Last updated 06/18/2024
Consent Requirements
The participant must be informed and consent to the delivery models, any applicable cost-sharing, provider qualifications, treatment methods, or limitations and virtual care technologies and provided adequate training on how to use the technology. The rendering provider at the distant site must also disclose to the participant their identity, current location, telephone number and Idaho license number. Providers can deliver virtual care services from any location in the United States. Providers must meet all applicable licensure requirements required by the State of Idaho. If the participant (or legal guardian) indicates at any point that they want to stop using the technology, the service should cease immediately, and an alternative (in-person) appointment should be scheduled. Providers are subject to all applicable state and federal laws regarding protected health information and personal privacy.
The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and those services were delivered via virtual care. The documentation must be of the same quality as is originated during an in-person visit, including but not limited to, billing the CPT® or HCPCS code with the number of minutes closest to the actual time spent providing the service, service type, amount, frequency, duration and time spent with the participant. If the code is a timed code of 15-minute increments, it must be billed with a number of units as described in the Billing 15-Minute Timed Codes section of the General Billing Instructions, Idaho Medicaid Provider Handbook. These documentation requirements are specific to delivery via virtual care and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan. 30, 2024), Section 9.12, 9.12.2, p. 133-134. (Accessed Jun. 2024).
Any written information must be provided to the participant before the telehealth appointment in a form and manner which the participant can understand using reasonable accommodations when necessary. The participant must be informed and consent to the delivery models, provider qualifications, treatment methods, or limitations and telehealth technologies. The rendering provider at the distant site must also disclose to the participant their identity, current location (must be within the United States), telephone number and Idaho license number. If the participant (or legal guardian) indicates at any point that they want to stop using the technology, the service should cease immediately, and an alternative (in-person) appointment should be scheduled.
SOURCE: ID MedicAide May 2023. (Accessed Jun. 2024).
Last updated 06/17/2024
Live Video
POLICY
Services delivered through virtual care will be considered for reimbursement when rendered within the provider’s scope of practice and billed according to all applicable administrative rules, policy, federal and state regulations. Any covered service may be delivered via virtual care when:
- The service can be safely and effectively delivered via virtual care and the medium utilized;
- The service fully meets the code definition when provided via virtual care;
- The service is billed with the FQ or GT modifier; and
- All other existing coverage criteria are met.
Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan. 30, 2024), Section 9.12 & 9.12.1 p. 133-134. Idaho MedicAide (May 2023). (Accessed Jun. 2024).
Services delivered via virtual care as defined in Title 54, Chapter 57, Idaho Code, must be identified as such in accordance with billing requirements published in the Idaho Medicaid Provider Handbook. Virtual care services billed without being identified as such are not covered. Virtual care services may be reimbursed within limitations defined by the Department in the Idaho Medicaid Provider Handbook. Fee-for-service reimbursement is not available for asynchronous services except remote monitoring. (NOTE: The term “telehealth” had been changed to “virtual care” in 2023, but the Administrative Code does not reflect that change in the currently posted version.)
SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09), Pg. 25 (Accessed Jun. 2024).
For Home Health, the face-to-face encounter that initiates treatment may occur virtually.
SOURCE: ID Administrative Code 16.03.09 Sec. 723 (02)(b), Pg. 101, ID Medicaid Provider Handbook: Home Health and Hospice Services, 1.2.4.1, p. 6. (Mar. 2, 2021). (Accessed Jun. 2024).
ELIGIBLE SERVICES/SPECIALTIES
Any covered service may be delivered via virtual care when:
- The service can be safely and effectively delivered via virtual care and the medium utilized;
- The service fully meets the code definition when provided via virtual care;
- The service is billed with the FQ or GT modifier; and
- All other existing coverage criteria are met.
Reporting of test results only is not covered as a telehealth service.
Only one eligible provider may be reimbursed per service per participant per date of service. No reimbursement is available for the use of equipment at the originating or remote sites. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties. Claims for services delivered via virtual care will be reimbursed at the same rate as face-to-face services.
Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers:
- FQ – A telehealth service was furnished using real-time audio-only communication technology.
- GT – A telehealth service was furnished using real-time audio-visual communication technology.
Additionally, providers can also use the following modifier in conjunction with one of the above:
- FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan. 30, 2024), Sections 9.12 & 9.12.3 p. 133-134, Idaho MedicAide May 2023. (Accessed Jun. 2024).
Physician/Non-Physician Practitioner Services:
Stand-alone vaccine counseling is also reimbursable when delivered as virtual care services.
Services in the National Diabetes Prevention Program are eligible for virtual care.
Physicians and non-physician practitioners are eligible to receive reimbursement for telehealth services.
Physicians and psychiatric nurse practitioners may provide psychotherapy (CPT® 90839 and 90840) to participants in crisis via virtual care. The medical record of the participant must support a crisis service was provided for the full duration billed and demonstrate that an urgent assessment of the participant’s mental state was necessary, and/or their health or safety was at risk. The participant must be in the room for the duration of the visit or a majority of the service, which is focused on the individual. 90839 is a stand-alone code not to be reported with psychotherapy or psychiatric diagnostic evaluation codes, the interactive complexity code, or any other psychiatry section code.
SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (May 1, 2024), p. 51, 58, 79, 86. (Accessed Jun. 2024).
Crisis Intervention
Crisis intervention is an eligible virtual care service. If crisis intervention is provided via virtual care, all requirements must be followed under the Idaho Medicaid virtual care services policy. Further information about Virtual Care Services can be found in the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook.
SOURCE: ID Medicaid Provider Handbook Agency Professional (Feb. 5. 2024), p. 28. (Accessed Jun. 2024).
Therapy Services (Occupational, Physical Therapists & Speech Language Pathologists)
Virtual care services covered for therapies are real-time communication through interactive technology that enables a provider and a patient at two locations separated by distance to interact simultaneously through two-way video and audio transmission. Evaluations and reevaluations may be provided by virtual care. The therapist must certify that the services can safely and effectively be done with virtual care services and the physician or non-physician practitioner order must specifically allow the services to be provided by virtual care services. Therapists must adhere to all requirements of their licensing board for virtual care services.
Specific service codes found in manual.
SOURCE: ID Medicaid Provider Handbook, Therapy Services (May 16, 2024) pg 38 , (Accessed Jun. 2024).
Psychiatric Crisis
Physicians and psychiatric nurse practitioners may provide psychotherapy (CPT® 90839 and 90840) to participants in crisis via virtual care. The medical record of the participant must support a crisis service was provided for the full duration billed and demonstrate that an urgent assessment of the participant’s mental state was necessary, and/or their health or safety was at risk. The participant must be in the room for the duration of the visit or a majority of the service, which is focused on the individual. 90839 is a stand-alone code not to be reported with psychotherapy or psychiatric diagnostic evaluation codes, the interactive complexity code, or any other psychiatry section code.
SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (May 1, 2024), p. 79. (Accessed Jun. 2024).
Laboratory Services
To be reimbursable, drug tests must be ordered by a licensed or certified healthcare professional who has performed a face-to-face evaluation of the participant (this may include telehealth if the requirements of the telehealth policy are met).
SOURCE: ID Medicaid Provider Handbook: Laboratory Services (Mar. 1, 2024), p. 22. (Accessed Jun. 2024).
Eye and Vision Services
Vision therapy is not covered for group therapy, telehealth or with home computer programs.
SOURCE: ID Medicaid Provider Handbook: Eye and Vision Services (Jan. 8, 2024), p. 54. (Accessed Jun. 2024).
Early Intervention Services (IDEA)
Medicaid reimburses for early intervention services in accordance with Medicaid established rates and reimbursement methodology. The ITP must provide virtual care servcies in accodance with the Idahol Medicaid Provider Handbook.
SOURCE: SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. 9.9.7, p. 128 (Jan. 30, 2024), (Accessed Jun. 2024).
Interpretative Services
Idaho Medicaid will reimburse for interpretation, translation, Braille and sign language services provided to participants in person or through virtual care. Reimbursement is also available when interpretive services are provided to the parent or guardian of a child under 18. The service is only eligible for reimbursement if the provider has no alternative means of oral or written communication. No additional reimbursement is available for multilingual providers that share a language with the participant. Interpreters and translators must meet state and professional licensure requirements and be at least eighteen years of age. See the Virtual Care Services section for more information about reimbursement eligibility using virtual care services.
SOURCE: SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. 9.10.3, p. 129 (Jan. 30, 2024), (Accessed Jun. 2024).
ELIGIBLE PROVIDERS
Only one eligible provider may be reimbursed for the same service per participant per date of service.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan 30, 2024), Sections 9.12.3 p. 134, Idaho MedicAide (May 2023). (Accessed Jun. 2024).
Idaho Medicaid therapy services, see manual for specific codes.
SOURCE: ID Medicaid Provider Handbook, Therapy Services (May 16, 2024) pg 38 (Accessed Jun. 2024).
Physicians and psychiatric nurse practitioners may provide psychotherapy to participants in crisis via telehealth, using CPT 90839 and 90840.
Physicians and non-physician practitioners are eligible to receive reimbursement for telehealth services.
SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician Practitioner. Sec. 4.34.3, Pg. 79, (4.38) 86. (May 1, 2024), (Accessed Jun. 2024).
FQHCs, RHCs & IHS
Telehealth services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Idaho Medicaid Telehealth Policy and applicable handbooks.
FQHC, RHC or IHS providers should not report the GT or FQ modifier with encounter code T1015 but should include it with each applicable supporting codes.
SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services, (Nov. 18, 2022), p. 30. Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan. 30, 2024), Sections 9.12.3 p. 134, Idaho MedicAide (May 2023). (Accessed Jun. 2024).
ELIGIBLE SITES
Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers:
- FQ – A telehealth service was furnished using real-time audio-only communication technology.
- GT – A telehealth service was furnished using real-time audio-visual communication technology.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan. 30, 2024), Sections 9.12.3 p. 134, Idaho MedicAide May 2023. (Accessed Jun. 2024).
Idaho Medicaid reduces physician and non-physician practitioner reimbursement when certain procedures are provided in a facility setting. For these procedure codes there is a 30 percent reduction for physicians, and a 40 percent reduction for non-physician practitioners, of the Idaho Medicaid Numerical Fee Schedule in the following places of service (POS) including POS 02 Telehealth (Not recognized by Idaho Medicaid).
SOURCE: Idaho Medicaid Provider Handbook: Physician and Non-Physician Practitioner. 9.2, p. 131. (May 1, 2024). (Accessed Jun. 2024).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Therapy Services
Therapy services covered via virtual care are listed in the table below. Reimbursement is according to the numerical fee schedule. There is no additional fee for either the originating or the distant site.
SOURCE: ID Medicaid Provider Handbook, Therapy Services (May 16, 2024) pg 38 (Accessed Jun. 2024).
Last updated 06/18/2024
Miscellaneous
If virtual services are offered, it is the rendering provider’s responsibility to ensure meaningful access to virtual services for individuals with limited English proficiency. Meaningful access includes but is not limited to ensuring high quality audio with a clear and audible transmission of voices and adequate training to users of the technology. Any electronic or written information must be provided to the participant before the virtual care appointment and provided in a form and manner which the participant can understand. The provider must make reasonable accommodations through methods such as a translator or qualified interpreter when necessary.
Technical Requirements:
Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible.
Documentation Requirements
The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and that services were delivered via virtual care. The documentation must be of the same quality as is originated during an in-person visit including but not limited to, billing the CPT® or HCPCS code with the number of minutes closest to the actual time spent providing the service, service type, amount, frequency, duration and time spent with the participant. If the code is a timed code of 15-minute increments, it must be billed with a number of units as described in the Billing 15-Minute Timed Codes section of the General Billing Instructions, Idaho Medicaid Provider Handbook. These documentation requirements are specific to delivery via virtual care and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan. 30, 2024) 9.12.1 & 1.12.2, p. 131, ID MedicAide (May 2023). (Accessed Jun. 2024).
