Last updated 05/31/2021
Consent Requirements
No Reference Found
Last updated 06/01/2021
Definitions
“Telemedicine is the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment.”
SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations. p. 16 (Mar. 2020). (Accessed May 2021).
“Telemedicine is the real-time or near real-time exchange of information for the purposes of diagnosis and treatment.”
SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Psychiatric Services Provider Manual, Covered Svcs. and Limitations. p. 17 (Aug. 2018) (Accessed May 2021).
Telehealth is defined as “the real-time or near real-time transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment.”
SOURCE: VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Home Health Manual, Covered Services and Limitations. p. 5 (Aug. 2020). (Accessed May 2021).
Medicaid-Medicare Waiver
“Telehealth” means the real-time or near real-time two-way transfer of data and information using an interactive audio and video connection for the purposes of medical diagnosis and treatment.
SOURCE: VA Reg Text 12VAC30-121-70(7(b)). (Accessed May 2021).
Last updated 05/31/2021
Live Video
POLICY
All coverage requirements described in the DMAS Provider Manuals apply when the service is delivered via telemedicine. The use of telemedicine must be noted in the service documentation of the patient record.
SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16 (Mar. 2020) (Accessed May 2021).
ELIGIBLE SERVICES/SPECIALTIES
The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services. Such plan shall include:
- A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.
SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).
Telemedicine is available for selected services and limited provider types.
SOURCE: VA Dept. of Medical Assistance Svcs. General Information. All Manuals, pg. 7, Jan. 2021, (Accessed Feb. 2021).
All coverage requirements described in the DMAS Provider Manuals apply when the service is delivered via telemedicine. The use of telemedicine must be noted in the service documentation of the patient record. Eligible telemedicine codes are listed in the manual in two tables.
See manual for non-covered services.
SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16-18 (Mar. 2020) & Billing Instructions, pg. 20 (5/1/17), (Accessed May 2021).
See billing information for specific codes.
Eligible services include:
- Evaluation and management
- Psychiatric care
- Specialty medical procedures such as echocardiography and obstetric ultrasound
- Speech therapy
- Radiology procedures
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 3. (May. 2014). (Accessed May 2021).
DMAS permits the delivery of covered speech-language therapy services by a DMAS qualified SLP provider through the use of audio and video conferencing to a child at a school-based site located remotely from the qualified provider. The presence of an aide with the student at the time of the encounter is optional, however, an aide must be present if the LEA intends to bill for the “originating site fee”.
SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Local Education Agency Provider Manual, Covered Svcs. and Limitations, p. 11 (Mar. 2021). (Accessed May 2021).
Community Mental Health Rehabilitative Services
A Comprehensive Needs Assessment meeting DMAS telemedicine standards is allowed for:
- Psychosocial rehabilitation
- Partial hospitalization
- Intensive Community Treatment
- Crisis intervention
SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Community Mental Health Rehabilitative Services, Covered Svcs. and Limitations, p. 18 (May. 2019). (Accessed May 2021).
Telemedicine is reimbursable for psychiatric evaluation in crisis stabilization services when coordinated with an outpatient provider and billed as physician or outpatient psychiatric services, however telemedicine is not allowed for services billed under Crisis Stabilization.
SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Community Mental Health Rehabilitative Services, Covered Svcs. and Limitations, p. 49-50 (May. 2019). (Accessed May 2021).
Durable Medical Equipment (DME) and Supplies
The face-to-face encounter to qualify for DME may occur through telehealth.
SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Durable Medical Equipment and Supplies Manual, Covered Svcs. and Limitations, p. 8 (10/20/20). (Accessed May 2021).
Opioid Treatment Services
Services can be provided face-to-face or by telemedicine according to DMAS policy regarding telemedicine. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telemedicine.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Covered Svcs and Limitations p. 7 & 34. (Dec. 2017). (Accessed May 2021).
MAT for Opioid Use Disorder
Prescribing controlled substances for the treatment of addiction delivered via telemedicine must include a qualified provider and a telepresenter located at the originating site, as well as a qualified prescribing provider located at the remote site. Psychotherapy and SUD counseling may also be provided via telemedicine by a qualified provider who is a credentialed addiction treatment professional as defined in this memorandum and DMAS ARTS Provider Manual. See manual for eligible MAT codes.
SOURCE: Medicaid Bulletin: Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p. 3-4. (Accessed May 2021).
Residential Treatment Service
An assessment for residential referrals can be completed face-to-face or through telemedicine. See Medicaid manual for DMAS policy.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Residential Treatment Services, Covered Services and Limitations, p. 5 & 33 (1/9/21), (Accessed May 2021).
Vision Manual
CPT codes that are recognized by DMAS are listed. Codes include:
- Consultations
- Office visits
- Individual psychotherapy
- Psychiatric diagnostic interview examination
- Pharmacologic management
- Colostomy
- Obstetric ultrasound
- Echocardiography, fetal
- Cardiography interpretation and report only
- Echocardiography
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Vision Manual, Billing Instructions, p. 23 (Jul. 2015), (Accessed May 2021).
ELIGIBLE PROVIDERS
Eligible providers:
- Physicians
- Nurse practitioners
- Nurse midwives
- Psychiatrist
- Clinical psychologist
- Clinical nurse specialists
- Clinical social worker
- Professional counselor
- Psychiatric clinical nurse specialist
- Psychiatric nurse practitioner
- Marriage and family therapist/counselor
- School psychologist
- Substance abuse treatment practitioner
- Local Education Agency (billing speech therapy)
- Federally Qualified Health Center Providers
- Appropriately licensed behavioral health and developmental services providers enrolled with Magellan.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Federally Qualified Health Centers Coverage of Telemedicine. (Mar. 2019) & Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May. 2014) (Accessed May 2021).
Medication Assisted Treatment
The Member is located at an approved originating site with the Medicaid enrolled telepresenter. The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.
SOURCE: Medicaid Bulletin: Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p.4. (Accessed May 2021).
ELIGIBLE SITES
Eligible originating sites locations:
- Rural Health Clinics
- Federally Qualified Health Centers
- Hospitals
- Nursing Facilities
- Health Department Clinics
- Renal Units (dialysis centers)
- Community Services Boards (mental health-intellectual disability provider)
- Residential Treatment Centers
All listed providers are considered eligible originating site providers.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Federally Qualified Health Centers Coverage of Telemedicine, p. 1 (Mar. 2019) & Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 6. (May 2014) (Accessed May 2021).
The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services. Such plan shall include:
- A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.
SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).
GEOGRAPHIC LIMITS
Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services. Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 2. (May. 2014) (Accessed May 2021).
FACILITY/TRANSMISSION FEE
Reimburses a facility fee.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May. 2014) & VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Billing Instructions, p. 22 (May 2017); Vision Manual, Billing Instructions, p. 24 (Jul. 2015). (Accessed May 2021).
DMAS permits the delivery of covered speech-language therapy services by a DMAS qualified SLP provider through the use of audio and video conferencing to a child at a school-based site located remotely from the qualified provider. The presence of an aide with the student at the time of the encounter is optional, however, an aide must be present if the LEA intends to bill for the “originating site fee”. See Billing Instructions for proper billing of originating site fee.
SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Local Education Agency Provider Manual, Covered Svcs. and Limitations, p. 11 (Mar. 2021) & Billing Instructions, (Mar. 2021), (Accessed May 2021).
Medication Assisted Treatment
The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.
SOURCE: Medicaid Bulletin: Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p.4. (Accessed May 2021).
Last updated 05/31/2021
Miscellaneous
The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services. Such plan shall include:
- A provision for payment of medical assistance services delivered to Medicaid-eligible students when such services qualify for reimbursement by the Virginia Medicaid program and may be provided by school divisions, regardless of whether the student receiving care has an individualized education program or whether the health care service is included in a student’s individualized education program. Such services shall include those covered under the state plan for medical assistance services or by the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), and shall include a provision for payment of medical assistance for health care services provided through telemedicine services. No health care provider who provides health care services through telemedicine shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
- A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
- A provision for payment of medical assistance for remote patient monitoring services provided via telemedicine for:
- High-risk pregnant persons;
- Medically complex infants and children; Transplant patients;
- Patients who have undergone surgery, for up to three months following the date of such surgery; and
- Patients with a chronic health condition who have had two or more hospitalizations or emergency department visits related to such chronic health condition in the previous 12 months.
“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.
“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.
SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 1987, SB 1307, HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).
Use of telemedicine must be noted in the service documentation of the patient record.
The originating site provider or designee must attend the encounter with the member, unless the encounter documentation in the patient record notes the reason staff was not present.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 3-4. (May 2014) & Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. And Limitations, p. 16-17 (Mar. 2020); Psychiatric Services Provider Manual, Covered Svcs, And Limitations pg. 17, (Aug. 2018), (Accessed May 2021).
Telemedicine also available for limited screening under the Governor’s Access Plan for the Seriously Mentally Ill (GAP).
SOURCE: VA Dept. of Medical Assistant Svcs., GAP Manual, p. 3 & 6 (Feb. 2019). (Accessed May 2021).
See Psychiatric Services Provider Manual for requirements around equipment, professional protocols, and confidentiality.
SOURCE: VA Dept. of Medical Assistance Svcs. Psychiatric Services Provider Manual, Covered Services, pg. 17, (Aug. 2018), (Accessed May 2021).
Dual Eligibles (Medicare and Medicaid)
DMAS established the Commonwealth Coordinated Care program and allows participating plans to reimburse for telehealth for Medicare and Medicaid services as an innovative way to reduce hospital readmissions, reduce ED visits, etc. Participating plans shall encourage the use of telehealth to promote community living and improve behavioral health services. Plans shall be permitted to use telehealth in rural and urban settings and reimburse for store-and-forward. Plans shall also have the ability to cover remote patient monitoring.
SOURCE: 12VAC30-121-70 (B(7)). (Accessed May 2021).
Last updated 05/31/2021
Out of State Providers
Newly enrolling out-of-state physicians who enter on their enrollment application a service address that is within 50 miles of the Virginia border may be enrolled as in-state providers.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 2-3. (May. 2014) (Accessed May 2021).
Out-of-state physicians must enroll with DMAS contractors to utilize telemedicine in the Medicaid program.
All providers utilizing telemedicine and billing for services must be enrolled with DMAS. All coverage requirements described in the DMAS provider manuals apply when the service is delivered via telemedicine.
Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services. Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin.Updates to Telemedicine Coverage. P. 2-3. (May. 2014) & VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16-17 (Mar. 2020) (Accessed May 2021).
Providers must have the appropriate required license from the Department of Behavioral Health and Developmental Services (http://www.dbhds.virginia.gov/) and enrolled with Magellan. These providers are considered as remote providers.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 6. (May. 2014), (Accessed May 2021).
Last updated 05/31/2021
Overview
Virginia Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under certain circumstances. Plans participating in the Medicare-Medicaid Demonstration Waiver are permitted to use store-and-forward and remote patient monitoring in rural and urban locations and to provide reimbursement for services.
Last updated 05/31/2021
Remote Patient Monitoring
POLICY
Face-to-face encounters for home health services may occur through telehealth.
SOURCE: VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Home Health Manual, Covered Services and Limitations. p. 5 (Aug. 2020). (Accessed May 2021).
VA Medicaid reimburses for Continuous Glucose Monitoring.
SOURCE: VA Department of Medical Assistance Services. Medicaid Memo. Clarification of Existing Medicaid Coverage of Continuous Glucose Monitoring for Members in Medicaid/FAMIS/FAMIS MOMS Fee-for-Service Programs. (Oct. 2016) (Accessed May 2021).
Medicare-Medicaid Demonstration Waiver:
Participating plans shall also have the ability to cover remote patient monitoring.
SOURCE: VA Reg. Text 12VAC30-121-70(7). (Accessed May 2021).
The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services. Such plan shall include a provision for payment of medical assistance for remote patient monitoring services provided via telemedicine for specific conditions (see section below).
“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.
SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 1987, SB 1307, HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).
CONDITIONS
The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services. Such plan shall include:
- A provision for payment of medical assistance for remote patient monitoring services provided via telemedicine for:
- High-risk pregnant persons;
- Medically complex infants and children; Transplant patients;
- Patients who have undergone surgery, for up to three months following the date of such surgery; and
- Patients with a chronic health condition who have had two or more hospitalizations or emergency department visits related to such chronic health condition in the previous 12 months.
“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.
SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 1987, SB 1307, HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).
Used for patients with one or more chronic conditions, such as:
- congestive heart failure
- cardiac arrhythmias
- diabetes
- pulmonary diseases
- anticoagulation treatment
Enrollee must agree to use of remote patient monitoring.
SOURCE: VA Reg. Text 12VAC30-121-20. (Accessed May 2021).
Coverage Continuous Glucose Monitoring is limited to members with:
- Type 1 diabetes
- Type 2 diabetes (when over 16 years old)
- Pregnant women who are injecting insulin with either Type 1 or 2.
Service authorization is required. Additional requirements apply.
SOURCE: VA Department of Medical Assistance Services. Medicaid Memo. Clarification of Existing Medicaid Coverage of Continuous Glucose Monitoring for Members in Medicaid/FAMIS/FAMIS MOMS Fee-for-Service Programs. (Nov. 2016) (Accessed May 2021).
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.
SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 1987, SB 1307, HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).
Last updated 05/31/2021
Store and Forward
POLICY
DMAS reimburses for diabetic retinopathy screening through telemedicine for Medicaid members with Type 1 or 2 diabetes. Radiology related procedures are also included under telemedicine coverage as well as certain codes for teledermatology.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 5-6. (May. 2014) & Dept. of Medical Assistance Svcs., Medicaid Provider Manual Physician/Practitioner Manual, Billing Instructions, p. 21 (May 2017). (Accessed May 2021).
Medicare-Medicaid Demonstration Waiver:
Participating plans shall be permitted to use telehealth in rural and urban settings and reimburse for store-and-forward applications.
SOURCE: VA Reg. Text 12VAC30-121-70-B-7. (Accessed May 2021).
ELIGIBLE SERVICES/SPECIALTIES
Refer to the manual for a full list of CPT and HCPCS codes reimbursable by Virginia Medicaid.
Services covered include:
- Radiology and radiology procedures
- Diabetic retinopathy (regardless of the number of fields viewed for all Medicaid Members with Type 1 or Type 2 diabetes)
- Outpatient teledermatology
SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner. Billing Instructions, p. 20-24 (May 2017) & VA Medicaid Memo. Clarification of Medicaid Coverage of Diabetic Retinopathy Screening via Telemedicine. Nov. 9, 2016. (Accessed May 2021).
GEOGRAPHIC LIMITS
Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services. Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 2. (May 2014) (Accessed May 2021).
TRANSMISSION FEE
Reimburses a facility fee.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May 2014) & VA Dept. of Medical Assistant Svcs, Medicaid Provider Manual, Physician/Practitioner-Manual. Covered Services and Limitations, p. 17 (Mar. 2020) (Accessed May 2021).
