Last updated 05/11/2021
Consent Requirements
Consent for care via the modality used is required for documentation.
Written informed consent is obtained from the client that store and forward technology will be used and who the consulting provider is.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 88 & 90 (May 2021). (Accessed May 2021).
Newly Passed Legislation – Managed Care and Behavioral Health Administrative Service Organizations
If a provider intends to bill a patient or a managed health care system for an audio-only telemedicine service, the provider must obtain patient consent for the billing in advance of the service being delivered. The authority may submit information on any potential violations of this subsection to the appropriate disciplining authority.
If the commissioner has cause to believe that a provider has engaged in a pattern of unresolved violations obtaining consent (as required above) the commissioner may submit information to the appropriate disciplining authority for action. Prior to submitting information to the appropriate disciplining authority, the commissioner may provide the provider with an opportunity to cure the alleged violations. See text for additional information.
SOURCE: Revised Code of Washington 71.24.335 & 74.09.325 as revised by House Bill 1196 (2021 Session), (Accessed May 2021).
Last updated 05/11/2021
Definitions
“Telemedicine is when health care practitioners use 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. 87 (May 2021); Accessed May 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, telephone, and facsimile transmissions
- Installation or maintenance of any telecommunication devices or systems
- Purchase, rental, or repair of telemedicine equipment
- Home health monitoring (in ABA manual only)
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 32-33 (Oct. 2020); Applied Behavior Analysis (ABA) Program, p. 33 (Mar. 2021); Maternity Support Services and Infant Case Management, p. 26 (Jan. 2021), (Accessed May 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 Apr. 2021; Rural Health Clinics, p. 46, Apr. 2021; Mental Health Services, p. 16 (Apr. 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, Apr. 2021 pg. 26; Respiratory Care, Oct. 2020, pg. 23; Substance Use Disorder, (Apr. 2021), pg. 23 (Accessed May 2021).
Newly Passed Legislation – Managed Care
“Telemedicine” means the delivery of health care or behavioral health services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. For purposes of this section only, “telemedicine” includes audio-only telemedicine, but does not include facsimile, or email.
SOURCE: RCW 74.09.325 as amended by HB 1196 (2021 Session), (Accessed May 2021).
Newly Passed Legislation – Behavioral Health Organization
“Telemedicine” means the delivery of health care or behavioral health services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. For purposes of this section only, “telemedicine” includes audio-only telemedicine, but does not include facsimile, or email.
SOURCE: RCW 71.24.335 as amended by HB 1196 (2021 Session), (Accessed May 2021).
Last updated 05/11/2021
Email, Phone & Fax
Newly Passed Legislation
The authority shall adopt rules regarding medicaid fee-for-service reimbursement for services delivered through audio-only telemedicine. The rules must establish a manner of reimbursement for audio-only telemedicine that is consistent with RCW 74.09.325. The rules shall require rural health clinics to be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.
“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between a patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. It does not include:
- The use of facsimile or email; or
- The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.
SOURCE: House Bill 1196 (2021 Session) (Accessed May 2021).
Newly Passed Legislation – Managed Care & Behavioral HEalth Administrative Services Organizations
“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. It does not include:
- The use of facsimile or email; or
- The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.
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 or store and forward technology if … Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.
“Established relationship” means the covered person has had at least one in-person appointment within the past year with the provider providing audio-only telemedicine or with a provider employed at the same clinic as the provider providing audio-only telemedicine or the covered person was referred to the provider providing audio-only telemedicine by another provider who has had at least one in-person appointment with the covered person within the past year and has provided relevant medical information to the provider providing audio-only telemedicine.
A rural health clinic shall be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.
If a provider intends to bill a patient or a managed health care system for an audio-only telemedicine service, the provider must obtain patient consent for the billing in advance of the service being delivered. The authority may submit information on any potential violations of this subsection to the appropriate disciplining authority, as defined in RCW 18.130.020.
SOURCE: Revised Code of Washington 74.09.325 & 71.24.335 as revised by House Bill 1196 (2021 Session) (Accessed May 2021).
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. 87 & 90 (May 2021), School-Based Health Care Services, p. 33 (Oct. 2020); Applied Behavioral Analysis (ABA) Program, p. 33 (Mar. 2021), (Accessed May 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. 51 (May 2021), (Accessed May 2021).
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. 70, Apr. 2021, (Accessed May 2021).
Last updated 05/11/2021
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. 87 (May 2021). (Accessed May 2021).
Newly Passed Legislation – Managed Care & Behavioral Health Administrative Organizations
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 medicaid managed care plan in which the covered person is enrolled provides coverage of the health care service when provided in person by the provider;
- The health care service is medically necessary;
- The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015;
- The health care service is determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information; and
- Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.
A managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine the same amount of compensation the managed health care system would pay the provider 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 an amount of compensation for telemedicine services that differs from the amount of compensation for in-person services.
A managed health care system may subject coverage of a telemedicine or store and forward technology health service to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.
SOURCE: RCW 74.09.325 & 71.24.335 as amended by SB 5325 & HB 1196 (2021 Session), (Accessed May 2021).
Newly Passed Legislation – Behavioral Health Administrative Services Organizations and Managed Care Organizations
If the service is provided through store and forward technology there must be an associated visit between the covered person and the referring provider. Nothing in this section prohibits the use of telemedicine for the associated office visit.
SOURCE: RCW 71.24.335 as amended by HB 1196 (2021 Session), (Accessed May 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. 87 & 89 (May 2021). (Accessed May 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 May 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. 32 (Mar. 2021) & WAC 182-531A-1200. (Accessed May 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. 70-71. (Apr. 2021). (Accessed May 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. 43. Apr. 2021, (Accessed May 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. 214 (May 2021). (Accessed May. 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. 46, Apr. 2021; Federally Qualified Health Centers, p. 64. (Accessed May 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 May 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, Apr. 2021, (Accessed May 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. 87-88 (May 2021). (Accessed May 2021).
Newly Passed Legislation – Managed Care
The following are eligible originating sites.
- Hospital;
- Rural health clinic;
- Federally qualified health center;
- Physician’s or other health care provider’s office;
- Licensed or certified behavioral health agency;
- Skilled nursing facility;
- Home or any location determined by the individual receiving the service; or
- Renal dialysis center, except an independent renal dialysis center.
SOURCE: RCW 74.09.325 as amended by HB 1196 (2021 Session), (Accessed May 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 May 2021).
GEOGRAPHIC LIMITS
A managed health care system may not distinguish between originating sites that are rural and urban in providing the coverage required in subsection (1) of this section.
SOURCE: RCW 74.09.325 as amended by HB 1196 (2021 Session), (Accessed May 2021).
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
See manual for specific billing instructions for each.
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 88-89 (May 2021). (Accessed May 2021).
Newly Passed Legislation – Managed Care
The following eligible originating sites (besides #7) can charge a facility fee for infrastructure and preparation of the patient. Reimbursement for a facility fee must be subject to a negotiated agreement between the originating site and the managed health care system.
- Hospital;
- Rural health clinic;
- Federally qualified health center;
- Physician’s or other health care provider’s office;
- Licensed or certified behavioral health agency;
- Skilled nursing facility;
- Home or any location determined by the individual receiving the service; or
- Renal dialysis center, except an independent renal dialysis center.
A distant site, a hospital that is an originating site for audio-only telemedicine, or any other site not identified in subsection (3) of this section may not charge a facility fee.
SOURCE: RCW 74.09.325 as amended by HB 1196 (2021 Session), (Accessed May 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. 46, (Apr. 2021) & Federally Qualified Health Centers, p. 64 (Apr. 2021) (Accessed May 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 May 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. 71 (Apr. 2021). (Accessed May 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. 214 (May 2021). (Accessed May 2021).
Last updated 05/11/2021
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. 89-90 (May 2021). (Accessed May 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. 87-88 (May 2021). (Accessed May 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., 89 (May 2021). (Accessed May 2021).
Last updated 05/11/2021
Out of State Providers
No Reference Found
Last updated 05/11/2021
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. 87 (May 2021); (Accessed May. 2021).
Telemedicine is covered by the Department.
SOURCE: WA Admin. Code Sec. 182-531-0100. (Accessed May 2021).
Last updated 05/11/2021
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 May 2021).
HCA covers the delivery of home health services through telemedicine for clients who have been diagnosed with an unstable condition who may be at risk for hospitalization or a more costly level of care.
SOURCE: Washington Apply Health Medicaid Home Health Billing Guide, pg. 33-34, (Apr. 2021), (Accessed May 2021).
CONDITIONS
Home Health Services
The client must have a diagnosis or diagnoses where there is a high risk of sudden change in medical condition which could compromise health outcomes.
SOURCE: Washington Apply Health Medicaid Home Health Billing Guide, pg. 33-34, (Apr. 2021), (Accessed May 2021).
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
Home Health Services
HCA pays for one telemedicine interaction, per eligible client, per day, based on the ordering licensed practitioner’s home health plan of care.
To receive payment for the delivery of home health services through telemedicine, the services must involve:
- A documented assessment, identified problem, and evaluation, which includes:
-
- Assessment and monitoring of clinical data including, but not limited to, vital signs, pain levels and other biometric measures specified in the plan of care. Also included is an assessment of response to previous changes in the plan of care.
- Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care
- Implementation of a documented management plan through one or
more of the following:
- Education regarding medication management as appropriate, based on the findings from the telemedicine encounter
- Education regarding other interventions as appropriate to both the patient and the caregiver
- Management and evaluation of the plan of care, including changes in visit frequency or the addition of other skilled services
- Coordination of care with the ordering licensed provider regarding findings from the telemedicine encounter
- Coordination and referral to other medical providers as needed
- Referral to the emergency room as needed
HCA does not pay for the purchase, rental, repair, or maintenance of telemedicine equipment and associated costs of operation of
telemedicine equipment.
HCA does not require prior authorization for the delivery of home health services through telemedicine.
SOURCE: Washington Apply Health Medicaid Home Health Billing Guide, pg. 33-34, (Apr. 2021), (Accessed May 2021).
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. 33 (Mar. 2021). (Accessed May 2021).
Last updated 05/11/2021
Store and Forward
POLICY
Newly Passed Legislation – Managed Care
“Store and forward technology” means use of an asynchronous transmission of a covered person’s medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the covered person, and does not include the use of audio-only telephone, facsimile, or email.
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 medicaid managed care plan in which the covered person is enrolled provides coverage of the health care service when provided in person by the provider;
- The health care service is medically necessary;
- The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015;
- The health care service is determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information; and
- Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.
A managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine the same amount of compensation the managed health care system would pay the provider if the health care service was provided in person by the provider. For purposes of this section, reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the managed health care system and health care provider.
Hospitals, hospital systems, telemedicine companies, and provider groups consisting of eleven or more providers may elect to negotiate an amount of compensation for telemedicine services that differs from the amount of compensation for in-person services.
A managed health care system may subject coverage of a telemedicine or store and forward technology health service to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.
SOURCE: RCW 74.09.325 as amended by HB 1196 (2021 Session), (Accessed May 2021).
Newly Passed Legislation – Behavioral Health Administrative Services Organizations and Managed Care Organizations
If the service is provided through store and forward technology there must be an associated visit between the covered person and the referring provider. Nothing in this section prohibits the use of telemedicine for the associated office visit.
Reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the behavioral health administrative services organization, or managed care organization, and the provider.
SOURCE: RCW 71.24.335 as amended by HB 1196 (2021 Session), (Accessed May 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. 90 (May 2021). (Accessed May 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. 71. (Apr. 2021), (Accessed May 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 (May 2021). (Accessed May 2021).
Health departments may use a recorded video submitted by the client in place of the in-home visit or office visit. HCPCS code G2010 may be billed when this modality is used and the requirements of the code are met. HCPCS code G2010 is not Federally Qualified Health Center (FQHC) encounter-eligible
SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 70 (May 2021). (Accessed May 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. 71 (Apr. 2021) (Accessed May 2021).
Behavioral Health Organizations
Reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the behavioral health administrative services organization, or managed care organization, and the provider.
SOURCE: RCW 71.24.335 as amended by HB 1196 (2021 Session), (Accessed May 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. 91 (May 2021). (Accessed May 2021).
