Last updated 02/28/2021
Consent Requirements
No Reference Found
Last updated 02/28/2021
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 Feb. 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 Feb. 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 Feb. 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)). (2017). (Accessed Feb. 2021).
Last updated 02/28/2021
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 Feb. 2021).
ELIGIBLE SERVICES/SPECIALTIES
Telemedicine is available for selected services and limited provider types.
SOURCE: VA Dept. of Medical Assistance Svcs. General Information. All Manuals, Feb. 2019, (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 Feb. 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 Feb. 2021).
Speech therapy is reimbursable for a speech-language pathologist at a remote location and a qualified school aide with the child during a tele-practice session.
SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Local Education Agency Provider Manual, Covered Svcs. and Limitations, p. 11 (Jul. 2018). (Accessed Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 2021).
Last updated 02/28/2021
Miscellaneous
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 Feb. 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 Feb. 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 Feb. 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 Feb. 2021).
Last updated 02/28/2021
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 Feb. 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 Feb. 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 Feb. 2021).
Last updated 02/28/2021
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 02/28/2021
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 Feb. 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 Feb. 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 Feb. 2021).
CONDITIONS
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 Feb. 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 Feb. 2021).
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
No Reference Found
Last updated 02/28/2021
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 Feb. 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 Feb. 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 Feb. 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 Feb. 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 Feb. 2021).
