Last updated 09/20/2021
Live Video
POLICY
Services delivered via telehealth will be eligible for reimbursement when all of the following conditions are met:
- The Provider at the distant site deems that the service being provided is clinically appropriate to be delivered via telehealth;
- The service delivered via telehealth meets the procedural definition and components of the CPT or HCPCS code, as defined by the American Medical Association (AMA);
- The service provided via telehealth meets all state and federal laws regarding confidentiality of health care information and a patient’s right to his or her medical information; and
- Services delivered via telehealth meet all applicable state laws, regulations and licensure requirements on the practice of telehealth; and
- DMAS deems the service eligible for delivery via telehealth.
In order to be reimbursed for services using telehealth that are provided to MCO-enrolled individuals, Providers must follow their respective contract with the MCO.
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), p. 2 (July 2021) (Accessed Sept. 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. 32.1-325, (Accessed Sept. 2021).
Telemedicine is available for selected services.
SOURCE: VA Dept. of Medical Assistance Svcs. General Information. All Manuals, pg. 10, Jun. 2021, (Accessed Sept. 2021).
Attachment A in the Telehealth Supplement lists covered services that may be reimbursed when provided via telehealth.
Certain types of services that would not be expected to be appropriately delivered via telemedicine include, but are not limited to, those that:
- are performed in an operating room or while the patient is under anesthesia;
- require direct visualization or instrumentation of bodily structures;
- involve sampling of tissue or insertion/removal of medical devices; and/or
- otherwise require the in-person presence of the patient for any reason
If, after initiating a telemedicine visit, the telemedicine modality is found to be medically and/or clinically inappropriate, or otherwise can no longer meet the requirements stipulated in the “Reimbursable Telehealth Services” section, the Provider shall provide or arrange, in a timely manner, an alternative to meet the needs of the individual (e.g., services delivered in-person; services delivered via telemedicine when conditions allow telemedicine to meet requirements stipulated in the “Reimbursable Telehealth Services” section). In this circumstance, the Provider shall be reimbursed only for services successfully delivered.
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), p. 2 (July 2021) (Accessed Sept. 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. 8 (Mar. 2021). (Accessed Sept. 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 (Jun. 2021). (Accessed Sept. 2021).
Opioid Treatment Services
Services can be provided face-to-face or by telemedicine according to DMAS policy regarding telemedicine.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Covered Svcs and Limitations p. 7 & 34. (July 2021). (Accessed Sept. 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 Sept. 2021).
Residential Treatment Service
DMAS reimburses for telemedicine services under limited circumstances. Telemedicine is the real-time or near real-time exchange of information for diagnosing and treating medical conditions. Telemedicine utilizes audio/video connections linking medical practitioners in one locality with medical practitioners in another locality. DMAS recognizes telemedicine as a means for delivering some covered Medicaid services.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Residential Treatment Services, Covered Services and Limitations, p. 5 (1/9/21), (Accessed Sept. 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 Sept. 2021).
ELIGIBLE PROVIDERS
The term “Provider” refers to the billing provider – either a qualified, licensed practitioner of the healing arts or a facility – who is enrolled with DMAS.
Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider site and bill under the encounter rate. When an FQHC or RHC serves as the originating site, the originating site fee is paid separately from the center or clinic all-inclusive rate.
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), p. 1 & 4, (July 2021) (Accessed Sept. 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 Sept. 2021).
Preferred OBOT services must be provided by a buprenorphine-waivered practitioner and a co- located Credentialed Addiction Treatment Professional and may be provided in a variety of practice settings including primary care clinics, outpatient health system clinics, psychiatry clinics, Federally-Qualified Health Centers (FQHCs), Community Service Boards (CSBs), local health department clinics, and physicians’/physician extenders’ offices. DMAS expects Preferred OBOT services to be primarily delivered in-person/on site and utilize telehealth as an option to increase access to services as needed. DMAS does not support Preferred OBOTs services to be delivered solely or primarily through telehealth. The practitioners must be credentialed by DMAS, the DMAS fee-for-service contractor or MCOs to perform Preferred OBOT services. Preferred OBOT providers do not require a separate DBHDS license.
Thus Preferred OBOT services may be provided via telehealth based on the individualized needs of the member and must have supporting documentation of why the in-person interactions are not meeting the member’s specific needs. The primary means of services delivery shall be in-person for the Preferred OBOT model with the exception of telehealth for specific member circumstances (such as transportation issues, childcare, employment, co-morbidities, distance, etc.) that impede their access to treatment. Providers delivering services using telemedicine shall bill according to the requirements in the DMAS Telehealth Services Supplemental Manual.
SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Opioid Treatment Services/Medication Assisted Treatment, p. 15 & 19 & (Jul. 2021), (Accessed Sept. 2021).
ELIGIBLE SITES
The originating site is the location of the member at the time the service is rendered, or the site where the asynchronous store-and-forward service originates (i.e., where the data are collected). Examples of originating sites include: medical care facility; Provider’s outpatient office; the member’s residence or school; or other community location (e.g., place of employment).
Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider site and bill under the encounter rate. When an FQHC or RHC serves as the originating site, the originating site fee is paid separately from the center or clinic all-inclusive rate.
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), p. 4 (July 2021) (Accessed Sept. 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. 32.1-325, (Accessed Sept. 2021).
GEOGRAPHIC LIMITS
No reference found.
FACILITY/TRANSMISSION FEE
In the event it is medically necessary for a Provider to be present at the originating site at the time a synchronous telehealth service is delivered, said Provider may bill an originating site fee (via procedure code Q3014) when the following conditions are met:
- The Medicaid member is located at a provider office or other location where services are delivered on an in-person basis (this does not include the member’s residence);
- The member and distant site Provider are not located in the same location;
- The distant site Provider providing the service also does not provide services on an in-person basis at the same location of the entity billing the Originating Site Fee; and
- The Provider (or the Provider’s designee), is affiliated with the provider office or other location where the Medicaid member is located and attends the encounter with the member. The Provider or designee may be present to assist with initiation of the visit but the presence of the Provider or designee in the actual visit shall be determined by a balance of clinical need and member preference or desire for confidentiality.
Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider site and bill under the encounter rate. When an FQHC or RHC serves as the originating site, the originating site fee is paid separately from the center or clinic all-inclusive rate.
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), p. 4 (July 2021) (Accessed Sept. 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. 8 (Mar. 2021) & Billing Instructions, pg 9 (Jul. 2021), (Accessed Sept. 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 Sept. 2021).
Last updated 09/20/2021
Miscellaneous
See Telehealth Supplement for Documentation and Equipment/Technology Requirements.
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), p. 5 (July 2021) (Accessed Sept. 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 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. 32.1-325, (Accessed Sept. 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 Sept. 2021).
Last updated 09/20/2021
Remote Patient Monitoring
POLICY
Face-to-face encounters may occur through telemedicine, which is defined as the two-way, real time interactive electronic communication between the member and the Provider located at a site distant from the member. This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine shall not include by telephone or email.
SOURCE: VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Home Health Manual, Covered Services and Limitations. p. 5 (July 2021). (Accessed Sept. 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 Sept. 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. 32.1-325 (Accessed Sept. 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. 32.1-325 (Accessed Sept. 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 Sept. 2021).
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
No reference found.
