Last updated 09/06/2021
Definitions
Telehealth enables a provider who is located at a distant site to render the service remotely to a member located at an originating site using a combination of interactive video, audio, and externally acquired images through a networking environment.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. (Accessed Sept. 2021).
“Telehealth” means a practice of health care delivery, diagnosis, consultation, treatment, or transfer of medically relevant data by means of audio, video, or data communications that are used either during a patient visit or a consultation or are used to transfer medically relevant data about a patient. “Telehealth” does not include communications delivered solely by audio-only telephone, facsimile machine, or electronic mail unless the department specifies otherwise by rule.
“Asynchronous telehealth service” is telehealth that is used to transmit medical data about a patient to a provider when the transmission is not a 2-way, real-time, interactive communication.
“Interactive telehealth” means telehealth delivered using multimedia communication technology that permits 2-way, real-time, interactive communications between a certified provider of Medical Assistance at a distant site and the Medical Assistance recipient or the recipient’s provider.
SOURCE: WI Statute Sec. 49.45 (61). (Accessed Sept. 2021).
Last updated 09/07/2021
Live Video
POLICY
The department shall provide reimbursement under the Medical Assistance program for any benefit that is a covered benefit under s. 49.46 (2) and that is delivered by a certified provider for Medical Assistance through interactive telehealth.
SOURCE: WI Statute 49.45(61), (Accessed Sept. 2021).
ForwardHealth reimburses the service rendered by distant site providers at the same rate as when the service is provided face-to-face.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth (Accessed Sept. 2021).
Date of Service (DOS) Before July 1, 2021
ForwardHealth only covers telehealth delivery of individual services.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. Dates of Service Before Jan. 1, 2021 (Accessed Sept. 2021).
ELIGIBLE SERVICES/SPECIALTIES
On July 1, 2021, the fee schedule was updated to allow providers to identify services allowable under permanent telehealth policy. Procedure codes for services allowed under permanent telehealth policy have place of service (POS) code 02 (Telehealth) listed as an allowable POS.
Effective January 1, 2022, if POS code 02 is not listed as an allowable POS for a procedure code, the service will not be reimbursed under permanent telehealth policy.
SOURCE: ForwardHealth Update 2021-21, Jul. 1, 2021, (Accessed Sept. 2021).
Procedure codes for services allowed under permanent telehealth policy have POS code 02 (Telehealth) listed as an allowable POS. Effective January 1, 2022, if POS code 02 is not listed as an allowable POS for a procedure code, the service will not be reimbursed under permanent telehealth policy.
Claims for telehealth services must include all modifiers required by coverage policy, in addition to POS code 02 and the GT modifier, in order to reimburse the claim correctly.
County-administered programs, school-based services, and any other programs that utilize cost reporting must include required modifiers, such as renderer credentials and group versus individual services, as well as correct details for cost reporting to ensure correct reimbursement.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth (Accessed Sept. 2021).
Statute requires reimbursement for any benefit that delivered via interactive telehealth that is a covered benefit under Medicaid.
Reimbursement must be provided for a consultation pertaining to a Medicaid recipient conducted through interactive telehealth between a certified provider of Medical Assistance and the recipient’s treating provider that is certified under medical assistance, except as provided by the Department by Rule.
Except as provided by the department by rule, Medicaid must cover all Medicare covered services. However, the Department may not cover or provide reimbursement for services that are first covered under the Medicare program after July 1, 2019 until the date that is one year after the date the service is covered under the Medicare program or the date the secretary explicitly approves the service as a Medical Assistance covered service, whichever is earlier.
The Department shall provide reimbursement under the Medical Assistance program for the following: Except as provided by the department by rule, services that are covered under the Medicare program under 42 USC 1395 et seq. for which the federal department of health and human services provides Medical Assistance federal financial participation and that are any of the following:
- Telehealth services;
- Remote physiologic monitoring,
- Remote evaluation of prerecorded patient information,
- Brief communication technology-based services,
- Care management services delivered through telehealth;
- Any other telehealth or communication technology-based services.
Any service not specified can be eligible if specified by the Department. The Department is required to promulgate rules specifying any services that are reimbursable. They may also exclude services from reimbursement.
SOURCE: WI Statute Sec. 49.45 (61). (Accessed Sept. 2021).
Date of Service (DOS) Before July 1, 2021
ForwardHealth only covers telehealth delivery of individual services. For those procedure codes that can be used for either individual or group services, providers may not submit claims for telehealth delivery of group services. Allowable providers may be reimbursed, as appropriate, for specific services (and applicable procedure codes) provided through telehealth listed in the manual.
ForwardHealth reimburses providers for telestroke services.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. Dates of Service Before Jan. 1, 2021 (Accessed Sept. 2021).
ELIGIBLE PROVIDERS
There is no restriction on the location of a distant site provider. In addition, there are no limitations on what provider types may be reimbursed for telehealth services.
Ancillary Providers
Claims for services provided via telehealth by distant site ancillary providers should continue to be billed under the supervising physician’s NPI using the lowest appropriate level office or outpatient visit procedure code or other appropriate CPT code for the service performed. These services must be provided under the direct on-site supervision of a physician who is located at the same physical site as the ancillary provider and must be documented in the same manner as services that are provided face to face.
Pediatric and Health Professional Shortage Area-Eligible Services
Claims for services provided via telehealth by distant site providers may additionally qualify for pediatric (services for members 18 years of age and under) or HPSA-enhanced reimbursement. Pediatric and HPSA-eligible providers are required to indicate POS code 02, along with modifier GT and the applicable pediatric or HPSA modifier, when submitting claims that qualify for enhanced reimbursement.
FQHCs and RHCs
For the purpose of this Online Handbook topic, FQHC refers to Tribal and Out-of-State FQHCs. This topic does not apply to Community Health Centers subject to PPS reimbursement.
They may serve as originating site and distant site providers for telehealth services. See manual for details.
FQHCs and RHCs may report services provided via telehealth on the cost settlement report when the FQHC or RHC served as the distant site and the member is an established patient of the tribal FQHC or RHC at the time of the telehealth service.
Services billed with modifier GT (modifier indicating telehealth) will be considered under the PPS reimbursement method for non-tribal FQHCs. Billing HCPCS procedure code T1015 (Clinic visit/encounter, all-inclusive) with a telehealth procedure code will result in a PPS rate for fee-for-service encounters.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth (Accessed Sept. 2021).
Community Health Centers
Services billed with HCPCS modifier GT (modifier indicating telehealth) will be considered under the PPS reimbursement. Billing HCPCS procedure codes T1015 (Clinic visit/encounter, all-inclusive) with a telehealth procedure code will result in a PPS for an allowable encounter.
SOURCE: Telehealth for Community Health Centers (Accessed Sept. 2021).
Date of Service (DOS) Before July 1, 2021
Allowable providers:
- Audiologists
- Individual mental health and substance abuse practitioners not in a facility certified by the DQA (Division of Quality Assurance)
- Nurse midwives
- Nurse practitioners
- Ph.D. psychologists
- Physician assistants
- Physicians
- Psychiatrists
- Professionals providing services in mental health or substance abuse programs certified by the DQA
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. Dates of Service Before Jan. 1, 2021 (Accessed Sept. 2021).
ELIGIBLE SITES
ForwardHealth allows coverage of telehealth for any originating site. However, only the following originating sites are eligible for a facility fee reimbursement:
- Hospitals, including emergency departments
- Office/clinic
- Skilled nursing facility
The following entities are also listed as allowable originating sites specifically:
- Federally Qualified Health Centers (FQHC)
- Rural Health Clinics (RHC)
FQHCs and RHCs
The originating site facility fee is not a FQHC or RHC reportable encounter on the cost report. Any reimbursement for the originating site facility fee must be reported as a deductive value on the cost report.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth, (Accessed Sept. 2021).
Community Health Centers
ForwardHealth will not separately reimburse the CHC for originating site services because all costs for providing originating site services have already been incorporated into the PPS rates for CHCs. However, claims billed by CHCs for originating site services may be used for future rate setting purposes, and CHC costs associated with telehealth services may be reported for change in scope adjustment consideration.
SOURCE: Telehealth for Community Health Centers (Accessed Sept. 2021).
The department may not limit coverage or reimbursement of a service provided under par. (b) or (c) based on the location of the Medical Assistance recipient when the service is provided.
SOURCE: WI Statute Sec. 49.45 (61). (Accessed Sept. 2021).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
In addition to reimbursement to the distant site provider, ForwardHealth reimburses an originating site facility fee for the staff and equipment at the originating site requisite to provide a service via telehealth. Eligible providers who serve as the originating site should bill the facility fee with HCPCS procedure code Q3014 (Telehealth originating site facility fee). HCPCS modifier GT should not be included with procedure code Q3014.
Eligible providers who bill on a professional claim form should bill Q3014 with a POS code that represents where the member is located during the service. The POS must be a ForwardHealth-allowable originating site for procedure code Q3014 in order to be reimbursed for the originating site fee. The originating site fee is reimbursed based on a maximum allowable fee.
Eligible providers who bill on an institutional claim form should bill Q3014 as a separate line item with the appropriate revenue code. ForwardHealth will reimburse these providers for the facility fee based on the provider’s standard reimbursement methodology.
An originating site facility fee is not a FQHC or RHC reportable encounter on the cost report. Any reimbursement for the originating site facility fee must be reported as a deductive value on the cost report.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. (Accessed Sept. 2021).
CHCs should submit claims for originating site services on a professional claim form with HCPCS procedure code Q3014 (Telehealth originating site facility fee) and a POS code that represents where the member is located during the service. Modifier GT should not be included with procedure code Q3014 for originating site services to be considered under the PPS reimbursement method. ForwardHealth will not separately reimburse the CHC for originating site services because all costs for providing originating site services have already been incorporated into the PPS rates for CHCs. However, claims billed by CHCs for originating site services may be used for future rate setting purposes, and CHC costs associated with telehealth services may be reported for change in scope adjustment consideration.
SOURCE: WI ForwardHealth Online Handbook, Telehealth for Community Health Centers. (Accessed Sept. 2021).
Last updated 09/07/2021
Overview
Newly passed statute requires Wisconsin’s Medicaid program to provide coverage for Telehealth services, as defined under 42 USC 1395m (m) (4) (F), remote physiologic monitoring, remote evaluation of pre-recorded patient information, brief communication technology-based services, care management services delivered through telehealth and any other telehealth or communication technology-based services.
ForwardHealth currently allows for only certain covered services to be provided via telehealth via interactive telehealth, specifically excludes store-and-forward from coverage and does not mention remote patient monitoring.
ForwardHealth updated their policy in July 2021 to allow any provider to deliver telehealth services and increase the services that are reimbursable.
Last updated 09/07/2021
Store and Forward
POLICY
Except as provided by the department by rule, asynchronous telehealth services in which the medical data pertains to a Medical Assistance recipient must be reimbursed.
Except as provided by the department by rule, services that are covered under Medicare for which the federal department of health and human services provides Medical Assistance federal financial participation and that are remote evaluation of prerecorded information shall be reimbursed.
SOURCE: WI Statute Sec. 49.45 (61). (Accessed Sept. 2021).
Services that are not covered when delivered in person are not covered as telehealth services. In addition, services that are not functionally equivalent to the in-person service when provided via telehealth are not covered.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth (Accessed Sept. 2021).
Date of Service (DOS) Before July 1, 2021
Store and forward services (defined as the asynchronous transmission of medical information to be reviewed at a later time by a provider at a distant site) is explicitly under the ‘noncovered services’ section.
SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. Dates of Service Before Jan. 1, 2021 (Accessed Sept. 2021).
ELIGIBLE SERVICES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
