Last updated 02/28/2021
Definitions
Telemedicine is the delivery of medical services and any diagnosis, consultation, treatment, transfer of medical data or education related to health care services using interactive audio or interactive video communication instead of in person contact.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 (Jul. 2020). (Accessed Feb. 2021).
“Telemedicine” is two-way, real-time interactive communication between the member and the physician or authorized provider at the distant site. This electronic communication uses interactive telecommunications equipment that includes, at a minimum, audio and video equipment.
SOURCE: UT Admin. Code R414-42-2. (Accessed Feb. 2021).
Last updated 02/28/2021
Email, Phone & Fax
Interprofessional telephone/internet assessment and management services are listed as a covered service for psychiatrists.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).
Telephone contact can be billed in the Targeted Case Management for Early Childhood program.
SOURCE: Utah Medicaid Provider Manual: Targeted Case Management, Early Childhood Ages 0-4, p. 10, (Jul. 2016). (Accessed Feb. 2021).
Last updated 02/28/2021
Live Video
POLICY
Providers are eligible for reimbursement for telemedicine services under Utah’s Medical Assistance Program.
SOURCE: UT Code Annotated Sec. 26-18-13. (Accessed Feb. 2021).
Utah Medicaid covers medically necessary, non-experimental and cost-effective services provided via telehealth.
Limitations:
- Must be HIPAA compliant
- Must comply with Utah Health Information Network Standards for Telehealth
CMS 1500 Professional Claims- Provider must indicate that the service(s) were provided via telehealth by indicating Place of Service 02 on the CMS 1500 claim form with the service’s usual billing codes.
UB-04 Institutional Claims- Providers must indicate that the service(s) were provided via telehealth by appending the GT modifier to the UB-04 institutional claim form with the service’s usual billing codes.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 & 50 (Jul. 2020). (Accessed Feb. 2021).
Covered services may be delivered by means of telemedicine, as clinically appropriate, including consultation, evaluation and management services, mental health services, substance use disorder services and telepsychiatric consultations. Must comply with privacy and security measures set forth by HIPAA and with Utah Health Information Network standards for telehealth. These standards provide a uniform standard of billing for claims and encounters delivered via telehealth.
The Department pays the lesser of the amount billed or the rate on the fee schedule. A provider shall not charge the Department a fee that exceeds the provider’s usual and customary charges for the provider’s private pay patients.
SOURCE: UT Admin. Code R414-42-3, R414-42-4, & R414-42-5 (Accessed Feb. 2021).
ELIGIBLE SPECIALTIES/SERVICES
Eligible services include but are not limited to:
- Consultation services
- Evaluation and management services
- Mental health services
- Substance use disorder services
- Teledentistry
- Telepsychiatric consultations
See manual for high level list of services that can be delivered via telemedicine.
Rural health clinic and federally qualified health clinic services may be delivered via telemedicine.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48-49 (Jul. 2020) & Utah Medicaid Provider Manual: Rural Health Clinics and Federally Qualified Health Centers Services. p.3 (Jan. 2019). (Accessed Feb. 2021).
The Medicaid program is required to reimburse for telemedicine services at the same rate the Medicaid program reimburses for other health care services (includes managed care plans). The Medicaid program is required to reimburse for telepsychiatric consultations at a rate set by the Medicaid program.
SOURCE: UT Code 26-18-13.5.(3) (Accessed Feb. 2021).
Telepsychiatric consultations between a physician and a board-certified psychiatrist are a covered service. See Medicaid Information Bulletin for specific CPT codes to bill.
SOURCE: Medicaid Information Bulletin. Jul. 2018. Sec. 18-67. (Accessed Feb. 2021).
Teledentistry services are limited to certain CPT codes.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).
Rehabilitative Mental Health and Substance Use Disorder
Services may be provided via telemedicine when clinically appropriate.
The scope of rehabilitative behavioral health services includes the following:
- Psychiatric Diagnostic Evaluation
- Mental Health Assessment by a Non-Mental Health Therapist
- Psychological Testing
- Psychotherapy with Patient and/or Family Member
- Family psychotherapy with Patient Present and Family Psychotherapy without Patient Present
- Group Psychotherapy and Multiple Family Group Psychotherapy
- Psychotherapy for Crisis
- Psychotherapy with Evaluation and Management (E/M) Services
- Evaluation and Management (E/M) Services (Pharmacologic Management)
- Therapeutic Behavioral Services
- Psychosocial Rehabilitative Services
- Peer Support Services
- SUD Services in Licensed SUD Residential Treatment Programs
- Assertive Community Treatment (ACT)
- Mobile Crisis Outreach Teams (MCOT)
SOURCE: Utah Medicaid Provider Manual: Rehabilitative Mental Health and Substance Use Disorder Services. P. 9-10 (Jan. 2021) (Accessed Feb.2021).
ELIGIBLE PROVIDERS
The distant site provider may participate in the telehealth interaction from any appropriate location.
Psychiatrists are limited to reporting certain CPT codes.
Rural health clinic and federally qualified health clinic services may be delivered via telemedicine.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49-51 (Jul. 2020). (Accessed Feb. 2021).
ELIGIBLE SITES
It is acceptable to use telehealth to facilitate contact directly between a member and a provider. Services can be provided between a member and a distant site provider when a member is in their home or other location of their choice.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).
GEOGRAPHIC LIMITS
There are no geographic restrictions for telehealth services.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 (Jul. 2020), (Accessed Feb. 2021).
Home and Community Based Services Autism Waiver
For those clients living outside of the Wasatch Front, the BCBA may use tele-health for the supervision time. In-person visits should be used for those clients living inside the Wasatch Front.
SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services Autism Waiver, p. 10, (Jan. 2016). (Accessed Feb. 2021).
FACILITY/TRANSMISSION FEE
The provider at the originating site receives no additional reimbursement for the use of telemedicine.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 50 (Jul. 2020) & R414-42-4.(3). (Accessed Feb. 2021).
Last updated 02/28/2021
Miscellaneous
Psychiatrist service will be covered by all Managed Care Entities (MCE). If a member receiving the service is part of an MCE, then the provider must be enrolled with the member’s MCE in order to receive reimbursement.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).
If the required face-to-face encounter for certain durable medical equipment occurred via telehealth it must be documented.
SOURCE: Utah Medicaid Provider Manual: Durable Medical Equipment, p. 6, (Jan. 2021). (Accessed Feb. 2021).
Home and Community Based New Choices Waiver Services
A non face-to-face medication reminder system using telecommunication device is covered.
SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services, New Choices Waiver, p. 75, (Oct.. 2020). (Accessed Feb. 2021).
Home and Community Based Services Autism Waiver
For those clients living outside of the Wasatch Front, the BCBA may use tele-health for the supervision time. In-person visits should be used for those clients living inside the Wasatch Front.
SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services Autism Waiver, p. 10, (Jan. 2016). (Accessed Feb. 2021).
Last updated 02/28/2021
Overview
Utah Medicaid reimburses for medically necessary, non-experimental and cost-effective services via live video telehealth, and does not reference store-and-forward modality in their policy.
SOURCE: Utah Medicaid Provider Manual: Section I: General Information, P. 48 (Jul. 2020). (Accessed Feb. 2021).
Home telemetry for outpatient long-term cardiac monitoring is allowable with prior authorization under certain conditions.
SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Jan. 2021). (Accessed Feb. 2021).
Last updated 02/28/2021
Remote Patient Monitoring
POLICY
Bulletin indicates The Skilled Nursing Pilot Project has been removed from manual.
SOURCE: Medicaid Information Bulletin July 2019 (Accessed Feb. 2021).
Home telemetry for outpatient long-term cardiac monitoring is allowed with prior authorization. Criteria include:
- Must be ordered by a neurologist
- Member must have had a stroke or TIA with no identifiable cause
- Member should have already had 24-hour monitoring done previously
- Member should not be currently taking anti-coagulated or Warfarin for any other reason
- Member should not have a known contraindication for Warfarin
- Outpatient long-term cardiac monitoring may only be authorized for the 30-day test
- Data from the test must be reviewed and interpreted by a cardiologist
SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Jan. 2021). (Accessed Feb.2021).
CONDITIONS
Only for patients with a long-term cardiac health issue.
SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 24 (Jan. 2021). (Accessed Feb. 2021).
PROVIDER LIMITATIONS
Test must be ordered by a neurologist and reviewed and interpreted by a cardiologist.
SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Jan. 2021). (Accessed Feb. 2021).
OTHER RESTRICTIONS
No Reference Found
