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 >
Click the map to scroll down to the state
Disclaimer

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

Federal

Last updated 03/18/2024

POLICY

Store and Forward For Telehealth Demonstration Projects in Alaska

POLICY

Store and Forward For Telehealth Demonstration Projects in Alaska and Hawaii Only:

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.

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 Mar. 2024).

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) (US Code Title 42, Sec. 1395m).  (Accessed Mar. 2024).

Temporary Policy – Ends Dec. 31, 2024

The term “practitioner” has the meaning given that term in section 1395u(b)(18)(C) of this title and, in the case that the emergency period described in section 1320b–5(g)(1)(B) of this title ends before December 31, 2024, for the period beginning on the first day after the end of such emergency period and ending on December 31, 2024, shall include a qualified occupational therapist (as such term is used in section 1395x(g) of this title), a qualified physical therapist (as such term is used in section 1395x(p) of this title), a qualified speech-language pathologist (as defined in section 1395x(ll)(4)(A) of this title), and a qualified audiologist (as defined in section 1395x(ll)(4)(B)).

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) (Accessed Mar. 2024).

Home Health (HH) Agencies

Starting on or after January 1, 2023, they may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. CMS will require this information on HH claims starting on July 1, 2023. Home Health Agencies will submit the use of telecommunications technology on the HH claim using the following 3 G-codes:

  • G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
  • G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
  • G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)

SOURCE: Telehealth Home Health Services: G-Codes, MLN Matters MM12805, (Effective Date: Jan. 1, 2023), (Accessed Mar. 2024).

CY 2024 Physician Fee Schedule notes that section 4113 of Division FF, Title IV, Subtitle A of the Consolidated Appropriations Act, 2023 (CAA, 2023) (Pub. L. 117-328, December 29, 2022) extends the telehealth policies enacted in the Consolidated Appropriations Act, 2022 (CAA, 2022) (Pub. L. 117-103, March 15, 2022) through December 31, 2024, if the PHE ends prior to that date, as discussed in section II.D.c. of this final rule. These provisions included:

  • Temporarily removing the geographic and site requirements for the patient location at the time the telehealth interaction takes place
  • Temporarily allowing a more expansive list of eligible providers in Medicare to provide services via telehealth such as physical and occupational therapists and federally qualified health centers (FQHCs) and rural health clinics (RHCs)
  • Temporarily allowing some services to continue to be provided via audio-only
  • Temporarily suspending the in-person service requirement prior to the delivery of mental and behavioral services via telehealth or audio-only in cases where the geographic requirement does not apply, the service takes place in the home and the patient was not being treated for a substance use disorder

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Mar. 2024).

For most non-behavioral or mental telehealth, you must use 2-way, interactive, audio-video technology.

For Alaska or Hawaii federal telemedicine demonstrations only, you may send medical information to a physician or practitioner by telehealth to review later.

Billing and Payment

  • Bill covered telehealth to your Medicare Administrative Contractor (MAC). They pay you the appropriate telehealth amount under the Physician Fee Schedule (PFS).
  • Submit professional telehealth claims using the appropriate CPT or HCPCS code.
  • If you performed telehealth through asynchronous telehealth, add the telehealth GQ modifier with the professional service CPT or HCPCS code. You’re certifying you collected and sent the asynchronous medical file at the distant site from a federal telemedicine demonstration conducted in Alaska or Hawaii.

SOURCE: Centers for Medicare and Medicaid Services (CMS), Telehealth Services MLN Fact Sheet, Feb. 2024, (Accessed Mar. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Store and Forward For Telehealth Demonstration Projects in Alaska and Hawaii 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) (US Code Title 42, Sec. 1395m).  (Accessed Mar. 2024).

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.

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 Mar. 2024).

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. Find the complete List of Telehealth Services by downloading the ZIP and opening the Excel or text files.

SOURCE:  CMS Telehealth List Year 2023, Updated 11/13/23.  (Accessed Mar. 2024).

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) (Title 42, Sec. 1395m).  (Accessed Mar. 2024).

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 nurse practitioner
  • Physician Assistant
  • 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
  • Any distant site practitioner who can appropriately bill for diabetes self-management training services may do so on behalf of others who personally furnish the services as part of the DSMT entity.
  • A marriage and family therapist
  • A mental health counselor

SOURCE: 42 CFR Sec. 410.78, (Accessed Mar. 2024).

After consideration of public comments, we are finalizing our proposal to add MFTs and MHCs as distant site practitioners for purposes of furnishing telehealth services. We are finalizing our proposed amendments to add MFTs and MHCs to the list of distant site  practitioners in the telehealth regulation at § 410.78(b)(2)(xi),(xii).

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Mar. 2024).

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.
  • Mobile Stroke Unit
  • The home of a beneficiary for the purposes of diagnosis, evaluation, and/or treatment of a mental health disorder for services furnished on or after the first day after the end of the PHE as defined in our regulation at § 400.200 except as otherwise provided in this paragraph. Payment will not be made for a telehealth service furnished under this paragraph unless the following conditions are met:
    • The physician or practitioner has furnished an item or service in-person, without the use of telehealth, for which Medicare payment was made (or would have been made if the patient were entitled to, or enrolled for, Medicare benefits at the time the item or service is furnished) within 6 months prior to the initial telehealth service;
    • The physician or practitioner has furnished an item or service in-person, without the use of telehealth, at least once within 12 months of each subsequent telehealth service described in this paragraph, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens associated with an in-person service outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reason(s) for this decision in the patient’s medical record.
    • The requirements of paragraphs (b)(3)(xiv)(A) and (B) may be met by another physician or practitioner of the same specialty and subspecialty in the same group as the physician or practitioner who furnishes the telehealth service, if the physician or practitioner who furnishes the telehealth service described under this paragraph is not available.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m) & 42 CFR Sec. 410.78.  (Accessed Mar. 2024).

After consideration of public comments, we are finalizing as proposed that beginning in CY 2024, claims for telehealth services billed with POS 10 will be paid at the non-facility PFS rate. Claims billed with POS 02 will continue to be paid at the facility rate. In addition, we are clarifying that modifier ’95’ should be used when the clinician is in the hospital and the patient is in the home, as well as for outpatient therapy services furnished via telehealth by PT, OT, or SLP.

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Mar. 2024).

Through CY 2024, we will continue to permit the distant site practitioner to use their currently enrolled practice location instead of their home address when providing telehealth services from their home. We will also consider this issue further for future rulemaking and request that interested parties provide clear examples of how the enrollment process shows material privacy risks to inform future enrollment and payment policy development. We request further information from interested parties to better understand the scope of considerations involved with including a practitioner’s home address as an enrolled practice location when that address is the distant site location where they furnish Medicare telehealth services.

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Mar. 2024).

Temporary Policy – Ends Dec. 31, 2024 – Delay of In-Person mental health requirement

Payment may not be made under this paragraph for telehealth services furnished on or after January 1, 2025 (or, if later, the first day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title) 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 subchapter (or would have been made under this subchapter if such individual were entitled to, or enrolled for, benefits under this subchapter at the time such item or service is furnished)—

  • 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.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) (Accessed Mar. 2024).

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, (Accessed Mar. 2024).

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, (Accessed Mar. 2024).

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, (Accessed Mar. 2024).

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 2018, (Accessed Mar. 2024).

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, (Accessed Mar. 2024).

Also see Table 11 for list of eligible codes in CY 2024 Physician Fee Schedule.

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Mar. 2024).


GEOGRAPHIC LIMITS

Store and Forward For Telehealth Demonstration Projects in Alaska and Hawaii Only:

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 Mar. 2024).

Temporary Policy – Ends Dec. 31, 2024

In the case that the emergency period described in section 1320b–5(g)(1)(B) of this title ends before December 31, 2024, with respect to telehealth services identified in subparagraph (F)(i) as of March 15, 2022, that are furnished during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024, the term “originating site” means any site in the United States at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system, including the home of an individual.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) (Accessed Mar. 2024).

Permanent Policy

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) (US Code Title 42, Sec. 1395m).  (Accessed Mar. 2024).

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 co-occurring 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.

[Implementation delayed until Jan. 1, 2025]

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Mar. 2024).

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.
  • Services furnished on or after the first day after the end of the PHE as defined in our regulation at § 400.200 for the purposes of diagnosis, evaluation, and/or treatment of a mental health disorder. Payment will not be made for a telehealth service furnished under this paragraph unless the physician or practitioner has furnished an item or service in person, without the use of telehealth, for which Medicare payment was made (or would have been made if the patient were entitled to, or enrolled for, Medicare benefits at the time the item or service is furnished) within 6 months prior to the initial telehealth service and within 6 months of any subsequent telehealth service.

SOURCE: 42 CFR Sec. 410.78 (Accessed Mar. 2024).

Communication Technology-Based Services (CTBS)

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


TRANSMISSION FEE

Store and Forward For Telehealth Demonstration Projects in Alaska and Hawaii Only:

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.

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) (US Code Title 42, Sec. 1395m).  (Accessed Mar. 2024).

No facility fee shall be paid under paragraph (2)(B) to an originating site with respect to a telehealth service described in subparagraph (A) if the originating site does not otherwise meet the requirements for an originating site under paragraph (4)(C).

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) (Accessed Mar. 2024).

Communication Technology-Based Services (CTBS)

No originating site fee (Q3014) reimbursed for Communication Technology-Based Services.

READ LESS

Alabama

Last updated 02/26/2024

POLICY

Asynchronous is included in definition of telemedicine and telehealth …

POLICY

Asynchronous is included in definition of telemedicine and telehealth but no further mention of it is made in telemedicine policy.

Services must be administered via an interactive audio or audio and video telecommunications system which permits two-way communication between the distant site provider and the site where the recipient is located (this does not include electronic mail message or facsimile transmission between the provider and recipient).

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Jan. 2024, (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Alaska

Last updated 02/27/2024

POLICY

The department shall pay for all services covered by …

POLICY

The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including …

  • services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio.

SOURCE: AK Statute Sec. 47.07.069, (Accessed Feb. 2024).

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 Physician, ARNP and PA Services (5/13), p. 31, (Accessed Feb. 2024).

Subject to the requirements of 7 AAC 110.620 — 7 AAC 110.639, the department will pay for a service delivered by means of one of the following telehealth modalities if the modality and use of the modality meet the requirements of P.L. 104 — 191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA)): …

  • asynchronous: a store-and-forward, through the transfer from one location to another, of recorded digital images, data, video, or sounds to allow a consulting provider to obtain information, analyze it, and report back to the rendering provider.

For patient-initiated online digital service, whether synchronous or asynchronous, the following are not reimbursable:

  • Nonevaluative or nonmanagement services including appointment scheduling and electronic communication of test results;
  • Provider-initiated online digital service;
  • Patient-initiated online digital service within the postoperative period of a completed procedure or within seven days of an in-person visit and related to the illness, injury, or other reason for that visit.

SOURCE:  Alaska Admin Code. Title 7, Sec. 110.625. (Accessed Feb. 2024).

What are the covered modalities for telehealth services?

Asynchronous:

  • Store-and-Forward: The transfer between healthcare providers of recorded digital images, video, or sounds from one location to another.

Patient-Initiated Online Digital Services:

  • Synchronous or asynchronous: Evaluation, assessment, and management services of an established patient through a secure platform such as an electronic record portal, secure electronic mail, or digital application.

What is a patient-initiated online digital service?

An online digital service is meant to expand a patient’s options to communicate health concerns and request clarification. They also enhance a provider’s ability to evaluate and manage a patient’s healthcare where an in-person or telehealth encounter is not warranted.

  • Separately Reimbursable Communications: Patient-initiated internet-based communications (e.g., patient portal messaging, text messaging, or email) for healthcare related reasons such as medication questions, prescription generation, clarification on test results, and reporting symptoms.
  • Non-Covered Communications: Use of online digital services for nonevaluative, non-management administrative functions such as updating the patient’s insurance or scheduling an appointment are not reimbursable.
  • Provider Initiated Communications: Providers are not prohibited from initiating communication through methods such as internet communications, electronic mail, and text messages but these are not reimbursable services.

What provider types are authorized to bill for patient initiated online digital services?

CPT Codes 98970-98972: Covered for behavioral health aides under the direction of a physician, psychologists, and school districts enrolled as a school-based
services provider. Federally Qualified Health Centers and Rural Health Centers may be reimbursed at their encounter rate for services provided by licensed clinical social workers, marital and family therapists, professional counselors, and psychologists.

CPT Codes 99421-99423: Covered for advanced practice registered nurses, audiologists, Community Health Aides, direct entry midwives, optometrists, physicians, physician assistants, and podiatrists. Federally Qualified Health Centers and Rural Health Clinic may be reimbursed at the facility’s encounter rate for services provided by a rendering providers listed here.

When are patient-initiated online digital services separately reimbursable?

Patient-initiated online digital services are separately reimbursable if the communication is:

  • Established Patient: Only reimbursable for an established patient,
  • Evaluative in Nature: The purpose is to evaluate, assess, or manage the member’s healthcare,
  • Patient-Initiated: Call must be initiated by the member or member’s guardian without prompting, and
  • No other Affiliated Service: Not separately reimbursable if affiliated to another evaluation and management service, assessment, or procedure.

Online digital services are not separately reimbursable if they are within seven days of (before or after) an in-person or telehealth (asynchronous or synchronous) visit directly related to the illness, injury, or other reason for that visit.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Procedure Code Modifier:

  • Two-Way Audio-Video Technology: GT or 95
  • Store-and-Forward: GQ
  • Two-Way Audio Only Technology : FQ and 93

Procedure Codes Defined as Audio Only: Failure to include either modifier FQ or modifier 93 will result in denial of payment for audio only services.

Patient Initiated Online Digital Services: Do not use telehealth modifiers when billing CPT codes 98970 – 98972 and 99421 – 99423.

Telehealth for Acute Stroke: Use procedure code modifier G0 (G-Zero) and the appropriate telehealth modifier (GT, 95, GQ, or FQ).

Helpful Hint: Modifier G0 (G-Zero) often gets confused with GO (G-Oh). Please ensure the appropriate modifier is utilized when billing either G0 (G-Zero) or GO (G-Oh).

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Feb. 2024).

The department will not pay

  • for the use, or any costs associated with the use, of technological equipment and systems associated with the delivery of a service by means of a telehealth modality;
  • a provider for communication with that provider’s supervising provider or communication with a provider who is acting in a supervisory capacity;
  • a supervising provider or a provider who is acting in a supervisory capacity for communication with a supervisee or for review of a supervisee’s work;
  • a provider participating in a telehealth encounter whose sole purpose is to facilitate the telehealth encounter between the recipient and a rendering provider or a consulting provider;
  • for a failed or unsuccessful telehealth connection or transmission;
  • for the following services when provided by means of a telehealth modality:
    • chiropractic services;
    • dental services;
    • private-duty nursing services;
    • pharmacy dispensing services;
    • durable medical equipment and related services;
    • prosthetic and orthotic devices and related services;
    • transportation services;
    • accommodation services;
    • personal care services;
    • home health services;
    • community First Choice services;
    • home and community-based waiver services, except for
      • care coordination services under 7 AAC 130.240;
      • day habilitation services under 7 AAC 130.260;
      • employment services under 7 AAC 130.270; or
      • intensive active treatment services under 7 AAC 130.275;
  • long term services and supports targeted case management services, except for case management services provided under 7 AAC 128.010(b)(2).

SOURCE:  AK Admin. Code, Title 7, 110. 635 (Accessed Feb. 2024).

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).

NOTE: Manual is under review.

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Section II: Professional Claims Management, Feb. 6, 2020, pg. 20, (Accessed Feb. 2024).

Eligible services:

  • Initial
  • 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.

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician, ARNP, PA Services (5/13), p. 31, (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The department will not pay

  • for the use, or any costs associated with the use, of technological equipment and systems associated with the delivery of a service by means of a telehealth modality;
  • a provider for communication with that provider’s supervising provider or communication with a provider who is acting in a supervisory capacity;
  • a supervising provider or a provider who is acting in a supervisory capacity for communication with a supervisee or for review of a supervisee’s work;
  • a provider participating in a telehealth encounter whose sole purpose is to facilitate the telehealth encounter between the recipient and a rendering provider or a consulting provider;
  • for a failed or unsuccessful telehealth connection or transmission

SOURCE: AK Admin. Code, Title 7, 110.635. (Accessed Feb. 2024).

READ LESS

Arizona

Last updated 02/09/2024

POLICY

Telehealth (asynchronous, store and forward) – Transmission of recorded …

POLICY

Telehealth (asynchronous, store and forward) – Transmission of recorded health history (e.g., pre-recorded videos, digital data, or digital images, such as xrays 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, asynchronous care allows practitioners to assess, evaluate, consult, or treat conditions using secure digital transmission services, data storage services, and software solutions.

SOURCE: AZ Health Cost Containment System, AHCCCS Contract and Policy Dictionary, 8/23, pg. 111, (Accessed Feb. 2024).

Asynchronous services are rendered after the initial collection of data from the member and are provided without real-time interaction with the member.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 3). Approved 8/29/23. (Accessed Feb. 2024).

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.”

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, (5/31/23), pg. 50-51 & IHS/Tribal Provider Billing Manual, (5/31/23). pg. 53, (Accessed Feb. 2024).

Remote monitoring

  • 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. 402. (Accessed Feb. 2024).


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 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, (5/31/23), pg. 50 & 52 & IHS/Tribal Provider Billing Manual, (5/31/23). pg. 52-54  (Accessed Feb. 2024).

AHCCS Medical Policy Manual

Asynchronous services are rendered after the initial collection of data from the member and are provided without real-time interaction with the member. Reimbursement for this type of consultation is limited to clinically appropriate services that are provided without real-time interaction and are limited to the following disciplines, with the exception of e-consults:

  • Dermatology
  • Radiology
  • Ophthalmology
  • Pathology
  • Neurology
  • Cardiology
  • Behavioral Health
  • Infectious Disease
  • Allergy/Immunology

The AHCCCS Telehealth code set defines which codes are billable as an asynchronous service and the applicable modifier(s) and place of service providers must use when billing for a service provided via asynchronous means.

E-Consult Services

The Contractor and FFS Programs shall cover medically necessary e-consult visits, to aid in the coordination of care between a Primary Care Provider (PCP) and a specialist, and to improve timely access to specialty providers.

The AHCCCS Telehealth code set defines which codes are billable as an e-consult service and the applicable modifier(s) and place of service providers must use when billing for a service provided through e-consult.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. 2-3), Approved 8/29/23. (Accessed Feb. 2024).

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

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Feb. 2024).


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. 1), Approved 8/29/23 ; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (5/31/23), pg. 49, & IHS/Tribal Provider Billing Manual, (5/31/23), pg. 52 (Accessed Feb. 2024).


FACILITY/TRANSMISSION FEE

No Reference Found

READ LESS

Arkansas

Last updated 02/06/2024

POLICY

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

POLICY

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

SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022, (Accessed Feb. 2024).

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 (1/1/23). (Accessed Feb. 2024).

Occupational Therapy, Physical Therapy and Speech-Language Pathology Services

All services delivered through telemedicine must be delivered in a synchronous manner, meaning through real-time interaction between the practitioner and client via a telecommunication link.

A store and forward telecommunication method of service delivery where either the client or practitioner records and stores data in advance for the other party to review at a later time is prohibited, although correspondence, faxes, emails, and other non-real time interactions may supplement synchronous telemedicine service delivery.

SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

California

Last updated 04/02/2024

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 (Jan. 2023). Pg. 1. (Accessed Apr. 2024).

CA Medicaid and Medi-Cal managed care plans are required to reimburse health care providers of applicable health care services delivered via video synchronous interaction, synchronous audio-only modality, or asynchronous store and forward, as applicable, at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.

A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forwardtelephonic (audio-only) synchronous interaction, remote patient monitoring, or other virtual communication modalities. The department may provide for specific exceptions to this prohibition, which shall be developed in consultation with affected stakeholders and published in departmental guidance. Additional exceptions apply for audio-only in particular as well. See Email, Phone & Fax Section for audio-only exception information.

In-person, face-to-face contact between a health care provider and a patient is not required under the Medi-Cal program for covered health care services and provider types designated by the department, when provided by video synchronous interaction, asynchronous store and forward, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities, when those services and settings meet the applicable standard of care and meet the requirements of the service code being billed.

Applicable health care services appropriately provided through video synchronous interaction, asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other permissible virtual communication modalities are subject to billing, reimbursement, and utilization management policies imposed by the department. Utilization management protocols adopted by the department pursuant to this section shall be consistent with, and no more restrictive than, those authorized for health care service plans pursuant to Section 1374.13 of the Health and Safety Code.

SOURCE: Welfare and Institutions Code 14132.725, as amended by SB 184 (2022 Session) and AB 32 (2022 Session). (Accessed Apr. 2024).

Brief Virtual Communications and Check-ins

Virtual or telephonic communication includes a brief communication with an established patient not physically present (face-to-face). Medi-Cal providers may be reimbursed using HCPCS codes G2010 and G2012 for brief virtual communications.

HCPCS code 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 hours, not originating from a related evaluation and management (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.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth (Mar. 2024). Pg. 12. (Accessed Apr. 2024).

FQHCs/RHCs 

Asynchronous store and forward means the transmission of a patient’s medical information from an originating site to the billable provider at a distant site.

Medi-Cal benefits or services being provided are clinically appropriate and meet the procedural and billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter.

A patient may be “established” on an asynchronous store and forward service, if all of the conditions of the “New Patient” requirements in this manual section are met.

Only one visit or store and forward service may be billed at the PPS rate when there is a service payment contract with a non-FQHC/RHC, contractor, or another FQHC or RHC. Conversely, the non-FQHC/RHC or contractor may request fee-for-service reimbursement for a visit or store and forward service directly from the appropriate managed care plan or the Medi-Cal Fiscal Intermediary if no service payment contract exists with the FQHC or RHC.

FQHCs and RHCs must use the appropriate telehealth modifier when billing for the covered service.

RHCs and FQHCs cannot use billing codes G2010 and G2017, which are for Fee-For-Service (FFS) providers. Likewise, effective the end of the COVID-19 public health emergency, code G0071 may not be billed to Medi-Cal.

An e-consult, e-visit, or remote patient monitoring is not a reimbursable telehealth service for FQHCs or RHCs.

SOURCE: CA Department of Health Care Services (DHCS). Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Mar. 2024. Pg. 16-17. (Accessed Apr. 2024).

Visits shall also include an encounter between an FQHC or RHC patient and a physician, physician assistant, nurse practitioner, certified nurse-midwife, clinical psychologist, licensed clinical social worker, visiting nurse, comprehensive perinatal services program practitioner, dental hygienist, dental hygienist in alternative practice, or marriage and family therapist using an asynchronous store and forward modality, when services delivered through that modality meet the applicable standard of care. A visit described in this clause shall be reimbursed at the applicable FQHC’s or RHC’s per-visit PPS rate to the extent the department determines that the FQHC or RHC has met all billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter.

An FQHC or RHC is not precluded from establishing a new patient relationship through an asynchronous store and forward modality, as defined in subdivision (a) of Section 2290.5 of the Business and Professions Code, if the visit meets all of the following conditions:

  • The patient is physically present at the FQHC or RHC, or at an intermittent site of the FQHC or RHC, at the time the service is performed.
  • The individual who creates the patient records at the originating site is an employee or contractor of the FQHC or RHC, or other person lawfully authorized by the FQHC or RHC to create a patient record.
  • The FQHC or RHC determines that the billing provider is able to meet the applicable standard of care.

SOURCE: Welfare and Institutions Code 14132.100, as amended by SB 184 (2022 Session) and AB 32 (2022 Session). (Accessed Apr. 2024).

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. Jun. 2023, Pg. 6. (Accessed Apr. 2024).

Managed Care

To ensure proper payment and record of Covered Services provided via Telehealth, all Providers must use the modifiers defined in the Medi-Cal Provider Manual with the appropriate CPT-4 or HCPCS codes when coding for services delivered through both synchronous interactions and asynchronous store and forward telecommunications. Regarding the rate of reimbursement, unless otherwise agreed to by the MCP and Provider, MCPs must reimburse Network Providers at the same rate, whether a Covered Service is provided in-person or through Telehealth, if the service is the same regardless of the modality of delivery, as determined by the Provider’s description of the service on the claim.

SOURCE: CA Department of Health Care Services (DHCS). All Plan Letter 23-007: Telehealth Services Policy. Apr. 10, 2023, Pg. 5. (Accessed Apr. 2024).

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

A patient may not be “established” on an asynchronous store and forward service with the exception of a homeless patient. Reimbursement is permitted for an established patient by a billable provider at the distant site.

SOURCE: CA Department of Health Care Services (DHCS). Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual. May 2023. Pg. 9. (Accessed Apr. 2024).

Local Education Agency

For purposes of LEA policy, the telehealth definition only includes synchronous, real-time interactions between a patient and a health care provider located at a distant site.

SOURCE: CA Department of Health Care Services (DHCS). Local Education Agency (LEA) Telehealth. Jun. 2023. Pg. 1. (Accessed Apr. 2024).

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.  See manual for codes and requirements.

DHCS has expanded its teledentistry policy to allow Medi-Cal dental Fee-for-Service (FFS) and Dental Managed Care (DMC) providers the ability to establish new patient relationships through an asynchronous store and forward modality, consistent with Federally Qualified Health Center/Rural health Clinic (FQHC/RHC) providers.

SOURCE: CA Department of Health Care Services (DHCS). Medi-Cal Dental Provider Handbook. Jan. 2023 Pg. 4-22 – 4-23. (Accessed Apr. 2024).


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 e-consults. Only the service(s) rendered from the distant site must be billed with modifier GQ.

The use of modifier GQ does not alter reimbursement for the CPT or HCPCS code billed. For additional information about policy and billing requirements relating to teledentistry, providers may refer to “Teledentistry” in the Medi-Cal Dental Provider Handbook.

For billing purposes, health care providers must ensure that the documentation, typically images, sent via store and forward be specific to the patient’s condition and adequate for meeting the procedural definition and components of the CPT or HCPCS code that is billed. In addition, all services billed via store and forward, including e-consult, are subject to all existing Medi-Cal coverage and reimbursement policies.

E-Consults

A health care provider at the distant site may bill for an e-consult with the CPT code listed below when the benefits or services delivered meet the procedural definition and components of the CPT code as defined by the AMA as well as any requirements described in this section of the Medi-Cal provider manual.

When billing for e-consults, health care providers at the originating and distant sites must clearly document the following information relating to previous and/or pertinent health care services, maintain this information in the patient’s medical record and make it available to DHCS upon request:

  • A health care provider at the originating site 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.
  • In order to bill for e-consults, the health care provider at the distant site must create and maintain the following: A record of the review and analysis of the transmitted medical information with written documentation of date of service and time spent; and A written report of case findings and recommendations with conveyance to the originating site.

To bill for e-consults, the health care provider at the distant site (consultant) may use CPT code 99451 in conjunction with the modifier GQ. In accordance with the AMA requirements, CPT code 99451 is not separately reportable or reimbursable if any of the following are true:

  • The distant site provider (consultant) saw the patient within the last 14 days.
  • The e-consult results in a transfer of care or other face-to-face service with the distant site provider (consultant) within the next 14 days or next available appointment date of the consultant.
  • The distant site provider did not spend at least five minutes of medical consultative time, and it did not result in a written report.

If more than one contact or encounter is required to complete the e-consult request, the entirety of the service and cumulative discussion and information review time should be reported only once using CPT code 99451. CPT code 99451 is not reimbursable more than once in a seven-day period for the same patient and health care practitioner. Medi-Cal covered benefits or services provided at the originating site (in-person) with the patient in connection with an e-consult are billed according to standard Medi-Cal policies (without modifier GQ).

E-consults are not applicable for FQHCs, RHCs, or IHS-MOA clinics.

See Telehealth Modifier Reference Sheet- Organized by Delivery System​​ ​for more information on modifiers.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Mar. 2024), Pg. 10-12. (Accessed Apr. 2024).

Medi-Cal covers an ‘e-visit’ which are communications between a patient and their provider through an online patient portal.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth (Aug. 2020). Pg. 2. (Accessed Apr. 2024).

Managed Care

All Providers, with the exception of Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Tribal Health Providers (THPs), are allowed to be reimbursed for consultations provided via a Telehealth modality. These electronic consultations (e-consults) are permissible using the appropriate CPT-4 code, modifier(s), and Medical Record documentation defined in the Medi-Cal Provider Manual. Members cannot initiate e-consults as they are interprofessional interactions, and therefore only permissible between Providers. Providers are permitted to be reimbursed for brief virtual communications that consist of a brief communication with a Member who is not physically present (face-to-face) at the FFS rate. Virtual communications reimbursement for FQHCs, RHCs, and THPs is no longer allowed consistent with the end of the COVID-19 Public Health Emergency on May 11, 2023.

SOURCE: CA Department of Health Care Services (DHCS). All Plan Letter 23-007: Telehealth Services Policy. Apr. 10, 2023. Pg. 3. (Accessed Apr. 2024).

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

A patient may not be “established” on an asynchronous store and forward service with the exception of a homeless patient. Reimbursement is permitted for an established patient by a billable provider at the distant site.

SOURCE: CA Department of Health Care Services (DHCS). Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual. May 2023. Pg. 9. (Accessed Apr. 2024).

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. Teleophthalmology services by store and forward must be billed with modifier GQ (service rendered by store and forward telecommunications system). Only the portion(s) rendered from the distant site (hub) are billed with modifier GQ. The use of modifier GQ does not alter reimbursement for the CPT or HCPCS code billed.

SOURCE: CA Department of Health Care Services, Vision Care: Professional Services Manual. (Dec. 2022), Pg. 5-6. (Accessed Apr. 2024).

Dental Services

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

SOURCE: CA Department of Health Care Services (DHCS). Medi-Cal Dental Provider Manual. Jan. 2023. Pg. 4-23 – 4-24. (Accessed Apr. 2024).

Opioid Use Disorder Treatment Services

Outpatient treatment services for opioid use disorder (OUD), which include management, care coordination, psychotherapy and counseling are reimbursable using HCPCS codes G2086, G2087 and G2088. At least one psychotherapy service must be furnished in order to bill for HCPCS codes G2086 thru G2088. Although the descriptions for these codes refer to “office-based treatment,” these services may be delivered via telehealth when they meet Medi-Cal requirements. See Medi-Cal Telehealth Provider Manual.

HCPCS codes G2086 thru G2088 are not reimbursable for treatment in state-licensed Opioid Treatment Programs as defined in Health and Safety Code Section 11875. HCPCS codes G2086 and G2087 each have a frequency limit of once per calendar month, per recipient, any provider and G2088 has a frequency limit of two per calendar month, per recipient, any provider. Only one provider can be reimbursed for HCPCS code G2086, G2087 or G2088 per calendar month.

SOURCE: Department of Health Care Services. Evaluation & Management Manual. Page 47-48 Dec. 2022. (Accessed Apr. 2024).

Drug Medi-Cal Providers

A Drug Medi-Cal certified provider shall not establish a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, audio-only synchronous interaction, remote patient monitoring, or other virtual communication modalities. The department may provide for specific exceptions to this prohibition, which shall be developed in consultation with affected stakeholders and published in departmental guidance.

SOURCE: Welfare and Institutions Code 14132.731, as amended by SB 184 (2022 Session). (Accessed Apr. 2024).

Behavioral Health Services

For purposes of Medi-Cal Specialty Mental Health Services (SMHS), the Drug Medi-Cal Organized Delivery System (DMC-ODS), and the Drug Medi-Cal (DMC) programs (including initial assessments, only as set forth in this BHIN), telehealth coverage is only specified for synchronous audio-only and synchronous video interactions. However, the following asynchronous code is covered and directed to be used as follows:

  • Asynchronous store and forward (e-consult in DMC-ODS only): GQ

As a general rule, State law prohibits the use of asynchronous store and forward, synchronous audio-only interaction, or remote patient monitoring when providers establish new patient relationships with Medi-Cal beneficiaries.

SOURCE: CA Department of Health Care Service (DHCS). Behavioral Health Information Notice No.: 23-018. Apr. 25, 2023. Pg. 2, 4, 8. (Accessed Apr. 2024).

Children’s Services Program

CCS providers must request prior authorization services from CCS paneled physicians (22, CCR Section 41412) who are available to provide telehealth services. Prior authorization requests are also authorized to CCS-approved hospitals and outpatient special care centers. GHPP providers must be Medi-Cal enrolled providers.

Physical and Occupational Therapy may be offered through appropriate telehealth modalities. Medical Therapy Unit therapists may offer remote/virtual teletherapy services as an alternative to in-person visits, as appropriate and directed by the Medical Therapy Conference and directing physicians. CCS clients receiving services through a Special Care Center and/or Medical Therapy Program Medical Therapy Conference must have an annual in-person evaluation by a CCS-paneled physician. GHPP clients require an annual evaluation to ensure continued program coverage.

Billing for telehealth services is contingent upon the CCS Program or GHPP clients meeting all eligibility criteria, with an approved CCS Program/GHPP SAR, and in conformance with required Medi-Cal claims submission procedures as outlined in the DHCS Medi-Cal Telehealth Policy.

  • When submitting a SAR for synchronous telemedicine services, the provider must use codes provided in the American Medical Association (AMA’s) CPT Manual, Appendix P.
  • Telehealth modifiers (93, 95 or GQ) are required on SARs to differentiate the telehealth service from the equivalent in-person service.
  • For services or benefits provided via asynchronous store-and-forward telecommunications systems, the health care provider bills with modifier GQ.

For Whole Child Model (WCM) counties, the client’s managed care plan (MCP) shall be responsible for authorizing, coordinating, and covering CCS telehealth services.

SOURCE: Department of Health Care Services. Numbered letter 03-0723 to the Children’s Services Program and Genetically Handicapped Persons Program (GHPP). Jul. 7, 2023 – supersedes Department of Health Care Services. Numbered letter 16-1217 to the CA Children’s Services Program and Genetically Handicapped Persons Program (GHPP).  Dec. 22, 2017. (Accessed Apr. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

If billing store and forward, including e-consult, providers at the originating site may bill the originating site fee with HCPCS code Q3014, but may not bill for the transmission fee.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Mar. 2024), Pg. 13. (Accessed Apr. 2024).

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. Jan. 2023. Pg. 8 & Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Mar. 2024. Pg. 13. (Accessed Apr. 2024).

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. (Oct. 2022), Pg. 5. (Accessed Apr. 2024).

Dental Care

The originating site and transmission fee and billing rules are not applicable to Safety Net Clinics (Federally Qualified Health Centers, Rural Health Clinics, Indian Health Services Memorandum of Agreement 683 Clinics). For policy and billing information specific to Safety Net Clinics, please refer to those sections of the Medi-Cal Provider Manual (Rural and Ind Health).

Transmission costs associated with store and forward are not payable.

SOURCE: CA Department of Health Care Services (DHCS). Denti-Cal Manual. Jan. 2023. Pg. 4-24-25. (Accessed Apr. 2024).

READ LESS

Colorado

Last updated 01/25/2024

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” 1/24. (Accessed Jan. 2024).

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 Jan. 2024).

Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat as long as the technologies are compliant with HIPAA. The health care or mental health care services are subject to reimbursement policies developed pursuant to the medical assistance program. Reimbursement rate must be, at minimum, the same as a comparable in-person services.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Jan. 2024).

Interim Therapeutic Restorations

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 telehealth, including 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 Jan. 2024).

eConsults

Effective February 1, 2024, eConsults that meet the criteria below are a covered benefit.

An eConsult is defined as an asynchronous dialogue initiated by a Treating Practitioner seeking a Consulting Practitioner’s expert opinion without a face-to-face member encounter with the Consulting Practitioner.

Treating Practitioner is defined as a member’s treating physician or other qualified health care practitioner who is a primary care provider contracted with a Regional Accountable Entity to participate in the Accountable Care Collaborative as a Network Provider.

Consulting Practitioner is defined as a provider who has education, training, or qualifications in a specialty field other than primary care.

Providers can utilize the Department’s eConsult platform, Colorado Medicaid eConsult, or a third-party eConsult platform that meets the Department’s criteria.

Approved Third-party eConsult Platform Criteria

  1. Platform must be capable of maintaining documentation that the eConsult is directly relevant to the individual patient’s diagnosis and treatment, and the consulting practitioner has specialized expertise in the particular health concerns of the patient.
  2. Platform must be capable of identifying the Colorado Medicaid enrollment status of providers using the platform. All providers must be licensed in the state of Colorado.
  3. Platform meets all state and federal privacy laws regarding the exchange of patient information.
  4. Platform must be capable of providing sufficient documentation for the treating and consulting provider to demonstrate that the consultation was provided for the direct benefit of the member.
  5. Platform must provide the treating and consulting practitioner with the information necessary to file a claim including date of service; name of recipient; Medicaid identification number; name of provider agency or person providing the service; nature, extent, or units of service; and the place of service.

Treating practitioners can bill this service using Procedure Code 99452. Consulting practitioners can bill this service using Procedure Code 99451.

Treating Practitioner Reimbursement:

  • All practitioners rendering services should submit claims for completed eConsults for fee-for-service reimbursement.

Consulting Practitioner Reimbursement:

  • Consulting practitioners who use the Department’s eConsult platform will be paid by Safety Net Connect’s subcontractor, ConferMED.
  • Consulting practitioners who use an approved eConsult platform should submit claims for completed eConsults to the Colorado interChange for fee-for-service reimbursement.

Refer to the Code of Colorado Regulations (1- CCR 2505-10, Section 8.095) for more information.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 1/24. (Accessed Jan. 2024).

A Treating Practitioner may request an eConsult with a Consulting Practitioner. eConsult services must:

  1. Be requested by the Treating Practitioner through an eConsult Platform;
  2. Be responded to by the Consulting Practitioner through an eConsult Platform;
    1. The Consulting Practitioner may send the eConsult to another Consulting Practitioner in a different specialty practice through an eConsult Platform, when clinically appropriate.
  3. The Consulting Practitioner must, when clinically appropriate, provide clinical guidance pertaining to the eConsult electronically to the requesting Treating Practitioner through an eConsult Platform; and,
  4. All dialogue between the Treating Practitioner and the Consulting Practitioner pertaining to an eConsult must be through an eConsult Platform.

eConsults that are not delivered, and responded to, through an eConsult Platform, are noncovered services.

SOURCE: CO Adopted Rule 8.095.4.C & 8.095.8.B. (Accessed Jan. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Limited reimbursement allowed for an interim therapeutic restoration in teledentistry.

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Jan. 2024).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No Reference Found

READ LESS

Connecticut

Last updated 04/12/2024

POLICY

Effective Now Until June 30, 2024

Notwithstanding the provisions …

POLICY

Effective Now Until June 30, 2024

Notwithstanding the provisions of section 19a-906 of the general statutes, as amended by this act, 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 May 10, 2021 and ending on June 30, 2024, 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), Sec. 1 & SB 2 (2022 Session), Sec. 32. (Accessed Apr. 2024).

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.

SOURCE: CT Policy – Provider Bulletin 2019-75. Dec. 2019, (Accessed Apr. 2024).

“Asynchronous” means any transmission to another site for review at a later time that uses a camera or other technology to capture images or data to be recorded.

SOURCE: CT Statute Sec. 19a-906(a)(1). (Accessed Apr. 2024).

“Store and forward transfer” means the asynchronous transmission of a patient’s medical information from an originating site to the telehealth provider at a distant site.

SOURCE: CT Statute Sec. 19a-906(a)(9). (Accessed Apr. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Delaware

Last updated 01/15/2024

POLICY

Telehealth store-and-forward (S&F) technology is the asynchronous, secure electronic …

POLICY

Telehealth store-and-forward (S&F) technology is the asynchronous, secure electronic transmission of a patient’s health information provided through the transference of text, digital images, sounds, previously recorded video, or responses to a survey from one location to another to allow a consulting distant telehealth practitioner the ability to obtain the information, analyze it, and report back to the referring provider.

Reimbursement for telehealth S&F services will be provided for Medicaid patients with conditions or clinical circumstances where the provision of S&F services can appropriately reduce the need for in-person visits.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.2.8, pg. 74. (Accessed Jan. 2024).

The Behavioral Health manual still states that asynchronous or “store-and-forward” applications do not meet the DMAP definition of telemedicine.

SOURCE: Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10 (Accessed Jan. 2024).


ELIGIBLE SERVICES/SPECIALTIES

When billing the DMAP for S&F services, the provider must use the appropriate CPT® procedure codes under Interprofessional Telephone/Internet/Electronic Health Record Consultations.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.6.5.2.3.1, pg. 80. (Accessed Jan. 2024).

Chart reviews, electronic mail messages, facsimile transmissions, or internet services for online medical evaluations are not considered telehealth.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.6.3, pg. 79. (Accessed Jan. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Florida

Last updated 02/23/2024

POLICY

Florida Medicaid will continue to cover store-and-forward and remote …

POLICY

Florida Medicaid will continue to cover store-and-forward and remote patient monitoring services.

SOURCE: FL Medicaid, Alert, Ending of Federal Public Health Emergency: Updated Co-Payment and Telemedicine Guidance for Medical and Behavioral Health Providers, May 4, 2023, (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Georgia

Last updated 01/31/2024

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 Telemedicine Guidance Handbook, p. 8 (Jan. 1, 2024). (Accessed Jan 2024).

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 Telemedicine Guidance Handbook, p. 36 (Jan. 1, 2024). & Part II Policies and Procedures for Dental Services, p. IX-21 (p. 60) (Jan. 1, 2024). (Accessed Jan 2024).


ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

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

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 36 (Jan. 1, 2024). & Part II Policies and Procedures for Dental Services, p. IX-21 (p. 60) (Jan. 1, 2024). (Accessed Jan 2024).

Comprehensive Supports Waiver Program

Telephone calls and store and forward (asynchronous) modalities are not allowed for billable therapy evaluation and services.

SOURCE: GA Dept. of Community Health, Division of Medicaid, Comprehensive Supports Waiver Program Chapters 1300-3700. (Jan. 1, 2024).  (Accessed Jan. 2024).


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 Telemedicine Guidance Handbook, p. 36 (Jan. 1, 2024). & Part II Policies and Procedures for Dental Services, p. IX-21 (p. 60) (Jan. 1, 2024). (Accessed Jan 2024).

READ LESS

Hawaii

Last updated 02/12/2024

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 Feb. 2024).

Always use one of the following when billing:  95, GQ or GT).

SOURCE: HI Med-QUEST Memo No. QI-2338/FFS 23-22/CCS-2311 (Replaces QI-2306/QI-2138, QI-2007,FFS 23-04, FFS-21015, FFS20-03, CCS-2302) (Accessed Feb. 2024).

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) p. 70 – Law passed & state plan amendment accepted prohibiting this limitation, however the prohibiting language is still present in regulation. (Accessed Feb. 2024).

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. 108 (Jan 2023) (Accessed Feb. 2024).


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 Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Idaho

Last updated 02/13/2024

POLICY

Services provided via asynchronous communication are not reimbursable under …

POLICY

Services provided via asynchronous communication are not reimbursable under Idaho Medicaid. However, remote monitoring services are covered for established patients.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  (Jan. 30, 2024), Sections 9.12 p. 133, Idaho MedicAide May 2023.  (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Illinois

Last updated 02/27/2024

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 only 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. 2024). 

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, June 2021; Handbook for Podiatrists, F-200, p. 27 (Oct. 2016); & Handbook for Encounter Clinic Services pg. 16-17 (Aug. 2016). (Accessed Feb. 2024).

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. (Accessed Feb. 2024).

Interprofessional Consultation for Psychiatry

Certain codes for Interprofessional Consultation will be allowed.  See bulletin for specific codes.

SOURCE: IL Dept of Healthcare and Family Services Provider Bulletin (Feb. 3. 2023). (Accessed Feb. 2024).

 


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No Reference Found

READ LESS

Indiana

Last updated 03/19/2024

POLICY

Telehealth means the delivery of healthcare services between a …

POLICY

Telehealth means the delivery of healthcare services between a practitioner in one location (the distant site) and a patient in another location (the originating site), using interactive electronic communications and information technology, in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA), including any of the following:

  • Secure videoconferencing
  • Store-and-forward technology
  • Remote patient monitoring technology

SOURCE: Indiana Health Coverage Programs, Telehealth and Virtual Services, Provider Reference Module (Nov. 1, 2023), p. 1.  (Accessed Mar. 2024).

“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.

SOURCE: IN Admin. Code, Title 405, “Article 5” 5-38-2 & 4., p. 199-200 (Accessed Mar. 2024)


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Iowa

Last updated 01/15/2024

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

Certain communication technology-based codes …

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

Certain communication technology-based codes that include store and forward (such as online digital evaluation and management services, or ‘evisits’) are included as permanent codes in Medicaid’s approved telehealth codes list.

SOURCE: IA Medicaid. New Telehealth Approved Codes [see quarterly codes dropdown], 10/12/23, (Accessed Jan. 2024).

All Iowa Medicaid recipients are eligible to receive services via asynchronous teledentistry. See informational letter for billing codes.

SOURCE: Informational Letter 2224-MC-FFS-D-CVD “Asynchronous Teledentistry” (Accessed Jan. 2024)


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Kansas

Last updated 03/04/2024

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. 2-33 (Jan. 2024). (Accessed Mar. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Kentucky

Last updated 03/18/2024

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 (asynchronous).

SOURCE: KY Revised Statutes 205.559. For definition, see: KY Revised Statute 205.510 & 211.332. (Accessed Mar. 2024).

“Asynchronous telehealth” means a store and forward telehealth service that is electronically mediated.

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 Mar. 2024).

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

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system; and
    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 (Accessed Mar. 2024).

Rural Health Clinic

The fallowing services or activities shall not be covered under this administrative regulation: …

  • A telephone call, an email, a text message or other electronic contact that does not meet requirements stated in the definition for telehealth established pursuant to KRS 205.510(16) and implemented pursuant to 907 KAR 3:170.

SOURCE: KY Admin Regs. Title 907 KAR 1:082, (Accessed Mar. 2024).


ELIGIBLE SERVICES/SPECIALTIES

An asynchronous telehealth service or store and forward transfer shall be limited to those telehealth services that have an evidence base establishing the service’s safety and efficacy.

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 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.

Unless otherwise prohibited by this section, an asynchronous telehealth service shall be reimbursable if that service supports an upcoming synchronous telehealth or in-person visit to a provider that is providing one (1) of the specialties or instances of care listed in subsection (2) of this section.

The department shall evaluate available asynchronous telehealth services quarterly, and may clarify that certain asynchronous telehealth services meet the requirements of this section 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.

Any asynchronous service that is determined by the department to meet the criteria established pursuant to this subsection shall be available on the department’s Web site.

Each asynchronous telehealth service shall involve timely actual input and responses from the provider, and shall not be solely the result of reviewing an artificial intelligence messaging generated interaction with a recipient.

Any recipient, upon being offered the option of an asynchronous or audio-only telehealth visit, shall have the opportunity or option to request to be accommodated by that provider in an in-person encounter or synchronous telehealth encounter.

A telehealth care provider that has received a request for an in-person encounter or synchronous telehealth encounter shall provide an alternative in-person or synchronous telehealth encounter for the recipient within:

  • A reasonable time;
  • The existing availability constraints of the provider’s schedule; and
  • No more than three (3) weeks of the recipient’s request, unless the recipient’s condition or described symptoms suggest a need for an earlier synchronous or in-person encounter.
A provider’s failure to accommodate a recipient with a synchronous telehealth or in-person encounter shall be reported to the Office of the Ombudsman and Administrative Review of the Cabinet for Health and Family Services.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Mar 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Louisiana

Last updated 02/15/2024

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/telehealth” 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. 165 (As issued on 6/27/22). (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Maine

Last updated 02/03/2024

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.

“Asynchronous encounters” means the interaction or consultation between an enrollee and the enrollee’s provider or between providers regarding the enrollee through a system with the ability to store digital information, including, but not limited to, still images, video, audio and text files, and other relevant data in one location and subsequently transmit such information for interpretation at a remote site by health professionals without requiring the simultaneous presence of the patient or the health professionals.

SOURCE: ME Statute Sec. 22:855.3173-H, Sub. Sec. 1 (Accessed Feb. 2024).

“Asynchronous encounters” means the interaction or consultation between a Member and the Member’s Health Care Provider or between Health Care Providers regarding the Member through a system with the ability to store digital information, including, but not limited to, still images, video, audio and test files, and other relevant data in one location and subsequently transmit such information for interpretation at a remote site by Health Care Providers without requiring the simultaneous presence of the Member or the Health Care Provider. The term “Store-and-Forward Telehealth” is also used for the term “Asynchronous encounters” in this rule.

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, (Nov. 6, 2023) (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

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

  1. Virtual Transfer of Health Information: The Health Care Provider uses health information that has been virtually transferred to evaluate a Member’s condition or render a covered MaineCare service separate from Telehealth Services. The Health Care Provider uses a computer or a mobile device, such as a smartphone, to gather and send the information. Information is transmitted by electronic mail, uploaded to a secure website, or a private network. Only the Health Care Provider who receives and reviews the recorded clinical information is eligible for reimbursement.
  2. Remote Consultation Between Treating Provider and Specialist: A Specialist provides interprofessional telecommunications assessment and management services to a Treating Provider. The interaction includes discussion (via telephone or internet) of a written report by the Specialist to assess the Member’s Electronic Health Record and/or diagnoses/treatment. Duration of this service must be a minimum of five minutes and no greater than thirty minutes. The Treating Provider must document that they have informed the Member as to results and conclusions following the Remote Consultation.
    1. The Treating Provider must document in the Member’s medical record the Member’s written, electronic, or verbal consent for each Remote Consultation. Billing for interprofessional services is limited to those practitioners who can independently bill MaineCare for evaluation and management services.
    2. Remote Consultation may be utilized as often as medically necessary, per the terms of these rules.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. (Nov. 6, 2023). (Accessed Feb. 2024).

Teledentistry

Providers may deliver diagnostic services via telehealth in accordance with Chapter I, Section 4, of the MaineCare Benefits Manual (MBM) and current Board rules and guidance. When delivering services via telehealth, providers shall bill for the underlying service and include, for tracking purposes only, the appropriate teledentistry CDT code that indicates a synchronous real-time encounter or an asynchronous encounter in which information is stored and forwarded to the dentist for subsequent review.

SOURCE: ME Benefits Manual, Dental Services and Reimbursement Methodology, 10-144, Ch. II, Sec. 25, pg. 3-4, (Sept. 28, 2022), (Accessed Feb. 2024).

Interprofessional Codes for Medication Management Providers

Medication management providers and other treating providers of Section 65 of the MaineCare Benefits Manual (MBM) may deliver and bill MaineCare for interprofessional consultations in alignment with MBM Chapter 1, Section 4.04-2(B). As described in CMS state health official letter #23-001, interprofessional consultations are assessments and management services in which a patient’s treating provider requests the opinion and/or treatment advice of a consultant with specific specialty expertise to assist the treating provider in the diagnosis and/or management of the patient’s condition without the need for the patient’s face-to-face contact with the consultant.

The consulting provider and the provider requesting the consultation must be able to independently bill for evaluation and management services. Examples of these provider types include physicians, nurse practitioners, clinical nurse specialists, physician assistants, and licensed clinical social workers. A registered nurse, for example, is not an eligible provider type.

The following examples illustrate when medication management providers may deliver and bill for interprofessional consultations:

  • A medication management provider provides consultation to a primary care provider (PCP) on cross-tapering a patient from one antidepressant to another due to concerning side-effects.
  • A medication management provider provides consultation to a PCP regarding antipsychotic medications because the PCP has a symptomatic patient who has been off of medications, and the PCP has never prescribed antipsychotic medication before.
  • The PCP has been treating a behavioral health patient who was previously stabilized and who is now reporting increased symptoms with active substance use. The PCP is not sure of what to do about medications in the context of active substance use and consults a medication management provider.

Providers must bill for interprofessional consultations using common procedural terminology (CPT) codes 99446-99449, 99451, and 99452. However, CPT code 99452 is different. Interprofessional consultation code 99452 applies when the patient’s PCP or other qualified health professional interacts with a consultant via telephone, the Internet, or an electronic health record to provide the consultant with the patient’s clinical data so that the consultant can form an opinion regarding further management of the patient’s condition. For example, a PCP would bill CPT code 99452 if they send a patient to a medication management provider and the PCP provided background information.

SOURCE: State of Maine Department of Health and Human Services, Bulletin:  Interprofessional Codes for Medication Management Providers, Nov. 13, 2024, (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Maryland

Last updated 02/21/2024

POLICY

Recently Passed Legislation

Telehealth definition includes both synchronous and …

POLICY

Recently Passed Legislation

Telehealth definition includes both synchronous and asynchronous interactions. The Program is required to reimburse a health care provider for the diagnosis, consultation, and treatment of a Program recipient for a health care service covered by the Program that can be appropriately provided through telehealth regardless of patient and provider location.

From July 1, 2021, to June 30, 2025, when appropriately provided through telehealth, the Program shall provide reimbursement in accordance on the same basis and the same rate as if the health care service were delivered by the health care provider in person.

The Department may adopt regulations to carry out this section.

SOURCE: MD Health General Code 15-141.2 (a-b, g, j), as amended by HB 1148/SB 582/SB 534 (2023 Session). (Accessed Feb. 2024).

According to the Maryland Medicaid Synchronous Telehealth Policy Guide, store and forward technology means the transmission of medical images or other media captured by the originating site provider and sent electronically to a distant site provider, who does not physically interact with the patient located at the originating site. The Guide states that it is not billable as a synchronous telehealth service, but is covered for dermatology, ophthalmology, or radiology services under Physician Services in COMAR 10.09.02.07.

SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 3-4. Updated Aug. 2023. (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

MD regulations state store and forward technology does not meet the Maryland Medical Assistance Program’s definition of telehealth. However, dermatology, ophthalmology and radiology are excluded from definition of store-and-forward and they do reimburse for these services according to COMAR 10.09.02.07.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.02; 10.09.49.07 (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Massachusetts

Last updated 04/15/2024

POLICY

Under this policy, MassHealth will continue to allow MassHealth-enrolled …

POLICY

Under this policy, MassHealth will continue to allow MassHealth-enrolled providers to deliver a broad range of MassHealth-covered services via telehealth. MassHealth will reimburse for such services at parity with their in-person counterparts, including services provided through live-video, audio-only, or asynchronous visits that otherwise meet billing criteria, including use of required modifiers. All providers delivering services via telehealth must comply with the policy detailed in this bulletin.

This bulletin applies to members enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) Plan, a Managed Care Organization (MCO), an Accountable Care Partnership Plan (ACPP), or a Primary Care Accountable Care Organization (PCACO). Information about coverage through MassHealth Managed Care Entities (MCEs) and the Program for All-inclusive Care for the Elderly (PACE) will be issued in a forthcoming MCE bulletin.

Providers must include the place of service (POS) code 02 when submitting a professional claim for telehealth provided in a setting other than in the patient’s home. They must include POS code 10 when submitting a professional claim for telehealth provided in the patient’s home. Additionally, for any such professional claim, providers must include:

  • modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
  • modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
  • modifier GQ to indicate services rendered via asynchronous telehealth.

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

  • modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
  • modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
  • modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

Billing and Payment Rates for Services

Providers billing under an 837I/UB-04 form must include the modifier GT when submitting claims for services delivered via telehealth. Providers billing under an 837P/1500 form must include the place of service (POS) code 02 or 10 when submitting claims for services delivered via telehealth.

Additionally, for any such professional claim, providers must include:

  • modifier 95 to indicate counseling and therapy services rendered via audio-video telehealth;
  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier GQ to indicate services rendered via asynchronous telehealth;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications; and/or
  • modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology.

Rates of payment for services delivered via telehealth will be the same as the rates of payment for services delivered via traditional (i.e., in-person) methods as set forth in the applicable regulations.

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2024).


ELIGIBLE SERVICES/SPECIALTIES

As under All Provider Bulletin 355, Section B of this bulletin identifies specific categories of service that MassHealth has deemed inappropriate for delivery via any telehealth modality. Except for those services identified in Section B in this bulletin, and notwithstanding any regulation to the contrary, including the physical-presence requirement at 130 CMR 433.403(A)(2), a MassHealth enrolled provider may deliver medically necessary MassHealth-covered services on an outpatient basis to a MassHealth member via the telehealth modalities of audio-only, live video, and asynchronous visits, if:

  • the provider has determined that it is clinically appropriate to deliver such service via telehealth, including the telehealth modality and technology employed, including obtaining member consent;
  • such service is payable under that provider type;
  • the provider satisfies all requirements set forth in this bulletin, including in Appendix A, and any applicable program-specific bulletin;
  • the provider delivers those services in accordance with all applicable laws and regulations (including M.G.L. c. 118E, § 79 and MassHealth program regulations); and
  • the provider is appropriately licensed or credentialed to deliver those services.

MassHealth will continue to monitor telehealth’s impacts on quality of care, cost of care, patient and provider experience, and health equity to inform the continued monitoring and iteration of its telehealth policy. Based on the results of this monitoring, and its analysis of relevant data and information, MassHealth may adjust its coverage policy, including by imposing limitations on the use of certain telehealth modalities for various covered services or provider types.

As under All Provider Bulletin 355, MassHealth has deemed these following categories of service ineligible for delivery via any telehealth modality.

  • Ambulance Services
  • Ambulatory Surgery Services
  • Anesthesia Services
  • Certified Registered Nurse
  • Anesthetist Services
  • Chiropractic Services
  • Hearing Aid Services
  • Inpatient Hospital Services1
  • Laboratory Services
  • Nursing Facility Services
  • Orthotic Services
  • Personal Care Services
  • Prosthetic Services
  • Renal Dialysis Clinic Services
  • Surgery Services
  • Transportation Services
  • X-Ray/Radiology Services

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2024).

Asynchronous teledentistry is in a list of eligible service codes.

SOURCE: MA 101 CMR 314. 05. (Accessed Apr. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2024).

READ LESS

Michigan

Last updated 01/16/2024

POLICY

The Michigan Department of Health and Human Services (MDHHS) …

POLICY

The Michigan Department of Health and Human Services (MDHHS) covers both synchronous (real-time interactions) and asynchronous (over separate periods of time) telemedicine services. MDHHS requires that all telemedicine policy provisions within this policy and other current policy are established and maintained within all telemedicine services.

Asynchronous telemedicine services include the transmission of a beneficiary’s medical or other personally identifiable information through a secure, Health Insurance Portability and Accountability Act (HIPAA)-compliant, electronic communications system to a provider, often a specialist, at a distant site without the beneficiary present. Such communications, including store and forward services, interprofessional telephone/Internet/electronic health record consultations, and RPM services, involve contact between two parties (beneficiary to provider or provider to provider) in a way that does not require real-time interaction. Services must be medically necessary or essential for behavioral health and part of a provider-directed treatment plan.

Asynchronous telemedicine services must be performed under the general or direct supervision of a Medicaid-enrolled physician or practitioner who has an active role in the management of the beneficiary’s physical and/or behavioral health. The analysis and interpretation of the beneficiary’s data must contribute to the development and/or monitoring of the beneficiary’s treatment plan. Asynchronous telemedicine services do not include telephone calls, images transmitted via facsimile machines, and text messages without visualization of the beneficiary. Photographs visualized by a telecommunications system must be specific to the beneficiary’s physical and/or behavioral health condition and adequate for furnishing or confirming a diagnosis and/or treatment plan.

Asynchronous telemedicine services generally may not be separately reported on the same day the beneficiary presents for an evaluation and management (E/M) or other related service to the same provider. These services are typically considered part of the E/M or other related service and are not separately reimbursed. Activities performed in the facility setting under the general or direct supervision of the provider are bundled with the facility services on the UB-04 claim form and cannot be reported on the CMS 1500 claim form or billed under the provider’s National Provider Identifier (NPI).

Store and forward services are asynchronous electronic transmissions of physical and/or behavioral health information from the beneficiary to a Medicaid-enrolled physician or practitioner at the distant site when video or face-to-face contact is not necessary. Information transmitted to the provider is analyzed and used in the diagnosis, development, or maintenance of an individualized treatment plan. Information may include, but is not limited to, digital images, documents, video clips, still images, x-rays, magnetic resonance images (MRIs), electrocardiograms (EKGs) and electroencephalograms (EEGs), and audio clips.

Store and forward services include interpretation and follow-up with the beneficiary. Services must not originate from or result in a related E/M service.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2139 & 2143-2144, Jan. 1, 2024 & Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 (Accessed Jan. 2024).

Asynchronous telemedicine service codes are listed on the corresponding provider specific fee schedules. Additional program-specific coverage will be represented on individual program fee schedules and will be indicated in the program-specific sections below as indicated.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2146 Jan. 1, 2024, (Accessed Jan. 2024).

In accordance with Section 16284 of Public Act No. 359 of 2016, telemedicine services, including asynchronous telemedicine, must be provided only with direct or indirect beneficiary consent and this consent must be properly documented in the beneficiary’s medical record in accordance with applicable standards of practice.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2144, Jan. 1, 2024 & Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Jan. 2024).

Interprofessional consultations (including eConsults), are defined as a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating provider (e.g., attending or primary) requests the opinion and/or treatment advice of a Medicaid-enrolled consulting provider with the specialty expertise to assist in the diagnosis and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consulting provider. The service must be for the direct benefit of the beneficiary, directly relevant to the individual beneficiary’s original evaluation, diagnosis, and/or treatment, and must conclude with a written report from the consulting provider to the treating provider.

The beneficiary for whom the service is requested may be either a new or established patient to the consulting provider. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology reports, is included in the service and should not be separately reported. The written or verbal request for the consultation must be documented in the beneficiary’s medical record by the treating provider. Additional documentation requirements (within the medical record of the beneficiary) include date of service; name of provider agency or person providing the service; nature, extent, or units of service; and the place of service, along with all record keeping requirements as outlined in the MDHHS Medicaid Provider Manual.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2144, Jan. 1, 2024 (Accessed Jan. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Telemedicine must only be utilized when there is a clinical benefit to the beneficiary. Examples of clinical benefit include:

  • Ability to diagnose a medical condition in a patient population without access to clinically appropriate in-person diagnostic services.
  • Treatment option for a beneficiary population without access to clinically appropriate in-person treatment options.
  • Decreased rate of subsequent diagnostic or therapeutic interventions (for example, due to reduced rate of recurrence of the disease process).
  • Decreased number of future hospitalizations or physician visits.
  • More rapid beneficial resolution of the disease process treatment.
  • Decreased pain, bleeding, or another quantifiable symptom.

Furthermore, telemedicine must only be utilized when the beneficiary’s goals for the visit can be adequately accomplished, there exists reasonable certainty of the beneficiary’s ability to effectively utilize the technology, and the beneficiary’s comfort with the nature of the visit is ensured. Telemedicine must be used as appropriate regarding the best interests/preferences of the beneficiary and not merely for provider ease. Appropriate guidance must be provided to the beneficiary to ensure they are prepared and understand all steps to effectively utilize the technology prior to the first visit. Beneficiary consent must be obtained prior to service provision (see policy for “Consent for Telemedicine Services” in MSA 20-09 for further information).

As standard practice, in-person visits are the preferred method of service delivery; however, in cases where this option is not available or in-person services are not ideal or are challenging for the beneficiary, telemedicine may be used as a complement to in-person services. Telemedicine services cannot be continued indefinitely for a given beneficiary without reasonably frequent and periodic in-person evaluations of the beneficiary by the provider to personally reassess and update the beneficiary’s medical treatment/history, effectiveness of treatment modalities, and current medical/behavioral condition and/or treatment plan. Applicable beneficiary records must contain documentation regarding the reason for the use of telemedicine and the steps taken to ensure the beneficiary was provided utilization guidance in an appropriate manner.

In special situations, depending upon the needs of the beneficiary, providers may opt to deliver the majority of services via telemedicine. If this situation occurs, it must be documented in the beneficiary’s record or in their individual plan of service (IPOS). This situation should be the exception, not the norm. (Refer to the program-specific subsections of this policy for specific guidance regarding this benefit.)

All services provided via telemedicine must meet all the quality and specifications as would be if performed in-person. Furthermore, if while participating in the visit the desired goals of the beneficiary and/or the provider are not being accomplished, either party must be provided the opportunity to stop the visit and schedule an in-person visit instead (refer to the “Contingency Plan” section of bulletin MSA 20-09 for such instances). This follow-up visit must be provided within a reasonable time and be as easy as possible to schedule.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2141-2142 Jan. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023 (Accessed Jan. 2024).

Allowable telemedicine services for synchronous telemedicine are listed on the telemedicine fee schedules which can be accessed on the MDHHS website at www.michigan.gov/medicaidproviders >> Billing and Reimbursement >> Provider Specific Information. Asynchronous telemedicine service codes are listed on the corresponding provider specific fee schedules. Additional program-specific coverage will be represented on individual program fee schedules and will be indicated in the program-specific sections below as indicated.

Covered asynchronous telemedicine services (as defined above, represented on corresponding fee schedules, and outlined in bulletin MSA 21-24 – Asynchronous Telemedicine Services) should be billed with applicable POS and modifiers as standard practice.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Jan. 2024).

Covered asynchronous telemedicine services must be billed with applicable POS and modifiers as standard practice.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2147, Jan. 1, 2024, (Accessed Jan. 2024).

The beneficiary for whom the service is requested may be either a new or established patient to the consulting provider. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology reports, is included in the service and should not be separately reported. The written or verbal request for the consultation must be documented in the beneficiary’s medical record by the treating provider. Additional documentation requirements (within the medical record of the beneficiary) include date of service; name of provider agency or person providing the service; nature, extent, or units of service; and the place of service, along with all record keeping requirements as outlined in the MDHHS Medicaid Provider Manual. Providers must also consult with the American Medical Association (AMA) coding guidelines to ensure appropriate reporting of these services. Providers should not report interprofessional telephone/Internet/electronic health record consultations when the sole purpose of the communication is to arrange a transfer of care or other face-to-face service.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2144, Jan. 1, 2024 (Accessed Jan. 2024).

Healthy Michigan Plan – Diabetes Prevention Program (MiDPP)

Sessions may take place in the following modalities and make-up sessions are encouraged:

  • In-person
  • Distance Learning (synchronous audio-visual or audio-only telemedicine): Lifestyle coaches deliver sessions where the coach is present in one location and participants are participating from another location. Claims for an audio-only session must include the appropriate procedure code, place of service code and modifier 93 and claims for an audio-visual session must include the appropriate procedure code, place of service code and modifier 95.
  • Online: An asynchronous mode of delivery where participants log into course sessions via a computer, tablet, or smart phone. Per CDC requirements, MiDPP lifestyle coach interaction (in person or via synchronous telemedicine) is required and must be no less than once per week during the first six months and once per month during the second six months.

When billing for a telemedicine session, synchronous or asynchronous, MiDPP providers are expected to adhere to current MDHHS telemedicine policy and modifiers. Refer to the Michigan Medicaid Telemedicine Fee schedule for the list of current codes acceptable for MiDPP telemedicine claims. Claims for an asynchronous session must include the appropriate procedure code and the following remark: “Service provided via an asynchronous telemedicine platform”.

SOURCE: MI Bulletin MMP 23-33, Michigan Diabetes Prevention Program (MiDPP), July 1, 2023, (Accessed Jan. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Minnesota

Last updated 02/29/2024

POLICY

“Telehealth” means the delivery of health care services or …

POLICY

“Telehealth” means the delivery of health care services or consultations using real-time two-way interactive audio and visual communication or accessible telehealth video-based platforms to provide or support health care delivery and facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient’s health care. Telehealth includes: the application of secure video conferencing consisting of a real-time, full-motion synchronized video; store-and-forward technology; and synchronous interactions, between a patient located at an originating site and a health care provider located at a distant site. Telehealth does not include communication between health care providers, or between a health care provider and a patient that consists solely of an audio-only communication, email, or facsimile transmission or as specified by law

SOURCE: MN Statute Sec. 256B.0625 Subd. 3b(e)(1).   (Accessed Feb. 2024).

MHCP allows payment for store-and-forward.

Store-and-forward is the asynchronous electronic transfer or transmission of a patient’s medical information or data from the originating site to a distant site for purposes of diagnostic and therapeutic assistance in the care of the patient. 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.

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

Place of service 02 (newly redefined): Telehealth provided other than the patient’s home. It’s the location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related service through telecommunication technology.

Place of service 10 (new place of service): Telehealth provided in patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.

When reporting a service with place of service 02 or 10, you are certifying that you are rendering services to a patient located in an eligible originating site via an interactive audio and visual telecommunications system.

All other telehealth modifiers: All the other telehealth modifiers (GT, GQ, GO, 95) can be used for informational purposes but will not be required. The telehealth place of service codes explain that the service is rendered through telehealth. No telehealth modifiers can be used without place of service 02 or 10 or the claim will deny.

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), As revised Nov. 8, 2023 &MN Dept. of Human Services, Provider Manual, Telehealth Services, As revised Jun. 2, 2023. (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

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

In addition to other requirements, refer to the following general telehealth information:

  • Out-of-state coverage policy applies to services provided via telehealth
  • Payment will be made for only one reading or interpretation of diagnostic tests such as X-rays lab tests and diagnostic assessments

SOURCE: MN Dept. of Human Services, Provider Manual, Physician and Professional Services (Telehealth), Nov. 8, 2023, (Accessed Feb. 2024).

Rehabilitation Services

MHCP allows payment for expanded telehealth services, including some rehabilitation services that are normally conducted face-to-face.  Physical and occupational therapists, speech-language pathologists and audiologists may use telehealth to deliver certain covered rehabilitation therapy services that they can appropriately deliver via telehealth. 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 telehealth services, use place-of-service code 02 to certify that the services meets the telehealth 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 telehealth policy by completing the “Provider Assurance Statement for Telehealth”.

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

MHCP allows payment for the following services:

Store and Forward”: Transmission of medical information in a way that it is stored to be reviewed later by a physician or practitioner at the distant site (known as asynchronous transmission). 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” services substitute for an interactive encounter with the patient present; the patient is not present in real-time.

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 telehealth must follow the same supervision policy as indicated in “Rehabilitation Service Practitioners”.  There are no specific authorized distant sites or restrictions, but providers must ensure a secure transmission that meets HIPAA requirements. See manual for documentation requirements.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Rehabilitation Svcs. Jan. 25, 2022 (Accessed Feb. 2024).

Store-and-Forward Telemedicine for IEP Services

MHCP will allow Minnesota public schools enrolled to provide Individualized Education Program (IEP) services and also approved to provide telehealth services, to use store-and-forward telehealth when a child is distance learning at home for the following services:

  • Physical therapy
  • Occupational therapy
  • Speech language therapy

Store-and-forward telehealth is asynchronous, non-real-time communications. Service providers and members transfer data from one site to another via camera or similar device that records (stores) an image and forwards it by telecommunications to another site for consultation. It can be used to support health care delivery, including sending and receiving health-related instructions, activities, or tasks that are identified in the child’s Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP). Real-time, two-way interactive video with the school professional and child or parent must accompany the store-and-forward telehealth components.

Use the store-and-forward method only when a child is distance learning at home. When a child is attending school in person, the school must provide IEP services either in person, or via two-way, interactive video conference.

IEP nursing services, special transportation, assistive technology and personal care assistance (PCA) services are not eligible for store-and-forward telehealth.

Use place of service 10 on claims to indicate when the child receives the health-related service via telecommunication technology in the child’s home. This is a location other than a hospital or other facility where the child receives care in a private residence.

Use place of service 02 on claims to indicate when the child receives the health-related service via telecommunication technology when the child is in a location other than a child’s home.

SOURCE: MN Dept. of Human Svcs., Provider Manual, IEP Services, As revised May 19, 2022 (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

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

Consultations performed by providers who are not located in Minnesota and contiguous counties require authorization prior to the service being provided.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Dental Svcs. Jan. 16, 2024 (Accessed Feb. 2024).

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. Jan. 25, 2022 (Accessed Feb. 2024).


TRANSMISSION FEE

MHCP does not pay an originating site facility fee. Services billed on an outpatient claim with the GQ modifier will pay zero.

SOURCE: MN Dept. of Human Services, Physician and Professional Services (Telehealth), Nov. 8, 2023. (Accessed Feb. 2024).

 

READ LESS

Mississippi

Last updated 04/05/2024

POLICY

Policy applies to Private payers, MS Medicaid and employee

POLICY

Policy applies to Private payers, MS Medicaid and employee benefit plans

“Store-and-forward telemedicine services” means the use of asynchronous computer-based communication between a patient and a consulting provider or a referring health care provider and a medical specialist at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients who otherwise have no access to specialty care. Store-and-forward telemedicine services involve the transferring of medical data from one (1) 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.

Store-and-forward telemedicine services allow a health care provider trained and licensed in his or her given specialty to review forwarded images and patient history in order to provide diagnostic and therapeutic assistance in the care of the patient without the patient being present in real time. Treatment recommendations made via electronic means shall be held to the same standards of appropriate practice as those in traditional provider-patient setting.

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.

Any patient receiving medical care by store-and-forward telemedicine services shall be notified of the right to receive interactive communication with the distant specialist health care provider and shall receive an interactive communication with the distant specialist upon request. If requested, communication with the distant specialist may occur at the time of the consultation or within thirty (30) days of the patient’s notification of the request of the consultation. Telemedicine networks unable to offer the interactive consultation shall not be reimbursed for store-and-forward telemedicine services.

All health insurance and employee benefit plans in this state must provide coverage and reimbursement for the asynchronous telemedicine services of store-and-forward telemedicine services and remote patient monitoring services based on the criteria set out in this section. Store-and-forward telemedicine services shall be reimbursed to the same extent that the services would be covered if they were provided through in-person consultation.

Health care providers seeking reimbursement for store-and-forward telemedicine services must be licensed Mississippi providers that are affiliated with an established Mississippi health care facility in order to qualify for reimbursement of telemedicine services in the state. If a service is not available in Mississippi, then a health insurance or employee benefit plan may decide to allow a non-Mississippi-based provider who is licensed to practice in Mississippi reimbursement for those services.

A health insurance or employee benefit plan may charge a deductible, co-payment, or coinsurance for a health care service provided through store-and-forward telemedicine services or remote patient monitoring services so long as it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation.

In a claim for the services provided, the appropriate procedure code for the covered service shall be included with the appropriate modifier indicating telemedicine services were used. A “GQ” modifier is required for asynchronous telemedicine services such as store-and-forward and remote patient monitoring.

SOURCE: MS Code Sec. 83-9-353. (Accessed Apr. 2024).

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 Apr. 2024).

There is reimbursement for teleradiology 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 Apr. 2024).

“Store-and-Forward Transfer Technology” is defined as technology which facilitates the gathering of data from the patient, via secure email or messaging service, which is then used for formulation of a diagnosis and treatment plan, also known as ‘asynchronous communication.’

SOURCE: MS Admin Code Agency 30 Part 2635, Ch. 5 Rule 5.1. (Accessed Apr. 2024). 


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 Apr. 2024).


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 Apr. 2024).


TRANSMISSION FEE

A fee per completed transmission for telehealth services provided by the RHC acting as an originating site provider. 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 in effect as of January 1, 2021.

SOURCE: MS Admin. Code Title 23, Part 211, Rule 1.5 (Accessed Apr. 2024).

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 Apr. 2024).

READ LESS

Missouri

Last updated 01/20/2024

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 Jan. 2024).

Asynchronous store-and-forward shall mean the transfer of a participant’s clinically important digital samples, such as still images, videos, audio, text files, and relevant data from an originating site through the use of a camera or similar recording device that stores digital samples that are forwarded via telecommunication to a distant site for consultation by a consulting provider without requiring the simultaneous presence of the participant and the participant’s treating provider.

  • Asynchronous store-and-forward technology shall mean cameras or other recording devices that store images which may be forwarded via telecommunication devices at a later time.
  • Asynchronous store-and-forward transfer shall mean the collection of a participant’s relevant health information and the subsequent transmission of that information from an originating site to a provider at a distant site without the participant being present.

Distant site shall mean a telemedicine site where the health care provider providing the telemedicine service is physically located.

Originating site shall mean a telemedicine site where the MO HealthNet participant receives the telemedicine service. Originating sites include, but are not necessarily limited to health care provider facilities, participants’ homes, and schools. For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location from which the referring provider transfers information to the distant site.

Licensed health care provider-patient relationship shall mean that a health care provider licensed under Chapter 334, RSMo, and/or other providers utilizing telemedicine, shall ensure that a properly established provider-patient relationship exists with the participant who receives telemedicine services.

Telemedicine shall mean the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.

Health care professional shall mean a physician or other health care practitioner licensed, accredited, or certified by the state of Missouri to perform specified health services consistent with state law.

Health care provider or provider shall mean a health care professional or a health care facility.

Health care service shall mean a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease, including but not limited to the provision of drugs or durable medical equipment.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(1), (Accessed Jan. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

MHD covers teledentistry services for participants under the age of 21, blind, pregnant or in a SNF. This benefit allows any licensed dental provider, enrolled with MO HealthNet, to provide teledentistry services if the services are within the scope of practice for which the dental provider is licensed. Teledentistry services must be performed with the same standard of care as an in-person, face-to-face service.

Prior to the delivery of teledentistry services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via teledentistry in the school for the remainder of the school year.

The MO HealthNet Dental Program allows reimbursement for CDT codes D9995 (Synchronous; real time encounter) and D9996 (Asynchronous; information stored and forwarded to dentist for subsequent review).

Teledentistry services must be billed by the distant site facility (physical location of the dentist or clinic providing the dental service to an eligible Medicaid participant through teledentistry). Dentists must bill either D9995 or D9996 and the CDT code(s) for services provided. Reimbursement to dental providers delivering the service at the distant site is equal to the current fee schedule amount for the service provided. There is not a separate teledentistry fee schedule. The originating site (physical location of the participant) is where diagnostic data is collected to be communicated to an off-site dentist for diagnosis or where a dental service is performed. The originating site cannot bill MHD for CDT codes D9995 or D9996. The originating site can bill procedure code Q3014 on the CMS-1500 claim form to receive reimbursement for use of the facility where teledentistry services were rendered. The distant site service must be billed on the 2019 ADA Dental Claim Form with the CDT code (D9995 or D9996) and any additional services provided, using place of service code 02 – Telehealth.

Health care service shall mean a service for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease, including but not limited to the provision of drugs or durable medical equipment.

A telemedicine service shall be covered only if it is medically necessary.

A telemedicine service must be performed with the same standard of care as an in-person, face-to-face service. If the same standard of care cannot be met, a telemedicine service shall not be provided.

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(B)(8) & (3), (Accessed Jan. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Montana

Last updated 02/13/2024

POLICY

Telehealth services may be provided using secure portal messaging, …

POLICY

Telehealth services may be provided using secure portal messaging, secure instant messaging, telephone communication, or audiovisual communication.

SOURCE: Montana Code Annotated 53-6-122 (Accessed Feb. 2024).

All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable if the services:

  • Are medically necessary and clinically appropriate for delivery via telemedicine/telehealth;
  • Follow the guidelines set forth in the applicable Montana Healthcare Programs provider manual; and
  • Are not a service specifically required to be face-to-face as defined in the applicable Montana Healthcare Programs provider manual.

There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.

Rates of payment for services delivered via telemedicine/telehealth will be the same as rates of payment for services delivered via traditional (e.g., in-person) methods set forth in the applicable regulations. Please refer to the fee schedules posted on the Provider Information website for current rates.

SOURCE:  MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Feb. 2024).

Despite the above more recent guidance, the General Information for Providers Telemedicine Manual still seems to restrict store-and-forward coverage based upon how it defines telehealth.

Distant site – Distance providers should submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with the GT modifier (interactive communication). Effective January 1, 2017, providers must also use the telehealth place of service of 02 for claims submitted on a CMS-1500 claim. By coding with the GT modifier and the 02 place of service, the provider is certifying that the service was a face-to-face visit provided via interactive audio-video telemedicine.

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Nebraska

Last updated 04/10/2024

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 Apr. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Nebraska Medicaid will reimburse for teleradiology 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  (Accessed Apr. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Nevada

Last updated 03/26/2024

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.

The DHCFP reimburses for services delivered via asynchronous telehealth, however, these services are not eligible for originating site facility fees.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, (Nov. 28, 2023). (Accessed Mar. 2024).


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, p. 1 & Section 3403.4, (Nov. 28, 2023). (Accessed Mar. 2024).

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. 2 (2/22/23). (Accessed Mar. 2024).

READ LESS

New Hampshire

Last updated 03/29/2024

POLICY

“Store and forward,” means “store and forward” as defined …

POLICY

“Store and forward,” means “store and forward” as defined in RSA 167:4-d, II(f) namely, “as it pertains to telemedicine and as an exception to 42 C.F.R. section 410.78, 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”.

Medical providers described in He-C 5004.03(a) above, shall be permitted to perform health care services through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media.

Payment for store and forward and remote patient monitoring shall only be available as funding and resources within the current state fiscal year are available.

Source: NH Admin Rules, HE-C 5004.01, 03, & .13 (Accessed Mar. 2024).

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 Mar. 2024).

Medicaid covers services delivered via telehealth, as well as remote patient monitoring and store and forward services.

SOURCE: NH Medicaid, General Billing Manual, Oct. 2023, (Accessed Mar. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

New Jersey

Last updated 02/02/2023

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 Feb. 2024).

The State Medicaid and NJ FamilyCare programs shall provide coverage and payment for health care services delivered to a benefits recipient through 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 the services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered when delivered through in-person contact and consultation in New Jersey.  Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate.

The State Medicaid and NJ FamilyCare programs may limit coverage to services that are delivered by participating health care providers, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.

In no case shall the State Medicaid and NJ FamilyCare Programs:

  • Restrict the ability of a provider to use any electronic or technical platform to provide services using telemedicine or telehealth, including but no limited to interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:
    • Allows the provider to meet the same standard of care as would be provided if the services were provided in person’
    • Is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164.

SOURCE: NJ Statute C.30:4D-6K. (Accessed Feb. 2024). 

Asynchronous store-and-forward means the acquisition and transmission of images, diagnostics, data, and medical information either to, or from, an originating site or to, or from, the health care provider at a distant site, which allows for the patient to be evaluated without being physically present.

SOURCE: NJ Statute C.30:4D-6K(e) – cites: NJ Statute C.45:1-61. (Accessed Feb. 2024).


ELIGIBLE SERVICES

No reference found.


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

New Mexico

Last updated 02/26/2024

POLICY

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

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 consultants that do not require face-to-face live encounter between patient and telemedicine provider.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Feb. 2024).

Applied Behavior Analysis

If members of the Family Set cannot face-to-face attend the recipient’s sessions, then other opportunities must be explored, such as the members of the Family Set participating via telemedicine (in real-time or through store-and-forward means).

Store-and-Forward telemedicine does not occur in real time (asynchronous) and does not require a F2F live encounter with the eligible recipient and the Mentored BA/Mentored BA/BAA/RBT/BCAT and the BA/Mentored BA/Supervising BAA. This technology allows through the transference of digital images, sounds, or previously recorded video sent from the onsite practitioner to the BA/Mentored BA/Supervising BAA to obtain information, analyze it, and report back to the onsite practitioner during their T1026 UD Case Supervision.

SOURCE: NM Medicaid Manual, Applied Behavior Analysis Guidance Supplement, pg. 26, 35. (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

New York

Last updated 03/11/2024

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.

Store-and-forward technology aids in diagnoses when live video contact is not readily available or not necessary. 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. 39, Number 3, February 2023 (Special Edition), p. 4. (Accessed Mar. 2024).

Reimbursement will be made to the consulting distant-site practitioner when billed with an appropriate procedure code. The consulting distant-site practitioner must provide the requesting originating-site practitioner with a written report of the consultation in order for payment to be made. The consulting practitioner should bill the CPT code for the professional service appended with the telehealth GQ modifier.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023 (Special Edition), p. 11. (Accessed Mar. 2024).

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

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc. (Accessed Mar. 2024).

Reimbursement for consultations provided via store and forward technology will be paid at 75% of the Medicaid fee for the service provided.

SOURCE: NYS Medicaid Telehealth. Dec. 2023. (Accessed Mar. 2024).

Recently Effective Regulations

“eConsults” means the asynchronous or synchronous, consultative, provider-to-provider assessment and management services conducted through telephone, internet, or electronic health records.

“Virtual Check-in” means a brief communication via a secure, technology-based service initiated by the patient or patient’s guardian/caregiver, e.g., virtual check-in by a physician or other qualified healthcare professional.

“Virtual Patient Education” means education and training for patient self-management by a qualified health care professional via telehealth.

Payment for telehealth services shall be made in accordance with section 538.3 of this Part only if the provision of such services appropriately reduces the need for on-site or in-office visits and the following standards are met:

  •  “eConsults” are intended to improve access to specialty expertise through consultations between consulting providers and treating providers. eConsults are reimbursable when the providers meet minimum time and billing requirements, as determined and specified by the commissioner in administrative guidance.
  • “Virtual Check-in” visits are intended to be used for brief medical discussions or electronic communications between a provider and a new or established patient, at the patient’s request. Virtual check-ins are reimbursable when the provider meets certain billing requirements, as determined and specified by the commissioner in administrative guidance.
  • “Virtual Patient Education” delivers health education to patients, their families, or caregivers, and is reimbursable only for services that are otherwise reimbursable when delivered in person and when the provider meets certain billing requirements, as determined and specified by the commissioner in administrative guidance

As required by Social Services Law § 367-u and, except for services paid by State only funds, contingent upon federal financial participation, reimbursement shall be made in accordance with fees determined by the commissioner based on and benchmarked to in-person fees for equivalent or similar services. Reimbursement shall not be made for services that do not warrant separate reimbursement as identified by the department during fraud, waste and abuse detection efforts. The department reserves the right to request additional documentation and deny payment for services deemed duplicative or included in a primary service. Any potential fraud, waste, or abuse, identified through claims monitoring or any other source, will be referred to the Office of Medicaid Inspector General.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538, as added by Final rule per Notice Of Adoption. (Accessed Mar. 2024).

Virtual Check-In

Virtual check-ins are brief medical interactions between a physician or other qualified health care professional and a patient. Virtual check-ins may be especially helpful for patients with ongoing chronic conditions that would benefit from recurring check-ins with their provider. A virtual check-in can be conducted via several technology-based modalities, including communication by telephone or by secure text-based messaging, such as electronic interactions via patient portal, secure email, or secure text messaging. Communication must be Health Insurance Portability and Accountability Act (HIPAA)-compliant and don’t relate to an Evaluation and Management (E&M) visit the patient had within the past seven days, nor lead to a related E&M visit within 24 hours (see “VII. Billing Rules for Telehealth Services” on page 8 of this issue for specific information on code and modifiers).

Virtual Patient Education

Virtual patient education means education and training for patient self-management by a qualified health care professional via telehealth. Virtual patient education delivers health education to patients, their families, or caregivers, and is reimbursable only for services that are otherwise reimbursable when delivered in-person and when the provider meets certain billing requirements.

The National Diabetes Prevention Program (NDPP) is reimbursable when provided as a live/synchronous program (using code “0403T”) and is now also reimbursable when provided as an on-demand/asynchronous program (using code “0488T”). NDPPs must meet Centers for Disease Control and Prevention (CDC) requirements and adhere to previously published guidance.

Virtual eTriage

In accordance with The CMS Emergency Triage, Treat, and Transport Model with the Department of Health Parallel Model article published in the November 2021 issue of the Medicaid Update, authorized ambulance services responding to 911 calls may facilitate telehealth encounters where appropriate when providing “treatment in place”. The visit should be reported by both the ambulance service [as an Emergency Triage, Treat, and Transport (ET3) claim] and the telehealth provider (as a telehealth claim). This model mirrors the Centers for Medicare and Medicaid Services (CMS) ET3 Model and will only be allowable while the CMS program is active, and only to ambulance services participating in the national model. The CMS ET3 program is scheduled to end December 31, 2023. A future Medicaid Update issue regarding treatment in place and alternative destinations will provide additional guidance for ambulance providers.

eConsults (Interprofessional Consultations)

eConsults, or interprofessional consultations between a treating/requesting provider and a consulting provider, are intended to improve access to specialty expertise by assisting the treating practitioner with the care of the patient without patient contact with the consulting practitioner.

eVisits

eVisits are patient-initiated communications with a medical provider through a text-based and HIPAA-compliant digital platform, such as a patient portal. eVisits are a type of Virtual Check-In which occur through asynchronous communication; the exchange is neither real-time nor face-to-face. They are intended to remotely assess non-urgent conditions and prevent unnecessary in-person visits. Coverage of eVisits reimburses providers for the problem-focused communication and medical decision-making conducted outside of their normal visits.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023 (Special Edition), p. 5-6. (Accessed Mar. 2024).

Effective October 1, 2023, the New York State (NYS) Medicaid Fee-for-Service (FFS) program will reimburse for eVisits. eVisits are a type of Virtual Check-In involving patient-initiated communications with a medical provider through a text-based and Health Insurance Portability and Accountability Act (HIPAA)-compliant digital platform, such as a patient portal. eVisits occur through asynchronous communication; the exchange is neither real-time nor face-to-face. Additional detail on telehealth modalities can be found in the February 2023 Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency Special Edition issue of the Medicaid Update. They are intended to remotely assess non-urgent conditions and prevent unnecessary in-person visits. Coverage of eVisits reimburses providers for the problem-focused communication and medical decision-making they do outside of normal visits.

eVisits may be provided to established patients only (though the presenting problem may be new). The patient must initiate the communication and the problem must require a physician or other qualified practitioner’s professional’s evaluation, assessment, and management. Claims for eVisits may not be submitted for contact initiated by the provider, whether individualized or as part of an outreach program. Communication of test results, scheduling appointments, medication refills, and any other communications outside the scope of evaluation and management are not considered eVisits.

Billing for eVisits is based on cumulative time spent with a single patient within a seven-day period. For example, if five to ten minutes are spent with a single patient for an eVisit over a seven-day period, procedure code “99421” may be billed (see table in Medicaid Update). For an encounter to qualify as an eVisit, the patient must not have been seen for the same clinical issue within the previous seven days.

See NY Medicaid Update for additional billing information, patient consent and documentation requirements and rates.

SOURCE: Medicaid Update Vol. 39, No. 13, Aug. 2023. (Accessed Mar. 2024).

eConsults

Effective April 1, 2024, the New York State (NYS) Medicaid fee-for-service (FFS) program will reimburse for eConsults. Medicaid Managed Care (MMC) Plans must comply with this coverage, effective June 1, 2024. eConsults, also known as electronic consultations or interprofessional consultations between a treating/requesting provider and a consultative provider [physicians (including psychiatrists), physician assistants (PAs), nurse practitioners (NPs), midwives (MWs)], are intended to improve access to specialty expertise by assisting the treating/requesting provider with the care of the patient without patient contact with the consultative provider.

The purpose of an eConsult is to answer patient-specific treatment questions in which a consultative provider can reasonably answer from information in the request for consultation and the electronic health record, without an inperson visit. The consultative provider should respond to the eConsult request within three business days. The response should include recommendations, rationale and may include contingencies that warrant a re-consult or referral. eConsults may not be appropriate for cases that involve complex decision-making and urgent medical decision-making.

eConsults cannot be used to arrange a referral for an in-person visit. They may be used for patients with or without an existing relationship with the consultative provider. For patients with an existing relationship with the consultative provider, eConsults may be used upon presentation of a new problem where management of the patient can be reasonably carried out by the practitioner seeking the consultation.

eConsults must be performed through electronic communication between the treating/requesting provider and the consultative provider. The complete record of the consult must be documented in the patient chart.

Both the treating/ requesting provider and the consultative provider can bill for the eConsult. To bill NYS Medicaid for eConsults, the provider must be enrolled in NYS Medicaid. Both the treating/requesting provider and the consultative provider can bill for an eConsult through independent claims. eConsults should be billed using the following CPT codes:

  • 99451 Consultative Provider Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician or other qualified health care professional, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.
  • 99452 Treating/ Requesting Provider Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.

To bill the above CPT codes, providers must meet all elements of the code, adhere to the American Medical Association (AMA) guidelines related to frequency of billing these codes, as well as follow billing restrictions when the eConsult leads to a face-to-face encounter. All NYS Medicaid billing guidelines, including those for practitioner types, apply.

SOURCE: NY State Medicaid Update January 2024 Volume 40, Number 1. (Accessed Mar. 2024).

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.

SOURCE: NY Dental Policy and Procedure Code Manual 2024, page 65 (Accessed Mar. 2024).


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 Mar. 2024).

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 2024, page 65 (Accessed Mar. 2024).

The types of teledental (audio-visual) encounters are synchronous (real time) encounters and asynchronous (Store and Forward) encounters. Synchronous (“D9995”) encounters are live, two-way encounters between a patient or caregiver and provider. By contrast, asynchronous (“D9996”) encounters involve the transmission of recorded health information such as charting, radiographs, digital impressions and video to a dental provider who assesses the information for treatment needs at a later time. For example, a hygienist who is employed by an Article 28 facility and has a collaboration arrangement with a dentist also employed by the same facility, can be in a remote location such as a School-Based Health Center (SBHC). From there the hygienist can perform dental hygiene services for the patient, including gathering information that will be sent to the dentist for further review. The dentist can then review the information at a later time, such as during last-minute cancellations or no-show appointments in their schedule.

When billing for teledentistry services, modifiers cannot be used by dentists. Both dental codes (“D9995” and “D9996”) are allowed to be used in place of modifiers.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 9. (Accessed Mar. 2024).

Telemental Health

The definition of telehealth services excludes store-and-forward since it states that telehealth services must be synchronous.

SOURCE: NY OMH Telehealth Services Guidance for OMH Providers. April 2023, page 5. (Accessed Mar. 2024).


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 2024, page 65 (Accessed Mar. 2024).

READ LESS

North Carolina

Last updated 03/17/2024

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 Patient Communication – 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.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, June 1, 2023. (Accessed Mar. 2024).


ELIGIBLE SERVICES/SPECIALTIES

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.

List of eligible Virtual Communication Services provided on page 13 of Attachment A of the Telehealth, Virtual Communications and Remote Patient Monitoring manual.  FQHCs, FQHC Lookalikes and RHCs are only allowed to bill for Online Digital Evaluation and Management Codes (not Telephonic Evaluation and Management and Virtual Communication Codes OR 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. 2, June 1, 2023. (Accessed Mar. 2024).

Teledentistry

Teledentistry eligible services may be provided to both new and established patients by the eligible providers listed within this policy.

D9996 – Teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review

  • Medicaid enrolled dentists may render provider to provider teledentistry services via asynchronous, store and forward or eConsults
  • Dentist in the distant site must have enough information and evidence to make a diagnosis
  • Must be billed with oral evaluation codes D0140 or D0170
  • Reported in addition to other procedures delivered on the same date of service
  • Dental treatment rendered through teledentistry must be documented in the beneficiary record including the date/time/duration of encounter, reasons for the encounter, technology used, records reviewed, diagnosis, and treatment recommendations
  • Limited to once per recipient, per provider for a one-week period
  • Limited to four teledentistry services (D9995 or D9996) in a six-month period
  • The originating site is the facility in which the beneficiary is located
  • The distant site is the facility from which the provider furnishes the teledentistry service
  • All services sites/providers must be Medicaid enrolled
  • Consultation must take place by an encrypted telecommunications system
  • Enter “02” (Telehealth) as the place of treatment for teledentistry claims

SOURCE: NC Medicaid Clinical Coverage Policy 4A: Dental Services, Dec. 15, 2023, (Accessed Mar. 2024).


GEOGRAPHIC LIMITS

There are no restrictions on the 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, June 1, 2023. (Accessed Mar. 2024).


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. 

Skilled nursing facilities (SNF) shall not bill an originating site facility fee when the SNF Medical Director or a beneficiary’s attending physician is conducting a telehealth visit. 

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, June 1, 2023. (Accessed Mar. 2024).

READ LESS

North Dakota

Last updated 11/15/2023

POLICY

Digital Health consists of online digital evaluation and management …

POLICY

Digital Health consists of online digital evaluation and management (E/M) services which are patient-initiated services with health care professionals. These are not real time services. Patients initiate services through HIPAA-compliant secure platforms which allow digital communication with the health care professional. Online digital evaluation and management services are for established patients only. These services do not include nonevaluative electronic communications of test results, scheduling of appointments, or other communication that does not include evaluation and
management.

SOURCE: ND Div. of Medical Assistance, Telehealth, (Jan. 2024), (Accessed Feb. 2024).

Teledentistry

Asynchronous (store-and-forward) teledentistry (D9996) is the transmission of recorded health information (i.e., radiographs, photographs, digital impressions) through a HIPAA compliant electronic communications system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.

SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Feb. 2024). & North Dakota Department of Human Services: Teledentistry Policy. (July 2023), (Accessed Feb. 2024).

Medical assistance coverage must include payment for the following services: …

  • Asynchronous teledentistry to reduce barriers to dental care through outreach programs and to integrate oral health into general health care settings to identify and refer treatment needs.

SOURCE: ND Statute Sec. 50-24.1-45 (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Digital Health Evaluation and Management Services

Cumulative online digital evaluation and management (E/M) services occurring within a seven-day period beginning with the health care professional’s review of the patientgenerated inquiry. Included services not separately billable:

  • For the same or a related problem within seven days of a previous E/M service,
  • Related to a surgical procedure occurring within the postoperative period of a previously completed procedure,
  • Any subsequent online communication that does not include a separately reported E/M service.
  • E/M services related to the patient’s inquiry provided by qualified health care professionals in the same group practice.

Separate reimbursement may be allowed for:

  • Online digital inquiries initiated for a new problem within seven days of a previous online digital E/M service.

Permanent documentation storage (electronic or hard copy) of the encounter is required.

Services that are not covered:

  • Store and forward (G2010)
  • Virtual check-in (G2012)
  • Interprofessional Services
  • Digital Assessment and Management Services

SOURCE: ND Div. of Medical Assistance, Telehealth, (Jan. 2024), (Accessed Feb. 2024).

Dentistry

Teledentistry code D9995 or D9996 is required when billing ND Medicaid. Service authorization is not required.  See manual for covered services.

Patient records must include the CDT© Code(s) that reflect the teledentistry encounter. The claim submission must include all applicable CDT© codes. ND Medicaid will reimburse CDT© code D9995 or D9996 once per date of service. Claim submissions must be billed using place of service (POS)/place of treatment codes:

  • 02 Teledentistry provided in a location other than the patient’s home.
  • 10 Telehealth provided in patient’s home.

Claims with any other place of service will be denied.

Non Covered Services

  • Examinations via online/email/electronic communication
  • Patient contact with dentist who provides the consultation using audio means only (no visual component)
  • Virtual check-in

SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Ohio

Last updated 02/16/2024

POLICY

“Telehealth” is the direct delivery of health care services …

POLICY

“Telehealth” is the direct delivery of health care services to a patient related to diagnosis, treatment, and management of a condition.

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

For services rendered by behavioral health providers as defined in rule 5160-27-01 of the Administrative Code, telehealth is further defined in rule 5122-29-31 of the Administrative Code.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022 & OAC 5160-1-18.  (Accessed Feb. 2024).

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 Feb. 2024).


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 7/15/2022, p. 17 (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Oklahoma

Last updated 03/06/2024

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.

“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, nonsecure video conference, or facsimile transmission.

SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Mar. 2024).


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. (Accessed Mar. 2024).

READ LESS

Oregon

Last updated 03/30/2024

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 Revised Statutes Sec.  414.723, (Accessed Mar. 2024).

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

  • Covered interprofessional consultations delivered online, through electronic health records or by telephone (CPT 99446-99449, 99451-99451)

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2024 Prioritized List of Health Services, p. AD-3. (1/22/24). (Accessed Mar. 2024).

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 Mar. 2024).

Teledentistry

Teledentistry can take multiple forms, both synchronous and asynchronous, including but not limited to: …

  • Store and forward, 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 member being present in real time.

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.

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.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Mar. 2024).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this general rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio without video, client or member portal and may include remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and DefinitionsOAR 410-141-3566, Health Systems Division: Medical Assistance, Oregon Health Plan, Telehealth Service and Reimbursement Requirements & OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Mar. 2024).

Communications may be between providers, or between one or more providers and one or more members, family members /caregivers /guardians.

SOURCE:  OAR 410-141-3566, Health Systems Division: Medical Assistance, Oregon Health Plan, Telehealth Service and Reimbursement Requirements & OAR 410-120-1990 Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Mar. 2024.


ELIGIBLE SERVICES/SPECIALTIES

HERC prioritized list indicate interprofessional consultation codes through EHRs are reimbursable.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Jan. 1, 2024 Prioritized List of Health Services, p. AD-3. (1/22/24). (Accessed Mar. 2024).

Teledentistry

Teledentistry includes 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 member being present in real time.

As stated in ORS 679.543 and this rule, 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. (Accessed Mar. 2024).


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 Jan. 1, 2024 Prioritized List of Health Services, p. AD-2. (1/22/24). (Accessed Mar. 2024).

READ LESS

Pennsylvania

Last updated 01/22/2024

POLICY

Telehealth does not include asynchronous or store and forward …

POLICY

Telehealth does not include asynchronous or store and forward technology such as facsimile machines, electronic mail systems, or remote patient monitoring devices. While asynchronous applications are not considered telehealth in the MA Program, they may be utilized as part of a MA covered service, such as a laboratory service, x-ray service or physician service. Telehealth also does not include text messages, although text messages and telephone may continue to be utilized for non-service activities, such as scheduling appointments.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-23-08, p. 4, Aug. 2, 2023 (Accessed Jan. 2024).

In response to CMS’s change in policy, the Department is providing coverage and payment for interprofessional consultation services in the MA Program. Allowing direct payments for interprofessional consultations between providers enrolled in the MA Program improves access to specialty care, supports patient-centered care, and maximizes the capacity of the existing workforce by supporting the focus of medical practice towards managing a beneficiary’s chronic conditions. Services must be directly relevant to the beneficiary’s diagnosis and treatment, and the consulting practitioner must have specialized expertise in the particular health concerns of the beneficiary. Interprofessional consultation services are intended to expand access to specialty care and foster interdisciplinary input on beneficiary care. They are not intended to be a replacement for direct specialty care when such care is clinically indicated.

Technology used for interprofessional consultation services must be real-time interactive telecommunication technology. Asynchronous communication and applications, such as store and forward, may be utilized as a part of the synchronous interprofessional consultation, but by themselves do not meet the requirements for interprofessional consultations. Providers must remain informed on federal and state statutes, regulations, and guidance regarding use of technology to render services.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin Interprofessional Consultation Services, (Dec. 27, 2023) (Accessed Jan. 2024).


ELIGIBLE SERVICES/SPECIALTIES

The MA Program will pay for interprofessional consultation services provided on behalf of a beneficiary between licensed and enrolled MA providers when clinically appropriate.  Interprofessional consultations occur between an initiating treating provider and a consulting provider to benefit the treatment of the beneficiary but without the beneficiary present.  See bulletins for codes eligible for interprofessional consultation services.

The treating provider enrolled in the MA Program who participates in an interprofessional consultation performed at the same time as an office visit is to bill using office visit procedure codes. The treating provider is to bill using procedure code 99452 when participating in a medical consultative discussion outside of an evaluation and management service, which can only be billed once every 14 days.

Consulting providers enrolled in the MA Program are to bill using procedure codes 99446, 99447, 99448, 99449, and 99451 when participating in a medical consultative discussion as the consulting provider. Consulting providers are not to bill for interprofessional consultation services if they have seen the beneficiary in the previous 14 days or if they plan to see the beneficiary in the next 14 days.

Providers who participate in an interprofessional consultation should bill with the POS codes identified in the attachment. Providers should not bill with POS 02 (telehealth provided other than in patient’s home) or POS 10 (telehealth provided in patient’s home) because these POS codes can only be utilized when the MA beneficiary is present.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin Interprofessional Consultation Services, (Dec. 27, 2023) (Accessed Jan. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Puerto Rico

Last updated 03/22/2024

Policy

Asynchronous – The asynchronous Teleconsultation (by email or text …

Policy

Asynchronous – The asynchronous Teleconsultation (by email or text messages) is developed by sending clinical information, and whose advice occurs later.

Source: Telemedicina Y Telesalud. Departamento de Salud. (Accessed Mar. 2024).

Requests for referral to different specialties are received from general practitioners. An expert doctor assesses that the data is complete and sends the results for the review and opinion of the specialist doctor. Asynchronous teleconsultations are carried out by sending clinical information, and subsequent counseling occurs some time later; A clear example of this type is teledermatology, where sometimes dermatological images are sent attached to E-mail to refer consultations or share clinical cases, likewise in pages such as the NHS in England, the patient is advised about the symptoms he presents . One of the biggest advantages of asynchronous teleconsultation, generally called “store-and-forward” is that the parties involved do not have to be present in the transfer of information. Additionally, they have the ability to capture and store static or moving images of the patient, as well as audio and text, which provides greater clinical information that is reflected in the quality of diagnoses. These applications are widely used in teledermatology, teleophthalmology, teleneurology, and otorhinolaryngology, and have the advantage of being inexpensive and ideal for high volume work and tests, as well as audio and text, which provides greater clinical information that is reflected in the quality of diagnoses.

Source: Telemedicina Y Telesalud. Departamento de Salud. (Accessed Mar. 2024).

Eligible Services/Specialties

No reference found.

Geographic Limits

No reference found.

Facility/Transmission Fee

No reference found.

 

READ LESS

Rhode Island

Last updated 02/01/2024

POLICY

Teledentistry Policy 

Teledentistry is not a specific service but …

POLICY

Teledentistry Policy 

Teledentistry is not a specific service but a mode of accomplishing a particular service. Teledentistry may include communication from one dental provider to another. Providers are asked to bill nonpaying codes D9995 (Synchronous teledentistry) and D9996 (Asynchronous teledentistry) for documentation but should use applicable D codes. Frequency limitations for service codes apply. Dentists billing for exams completed by dentistry acknowledge they have received and reviewed essential information to make a diagnosis, comparable to what would be used in an in-person visit.

SOURCE: RI Executive Office of Health and Human Services Medicaid Program, Dental Manual, pg. 11. (Nov 2023). (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

South Carolina

Last updated 02/07/2024

POLICY

G2010 (Remote image submitted by a patient) is listed

POLICY

G2010 (Remote image submitted by a patient) is listed as reimbursed for established patients.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Feb. 2024).

South Carolina Medicaid coverage guidelines appear to exclude reimbursement 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. 34-35 (Feb. 2024). (Accessed Feb. 2024).

Interprofessional Consultation

SCDHHS will reimburse providers for interprofessional consultation services as distinct services under the Medicaid physician fee schedule.

Interprofessional consultation is defined as a situation in which the patient’s treating physician or other qualified health care practitioner (hereafter referred to as the treating practitioner) requests the opinion and/or treatment advice of a physician or other qualified health care practitioner with specific specialty expertise (hereafter referred to as the consulting practitioner) to assist the treating practitioner with the patient’s care.

Interprofessional consultation is intended to expand access to specialty care and foster interdisciplinary input on patient care. It is not intended to be a replacement for direct specialty care when such care is clinically indicated. Reimbursement of interprofessional consultation is permissible, even when the beneficiary is not present, as long as the consultation is for the direct benefit of the beneficiary. The consulting provider must be an enrolled Medicaid provider. Interprofessional consultation services may be provided via telehealth and reimbursed with the use of the appropriate modifier.

SOURCE: SC Health and Human Svcs. Dept. Medicaid Bulletin 23-063, Dec. 2023SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 85-86. (Feb. 2024). (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

South Dakota

Last updated 04/02/2024

POLICY

Services provided via teledentistry must meet the applicable standard

POLICY

Services provided via teledentistry must meet the applicable standard of care. When reporting a service completed via teledentistry, providers are certifying the services rendered to the recipient were functionally equivalent to services provided through a face-to-face visit. Services provided via teledentistry must be provided in accordance with the coverage criteria in the adult and children dental provider manuals. Synchronistic services must be of sufficient audio and visual fidelity and clarity to be functionally equivalent to a face-to-face encounter.

“Asynchronous (store and forward)”, transmission of recorded health information (for example, radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to a dentist, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.

“Teledentistry”, the delivery of dental care while the patient and the dentist are in different locations via synchronous telecommunication technology or the transmission and review of recorded health information collected by another oral health professional and transmitted via asynchronous communication to create a treatment plan.

SOURCE: South Dakota Medicaid Billing and Policy Manual, Teledentistry Services, pg. 4. (Jun. 2023), (Accessed Apr. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Services provided via teledentistry must meet the applicable standard of care. When reporting a service completed via teledentistry, providers are certifying the services rendered to the recipient were functionally equivalent to services provided through a face-to-face visit. Services provided via teledentistry must be provided in accordance with the coverage criteria in the adult and children dental provider manuals. Synchronistic services must be of sufficient audio and visual fidelity and clarity to be functionally equivalent to a face-to-face encounter.

The following coverage limitations apply:

  • Reimbursement is limited to only one reading or interpretation of diagnostic tests such a x-rays, lab tests and diagnostic assessment.
  • Transmission of materials is not separately reimbursable.
  • Only D0140, limited oral exam, is covered for providers that primarily or only see South Dakota Medicaid recipients via teledentistry.

CDT codes not included in this list may not be provided via teledentistry.

Reimbursement for services provided via teledentistry is the same as reimbursement for services provided at a face-to-face visit. When services are provided via teledentistry, CDT D9995 or D9996 must be reported with the CDT codes for the services provided on the date of service.

In addition to the applicable CDT code(s), a claim for services provided via teledentistry must include one of the following codes:

  • D9995 – Teledentistry, synchronistic; real-time encounter; and
  • D9996 – Teledentistry, asynchronistic; information stored and forwarded to dentist for subsequent review.

D9995 and D9996 should never be reported alone on a claim form. Services that are not covered when provided via teledentistry must not be reported on the same claim as D9995 or D9996.

See manual for a list of covered services.

SOURCE: South Dakota Medicaid Billing and Policy Manual, Teledentistry Services, pg. 2-4 (Jun. 2023) (Accessed Apr. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Tennessee

Last updated 01/21/2024

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.

SOURCE: TN Code Annotated, Sec. 56-7-1002 & 1003, (Accessed Jan. 2024).

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 for healthcare services delivered by means of telehealth if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of telehealth if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Jan. 2024).

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

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 for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Jan. 2024).

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 Sept. 2022) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4, (2012) (Accessed Jan. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRPAHIC LIMITS

A health insurance entity … Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth 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.

A health insurance entity shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without 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, Title 56, Ch. 7, Part 1002, (Accessed Jan. 2024).

A health insurance entity: … Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine 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.

A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without 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, Part 1003, (Accessed Jan. 2024).


TRANSMISSION FEE

No Reference Found

 

READ LESS

Texas

Last updated 01/06/2024

POLICY

Clinical and cost effectiveness determinations that result in prohibiting

POLICY

Clinical and cost effectiveness determinations that result in prohibiting a service from being delivered using a synchronous audio-only technology, or store and forward technology in conjunction with synchronous audio-only technology are not considered denying, limiting, or reducing reimbursement for a covered health care service.

Store and forward technology – A telecommunications platform that stores and transmits or grants access to a person’s clinical information for review by a health professional at a different physical location than the person that meets the privacy requirements of the Health Insurance Portability and Accountability Act.

The following delivery methods may be used to provide telehealth/telemedicine within fee-for-service (FFS) Medicaid:

  • Synchronous audiovisual technology between the distant site provider and the client in another location
  • Synchronous audio-only technology between the distant site provider and the client in another location
  • Store and forward technology in conjunction with synchronous audio-only technology between the distant site provider and the client in another location. The distant site provider must use one of the following:
    • Clinically relevant photographic or video images, including diagnostic images
    • The client’s relevant medical records, such as medical history, laboratory and pathology results, and prescriptive histories

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 5, 6, 9, & 13 (Jan. 2024). (Accessed Jan. 2024).

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 Jan. 2024).


ELIGIBLE SERVICES

Not all Medicaid-covered services are authorized by HHSC for telemedicine or telehealth delivery in fee-for-service. Providers must always ensure the covered service is allowable by HHSC for telemedicine or telehealth services delivery.

Note: For example, if a service is authorized for telemedicine or telehealth delivery only when using synchronous audiovisual technology, that service may not be delivered using store and forward technology, store and forward technology in conjunction with synchronous audio-only technology, synchronous audio-only technology, or asynchronous audio-only technology.

Telemedicine or telehealth may be provided if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit.

Conditions for reimbursement applicable to telemedicine and telehealth provided using a synchronous audiovisual technology platform, or using store and forward technology in conjunction with synchronous audio-only are those that meet the following conditions:

  • Must be designated for reimbursement by HHSC.
  • Must be clinically effective and cost-effective, as determined and published in the benefit language by HHSC.
  • May not be denied solely because an in-person medical service between a provider and client did not occur.
  • May not be limited by requiring the provider to use a particular synchronous audiovisual technology platform to receive reimbursement for the service.

Other conditions for reimbursement applicable to services may vary by service type. Providers may refer to the appropriate TMPPM handbook for additional information on synchronous audiovisual technology platform coverage conditions.

Note: Telemedicine and telehealth services that HHSC has determined are clinically effective and cost-effective when provided via a synchronous audiovisual technology platform or using store and forward technology in conjunction with synchronous audio-only technology can be found in the appropriate TMPPM handbooks.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 6. (Jan. 2024). (Accessed Jan. 2024).

To the extent permitted by federal law and to the extent it is cost-effective and clinically effective, as determined by the commission, the commission shall ensure that Medicaid recipients, child health plan program enrollees, and other individuals receiving benefits under a public benefits program administered by the commission or a health and human services agency, regardless of whether receiving benefits through a managed care delivery model or another delivery model, have the option to receive services as telemedicine medical services, telehealth services [includes store and forward], or otherwise using telecommunications or information technology, including the following services:

  • preventive health and wellness services;
  • case management services, including targeted case management services;
  • subject to Subsection (c), behavioral health services;
  •  occupational, physical, and speech therapy services;
  • nutritional counseling services; and
  • assessment services, including nursing assessments under the following Section 1915(c) waiver programs:
    • the community living assistance and support services (CLASS) waiver program;
    • the deaf-blind with multiple disabilities (DBMD) waiver program;
    • the home and community-based services (HCS) waiver program; and
    • the Texas home living (TxHmL) waiver program.

SOURCE:  TX Statute Sec. 531.02161, [repealed eff. Apr. 1, 2025], (Accessed Jan. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Utah

Last updated 02/28/2024

POLICY

“Telemedicine services” means telehealth services including:

  • clinical care;
  • health

POLICY

“Telemedicine services” means telehealth services including:

  • clinical care;
  • health education;
  • health administration;
  • home health;
  • facilitation of self-managed care and caregiver support; or
  • remote patient monitoring occurring incidentally to general supervision; and

provided by a provider to a patient through a method of communication that:

  • uses asynchronous store and forward transfer or synchronous interaction; and
  • meets industry security and privacy standards, including compliance with the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health Act.

SOURCE: UT Code Sec. 26B-4-704, (Accessed Feb. 2024).

Medicaid does not cover telehealth services when performed by means of asynchronous communication.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Jan. 2024). (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Medicaid does not cover telehealth services when performed by means of asynchronous communication.  Examples of asynchronous communication include:

  • Email communication
  • Text messaging
  • Other forms of messaging with follow-up instructions or confirmations
  • Mobile Health (mHealth)
    • Fitness tracker
    • Phone applications that record a patient’s exercise
    • Automatic reminders such as when to take medicine.
    • Storing information or educational materials such as discharge instructions
  • Remote patient monitoring (RPM)
    • Blood pressure monitors
    • Pacemakers
    • Glucose meters
    • Oximeters
    • Wireless scales
    • Heart rate monitors
  • Store-and-forward imaging
  • Transmission of lab or other diagnostic/screening results

Telepsychiatry

Psychiatrists can report:

  • Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Jan. 2024). (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Vermont

Last updated 03/05/2024

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.

Qualified telemedicine and store and forward providers shall:

  • Meet or exceed applicable federal and state legal requirements of medical and health information privacy, including compliance with HIPAA.
  • Provide appropriate informed consent, in a language that the beneficiary understands, consistent with 18 VSA § 936l(c)(l) (see code for details)
  • Take appropriate steps to establish the provider-patient relationship and conduct all appropriate evaluations and history of the beneficiary consistent with traditional standards of care.
  • Maintain medical records for all beneficiaries receiving health care services through telemedicine that are consistent with established laws and regulations governing patient health care records.
  • Establish an emergency protocol when care indicates that acute or emergency treatment is necessary for the safety of the beneficiary.
  • Address needs for continuity of care for beneficiaries (e.g., informing beneficiary or designee how to contact provider or designee and/or providing beneficiary or identified providers timely access to medical records).
  • If prescriptions are contemplated, follow traditional standards of care to ensure beneficiary safety in the absence of a traditional physical examination.

Services provided through telehealth are subject to the same prior authorization requirements that exist for the service when not provided through telehealth.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.1) & (3.101.5-6), Telehealth, (Accessed Mar. 2024).

“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 Mar. 2024).


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. 91, (Dec. 20, 2023). (Accessed Mar. 2024).

To be covered, services shall:

  • Be clinically appropriate for delivery through store-and-forward
  • Be medically necessary

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Mar. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Virgin Islands

Last updated 03/25/2024

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.


Facility/Transmission Fee

No reference found.

READ LESS

Virginia

Last updated 01/05/2024

POLICY

Store-and-forward means the asynchronous transmission of a member’s medical …

POLICY

Store-and-forward means the asynchronous transmission of a member’s medical information from an originating site to a health care Provider located at a distant site. A member’s medical information may include, but is not limited to, video clips, still images, x-rays, laboratory results, audio clips, and text. The information is reviewed at the Distant Site without the patient present with interpretation or results relayed by the distant site Provider via synchronous or asynchronous communications.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), (Oct. 2022) (Accessed Aug. 2023).


ELIGIBLE SERVICES/SPECIALTIES

Refer to the telehealth supplement and billing manual for a full list of CPT and HCPCS codes reimbursable by Virginia Medicaid, including those through store and forward.

Coverage of services delivered by telehealth are described in the manual supplement “Telehealth Services.”  MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals),  (Oct. 2022) & VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Physician/Practitioner. Billing Instructions, (8/28/23) (Accessed Jan. 2024).

Virtual Check-Ins

Additions to the Telehealth Supplement include defining virtual check-in services, identifying covered codes, specifying reimbursement requirements, and outlining fee-for-service (FFS) billing details. Billing codes covered by this policy, when conditions of coverage are met, and for services with dates of service on and after April 18, 2022, include the following:

  • 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
  • G2250: Remote assessment 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 service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment

SOURCE: VA Department of Medical Assistance Services, Coverage of Virtual Check-In and Audio Only Services/Updates to Telehealth Services Supplement, April 1, 2022. (Accessed Jan. 2024).


GEOGRAPHIC LIMITS

The originating site is the location of the member at the time the service is rendered, or the site where the asynchronous store-and-forward service originates (i.e., where the data are collected). Examples of originating sites include: medical care facility; Provider’s outpatient office; the member’s residence or school; or other community location (e.g., place of employment).

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals), (Oct. 2022) (Accessed Jan. 2024).


TRANSMISSION FEE

Originating site fee is only available for synchronous telehealth services.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals),  (Oct. 2022) (Accessed Jan. 2024).

READ LESS

Washington

Last updated 03/28/2024

POLICY

The medicaid agency determines the health care services that …

POLICY

The medicaid agency determines the health care services that may be paid for when provided through telemedicine or store and forward technology as authorized by state law, including RCW 71.24.33574.09.325, and 74.09.327.

SOURCE: WAC 182-501-0300(3)(a). (Accessed Mar. 2024).

Store and Forward is the transmission of medical information to be reviewed later by a physician or practitioner at a distant site. A client’s medical information may include, but is not limited to, video clips, still images, x-rays, laboratory results, audio clips, and text. The physician or practitioner at the distant site reviews the case without the client present.

HCA pays for Store and Forward when all the following conditions are met:

  • The visit results in a documented care plan that is communicated back to the referring provider.
  • The transmission of protected health information is HIPAA-compliant.
  • Written informed consent is obtained from the client 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, HCA does not pay for the Store and Forward consultation.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide, Telemedicine Policy and Billing, p. 23 (Apr. 2024). (Accessed Mar. 2024).

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

SOURCE: RCW 74.09.325; WA State Health Care Authority. Medicaid Provider Guide, Telemedicine Policy and Billing, p. 7 (Apr. 2024). (Accessed Mar. 2024).

Managed Care 

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 behavioral or 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. (Accessed Mar. 2024).

Behavioral Health Administrative Services Organizations and Managed Care Organizations

Upon initiation or renewal of a contract with the authority, behavioral health administrative services organizations and managed care organizations shall reimburse a provider for a behavioral health service provided to a covered person through telemedicine or store and forward technology if:

  • The behavioral health administrative services organization or managed care organization in which the covered person is enrolled provides coverage of the behavioral health service when provided in person by the provider;
  • The behavioral health service is medically necessary; and
  • Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

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. (Accessed Mar. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Teledermatology

Teledermatology services must meet the following criteria:

  • The teledermatology is associated with an office visit between the eligible client and the referring health care provider.
  • The teledermatology is asynchronous telemedicine and the service results in a documented care plan, which is communicated back to the referring provider.
  • The transmission of protected health information is HIPAA compliant.
  • Written informed consent is obtained from the client that store and forward technology will be used and who the consulting provider is.
  • GQ modifier required.

See manual for acceptable CPT/HCPCS codes.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 345 (Mar. 2024). (Accessed Mar. 2024).

HCA pays for Store and Forward for teledermatology. Teledermatology does not include single-mode consultations by telephone calls, images transmitted via facsimile machines, or electronic mail.

Teledermatology services provided via Store and Forward telecommunications system must be billed with modifier GQ. Bill only the portion(s) rendered from the distant site with modifier GQ. The sending provider bills as usual with the E/M and no modifier. The use of modifier GQ does not alter reimbursement for the CPT® or HCPCS code billed. You must use POS 02 to indicate the location where health services are provided through Store and Forward technology. POS 02 code does not apply to the originating site.

HCA denies claims submitted for Store and Forward services with POS code 02 if modifier GQ is not included.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide, Telemedicine Policy and Billing, p. 24-25 (Apr. 2024). (Accessed Mar. 2024).

Consultations—TB treatment services

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. 81 (Mar. 2024). (Accessed Mar. 2024).

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 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.

See manual for acceptable CPT codes.

SOURCE: WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 75. (Apr. 2024). (Accessed Mar. 2024).

Behavioral Health

For behavioral health services authorized for delivery through store and forward technology, there must be an associated visit between the referring provider and the client.

SOURCE: WAC 182-501-0300(3)(d). (Accessed Mar. 2024).

Communication Technology-Based Procedure Codes

Evaluation and management services may be provided via telephone or patient portal to established patients. Virtual check-ins and e-consults are also covered in certain instances. See manual for eligible codes and requirements.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide, Telemedicine Policy and Billing, p. 26-27 (Apr. 2024). (Accessed Mar. 2024).

 


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, Telemedicine Policy and Billing, p. 23 (Apr. 2024). (Accessed Mar. 2024).

READ LESS

West Virginia

Last updated 02/13/2024

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.

Ophthalmologists and Optometrists may bill store and forward telehealth services (92227 and 92228) in combination with certain diagnosis restrictions.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Effective Jan. 1, 2022) p. 3, 5. (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

Only available for ophthalmologist and optometrist providers for two specific codes.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Effective Jan. 1, 2022) p. 3. (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Wisconsin

Last updated 01/11/2024

POLICY

“Store and forward” is a term for asynchronous telehealth …

POLICY

“Store and forward” is a term for asynchronous telehealth that involves the transmission of medical information to be reviewed at a later time by a provider at a distant site. The physician or practitioner at the distant site then reviews the case without the member present.

Effective January 1, 2023, ForwardHealth will begin reimbursing certain asynchronous telehealth services. Asynchronous telehealth services are defined as telehealth that is used to transmit medical data about a patient to a provider when the transmission is not a two-way, real-time, interactive communication.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, (Accessed Jan. 2024).

Both synchronous (two-way, real-time, interactive communications) and asynchronous (information stored and forwarded to a provider for later review) services identified under permanent policy may be reimbursed when provided via telehealth (also known as “telemedicine”). ForwardHealth will require providers to follow permanent billing guidelines for both synchronous and asynchronous telehealth services.

SOURCE: WI ForwardHealth Telehealth Policy, Topic #510. (Accessed Jan. 2024).

A virtual check-in is a brief patient-initiated asynchronous or synchronous communication and technology-based service intended to be used to decide whether an office visit or other service is needed. The encounter may involve synchronous discussion over a phone or exchange of information through video or image. A provider may respond to the member’s concern by phone, audio-visual communications, or a secure patient portal. Covered services include both the remote evaluation of a recorded video or image submitted by a member and the interpretation and follow-up by the provider.

An e-visit is a communication between a member and their provider through an online HIPAA-compliant patient portal. These patient-initiated asynchronous services involve a member having non-face-to-face communications cumulatively over a span of seven days with a provider with whom they have an established relationship. Providers who can bill evaluation and management (E&M) services may utilize online digital E&M codes while other providers may be eligible to bill online assessment and management codes.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, & Virtual Check-In, E-Visit and Telephone Evaluation and Management Services, Topic #22742. (Accessed Jan. 2024).

Modifiers

Claims for asynchronous services should be indicated using the GQ modifier.

For services that include both asynchronous and synchronous components, claims should indicate that the cumulative services were rendered through both real-time interactions and store-and-forward delivery. For example, in a virtual check-in, if a provider reviews an image submitted by an established patient sent through a secure provider portal and calls the member on the phone to discuss treatment and next steps, the claim should indicate both the 93 and GQ modifiers.

Providers are required to include any additional provider, benefit, or service specific modifiers that may apply to a service code when delivered through telehealth. For example, when a service is provided by a physical therapist (PT), the codes would need to include the corresponding therapy modifier GP (Services delivered under an outpatient physical therapy plan of care) to signify the telehealth service is furnished as therapy services furnished under a PT plan of care.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, (Accessed Jan. 2024).

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 Jan. 2024).

Interprofessional Consultations (E-Consults)

An interprofessional consultation or e-consult is an assessment and management service in which a member’s treating provider requests the opinion and/or treatment advice of a provider with specific expertise (the consultant) to assist the treating provider in the diagnosis and/or management of the member’s condition without requiring the member to have face-to-face contact with the consultant. Both the treating and consulting providers may be reimbursed for the e-consult as described below.

Consulting providers must be physicians enrolled in Wisconsin Medicaid as an eligible rendering provider. Consulting providers may bill CPT procedure codes 99446–99449 and 99451 under the following limitations:

  • Services are not covered if the consultation leads to a transfer of care or other face-to-face service within the next 14 days or next available date of the consultant. Additionally, if the sole purpose of the consultation is to arrange a transfer of care or other face-to-face service, these procedure codes should not be submitted.
  • Consulting services are covered once in a seven-day period.

Treating providers may be a physician, nurse practitioner, physician assistant, or podiatrist enrolled in Wisconsin Medicaid as an eligible rendering provider. Treating providers may bill CPT procedure code 99452 as a covered service once in a 14-day period.

Both the consulting and treating providers must be enrolled in Wisconsin Medicaid to receive reimbursement for the e-consult and the consultation must be medically necessary.

Providers are expected to follow CPT guidelines including that the CPT procedure codes should not be submitted if the consulting provider saw the member in a face-to-face encounter within the previous 14 days.

The following documentation requirements apply for e-consults:

  • The consulting provider’s opinion must be documented in the member’s medical record.
  • The written or verbal request for a consultation by the treating provider must be documented in the member’s medical record including the reason for the request.
  • Verbal consent for each consultation must be documented in the member’s medical record. The member’s consent must include assurance that the member is aware of any applicable cost-sharing.

SOURCE: WI ForwardHealth Online Handbook. Topic #22738, Interprofessional Consultations (E-Consults), (Accessed Jan. 2024).

Interprofessional consultations shall be covered if all of the following apply:
  • The consultation is a professional service furnished to a recipient by a certified provider at the request of the treating provider.
  • The consultation constitutes an evaluation and management service in which the certified provider treating a recipient requests the opinion or treatment advice of a consulting provider with specific expertise to assist the treating provider in the evaluation or management of the recipient’s problem without requiring the recipient to have facetoface contact with the consulting provider.
  • The consulting provider provides a written report that becomes a part of the recipient’s permanent medical record.

SOURCE: Department of Health Services Administrative Rules Sec. 107.06, (Accessed Jan. 2024).

Behavioral Health Services

Behavioral health services should be indicated by the following modifiers.

  • FQ*:  A telehealth service was furnished using audio-only communication technology
  • FR*: A supervising practitioner was present through a real-time two-way, audio/video communication technology
  • GQ: Via asynchronous telecommunications system
  • GT: Via interactive audio and video telecommunication systems

*Use for behavioral health services only.

SOURCE: WI ForwardHealth Online Handbook. Topic #22737 Behavioral Health Telehealth Services, (Accessed Jan. 2024).


ELIGIBLE SERVICES

Services that are rendered asynchronously must adhere to the ForwardHealth guidelines for functional equivalency. “Functionally equivalent” means that when a service is provided via telehealth, the transmission of information must be of sufficient quality as to be the same level of service as an in-person visit. Transmission of voices, images, data, or video must be clear and understandable.

Asynchronous delivery is indicated by modifier GQ (Via asynchronous telecommunications system). Modifier GQ must be used for all ForwardHealth-covered asynchronous services including, but not limited to, teleophthalmology, teledermatology, and teleradiology delivered through asynchronous telecommunications systems (for example: through e-consult and remote patient monitoring). Only the service rendered from the distant site must be billed with modifier GQ. The originating site for asynchronous services is not eligible to receive an originating site fee.

A member’s medical information may include, but is not limited to:

  • Video clips
  • Still images
  • X-rays
  • MRIs
  • Laboratory results
  • Audio clips
  • Text documents

The transmission of protected health information must be performed in a manner compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

ForwardHealth will not reimburse for any asynchronous service that does not adhere to the Healthcare Common Procedure Coding System or Current Procedural Terminology code description, meaning all the components listed in the description need to be present to be reimbursed. For example, if the code definition specifies “face-to-face” or “hands-on delivery,” this would not allow the service to be performed asynchronously. Providers must adhere to the delivery mode specified in the code description.

For dates of services on and after January 1, 2023, providers should report procedure code D9996 (Teledentistry asynchronous; information stored and forwarded to dentist for subsequent review) along with applicable dental evaluation and diagnostic imaging procedure codes to indicate the service was delivered through store and forward asynchronous teledentistry.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, (Accessed Jan. 2024).

Allowable procedure codes for virtual check-in and e-visit services can be found in the Attachment to this Update/Manual section.

These services will not require prior authorization and are patient-initiated by established patients of the provider’s practice.

Virtual check-in and e-visit telehealth services are not covered or billable if they:

  • Take place during an in-person visit.
  • Take place within seven days after an in-person visit furnished by the same provider.
  • Trigger an in-person visit within 24 hours or the soonest available appointment.
  • Do not have sufficient information from the remote evaluation of an image or video (store and forward) for the provider to complete the service.

Only the relevant in-person procedure code that was rendered would be reimbursed if any of the above conditions apply

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, & Virtual Check-In, E-Visit and Telephone Evaluation and Management Services, Topic #22742. (Accessed Jan. 2024).

ForwardHealth covers synchronous (two-way, real-time, interactive communications) and asynchronous (information stored and forwarded to a provider for subsequent review) teledentistry services.

The following code should be used on dental claims to indicate teledentistry.

  • D9996 – Teledentistry asynchronous; information stored and forwarded to dentist for subsequent review

Providers should report code D9995 or D9996 along with the applicable allowable oral evaluation procedure codes to indicate the service was delivered via synchronous or asynchronous teledentistry.

SOURCE: WI ForwardHealth Online Handbook. Topic #22637: Teledentistry Policy, (Accessed Jan. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

Only the service rendered from the distant site must be billed with modifier GQ. The originating site for asynchronous services is not eligible to receive an originating site fee.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, (Accessed Jan. 2024).

READ LESS

Wyoming

Last updated 01/31/2024

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 member, or a consultation between two health care practitioners asynchronous “store and forward” technology.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, pg. 137 (Jan. 2, 2024), WY Division of Healthcare Financing Tribal Provider Manual, pg. 135 & 214, (Jan. 2, 2024) & Institutional Provider Manual pg. 135.  (Jan. 2, 2024). (Accessed Jan. 2024).

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

SOURCE: WY Division of Health Insurance, School Based Services Manual, pg. 16, (Jan. 2, 2024). (Accessed Jan. 2024).


ELIGIBLE SERVICES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

READ LESS

Medicaid & Medicare

Store-and-Forward

jump to: