Store-and-Forward

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 Feb. 2023).

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 Feb. 2023).

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

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

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5, June 2021, (Accessed Feb. 2023).

Temporary Policy – Ends Dec. 31, 2024

Practitioner. The term “practitioner” has the meaning given that term in section 1842(b)(18)(C) [42 USCS § 1395u(b)(18)(C)] and, in the case that the emergency period described in section 1135(g)(1)(B) 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 1861(g) [42 USCS § 1395x(g)]), a qualified physical therapist (as such term is used in section 1861(p) [42 USCS § 1395x(p)]), a qualified speech-language pathologist (as defined in section 1861(ll)(4)(A) [42 USCS § 1395x(ll)(4)(A)), and a qualified audiologist (as defined in section 1861(ll)(4)(B) [42 USCS § 1395x(ll)(4)(B)).

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

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

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

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

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

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:  Medicare Learning Network Factsheet. Telehealth Services, p. 5, June 2021 & CMS Telehealth List Year 2023.  (Accessed Feb. 2023).

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 Feb. 2023).

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

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

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

SOURCE: 42 CFR Sec. 410.78 & Medicare Learning Network Factsheet. Telehealth Services, p. 4, June 2021 (Accessed Feb. 2023).

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) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5 [some info excluded due to document being out of date]  & 42 CFR Sec. 410.78.  (Accessed Feb. 2023).

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

In general. 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 1395(g)(1)(B)) 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 (or would have been made under this title if such individual were entitled to, or enrolled for, benefits under this title 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) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

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

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

Temporary Policy – Ends Dec. 31, 2024

Expanding access to telehealth services. In the case that the emergency period described in section 1135(g)(1)(B) ends before December 31, 2024, with respect to telehealth services identified in subparagraph (F)(i) as of the date of the enactment of this clause [enacted 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) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

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 Feb. 2023).

An originating site is the location where a Medicare patient gets physician or practitioner medical services through a telecommunications system. The patient must go to the originating site for the services located in either:

• County outside a Metropolitan Statistical Area (MSA)
• Rural Health Professional Shortage Area (HPSA) in a rural census tract

The Health Resources and Services Administration (HRSA) decides HPSAs and the Census Bureau decides MSAs. Find potential Medicare telehealth originating site payment eligibility at HRSA’s Medicare Telehealth Payment Eligibility Analyzer.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

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.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Feb. 2023).

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 Feb. 2023).

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removed originating site geographic conditions and added an individual’s home as a permissible originating telehealth services substance use disorder or co-occurring mental health treatment site.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

Requirements for mental health services furnished through telehealth

Payment may not be made under this paragraph for telehealth services furnished on or after the day that is the 152nd 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.

These requirements do not apply to services:

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

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Feb. 2023).

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 Feb. 2023).

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

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 5, June 2021, (Accessed Feb. 2023).

No facility fee for new sites. In the case that the emergency period described in section 1135(g)(1)(b) ends before December 31, 2024, with respect to telehealth services identified in paragraph (4)(F)(i) as of the date of the enactment of this clause [enacted March 15, 2022] that are furnished during the period beginning on the first day after the end of the emergency period and ending December 31, 2024 described in section 1135(g)(1)(B) [42 USCS § 1320b-5(g)(1)(B)], a facility fee shall only be paid under this subparagraph to an originating site that is described in paragraph (4)(C)(ii) (other than subclause (X) of such paragraph).

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Communication Technology-Based Services (CTBS)

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

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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 House Bill 265 (2022 Session) and Sec. 47.07.069, (Accessed Feb. 2023).

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

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services (1/2/19); Mental Health Physician Clinic (1/2/2019); Physician, ARNP and PA Services (5/13), (Accessed Feb. 2023).

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

SOURCE:  Alaska Admin Code. Title 7, Sec. 110.620 & 625. (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

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

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Audiology Services (6/12); Autism Services (6/12); Chiropractic Services (6/12); Community Behavioral Health Clinic Services (6/12); Direct-Entry Midwives Services (6/12); EPSDT (6/12); Family Planning (6/12); FQHC/RHC (6/12); Imaging Services (6/12); Independent Laboratory (6/12); Mental Health Physician Clinic (6/12); Nutrition (6/12); Physician (6/12); Private Duty Nursing (6/12); Professional Claims Management (6/12): Psychologist (6/12); Podiatry (6/12); School-Based Services (6/12); Residential Behavioral Rehabilitation Services (6/12); Therapies (6/12); Vision (6/12) (Accessed Feb. 2023).

Eligible services:

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

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Community Behavioral Health Services; Mental Health Physician Clinic (1/2/2019); & Physician, ARNP and PA Services (5/13) & Alaska Medicaid Policy Clarification: Medicaid Telehealth Coverage. Mar. 1, 2022. (Accessed Feb. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

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

SOURCE: AK Admin. Code, Title 7, 110.635(b). (Accessed Feb. 2023).

POLICY

Telehealth – 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, 10/22, pg. 107, (Accessed Jan. 2023).

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. 2). Approved Apr. 2022. (Accessed Jan. 2023).

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, (8/23/2022), pg. 48-49 & IHS/Tribal Provider Billing Manual, (10/17/2022). pg. 51, (Accessed Jan. 2023).

Two HCPCS codes are included in this section of the 2021/2022 Fee Schedule:

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

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 346. (Accessed Jan. 2023).

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, (8/23/2022), pg. 48-49 & IHS/Tribal Provider Billing Manual, (10/17/2022). pg. 50-51 (Accessed Jan. 2023).

AHCCS Medical Policy Manual

Reimbursement for this type of consultation is limited to clinically appropriate services that are provided without real-time interaction and are limited to:

• 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.

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 following conditions shall be met for the use of e-consults:

1. Coverage is restricted to the asynchronous service types specified in this Policy.
2. Coverage is restricted to specific e-consult codes.

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 Apr. 2022. (Accessed Jan. 2023).

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 Jan. 2023).

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 Apr. 2022 ; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (8/23/22), pg. 47, & IHS/Tribal Provider Billing Manual, (10/17/2022), pg. 510 (Accessed Jan. 2023).

FACILITY/TRANSMISSION FEE

No Reference Found

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 Jan. 2023).

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

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

SOURCE: PASSE Program. P. II-8, (1/1/23). (Accessed Jan. 2023).

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 Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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 Feb. 2023).

Recently enacted legislation requires CA Medicaid and Medi-Cal managed care plans 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 forward, telephonic (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 Feb. 2023).

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 (Jan. 2023). Pg. 10. (Accessed Feb. 2023).

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.

E-consult is not covered.

SOURCE: CA Department of Health Care Services (DHCS). Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Jan. 2023. Pg. 13-15. (Accessed Feb. 2023).  

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 Feb. 2023).

Family PACT

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

SOURCE: CA Department of Health Care Services. Family Planning, Access, Care and Treatment Program. Benefits Manual. Aug. 2022, Pg. 6. (Accessed Feb. 2023).

Managed Care

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

SOURCE: CA Department of Health Care Services (DHCS). All Plan Letter 19-009: Telehealth Services Policy. Oct. 16, 2019. (Accessed Feb. 2023).

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. Jan. 2023. Pg. 9. (Accessed Feb. 2023). 

Local Education Agency: Speech Therapy

A telehealth service must use interactive audio, video or data communication to qualify for reimbursement. The qualified service must be in real-time or near real-time (delay in seconds or minutes) to qualify as an interactive two-way transfer of medical data and information between the student and health care provider. Medi-Cal does not reimburse for telephone calls, electronic mail messages or facsimile transmissions.

SOURCE: CA Department of Health Care Services (DHCS). Local Education Agency (LEA) Telehealth. Aug. 2021. Pg. 3. (Accessed Feb. 2023). 

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.

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

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.

SOURCE: CA Department of Health Care Services.  Medi-Cal Part 2 General Medicine Manual. Telehealth (Jan 2023), Pg. 8-10. (Accessed Feb. 2023).

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 (Jan. 2023). Pg. 2. (Accessed Feb. 2023).

Managed Care

MCP 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 via telehealth, including asynchronous store and forward telecommunications. Consultations via asynchronous electronic transmission cannot be initiated directly by patients. Electronic consultations (e-consults) are permissible using CPT-4 code 99451, modifier(s), and medical record documentation as defined in the Medi-Cal Provider Manual. E-consults are permissible only between health care providers.

SOURCE: CA Department of Health Care Services (DHCS).  All Plan Letter 19-009:  Telehealth Services Policy.  Oct. 16, 2019. (Accessed Feb. 2023). 

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. Jan. 2023. Pg. 9. (Accessed Feb. 2023).  

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 Feb. 2023).

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 Feb. 2023).

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 Feb. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2023), Pg. 11. (Accessed Feb. 2023).  

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. Jan. 2023. Pg. 12. (Accessed Feb. 2023).  

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 Feb. 2023).

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).

SOURCE: CA Department of Health Care Services (DHCS). Denti-Cal Manual. Jan. 2023. Pg. 4-23. (Accessed Feb. 2023).

POLICY

The member must be present during any Telemedicine visit.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 10/22. (Accessed Jan. 2023).

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. 2023).

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. 2023).

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

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Limited reimbursement allowed for an interim therapeutic restoration in teledentistry.

SOURCE: CO Revised Statutes 25.5-5-321.5. (Accessed Jan. 2023).

GEOGRAPHIC LIMITS

No Reference Found

FACILITY/TRANSMISSION FEE

No Reference Found

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 Feb. 2023).

Permanent Policy

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

SOURCE: CT Policy – Provider Bulletin 2019-75. Dec. 2019, (Accessed Feb. 2023).

“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 Feb. 2023).

“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 Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 10/28/22. Ch. 16.3.4.1 Telemedicine, pg. 74 & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10 (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

No reimbursement for store-and-forward.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.29,Physicians Billing Manual.  DC Medicaid.  (Jan. 2023) Sec. 15.8. P. 54, Clinic Billing Manual, DC Medicaid (Jan. 2023), Sec. 15.8, P. 52.FQHC Billing Manual, DC Medicaid 15.6,2 P. 54. (Jan. 2023), Behavioral Health Billing Manual (Jan. 2023) 14.8, p. 70., Outpatient Hospital Billing Guide, 16.8, p. 78 (Jan 2023), Inpatient Hospital Billing Guide, 11.8, p. 62 (Jan. 2023), Long-Term Care Billing Manual, 15.8, p. 54 (Jan 2023). (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found.

GEOGRAPHIC LIMITS

No Reference Found.

TRANSMISSION FEE

No Reference Found.

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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. 6 (Jan 1, 2023). (Accessed Jan. 2023).

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. 40 (Jan 1, 2023). & Part II Policies and Procedures for Dental Services, p. IX-22 (Jan 2023). (Accessed Jan. 2023).

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. 40 (Jan 2023). & Part II Policies and Procedures for Dental Services, p. IX-22 (Jan 2023). (Accessed Jan. 2023).

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. 40 (Jan 2023). & Part II Policies and Procedures for Dental Services, p. IX-22 (Jan 2023). (Accessed Jan. 2023).

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 Jan. 2023).

To properly identify telehealth services, one of the following modifiers (95, GQ or GT) must always be used when billing with CPT or HCPCS code for telehealth services.

SOURCE: HI Med-QUEST Memo No. QI-2139/FFS 21-15 (Replaces QI-1702A/FFS-1701A) (Accessed Jan. 2023).

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 Jan. 2023).

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 Jan. 2023).

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 Jan. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

SOURCE: Idaho Medicaid Provider Handbook.  General Information and Requirements for Providers Nov. 18, 2022, p. 128. (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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. 2023). 

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, 2010; IL 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. 2023).

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. 2023).

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. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

FACILITY/TRANSMISSION FEE

No Reference Found

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 (Sept. 27, 2022), p. 1.  (Accessed Feb. 2023).

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

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

SOURCE: IN Admin. Code, Title 405, “Article 5” 5-38-2 & 4., p. 182-183 (Accessed Feb. 2023)

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

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. 2023)

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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. 2-32 (Jan. 2023). (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

SOURCE: KY Revised Statutes 205.559. For definition, see: KY Revised Statute 205.510 & 211.332. (Accessed Feb. 2023).

“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 Feb. 2023).

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 Feb. 2023).

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.

• 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.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Nov. 2022).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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 Sept. 3, 2020). (Accessed Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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 Jan. 2023).

New Medicaid Policy (Effective Upon Approval from CMS)

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

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. Pg. 5, (June 15, 2020) (Accessed Jan. 2023).

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 the information to evaluate a Member’s condition or render a covered MaineCare service separate from services delivered via Interactive Telehealth. The Health Care Provider uses a desktop 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 and Treating Provider and Specialist:  Interprofessional telecommunications assessment and management service provided by a Specialist. A primary care referral is required for a Member to seek Specialist care. 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 is a minimum of five minutes to 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.

Written or verbal Member consent for each Remote Consultation must be documented in the Member’s medical record. Billing for interprofessional services is limited to those practitioners who can independently bill Medicaid for evaluation and management services.

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. Pg. 5-6, (June 15, 2020). (Accessed Jan. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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, 2023, 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). (Accessed Jan. 2023).

According to the Maryland Medicaid Telehealth Provider Manual, 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. As of the last update, the manual states that store-and-forward is only covered for dermatology, ophthalmology and radiology under Physician services of COMAR 10.09.02.07.

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. p. 4, Updated April 2020. (Accessed Jan. 2023).

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. 10.09.49.09. (Accessed Jan. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

MassHealth reimburses the GQ modifier which is used when providers are rendering services via asynchronous telehealth.

Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

ELIGIBLE SERVICES/SPECIALTIES

Asynchronous teledentistry is covered.

SOURCE: MA 101 CMR 314. 05. (Accessed Nov. 2022).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 1886, Oct. 1, 2022 (Accessed Nov. 2022).

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.

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.

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.

Interprofessional telephone/Internet/electronic health record consultations, including e-Consults, are a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating physician (e.g., attending or primary) or practitioner requests the opinion and/or treatment advice of a Medicaid enrolled physician or practitioner with the specialty expertise to assist in the diagnosis of a condition and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consultant. The service concludes with a written report from the consultant to the treating physician/requesting provider.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022)

ELIGIBLE SERVICES/SPECIALTIES

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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 Jan. 2023).

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 Jan. 4, 2023 &MN Dept. of Human Services, Provider Manual, Telehealth Services, As revised Jun. 14, 2022. (Accessed Jan. 2023).

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:

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 Jan. 2023).

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 Jan. 2023).

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. Aug. 26, 2022 (Accessed Jan. 2023).

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 Jan. 2023).

TRANSMISSION FEE

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

SOURCE: MN Dept. of Human Services, Physician and Professional Services (Telehealth), Jan. 4, 2023. (Accessed Jan. 2023).

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 Mar. 2023).

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 Mar. 2023).

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 Mar. 2023).

“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 Code Title 30 Part 2635, Ch. 5 Rule 5.1. (Accessed Mar. 2023). 

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 Mar. 2023).

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 Mar. 2023).

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 Mar. 2023).

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 Mar. 2023).

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 Mar. 2023).

The telemedicine program shall be administered by the MO HealthNet Division (MHD). This rule is established pursuant to the authority granted to the Missouri Department of Social Services, MO HealthNet Division, to promulgate rules governing the practice of telemedicine in the MO HealthNet Program and to provide services under established, approved MO HealthNet benefits.

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.

ELIGIBLE SERVICES/SPECIALTIES

Teledentistry

MO HealthNet covers teledentistry services. MO HealthNet 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.

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

SOURCE: NE Rev. Statute, 71-8503(3) (Accessed Mar. 2023).

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 Mar. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

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

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403, p. 1 & Section 3403.4, p. 2 (Jun. 1, 2022). (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

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

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.4, p. 2 (Jun. 1, 2022). (Accessed Feb. 2023).

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 (Nov. 18, 2020) (Accessed Feb. 2023).

POLICY

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

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

The Medicaid program shall provide reimbursement for all modes of telehealth, including video and audio, audio-only, or other electronic media provided by medical providers to treat all members for all medically necessary services.

SOURCE: NH Revised Statutes 167:4-d (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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 Dec. 2022).

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 Dec. 2022). 

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 Dec. 2022).

ELIGIBLE SERVICES

No reference found.

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Feb. 2023).

Applied Behavior Analysis

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

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

Applied Behavior Analysis

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

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Feb. 2023).

GEOGRAPHIC LIMITS

Applied Behavior Analysis

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

SOURCE: NM Applied Behavior Analysis Agency Manual Instructions, pg. 3, (Accessed Feb. 2023).

TRANSMISSION FEE

No Reference Found

POLICY

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

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

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019 (Special Edition), p. 4. (Accessed Feb. 2023).

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

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

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019 (Special Edition), p. 11. (Accessed Feb. 2023).

“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 Feb. 2023).

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 proposed to be added by Final rule per Notice Of Adoption. (Accessed Feb. 2023).

Teledentistry

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

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 87 (Accessed Feb. 2023).

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 Feb. 2023).

Teledentistry

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

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 87 (Accessed Feb. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

Teledentistry

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

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 87 (Accessed Feb. 2023).

POLICY

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

Virtual communication, including:

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

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2 & 6, Oct. 1, 2022. (Accessed Feb. 2023).

A special COVID-19 Medicaid bulletin lists codes that include an element of store-and-forward (such as online digital evaluation and management) have been made permanently eligible for reimbursement that have not yet been incorporated into the 1H Telehealth, Virtual Communication and Remote Patient Monitoring provider manual.

SOURCE: NC Medicaid Special Bulletin COVID-19 #237, Oct 2022, (Accessed Feb. 2023).

ELIGIBLE SERVICES/SPECIALTIES

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

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

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

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, 8 & 14, Oct. 1, 2022. (Accessed Feb. 2023).

GEOGRAPHIC LIMITS

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

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 2, Oct. 1, 2022. (Accessed Feb. 2023).

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. 9, Oct. 1, 2022. (Accessed Feb. 2023).

POLICY

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

SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 158, (Oct. 2022), (Accessed Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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 Mar. 2023).

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 Mar. 2023).

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. 15. (Accessed Mar. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

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

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

SOURCE: OK Admin. Code Sec. 317:30-3-27(e). (Accessed Dec. 2022).

“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 (a). (Accessed Dec. 2022).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

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

SOURCE: OK Admin. Code Sec. 317:30-3-27(e)(4). (Accessed Dec. 2022).

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. 2023).

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

• (CPT 99446-99449, 99451-99451)

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Mar. 2023).

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. 2023).

Teledentistry

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

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

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

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

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Mar. 2023).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio, or member portal and may include transmission of data from remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

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. 2023).

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 Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Mar. 2023).

Teledentistry

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

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

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Mar. 2023).

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 Feb. 1, 2023 Prioritized List of Health Services, p. AD-3. (1/29/23). (Accessed Mar. 2023).

POLICY

Telemedicine, for purposes of Medicaid payment, does not include telephone, asynchronous or store and forward technology or facsimile machines, electronic mail systems or remote patient monitoring devices. However, these technologies may be utilized as a part of the provision of a MA-covered service.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-22-02, p. 2, May 6, 2022 (Accessed Mar. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

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. 2023).

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, often referred to as “store-and-forward” in English) 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. 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. 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.

Source: Telemedicina Y Telesalud. Departamento de Salud. (Accessed Mar. 2023).

Eligible Services/Specialties

No reference found.

Geographic Limits

No reference found.

Facility/Transmission Fee

No reference found.

POLICY

Teledentistry Policy 

Teledentistry is not a specific service but a mode of accomplishing a particular service. Providers are asked to bill non-paying codes D9995 (Asynchronous teledentistry) and D9996 (Synchronous teledentistry) for documentation but should use applicable D codes. Frequency limitations for codes apply. 

SOURCE: RI Executive Office of Health and Human Services Medicaid Program, Dental Manual, pg. 11. (Oct. 2022). (Accessed Jan. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

ELIGIBLE SERVICES/SPECIALTIES

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

POLICY

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

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

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

SOURCE: TN Code Annotated, Sec. 56-7-1003 & 1002, (Accessed Dec. 2022).

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 Dec. 2022).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRPAHIC LIMITS

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

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

SOURCE: TN Code Annotated, Sec. 56-7-1002, as amended by House Bill 620 & Senate Bill 429, (2021 Session), (Accessed Apr. 2022).

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

SOURCE: TN Code Annotated, Sec. 56-7-1003 & 1002, (Accessed Apr. 2022).

TRANSMISSION FEE

No Reference Found

POLICY

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. 6, 9 & 13, (Accessed Dec. 2022).

The following delivery methods may be used to provide 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. 9, & 13 (Dec. 2022). (Accessed Dec. 2022).

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

SOURCE: TX Admin. Code, Title 1 Sec. 354.1430 (Accessed Dec. 2022).

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 Dec. 2022).

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.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 6, (Accessed Dec. 2022).

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.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 6. (Dec. 2022). (Accessed Dec. 2022).

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, (Accessed Dec. 2022).

GEOGRAPHIC LIMITS

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TRANSMISSION FEE

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POLICY

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ELIGIBLE SERVICES/SPECIALTIES

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GEOGRAPHIC LIMITS

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TRANSMISSION FEE

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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.

A qualified telemedicine and store-and-forward provider must:

• Meet or exceed federal and state legal requirements of medical and health information privacy, including HIPAA
• Provide appropriate informed consent in a language the beneficiary understands. Specific requirements exist, see rule.
• 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 Feb. 2023).

“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 Feb. 2023).

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. 86, (Oct. 5, 2022). (Accessed Oct. 2022).

To be covered, services shall:

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

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Oct. 2022).

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

SOURCE: Department of Vermont Health Access. Agency of Human Services. Telehealth: Methods for healthcare service delivery using telecommunications technologies. (Accessed Mar. 2022).

GEOGRAPHIC LIMITS

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TRANSMISSION FEE

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Policy

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Eligible Services/Specialties

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Geographic Limits

No reference found.

Facility/Transmission Fee

No reference found.

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 Nov. 2022).

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.

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) & VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner. Billing Instructions, (July 2022) (Accessed Nov. 2022).

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 Nov. 2022).

GEOGRAPHIC LIMITS

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 Nov 2022).

TRANSMISSION FEE

Facility fee is only available for synchronous telehealth services.

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 Nov. 2022).

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 71.24.335, 74.09.325, and 74.09.327.

SOURCE:  WAC 182-501-0300(3)(a).  (Accessed Mar. 2023).

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. 22 (Jan. 2023). (Accessed Feb. 2023).

“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. 6 (Jan. 2023). (Accessed Feb. 2023).

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 Feb. 2023).

Behavioral Health Administrative Services Organizations and Managed Care Organizations

• 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.

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 Feb. 2023).

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. 336 (Jan. 2023). (Accessed Feb. 2023).

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. 23-24  (Jan. 2023). (Accessed Feb. 2023).

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 (Jan. 2023). (Accessed Feb. 2023).

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. 73. (Jan. 2023). (Accessed Feb. 2023).

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. 22 (Jan. 2023). (Accessed Feb. 2023).

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. 2023).

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. 2023).

GEOGRAPHIC LIMITS

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TRANSMISSION FEE

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POLICY

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

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

SOURCE: WI Statute Sec. 49.45 (61). (Accessed Nov. 2022).

Services that are not covered when delivered in person are not covered as telehealth services. In addition, services that are not functionally equivalent to the in-person service when provided via telehealth are not covered.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth (Accessed Nov. 2022).

ELIGIBLE SERVICES

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GEOGRAPHIC LIMITS

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TRANSMISSION FEE

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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. 136 (Jan. 1, 2023), WY Division of Healthcare Financing Tribal Provider Manual, Ch. 6 Institutional/UB Common Billing Information, pgs. 144 & Ch. 7 CMS-1500 Common Billing Information, pg. 223 (Jan. 1, 2023) & Institutional Provider Manual pg. 141.  (Jan. 1, 2023). (Accessed Jan. 2023).

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, (Jan. 2023). (Accessed Jan. 2023).

ELIGIBLE SERVICES

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GEOGRAPHIC LIMITS

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TRANSMISSION FEE

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