Last updated 02/28/2021
Definitions
“Telemedicine is when a health care practitioner uses HIPAA-compliant interactive real-time audio and video telecommunications (including web-based applications) or store-and-forward technology to deliver covered services that are within his or her scope of practice to a client at a site other than the site where the provider is located.”
SOURCE: WA Admin. Code Sec. 182-531-1730 & WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 84 (Feb. 2021); Accessed Feb. 2021).
Telemedicine is when a health care provider uses HIPAA-compliant, interactive, real-time audio and video telecommunications (including web-based applications) to deliver covered services that are within the provider’s scope of practice to a student at a site other than the site where the provider is located. The HCA does not cover the following services provided through telemedicine:
- Email, audio only telephone, and facsimile transmissions
- Installation or maintenance of any telecommunication devices or systems
- Purchase, rental, or repair of telemedicine equipment
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 33 (Oct. 2020); Applied Behavior Analysis (ABA) Program, p. 33 (Dec. 2020); Maternity Support Services and Infant Case Management, p. 26 (Jan. 2021), (Accessed Feb. 2021).
Manuals for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Maternity Support Services, Mental Health Services, Medical Nutrition Therapy, Neurodevelopmental Centers, Habilitative Services, Outpatient Hospital Services, Outpatient Rehabilitation Respiratory Care, and Substance Use Disorder refer to agency’s telemedicine coverage policy in the Physician-related services manual.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide. Federally Qualified Health Centers Manual, p. 64 Jan. 2021; Rural Health Clinics, p. 44, Jan. 2021; Mental Health Services, p. 20 (Jan. 2021); Maternity Support Services Manual, Jan. 2021, pg. 26; Medical Nutrition Therapy Manual, Oct. 1, 2020, pg. 15; Neurodevelopmental Centers, (Jan. 2021), Habilitative Services, pg. 14, (Jan. 2021); Outpatient Rehabilitation, (Jan. 2021), pg. 13; Outpatient Hospital Services Manual, Jan. 2021 pg. 27; Respiratory Care, Oct. 2020, pg. 23; Substance Use Disorder, (Jan. 2021), pg. 24 (Accessed Feb. 2021).
Last updated 02/28/2021
Email, Phone & Fax
No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.
Teledermatology does not include single-mode consultations by telephone calls, images transmitted via facsimile machines, or electronic mail.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 88 (Jan. 2021), School-Based Health Care Services, p. 33 (Oct. 2020); Applied Behavioral Analysis (ABA) Program, p. 34, (Accessed Feb. 2021).
HCA pays for telephone services when used by a physician to report and bill for episodes of care initiated by an established patient (i.e., someone who has received a face-to-face service from you or another physician of the same specialty in your group in the past three years) or by the patient’s guardian. See manual for codes and additional requirements.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 48 (Feb. 2021), (Accessed Feb. 2021).
Effective for dates of service on and after March 1, 2021, the agency will no longer reimburse CDT code D9992 for triage and care coordination over the telephone.
The agency does not cover email, audio only telephone, and facsimile transmissions as teledentistry services.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental-Related Services, p. 68, Mar. 2021, (Accessed Feb. 2021).
Last updated 02/28/2021
Live Video
POLICY
Fee-for-service clients are eligible for medically necessary covered health care services delivered via telemedicine. The referring provider is responsible for determining and documenting that telemedicine is medically necessary. The referring provider is responsible for determining and documenting medical necessity.
As a condition of payment, the client must be present and participating in the telemedicine visit.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 85 (Feb. 2021). (Accessed Feb. 2021).
ELIGIBLE SERVICES/SPECIALTIES
Physician-Related Services
WA Medicaid covers telemedicine when it is a substitute for an in-person face-to-face hands-on encounter for only those services specifically listed in the telemedicine section of the manual.
The agency reimburses medically necessary covered services through telemedicine when the service is provided by a Washington Apple Health (Medicaid) provider and is within their scope of practice. Place of service 02 to indicate the service was furnished as a telemedicine service from the distant site.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 85 & 87 (Feb. 2021). (Accessed Feb. 2021).
School Based Services
In order for a school district to receive reimbursement for telemedicine, the provider furnishing services through telemedicine must be enrolled as a servicing provider under the school district’s ProviderOne account. Services provided by nonlicensed school staff must be billed under the supervising provider’s NPI in ProviderOne.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School-Based Health Services, p. 33 (Oct. 2020). (Accessed Feb. 2021).
Applied Behavior Analysis (ABA) for Clients Age 20 and Younger
Eligible telemedicine services:
- Program supervision when the child is present
- Family training, which does not require the child’s presence
The LBA may use telemedicine to supervise the CBT’s delivery of ABA services to the client, the family, or both. LBAs who use telemedicine are responsible for determining if telemedicine can be performed without compromising the quality of the parent training, or the outcome of the ABA therapy treatment plan.
See ABA Treatment fee schedule for telemedicine billing instructions.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Applied Behavior Analysis for Clients 20 and Younger, p. 33 (Feb. 2021) & WAC 182-531A-1200. (Accessed Feb. 2021).
Behavioral Health
Behavioral health administrative services organizations and managed care organizations who have a contract with the department shall reimburse a provider for behavioral health services provided to a covered person who is under 18 years old through telemedicine or store-and-forward if:
- The behavioral health administrative services organization or managed care organization provides coverage for behavioral health services when provided in-person; and
- The service is medically necessary
SOURCE: Revised Code of WA Sec. 71.24.335(1). (Accessed Feb. 2021).
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, within the scope of practice of the performing agency-contracted providers, and Department of Health teledentistry guidelines.
A dentist or authorized dental provider may delegate allowable tasks to Washington State Registered Dental Hygienists and Expanded Function Dental Assistants through teledentistry. Delegation of tasks must be under general supervision. Teledentistry does not meet the definition of close supervision.
See manual for acceptable CPT codes.
SOURCE: WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 67-68. (Mar. 2021). (Accessed Feb. 2021).
Mental Health Services
Drug monitoring must be provided during a face-to-face visit with the client, unless it is part of a qualified telemedicine visit.
SOURCE: WA State Health Care Authority, Medicaid Provider. Mental Health Services, p. 47. Jan. 2021, (Accessed Feb. 2021).
Abortion
Medical abortion services provided via telemedicine to a client who does not receive ultrasound(s) and laboratory studies from the medical abortion provider are not eligible for the HCPCS S0199 bundled payment.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 213 (Feb. 2021). (Accessed Feb. 2021).
ELIGIBLE PROVIDERS
Rural Health Clinics (RHCs) & FQHCs
RHCs & FQHCs are authorized to serve as an originating site for telemedicine services. RHCs and FQHCs may receive the encounter rate when billing as a distant site provider if the service being billed is encounter eligible. Clients enrolled in an agency-contracted MCO must contact the MCO regarding whether or not the plan will authorize telemedicine coverage.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Rural Health Clinics, p. 44, Jan. 2021; Federally Qualified Health Centers, p. 64. (Accessed Feb. 2021).
School Based Health Care Services
Under the SBHS program, HCA pays for services provided through telemedicine as outlined in this billing guide. Licensed providers, licensed assistants, compact license holders, interim permit holders, and non-licensed school staff practicing under the supervision of a licensed provider may provide SBHS through telemedicine.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based-Health Care Services, p. 32, Oct. 2020. (Accessed Feb. 2021).
Tribal Health Program
An encounter can be conducted face-to-face or via real-time telemedicine.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Tribal Health Program, p. 17, Jan. 2021, (Accessed Feb. 2021).
ELIGIBLE SITES
Approved Originating Sites
- Clinics;
- Community mental health center/chemical dependency settings;
- Dental offices;
- Federally qualified health center;
- Home or any location determined appropriate by the individual receiving the service;
- Hospitals—inpatient or outpatient;
- Neurodevelopmental centers;
- Physician’s or other health professional’s office;
- Renal dialysis centers, except an independent renal dialysis center;
- Rural health clinic;
- Schools; or
- Skilled nursing facility
Originating site (referring) providers are responsible for determining and documenting that telemedicine is medically necessary.
SOURCE: WAC 182-531-1730.(3) & WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 86 (Feb. 2021). (Accessed Feb. 2021).
School-Based Health Care Services (SBHS)
When the originating site is a school, the school district must submit a claim on behalf of both the originating and distant site. The location of the student and provider must be documented. The SBHS program allows the following approved originating sites:
- The school
- The home, daycare, or any location determined appropriate by the students or parents
See manual for specific scenarios and appropriate modifiers.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 33-34 (Oct. 2020), (Accessed Feb. 2021).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Facility fees are available for originating sites, except inpatient hospitals, skilled nursing facilities, homes or other locations determined appropriate by the individual receiving service. Eligible originating sites explicitly listed for the facility fee include:
- Hospital outpatient
- Critical access hospitals
- FQHCs and RHCs
- Physicians or other health professional office
- Other settings, when approved as an originating site
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 86-87 (Feb. 2021). (Accessed Feb. 2021).
FQHCs and Rural Health Clinics that serve as an originating site for telemedicine services are paid an originating site facility fee. Charges for the originating site facility fee may be included on a claim, but the originating site facility fee may not be included on the cost report.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide Rural Health Clinics, p. 44, Jan. 2021 & Federally Qualified Health Centers, p. 64 (Jan. 2021)) (Accessed Feb. 2021).
School-Based Health Care Services (SBHS)
When the originating site is a school, the school district will receive a telemedicine fee per completed telemedicine transmission.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 33 (Oct. 2020), (Accessed Feb. 2021).
Dental Related Services
The facility fee is included in the CPT code. There is no separate facility fee for teledentistry.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental Services, p. 67 (Mar. 2021). (Accessed Feb. 2021).
Abortion
When telemedicine is used to provide HCPCS S0199 bundled services, HCA does not pay any additional originating facility fees.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 213 (Feb. 2021). (Accessed Feb. 2021).
Last updated 02/28/2021
Miscellaneous
Use place of service (POS) 02 to indicate that a billed service was furnished as a telemedicine service from a distant site. Distant site practitioners billing for telemedicine services under Critical Access Hospital (CAH) optional payment method must use the GT modifier. Add modifier 95 if the distant site is designated as a nonfacility.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 87-88 (Feb. 2021). (Accessed Feb. 2021).
Additional Documentation Requirements for Telemedicine:
- Specification of the telehealth modality that was used (e.g., visit was conducted via HIPAA-compliant real-time audio/visual)
- Verification that telemedicine was clinically appropriate for this service
- Whether any assistive technologies were used
- The location of the client
- The names and credentials (MD, ARNP, RN, PA, CNA, etc.) of all provider personnel involved in the telemedicine visit
- Consent for care via the modality that was used
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 85-86 (Feb. 2021). (Accessed Feb. 2021).
“If a provider from the originating site performs a separately identifiable service for the client on the same day as telemedicine, documentation for both services must be clearly and separately identified in the client’s medical record.”
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., 87 (Feb. 2021). (Accessed Feb. 2021).
Last updated 02/28/2021
Out of State Providers
No Reference Found
Last updated 02/28/2021
Overview
Washington Medicaid (Apple Health) reimburses for live video, limited store-and-forward, and remote patient monitoring under some circumstances.
Client must be present and participating in telemedicine visit. Clients under the Family Planning Only – Pregnancy Related program, Family Planning Only program (formerly TAKE CHARGE), First Steps, and School Based Health Care Service program are eligible for telemedicine through fee-for-service.
MCO’s cover the delivery of care via telemedicine. Follow the MCO’s policy and billing requirements.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 84-85 (Feb. 2021); (Accessed Feb. 2021).
Telemedicine is covered by the Department.
SOURCE: WA Admin. Code Sec. 182-531-0100. (Accessed Feb. 2021).
Last updated 02/28/2021
Remote Patient Monitoring
POLICY
Home Health Services
“Telemedicine means the use of tele-monitoring to enhance the delivery of certain home health skilled nursing services through:
- The collection of clinical data and the transmission of such data between a patient at a distant location and the home health provider through electronic processing technologies. Objective clinical data that may be transmitted includes, but is not limited to, weight, blood pressure, pulse, respirations, blood glucose, and pulse oximetry; or
- The provision of certain education related to health care services using audio, video, or data communication instead of a face-to-face visit.”
SOURCE: WA Admin. Code Sec. 182-551-2010. (Accessed Feb. 2021).
CONDITIONS
No Reference Found
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
Home health monitoring is not covered in Applied Behavior Analysis Program for clients Age 20 or younger.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Applied Behavior Analysis for Clients 20 and Younger, p. 34 (Feb. 2021). (Accessed Feb. 2021).
Last updated 02/28/2021
Store and Forward
POLICY
Newly Passed Legislation (Effective Now)
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 health care service was provided in person by the provider.
Hospitals, hospital systems, telemedicine companies, and provider groups consisting of eleven or more providers may elect to negotiate a reimbursement rate for telemedicine services that differs from the reimbursement rate for in-person services.
SOURCE: RCW 74.09.325 (SB 5385 – 2020 Session), (Accessed Feb. 2021).
Washington Medicaid reimburses for some store-and-forward services under certain circumstances. If the service is provided through store-and-forward technology, there must be an associated office visit between the client and the referring health care provider.
As a condition of payment, the client must be present and participating in the telemedicine visit.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 84-85 (Feb. 2021) (Accessed Feb. 2021).
WA Medicaid covers asynchronous teledentistry when 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.
SOURCE: WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 68. (Mar. 2021), (Accessed Feb. 2021).
WA Medicaid pays for store-and-forward for teledermatology or when all of the following conditions are met:
- There is an associated office visit that can be done either in-person or via asynchronous telemedicine and include one or more of the following types of information: video clips, still images, x-rays, MRIs, electrocardiograms and electroencephalograms, laboratory results, audio clips, and text. The visit results in a documented care plan that is communicated back to the referring provider.
- The transmission of information is HIPAA compliant.
- Written informed consent is obtained 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, the agency does not pay for the consult.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 88 (Feb. 2021). (Accessed Feb. 2021).
ELIGIBLE SERVICES/SPECIALTIES
WA Apple Health pays for store-and-forward for teledermatology. Teledermatology services via store-and-forward must be billed with GQ modifier and 02 POS Code from the distant site. The sending provider bills as usual with the E&M code and no modifier.
See manual for acceptable CPT/HCPCS codes.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 88 (Feb. 2021). (Accessed Feb. 2021).
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 sent via store-and-forward technology from the originating site 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. 68 (Mar. 2021) (Accessed Feb. 2021).
Behavioral Health Organizations
Store-and-forward reimbursable only for covered services specified in the negotiated agreement between the behavioral health administrative services organization and health care provider.
SOURCE: RCW 71.24.335(2(b)), (Accessed Feb. 2021).
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, Physician-Related Svcs./Health Care Professional Svcs., p. 88 (Feb. 2021). (Accessed Feb. 2021).
