPT-4 code 99451, modifier(s), and medical record documentation as defined in the Medi-Cal Provider Manual. E-consults are permissible only between health care providers.

SOURCE: CA Department of Health Care Services (DHCS).  All Plan Letter 19-009:  Telehealth Services Policy.  Oct. 16, 2019. (Accessed Feb. 2021). 

Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC)

Reimbursement is permitted for established patients for teleophthalmology, teledermatology and teledentistry, when it is furnished by a billable provider at the distant site.

Asynchronous store-and-forward reimbursement may not be used to “establish” a patient, with the exception of a homeless, homebound or a migratory or seasonal worker (HHMS).  E-consult is not a reimbursable telehealth service of FQHCs/RHCs.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 12.  (Accessed Feb. 2021). 

Indian Health Services, Memorandum of Understanding Agreement (IHS-MOA)

Reimbursement is permitted for established patients for teleophthalmology, teledermatology and teledentistry, when it is furnished by a billable provider at the distant site.

Asynchronous store-and-forward reimbursement may not be used to “establish” a patient, with the exception of a homeless patient.  E-consult is not a reimbursable telehealth service of IHS-MOA clinics.

SOURCE: CA Department of Health Care Services (DHCS).  Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual.  Aug. 2020. Pg. 9.  (Accessed Feb. 2021).  

Vision Care

Teleophthalmology by store-and-forward is covered for three specific CPT codes.  Information can be reviewed by a physician or optometrist at a distant site.   If the reviewing optometrist identifies a disease or condition requiring consultation or referral pursuant to Section 3041 of the Business and Professions Code, a referral must be made with an appropriate physician and surgeon or ophthalmologist, as required.

SOURCE: CA Department of Health Care Services, Vision Care: Professional Services Manual.  (Aug. 2020), Pg. 5.  (Accessed Feb. 2021).

Dental Services

Reimburses for specific teledentistry codes via store-and-forward (see manual).

SOURCE:  CA Department of Health Care Services (DHCS).  Denti-Cal Manual.  Nov. 2020. Pg. 4-15.  (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The originating site is eligible for a facility fee with HCPCS code Q3014.  A transmission fee is only reimbursed for live video; therefore, store-and-forward is not eligible.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual.  Telehealth.  (Aug. 2020), Pg. 11. (Accessed Feb. 2021).  https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/mednetele.pdf

FQHC & RHC/IHS-MOA

These sites are not eligible for the facility or transmission fee.

SOURCE: CA Department of Health Care Services (DHCS).  Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual.  Aug. 2020. Pg. 8 & Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 12.  (Accessed Feb. 2021).  

Vision Care

The facility fee is reimbursable to the originating site when billed with HCPCS code Q3014.  Transmission costs incurred from providing telehealth services via audio/video communication is also reimbursable for the original site and the consulting provider when billed with HCPCS code T1014.  Expenses involving telehealth equipment and telecommunications and transmission costs by Internet service providers will not be reimbursed by Medi-Cal.

SOURCE: CA Department of Health Care Services, Vision Care: Professional Services Manual.  (Aug. 2020), Pg. 5.  (Accessed Feb. 2021).

Dental Care

Transmission costs associated with store-and-forward are not reimbursable.

SOURCE:  CA Department of Health Care Services (DHCS).  Denti-Cal Manual. Nov. 2020. Pg.4-15.  (Accessed Feb. 2021).

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Colorado

Last updated 02/28/2021

POLICY

The member must be present during any Telemedicine visit.…

POLICY

The member must be present during any Telemedicine visit.

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

Telemedicine includes interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission). Any health benefits provided through interactive audio, interactive video, or interactive data communication must meet the same standard of care as in-person care.

SOURCE:  Colorado Adopted Rule 8.200.3.B. (Accessed Feb. 2021).

In-person contact between a health care provider and a recipient is not required under the state’s medical assistance program for the diagnosis, development of a treatment plan, instruction to perform an interim therapeutic restoration procedure, or supervision of a dental hygienist performing an interim therapeutic restoration procedure. A health care provider may provide these services through store-and-forward transfer and is entitled to reimbursement for the delivery of those services via telehealth to the extent the services are otherwise eligible for reimbursement under the program when provided in-person. The services are subject to the reimbursement policies developed pursuant to the state medical assistance program.

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Limited reimbursement allowed for an interim therapeutic restoration in teledentistry.

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No Reference Found

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Connecticut

Last updated 06/30/2021

POLICY

Effective Now Until June 30, 2023

Notwithstanding the provisions …

POLICY

Effective Now Until June 30, 2023

Notwithstanding the provisions of section 19a-906 of the general statutes and subdivision (1) of this subsection, a telehealth provider that is an in-network provider or a provider enrolled in the Connecticut medical assistance program that provides telehealth services to a Connecticut medical assistance program recipient, may, during the period beginning on the effective date of this section and ending on June 30, 2023, use any information or communication technology in accordance with the directions, modifications or revisions, if any, made by the Office for Civil Rights of the United States Department of Health and Human Services to the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191, as amended from time to time, or the rules and regulations adopted thereunder.

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

Permanent Policy

Although CT Medicaid previously covered electronic consultations, as of January 1, 2020 and forward, the codes used to bill for electronic consultations are no longer payable under the CT Medical Assistance Program.  This is due to guidance received by the Centers for Medicare and Medicaid Services (CMS), that reimbursement for electronic consultations does not meet the federal requirements.

SOURCE: CT Policy – Provider Bulletin 2019-75.  Dec. 2019, (Accessed June 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Delaware

Last updated 07/09/2021

POLICY

Asynchronous or “store-and-forward” applications do not meet the DMAP …

POLICY

Asynchronous or “store-and-forward” applications do not meet the DMAP definition of telemedicine.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 5/20/21. Ch. 16.3.4.1 Telemedicine, pg. 80 & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. p. 10 (Accessed July 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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District of Columbia

Last updated 02/28/2021

POLICY

No reimbursement for store-and-forward.

SOURCE: DC Municipal Regulation. Title

POLICY

No reimbursement for store-and-forward.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.29. (Accessed Feb. 2021) & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.7. P. 67. & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 6 (Mar. 2020). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Florida

Last updated 07/17/2021

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Georgia

Last updated 07/26/2021

POLICY

GA Medicaid defines asynchronous or “store-and-forward” as the “transfer …

POLICY

GA Medicaid defines asynchronous or “store-and-forward” as the “transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous communication does not include telephone calls, images transmitted via fax machines and text messages without visualization of the patient (electronic mail).

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p. 6 (July 2021) (Accessed July 2021).

Certain teledentistry codes can be delivered via store-and-forward.

Department of Public Health (DPH) Districts and Boards of Health Dental Hygienists shall only perform duties under this protocol at the facilities of the DPH District and Board of Health, at school-based prevention programs and other facilities approved by the Board of Dentistry and under the approval of the District Dentist or dentist approved by the District Dentist.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.39 (July 2021), & Part II Policies and Procedures for Dental Services, p. IX-21 (July 2021). (Accessed July 2021).


ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

The State allows reimbursement for one specific teledentistry store-and-forward codes.  See manual for approved code.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.39 (July 2021) & Part II Policies and Procedures for Dental Services, p. IX-21 (July 2021). (Accessed July 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The originating site fee (billed as D9996) associated with a real-time teledentistry exam is supposed to cover the asynchronous sending of information by a dental hygienist to a dentist for review.

SOURCE: GA Dept. of Community Health, GA Medicaid Telehealth Guidance Handbook, p.39 (July 2021) & Part II Policies and Procedures for Dental Services, p. IX-21 (July 2021). (Accessed July 2021).

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Hawaii

Last updated 06/17/2021

POLICY

Hawaii Medicaid and private payers are required to cover …

POLICY

Hawaii Medicaid and private payers are required to cover appropriate telehealth services (which includes store-and-forward) equivalent to reimbursement for the same services provided in-person.

SOURCE: HI Revised Statutes § 346-59.1 & 431:10A-116.3. (Accessed June 2021).

Hawaii Medicaid requires, as a condition of payment, the patient to be present and participating in the telehealth visit.

SOURCE: Code of HI Rules 17-1737.-51.1(c) – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation. (Accessed June 2021).

Teledentistry

D9996 (teledentistry-asynchronous; information stored and forwarded to dentist for subsequent review) can be used to identify eligible telehealth delivered services.

SOURCE: HI Med-QUEST Medicaid Provider Manual: Dental, pg. 77 (June 2021).


ELIGIBLE SERVICES/SPECIALTIES

Federally Qualified Health Centers

Telemedicine-based retinal imaging and interpretation is not a covered service for PPS reimbursement. A face-to-face encounter with a member by an ophthalmologist or optometrist is eligible for PPS reimbursement, regardless of whether retinal imaging or interpretation is a component of the services provided.

SOURCE: Med-QUEST Provider Manual.  Ch. 21: Federally Qualified Health Centers. Mar. 2016, p. 4.  (Accessed June 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Idaho

Last updated 02/28/2021

POLICY

Idaho Medicaid specifies that coverage is available only for …

POLICY

Idaho Medicaid specifies that coverage is available only for ‘two-way live video between the provider and the participant.”

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


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Illinois

Last updated 02/28/2021

POLICY

Although store-and-forward is included within the definitions of telehealth …

POLICY

Although store-and-forward is included within the definitions of telehealth in IL Medicaid manuals and administrative code (see descriptions below), there are no details provided on store-and-forward reimbursement and other areas of policy indicate that the GT (live video) modifier is required for telehealth services.

SOURCE:  Provider Notice Changes to Professional Claims for Telehealth Services.  Jan. 10, 2018. (Accessed Feb. 2021). 

The Illinois Medicaid definition encompasses store-and-forward.  “The information or data exchanged can occur in real time (synchronous) through interactive video or multimedia collaborative environments or in near real time (asynchronous) through ‘store-and-forward’ applications.”

SOURCE: IL Dept. of Healthcare and Family Svcs., Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010IL Dept. of Healthcare and Family Svcs., Handbook for Practitioners. Ch. 200, p. 24, Sept. 2020; PractitionerHandbookPolicyPhysicianAssistantChangesFinal.pdf Handbook for Podiatrists, F-200, p. 27 (Oct. 2016);  & Handbook for Encounter Clinic Services pg. 16-17 (Aug. 2016). (Accessed Feb. 2021).

Additionally, IL Admin Code encompasses store-and-forward, addressing that a provider at a distant site can “review the medical case without the patient being present.”

“Asynchronous Store and Forward Technology” means the transmission of a patient’s medical information from an originating site to the provider at the distant site.  The provider at the distant site can review the medical case without the patient being present.  An asynchronous telecommunication system in single media format does not include telephone calls, images transmitted via facsimile machines and text messages without visualization of the patient (electronic mail).  Photographs visualized by a telecommunication system must be specific to the patient’ s medical condition and adequate for furnishing or confirming a diagnosis and/or treatment plan.  Dermatological photographs (for example, a photograph of a skin lesion) may be considered to meet the requirement of a single media format under this provision.

SOURCE: IL Administrative Code, Title 89 ,140.403 (2012). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No Reference Found

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Indiana

Last updated 02/28/2021

POLICY

The IHCP allows store-and-forward technology (the electronic transmission of …

POLICY

The IHCP allows store-and-forward technology (the electronic transmission of medical information for subsequent review by another healthcare provider) to facilitate other reimbursable services; however, separate reimbursement of the originating-site payment is not provided for store-and-forward technology because of restrictions in 405 IAC 5-38-2(4). Only live video is separately reimbursed by the IHCP.

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

“Store and forward” means the transmission of a patient’s medical information from an originating site to the provider at a distant site without the patient being present for subsequent review by a health care provider at the distant site. Restrictions placed on store and forward reimbursement in this rule shall not disallow the permissible use of store and forward technology to facilitate reimbursable services.

Indiana Medicaid will not reimburse for store-and-forward services. However, restrictions placed on store-and-forward reimbursement shall not disallow the permissible use of store-and-forward technology to facilitate other reimbursable services.

SOURCE: IN Admin. Code, Title 405, 5-38-2 & 4. (Accessed Feb. 2021)


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Iowa

Last updated 02/28/2021

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Kansas

Last updated 02/28/2021

POLICY

Kansas Medicaid requires the patient to be present at …

POLICY

Kansas Medicaid requires the patient to be present at the originating site indicating store-and-forward will not be reimbursed, despite including store-and-forward in their definition of telemedicine.

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


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Kentucky

Last updated 05/26/2021

POLICY

KY Medicaid reimburses for telehealth consultations, the definition of …

POLICY

KY Medicaid reimburses for telehealth consultations, the definition of which encompasses store-and-forward.

SOURCE: KY Revised Statutes 205.559. For definition, see: KY Revised Statute 205.510. (Accessed Feb. 2021).

A store and forward service shall be permissible if the primary purpose of the asynchronous interaction involves high quality digital data transfer, such as digital image transfers.

An asynchronous telehealth service shall be reimbursable if that service supports an upcoming synchronous telehealth or face-to-face visit to a provider that is providing one of the eligible specialties (see next section).

The department shall evaluate available asynchronous telehealth services quarterly, and may clarify that certain asynchronous telehealth services meet the requirements to be included as permissible asynchronous telehealth, as appropriate and as funds are available, if those asynchronous telehealth services have an evidence base establishing the service’s:

  • Safety; and
  • Efficacy.

A provider shall not receive additional reimbursement for an asynchronous telehealth service if the service is an included or integral part of the billed office visit code or service code.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

An asynchronous telehealth service within the following specialties or instances of care that meets the criteria established in this section shall be reimbursable as a store-and-forward telehealth service:

  • Radiology;
  • Cardiology;
  • Oncology;
  • Obstetrics and gynecology;
  • Ophthalmology and optometry, including a retinal exam;
  • Dentistry;
  • Nephrology;
  • Infectious disease;
  • Dermatology;
  • Orthopedics;
  • Wound care consultation;
  • A store and forward telehealth service in which a clear digital image is integral and necessary to make a diagnosis or continue a course of treatment;
  • A speech language pathology service that involves the analysis of a digital image, video, or sound file, such as for a speech language pathology diagnosis or consultation; or
  • Any code or group of services included as an allowed asynchronous telehealth service.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed May. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Louisiana

Last updated 02/28/2021

POLICY

Louisiana Medicaid will not provide reimbursement for store-and-forward based …

POLICY

Louisiana Medicaid will not provide reimbursement for store-and-forward based upon the definition of “telemedicine” which describes telemedicine as including “audio and video equipment permitting two-way, real time interactive communication” therefore excluding store-and-forward.

SOURCE: LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, Section 5.1, p. 151 (As revised on Sept. 03, 2020). (Accessed Feb. 2021). 


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Maine

Last updated 02/28/2021

POLICY

“Store and forward transfers” means transmission of a patient’s …

POLICY

“Store and forward transfers” means transmission of a patient’s recorded health history through a secure electronic system to a health professional.

Source: ME Statute Sec. 22:855.3173-H(D) (Accessed Feb. 2021).

New Medicaid Policy (Effective Upon Approval from CMS)

Store-and-Forward (asynchronous) Telehealth is only permitted for Established Patients and involves the transmission of recorded clinical information (including, but not limited to radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to a Health Care Provider. All health information must be transmitted via secured email. In order for the Health Care Provider to be reimbursed for a covered service delivered via Store-and-Forward Telehealth, a Member must not be present.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. Pg. 5, (June 15, 2020) (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

MaineCare will provide reimbursement for two types of store-and-forward:

  1. Virtual Transfer of Health Information:  Only the Health Care Provider who receives and reviews the recorded clinical information is eligible for reimbursement.
  2. Remote Consultation Between and Treating Provider and Specialist:  Billing for interprofessional services is limited to those practitioners who can independently bill Medicaid for evaluation and management services.

See manual for additional details on each.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. Pg. 5 & 6, (June 15, 2020). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Maryland

Last updated 02/28/2021

POLICY

The department may provide reimbursement for services delivered through …

POLICY

The department may provide reimbursement for services delivered through store-and-forward technology.

SOURCE: Health General Code 15-105.2. (Accessed Feb. 2021). 

Maryland Medicaid does not cover store-and-forward, however dermatology, ophthalmology and radiology are covered under Physician services of COMAR.

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. p. 4, Updated April 2020. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

MD Medicaid does not cover store-and-forward.  However, dermatology, ophthalmology and radiology are excluded from definition of store-and-forward.  They do reimburse for these services according to COMAR 10.09.02.07.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.09. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Massachusetts

Last updated 02/28/2021

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Michigan

Last updated 02/28/2021

POLICY

Telecommunication systems using store-and-forward technology are not included in …

POLICY

Telecommunication systems using store-and-forward technology are not included in MI Medicaid’s telemedicine policy.

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


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Minnesota

Last updated 02/28/2021

POLICY

Telemedicine may be provided by means of real-time two-way, …

POLICY

Telemedicine may be provided by means of real-time two-way, interactive audio and visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care.

SOURCE: MN Statute Sec. 256B.0625 Subd. 3b(d) (Accessed Feb. 2021).

MHCP allows payment for store-and-forward.

“Store and Forward”: The asynchronous transmission of medical information to be reviewed at a later time by a physician or practitioner at the distant site. Medical information may include, but is not limited to, video clips, still images, x-rays, MRIs, EKGs, laboratory results, audio clips and text. The physician at the distant site reviews the case without the patient being present. Store and forward substitutes for an interactive encounter with the patient present; the patient is not present in real-time.

 SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telemedicine), As revised Jan. 28, 2020. (Accessed Feb. 2021). 

Providers must use the place of service code 02.

Eligible providers:

  • Physician
  • Nurse practitioner
  • Physician assistant
  • Nurse midwife
  • Clinical nurse specialist
  • Registered dietitian or nutrition professional
  • Dentist, dental hygienist, dental therapist, advanced dental therapist
  • Mental health professional, when following requirements and service limitations
  • Pharmacist
  • Certified genetic counselor
  • Podiatrist
  • Speech therapist
  • physical Therapist
  • Occupational therapist
  • Audiologist
  • Public health nursing organizations

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telemedicine), As revised Jan. 28, 2020. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See Live Video Eligible Services section for examples of eligible telemedicine services as well as noncovered services.

Rehabilitation Services

MHCP allows payment for expanded telemedicine services, including some rehabilitation services that are normally conducted face-to-face.  Physical and occupational therapists, speech-language pathologists and audiologists may use telemedicine to deliver certain covered rehabilitation therapy services that they can appropriately deliver via telemedicine. Service delivered by this method must meet all other rehabilitation therapy service requirements and providers must adhere to the same standards and ethics as they would if the service was provided face-to-face.  When submitting claims for telemedicine services, use place-of-service code 02 to certify that the services meets the telemedicine requirements. The GQ modifier is required when billing for services via asynchronous telecommunication systems. Providers must self-attest that they meet all of the conditions of MHCP telemedicine policy by completing the “Provider Assurance Statement for Telemedicine”.

Limited to three sessions per week per recipient.  Payment not available for sending materials to a recipient, other providers or other facilities.

Noncovered services:

  • Electronic connections that are not conducted over a secure encrypted website as specified by HIPAA
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Non-clinical communication
  • Communication via telephone, email or fax

Eligible providers:

  • Speech-language pathologists
  • Physical therapists
  • Physical therapist assistants
  • Occupational therapists
  • Occupational therapy assistants
  • Audiologists

Physical therapist assistants and occupational therapy assistants providing services via telemedicine must follow the same supervision policy as indicated in “Rehabilitation Service Practitioners”.  No distant site limitations beyond provider types.   See manual for documentation requirements.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Feb. 10, 2021 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

Authorized originating sites include:

  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Critical access hospital (CAH)
  • Rural health clinic (RHC) and Federally Qualified Health Center (FQHC)
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility (SNF)
  • End-stage renal disease (ESRD) facilities
  • Community mental health center
  • Dental clinic
  • Residential facilities, such as a group home and assisted living, shelter or group housing
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)
  • School
  • Correctional facility-based office
  • Mobile Stroke Unit

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telemedicine), As revised Jan. 28, 2020. (Accessed Feb. 2021).

Dental

Affiliate practice or originator within Minnesota Board of Dentistry defined scope of practice must be present at originating site:

  • Dentist
  • Advanced dental therapists
  • Dental therapists
  • Dental hygienists
  • Licensed dental assistants
  • Other licensed health care professionals

SOURCE: MN Dept. of Human Svcs., Provider Manual, Dental Svcs. December 24, 2020 (Accessed Feb. 2021).

Rehabilitation Services

Eligible originating sites:

  • Office of physician or practitioner
  • Hospital (inpatient or outpatient)
  • Critical access hospital (CAH)
  • Rural health clinic (RHC) and Federally Qualified Health Center (FQHC)
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility (SNF)
  • End-stage renal disease (ESRD) facilities
  • Community mental health center
  • Dental clinic
  • Residential facilities, such as a group home and assisted living
  • Home (a licensed or certified health care provider may need to be present to facilitate the delivery of telemedicine services provided in a private home)
  • School

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Feb. 10, 2021 (Accessed Feb. 2021).


TRANSMISSION FEE

No Reference Found

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Mississippi

Last updated 02/28/2021

POLICY

Private payers, MS Medicaid and employee benefit plans are …

POLICY

Private payers, MS Medicaid and employee benefit plans are required to provide coverage to the same extent as in-person consultation for store-and-forward telemedicine services. A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.  Patients receiving medical care through store-and-forward must be notified of their right to receive interactive communication with the distant site provider. Telemedicine networks unable to offer this will not be reimbursed for store-and-forward telemedicine services.

SOURCE: MS Code Sec. 83-9-353. (Accessed Feb. 2021).

The Division of Medicaid defines store-and-forward as telecommunication technology for the transfer of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image which is transmitted or forwarded via telecommunication to another site for teleconsultation and includes, but is not limited to, teleradiology services.

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

There is reimbursement for tele-radiology services, however there is no reference to reimbursing for other specialties in regulation.

Teleradiology services must be delivered by an enrolled Medicaid provider acting within their scope-of-practice and license and in accordance with state and federal guidelines.

The use and delivery of teleradiology services does not alter a covered provider’s privacy obligations under federal/and or state law and a provider or entity operating telehealth services that involve protected health information (“PHI”) must meet the same HIPAA requirements the provider or entity would for a service provided in person.

SOURCE: MS Admin Code Title 23, Part 225, Rule. 3.2. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Store-and-forward includes, but is not limited to teleradiology.  The Division of Medicaid covers one technical and one professional component for each teleradiology procedure only for providers enrolled in MS Medicaid and when there are no geographically local radiologist providers to interpret the images. See regulations for detailed requirements for teleradiology.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 3.1 & 3.3 (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

MS Medicaid only covers teleradiology when there are no geographically local radiologist providers to interpret images.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 3.3 (Accessed Feb. 2021).


TRANSMISSION FEE

The Division of Medicaid reimburses an FQHC a fee per completed transmission, for telehealth services provided by the FQHC acting as the originating site provider, which meets the requirements in Miss. Admin. Code Part 225, Chapter 1, effective January 1, 2015. The FQHC may not bill for an encounter visit unless a separately identifiable service is performed. The originating site facility fee will be paid at the existing fee-for-service rate.

FQHCs acting in the role of an originating site provider with no other separately identifiable service being provided will only be paid the telehealth originating site facility fee per completed transmission and will not receive reimbursement for an encounter. The originating site facility fee will be paid at the existing fee-for-service rate.

SOURCE: MS Admin. Code Title 23, Part 211, Rule 1.5 (Accessed Feb. 2021).

The Division of Medicaid does not cover the transmission cost or any other associated cost of teleradiology.

SOURCE: Code of MS Rules 23-225, Rule. 3.4 (Accessed Feb. 2021).

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Missouri

Last updated 02/28/2021

POLICY

Reimbursement for asynchronous store-and-forward may be capped at the …

POLICY

Reimbursement for asynchronous store-and-forward may be capped at the reimbursement rate had the service been provided in-person.

SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Dentistry

Dentist review via teledentistry is covered. See manual for codes.

SOURCE: MO HealthNet, Dental Manual, p. 262. (Nov. 24, 2020). (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Montana

Last updated 04/27/2021

POLICY

There is no reimbursement for store-and-forward based on the …

POLICY

There is no reimbursement for store-and-forward based on the definition for telemedicine restricting the service to interactive audio-video.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Apr 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Nebraska

Last updated 08/02/2021

POLICY

Asynchronous service is included in the definition for telehealth …

POLICY

Asynchronous service is included in the definition for telehealth in Nebraska statutes.

SOURCE: NE Rev. Statute, 71-8503(3) (Accessed Aug. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Nebraska Medicaid will reimburse for tele-radiology when it meets the American College of Radiology standards for tele-radiology.  There is no other reference to reimbursing for other specialties.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.06(B), Ch. 1, p.9.  (Accessed Aug. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Nevada

Last updated 07/28/2021

POLICY

Asynchronous telehealth services, also known as Store-and-Forward, are defined …

POLICY

Asynchronous telehealth services, also known as Store-and-Forward, are defined as the transmission of a patient’s medical information from an originating site to the health care provider distant site without the presence of the recipient.

Reimbursement is available for services delivered via asynchronous telehealth, however, these services are not eligible for originating site facility fees. Photographs must be specific to the patient’s condition and adequate for rendering or confirming a diagnosis or a treatment plan.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403, p. 1 & Section 3403.4, p. 2 (Jul. 27, 2017). (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

Store-and-forward services are not eligible for originating site facility fees.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.4, p. 9 (Jul. 27, 2017). (Accessed Feb. 2021).

A facility fee is not billable if the telecommunication system used is a recipient’s smart phone or home computer.

SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (May 20, 2020) (Accessed Feb. 2021).

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New Hampshire

Last updated 07/26/2021

POLICY

New Hampshire statute addressing Medicaid has a definition for …

POLICY

New Hampshire statute addressing Medicaid has a definition for store-and-forward as it pertains to telemedicine and as an exception to 42 CFR 410.78.

Store-and-forward means the use of asynchronous electronic communications between a patient at an originating site and a health care service provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients. This includes the forwarding and/or transfer of stored medical data from the originating site to the distant site through the use of any electronic device that records data in its own storage and forwards its data to the distant site via telecommunication for the purpose of diagnostic and therapeutic assistance.

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.

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


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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New Jersey

Last updated 07/21/2021

POLICY

“Asynchronous store and forward technology” is defined as the …

POLICY

“Asynchronous store and forward technology” is defined as the acquisition and transmission of a patient’s medical information either to, or from, an originating site to the provider at the distant site, where the provider can review the information without the patient being present. Information includes transmission of images, diagnostics, data and other information necessary to the medical process.

A provider may use interactive, real-time, two-way audio in combination with asynchronous store-and-forward technology, without video communication, if the provider has determined that the provider is able to meet the accepted standard of care provided if the visit was face-to-face. The interactive audiovisual equipment must provide for two-way communication at a minimum bandwidth of 384 kbps (kilobits per second).

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018. (Accessed Jul. 2021).

Insurers and NJ Medicaid must provide reimbursement for telemedicine or telehealth on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when services are delivered through in-person contact and consultation. Store-and-forward is not explicitly included, but could fit into these definitions.

SOURCE: NJ Statute C.30:4D-6k. (Accessed Jul. 2021).


ELIGIBLE SERVICES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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New Mexico

Last updated 07/19/2021

POLICY

MAD will reimburse for services delivered through store-and forward.  …

POLICY

MAD will reimburse for services delivered through store-and forward.  To be eligible for payment under store-and-forward, the service must be provided through the transference of digital images, sounds, or previously recorded video from one location to another; to allow a consulting provider to obtain information, analyze it, and report back to the referring physician providing the telemedicine consultation.  Store-and-forward telemedicine includes encounters that do not occur in real time (asynchronous) and are consultations that do not require a face-to-face live encounter between patient and telemedicine provider.

SOURCE: NM Administrative Code 8.310.2.12(M (3)) (Accessed Jul. 2021).

Applied Behavior Analysis

Store and Forward Technology is when the originating site practitioner records in real time audio and video a service and then transmits the image to a distant site practitioner.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Applied Behavior Analysis

For Case Supervision, MAD allows a BT or BAA to video a session, store the video and sent to the BA or Supervising BAA for both practitioners to later review and plan for the next intervention with the recipient.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

Applied Behavior Analysis

In New Mexico, recipients are in areas where there is no Internet, so telemedicine delivered services cannot be rendered. For Case Supervision, MAD allows a BT or BAA to video a session, store the video and sent to the BA or Supervising BAA for both practitioners to later review and plan for the next intervention with the recipient.

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Jul. 2021).


TRANSMISSION FEE

No Reference Found

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New York

Last updated 07/15/2021

POLICY

Store-and-forward technology involves the asynchronous, electronic transmission of a …

POLICY

Store-and-forward technology involves the asynchronous, electronic transmission of a member’s health information in the form of patient-specific pre-recorded videos and/or digital images from a provider at an originating site to a telehealth provider at a distant site.

Pre-recorded videos and/or static digital images (e.g., pictures), excluding radiology, must be specific to the member’s condition as well as be adequate for rendering or confirming a diagnosis or a plan of treatment.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 4. (Accessed Jul.  2021).

Reimbursement for store-and-forward is made to the consulting distant-site practitioner and is paid at 75 percent of the Medicaid fee for the service provided.

The consulting provider must provide the requesting originating-site practitioner with a written report of the consultation and use the GQ modifier in order for payment to be made.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 11. (Accessed Jul. 2021).

Teledentistry

Store-and-Forward Technology – involves the asynchronous, electronic transmission of a member’s health information in the form of patient-specific pre-recorded videos and/or digital images from a provider at an originating site to a telehealth provider at a distant site. Accompanying payable services will be reimbursed at 75% of the requested fee, not exceeding 75% of the current Medicaid fee.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 85 (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Store-and-forward services may be reimbursed, based on the definition of telehealth.

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

Teledentistry

Pre-recorded videos and/or static digital images (e.g., pictures), excluding radiology, must be specific to the
member’s condition as well as be adequate for rendering or confirming a diagnosis or a plan of treatment.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 85 (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

Teledentistry

Procedure code Q3014 may be used by the provider at the originating site.

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 85 (Accessed Jul. 2021).

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North Carolina

Last updated 07/12/2021

POLICY

Virtual communications is the use of technologies other than …

POLICY

Virtual communications is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a beneficiary or a provider and another provider. As outlined in Attachment A and program specific clinical coverage policies, covered virtual communication services include: telephone conversations (audio only); virtual portal communications (secure messaging); and store and forward (transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Virtual communication, including:

  • online digital evaluation and management codes;
  • telephonic evaluation and management;
  • telephonic evaluation and management and virtual communication codes; and
  • interprofessional assessment and management codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 6 & 2, Nov. 15, 2020. (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Virtual patient communications must be transmitted between a patient and provider, or between two providers, in a manner that is consistent with the CPT code definition for those services. Provider(s) shall follow all applicable HIPAA rules.

Covered virtual communication services include: telephone conversations (audio only); virtual portal communications (secure messaging); and store and forward (transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Virtual communications include online digital evaluation and management codes and interprofessional assessment and management codes. See manual for covered codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, 8 & 14, Nov. 15, 2020. (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

There are no site restrictions on the use of virtual communications for originating or distant sites.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, Nov. 15, 2020. (Accessed Jul. 2021).


TRANSMISSION FEE

Any Medicaid enrolled provider who provides a beneficiary with access to audio and visual equipment in order to complete a telehealth encounter may bill for a facility fee when their office or facility is the site at which the beneficiary is located when the service is provided and the distant site provider is at a different physical location.

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

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North Dakota

Last updated 07/08/2021

POLICY

North Dakota Medicaid does not reimburse for store-and-forward.

SOURCE: …

POLICY

North Dakota Medicaid does not reimburse for store-and-forward.

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Apr. 2021), (Accessed Jul. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Ohio

Last updated 07/06/2021

POLICY

Telehealth is the interaction with a patient via synchronous, …

POLICY

Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes both audio and video elements; OR

The following activities that are asynchronous or do not have both audio and video elements:

  • Telephone calls
  • Remote patient monitoring
  • Communication with a patient through secure electronic mail or a secure patient portal

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021. & OAC 5160-1-18.  (Accessed Jul. 2021).

Conversations or electronic communication between practitioners regarding a patient without the patient present is not considered telehealth unless the service would allow billing for practitioner to practitioner communication in a non-telehealth setting.

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


ELIGIBLE SERVICES/SPECIALTIES

G2010, which is the remote evaluation of recorded video and/or images submitted by an established patient (e.g. store and forward) is listed as a covered telehealth service.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 2/8/2021. (Accessed Jul. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Oklahoma

Last updated 06/29/2021

POLICY

Health care services delivered by telehealth such as remote …

POLICY

Health care services delivered by telehealth such as remote patient monitoring, store-and-forward, or any other telehealth technology must be compensable by OHCA in order to be reimbursed.

Services provided by telehealth must be billed with the appropriate modifier.

If the technical component of an X-ray, ultrasound or electrocardiogram is performed during a telehealth transmission, the technical component can be billed by the provider that provided that service. The professional component of the procedure and the appropriate visit code should be billed by the provider that rendered that service.

SOURCE: OK Admin. Code Sec. 317:30-3-27(e). (Accessed Jun. 2021).

“Store and forward technologies” means the transmission of a patient’s medical information from an originating site to the health care provider at the distant site; provided, photographs visualized by a telecommunications system shall be specific to the patient’s medical condition and adequate for furnishing or confirming a diagnosis or treatment plan. Store and forward technologies shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, non-secure video conference, or facsimile transmission.

SOURCE: OK Admin. Code Sec. 317:30-3-27 (a). (Accessed Jun. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.

SOURCE: OK Admin. Code Sec. 317:30-3-27(e)(4). (Accessed Jun. 2021).

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Oregon

Last updated 06/30/2021

POLICY

To encourage the efficient use of resources and to …

POLICY

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

  • Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
  • Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
  • Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Statute Ch. 414 & House Bill 2508 (2021 Session), (Accessed Jun. 2021).

Coverage of interprofessional consultations delivered online, through electronic health records or by telephone is included as follows:

  • Consulting Providers (CPT 99451, 99446-99449) – See guidance for additional requirements.
  • Requesting Providers (CPT 99452) – See guidance for additional requirements.

Limited information provided by one clinician to another that does not constitute collaboration (e.g., interpretation of an electroencephalogram, report on an x-ray or scan, or reporting the results of a diagnostic test) is not considered a consultation. See HERC prioritized list guidelines for additional criteria.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. AD-3-4. (02/19/21). (Accessed Jun. 2021).

Behavioral Health Services:

Unless specifically authorized by OAR 410-120-1200 other types of telecommunication are not covered such as images transmitted via facsimile machines and electronic mail when:

  • Those methods are not being used in lieu of videoconferencing, due to limited video conferencing equipment access; or
  • Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: 410-172-0850 Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Jun. 2021).

Teledentistry

Teledentistry can take multiple forms, including ‘store and forward’, defined as “an asynchronous transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist. The dentist at a distant site reviews the information without the patient being present in real time.”

The assessment and evaluation may not be billed or covered by both the originating site dental care provider and a distant site dentist using the modality of teledentistry, even if due to store-and-forward review, if the dates of services are on different days.

Unless authorized in OAR 410-120-1200 Exclusions or OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered:

  • When those types are not being used in lieu of teledentistry, due to limited teledentistry equipment access; or
  • When those types and specific services are not specifically allowed in this rule per the Oregon Health Evidence Review Commission’s Prioritized List of Health Services.

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


ELIGIBLE SERVICES/SPECIALTIES

See HERC prioritized list guidelines for covered S&F codes.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. AD-3-4. (02/19/21). (Accessed Jun. 2021).

Teledentistry

A dentist may collect the transmission of recorded health information such as radiographs, photographs, video, digital impressions, or photomicrographs transmitted through a secure electronic communication system to a dentist, and it is reviewed at a later point in time by a dentist.

Payment for dental services may not distinguish between services performed using teledentistry, real time, or store-and-forward and services performed in-person.

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


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The originating site code Q3014 is covered only when the patient is present in an appropriate health care setting and receiving services from a provider in another location.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. AD-3. (02/19/21). (Accessed Jun. 2021).

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Pennsylvania

Last updated 06/19/2021

POLICY

Telemedicine does not include the use of telephones, or …

POLICY

Telemedicine does not include the use of telephones, or asynchronous “store and forward” technology such as facsimile machines, electronic mail systems or remote patient monitoring devices.

SOURCE: PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (Accessed Jun. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Rhode Island

Last updated 06/25/2021

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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South Carolina

Last updated 06/19/2021

POLICY

South Carolina Medicaid will not reimburse for store-and-forward due …

POLICY

South Carolina Medicaid will not reimburse for store-and-forward due to the requirements that the beneficiary must be present and participating in the visit and interactive audio and video telecommunication must be used.

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


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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South Dakota

Last updated 04/29/2021

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Tennessee

Last updated 06/14/2021

POLICY

“Store-and-forward telemedicine services”: (A) Means the use of asynchronous …

POLICY

“Store-and-forward telemedicine services”: (A) Means the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and (B) Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

This section does not require a health insurance entity to provide coverage or reimbursement for healthcare services delivered by means of telehealth/provider-based telemedicine (which includes store-and-forward) if the applicable health insurance policy would not provide coverage or reimbursement for the same healthcare services if delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1003 & 1002, (Accessed Jun. 2021).

Mental Health & Substance Abuse Services

TennCare will not reimburse for store-and-forward based upon definition of “telehealth systems” which describes it as “live interactive audio-video”.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 46, (2017) (Accessed Feb. 2021 & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4, (2012) (Accessed Jun. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRPAHIC LIMITS

“Qualified site” means the s the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, a facility licensed under title 33, or another location deemed acceptable by the health insurance entity; and

Includes, for the provision of behavioral health services provided via telehealth, the patient’s home or a remote location chosen by the patient.

SOURCE: TN Code Annotated, Sec. 56-7-1002, as amended by House Bill 620 & Senate Bill 429, (2021 Session), (Accessed Jun. 2021).

Reimbursement and coverage must be provided for telehealth services without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Sec. 56-7-1003 & 1002, (Accessed Jun. 2021).


TRANSMISSION FEE

No Reference Found

 

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Texas

Last updated 06/07/2021

POLICY

Asynchronous store-and-forward technology, including asynchronous store-and-forward technology in conjunction …

POLICY

Asynchronous store-and-forward technology, including asynchronous store-and-forward technology in conjunction with synchronous audio interaction between the distant site provider and the patient in another location is reimbursable under Texas Medicaid. The distant site provider would need to use one of the following:

  • Clinically relevant photographic or video images, including diagnostic images
  • The patient’s relevant medical records, such as medical history, laboratory and pathology results, and prescriptive histories

Other forms of audiovisual telecommunication technologies that allow the distant site provider to meet the in-person visit standard of care may also be used.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 7 & 14, (Accessed Jun. 2021).

TX Administrative Code includes definitions of “Telemedicine Medical Service,” “Telehealth Services” and “Telemedicine” which encompasses store-and-forward, stating that it includes “clinical data transmission using computer imaging by way of still-image capture and store-and-forward.”

SOURCE: TX Admin. Code, Title 1 Sec. 354.1430 (Accessed Jun. 2021).

Reimbursement to eligible providers must be made in the same manner as in-person services.

SOURCE: TX Admin. Code, Title 1 Sec. 355.7001. (Accessed Jun. 2021).


ELIGIBLE SERVICES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Utah

Last updated 06/09/2021

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Vermont

Last updated 06/02/2021

POLICY

“Store and forward” means an asynchronous transmission of a …

POLICY

“Store and forward” means an asynchronous transmission of a beneficiary’s medical information from a health care professional to a provider at a distant site, through a secure connection that complies with HIPAA, without the beneficiary present in real time.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.1), Telehealth, (Accessed May 2021).

“Store and forward” means an asynchronous transmission of medical information, such as one or more video clips, audio clips, still images, x-rays, magnetic resonance imaging scans, electrocardiograms, electroencephalograms, or laboratory results, sent over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191 to be reviewed at a later date by a health care provider at a distant site who is trained in the relevant specialty. In store and forward, the health care provider at the distant site reviews the medical information without the patient present in real time and communicates a care plan or treatment recommendation back to the patient or referring provider, or both.

A health insurance plan (including Medicaid) shall reimburse for health care services and dental services delivered by store-and-forward means.

A health insurance plan shall not impose more than one cost-sharing requirement on a patient for receipt of health care services or dental services delivered by store-and-forward means. If the services would require cost-sharing under the terms of the patient’s health insurance plan, the plan may impose the cost-sharing requirement on the services of the originating site health care provider or of the distant site health care provider, but not both.

A health insurer shall not construe a patient’s receipt of services delivered through telemedicine or by store-and-forward means as limiting in any way the patient’s ability to receive additional covered in-person services from the same or a different health care provider for diagnosis or treatment of the same condition.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

DVHA will not reimburse for teleophthalmology or teledermatology by store-and-forward means.*

SOURCE: VT Agency of Human Services. General Billing and Forms Manual. Sec. 5.3.52, p. 88, (Nov. 2020). (Accessed Feb. 2021).

To be covered, services shall:

  • Be clinically appropriate for delivery through store-and-forward
  • Be medically necessary
  • Only be allowed for teledermatology and teleophthalmology.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed May 2021).

Effective July 1, 2020, Vermont Medicaid announced continued coverage and reimbursement for HCPCS G2010 and new coverage and reimbursement for interprofessional consultations when performed through store and forward technology (i.e., provider to provider store and forward, CPT codes 99451 & 99452). The allowed modifier for CPT codes 99451 & 99452 is modifier GQ (i.e., “through an asynchronous telecommunications system”).”

SOURCE: Department of Vermont Health Access. Agency of Human Services. Telehealth: Methods for healthcare service delivery using telecommunications technologies. (Accessed May 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Virginia

Last updated 05/31/2021

POLICY

DMAS reimburses for diabetic retinopathy screening through telemedicine for …

POLICY

DMAS reimburses for diabetic retinopathy screening through telemedicine for Medicaid members with Type 1 or 2 diabetes.  Radiology related procedures are also included under telemedicine coverage as well as certain codes for teledermatology.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 5-6. (May. 2014) & Dept. of Medical Assistance Svcs., Medicaid Provider Manual Physician/Practitioner Manual, Billing Instructions, p. 21 (May 2017). (Accessed May 2021).

Medicare-Medicaid Demonstration Waiver:

Participating plans shall be permitted to use telehealth in rural and urban settings and reimburse for store-and-forward applications.

SOURCE: VA Reg. Text 12VAC30-121-70-B-7. (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

Refer to the manual for a full list of CPT and HCPCS codes reimbursable by Virginia Medicaid.

Services covered include:

  • Radiology and radiology procedures
  • Diabetic retinopathy (regardless of the number of fields viewed for all Medicaid Members with Type 1 or Type 2 diabetes)
  • Outpatient teledermatology

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner. Billing Instructions, p. 20-24 (May 2017) & VA Medicaid Memo. Clarification of Medicaid Coverage of Diabetic Retinopathy Screening via Telemedicine.  Nov. 9, 2016.   (Accessed May 2021).


GEOGRAPHIC LIMITS

Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services.  Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.

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


TRANSMISSION FEE

Reimburses a facility fee.

SOURCE:  VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May 2014) & VA Dept. of Medical Assistant Svcs, Medicaid Provider Manual, Physician/Practitioner-Manual. Covered Services and Limitations, p. 17 (Mar. 2020) (Accessed May 2021).

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Washington

Last updated 05/11/2021

POLICY

Newly Passed Legislation – Managed Care

“Store and forward …

POLICY

Newly Passed Legislation – Managed Care

“Store and forward technology” means use of an asynchronous transmission of a covered person’s medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the covered person, and does not include the use of audio-only telephone, facsimile, or email.

Upon initiation or renewal of a contract with the Washington state health care authority to administer a Medicaid managed care plan, a managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine at the same rate as if:

  • The medicaid managed care plan in which the covered person is enrolled provides coverage of the health care service when provided in person by the provider;
  • The health care service is medically necessary;
  • The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015;
  • The health care service is determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information; and
  • Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

A managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine the same amount of compensation the managed health care system would pay the provider if the health care service was provided in person by the provider.  For purposes of this section, reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the managed health care system and health care provider.

Hospitals, hospital systems, telemedicine companies, and provider groups consisting of eleven or more providers may elect to negotiate an amount of compensation for telemedicine services that differs from the amount of compensation for in-person services.

A managed health care system may subject coverage of a telemedicine or store and forward technology health service to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.

SOURCE: RCW 74.09.325 as amended by HB 1196 (2021 Session), (Accessed May 2021).

Newly Passed Legislation – Behavioral Health Administrative Services Organizations and Managed Care Organizations

If the service is provided through store and forward technology there must be an associated visit between the covered person and the referring provider. Nothing in this section prohibits the use of telemedicine for the associated office visit.

Reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the behavioral health administrative services organization, or managed care organization, and the provider.

SOURCE: RCW 71.24.335 as amended by HB 1196 (2021 Session), (Accessed May 2021).

WA Medicaid pays for store-and-forward for teledermatology or when all of the following conditions are met:

  • There is an associated office visit that can be done either in-person or via asynchronous telemedicine and include one or more of the following types of information: video clips, still images, x-rays, MRIs, electrocardiograms and electroencephalograms, laboratory results, audio clips, and text. The visit results in a documented care plan that is communicated back to the referring provider.
  • The transmission of information is HIPAA compliant.
  • Written informed consent is obtained that store and forward technology will be used and who the consulting provider is.

If the consultation results in a face-to-face visit in-person or via telemedicine with the specialist within 60 days of the store-and-forward consult, the agency does not pay for the consult.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 90 (May 2021). (Accessed May 2021).

WA Medicaid covers asynchronous teledentistry when the client’s dental clinical information is gathered at the originating site the information is sent via store-and-forward technology to a dentist or authorized dental provider (distant site) for review and subsequent intervention at a later point in time.

SOURCE:  WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 71. (Apr. 2021), (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

WA Apple Health pays for store-and-forward for teledermatology.  Teledermatology services via store-and-forward must be billed with GQ modifier and 02 POS Code from the distant site.  The sending provider bills as usual with the E&M code and no modifier.

See manual for acceptable CPT/HCPCS codes.

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

Health departments may use a recorded video submitted by the client in place of the in-home visit or office visit. HCPCS code G2010 may be billed when this modality is used and the requirements of the code are met. HCPCS code G2010 is not Federally Qualified Health Center (FQHC) encounter-eligible

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 70 (May 2021). (Accessed May 2021).

Teledentistry

Teledentistry can be delivered through a synchronous or asynchronous method.  The agency covers teledentistry as a substitute for an in-person, face-to-face, hands-on encounter when medically necessary.  For asynchronous teledentistry, the client’s dental clinical information is sent via store-and-forward technology from the originating site to a dentist or authorized dental provider (distant site) for review and subsequent intervention at a later point in time.

See manual for acceptable CPT codes.

SOURCE: WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 71  (Apr. 2021) (Accessed May 2021).

Behavioral Health Organizations

Reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the behavioral health administrative services organization, or managed care organization, and the provider.

SOURCE: RCW 71.24.335 as amended by HB 1196 (2021 Session), (Accessed May 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The originating site for store-and-forward is not eligible to receive an originating site fee.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 91 (May 2021). (Accessed May 2021). 

 

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West Virginia

Last updated 05/24/2021

POLICY

Store and forward means the asynchronous computer-based communication of …

POLICY

Store and forward means the asynchronous computer-based communication of medical data or images from an originating location to a health care provider at another site for the purpose of diagnostic or therapeutic assistance.

Store and Forward telehealth services may only be utilized for specific codes for the Optometrist provider type only.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

Only available for optometrist providers for two specific codes.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed May 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Wisconsin

Last updated 05/18/2021

POLICY

Except as provided by the department by rule, asynchronous …

POLICY

Except as provided by the department by rule, asynchronous telehealth services in which the medical data pertains to a Medical Assistance recipient must be reimbursed.

Except as provided by the department by rule, services that are covered under Medicare for which the federal department of health and human services provides Medical Assistance federal financial participation and that are remote evaluation of prerecorded information shall be reimbursed.

SOURCE: WI Statute Sec. 49.45 (61). (Accessed May 2021).

Store and forward services (defined as the asynchronous transmission of medical information to be reviewed at a later time by a provider at a distant site) is explicitly under the ‘noncovered services’ section.

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


ELIGIBLE SERVICES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Wyoming

Last updated 05/12/2021

POLICY

Telehealth does not include a telephone conversation, electronic mail …

POLICY

Telehealth does not include a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a healthcare practitioner and a client, or a consultation between two health care practitioners asynchronous “store and forward” technology.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 119 (Apr. 2021); Institutional Manual, pg. 114, (Apr. 2021); Tribal Provider Manual, pg. 116, (Apr. 2021), (Accessed May 2021).


ELIGIBLE SERVICES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

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Medicaid & Medicare

Store-and-Forward

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