Last updated 02/06/2025
Consent Requirements
The participant (or legal guardian) must be informed and consent to the delivery models unless exempted by State or Federal law and informed of any applicable cost-sharing, provider qualifications, treatment methods, limitations and virtual care technologies and provided adequate training on how to use the technology.
The participant (or legal guardian) has the right to end the service or refuse the delivery of service at any time and have access to all medical information resulting from the service without affecting their right to future care or treatment. If the participant (or legal guardian) indicates that they want to stop using the technology, the service should cease immediately, and an alternative (in-person) appointment should be scheduled. The rendering provider at the distant site must also disclose to the participant their identity, current location, telephone number and Idaho license number.
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. (Aug. 16, 2024), Section 9.12, 9.12.2, p. 126-127. (Accessed Feb 2025).
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 Feb. 2025).
Last updated 02/05/2025
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.
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. A service is considered audio only if 50% or more of the service is provided via audio only. Virtual service visits will be subject to retrospective review as appropriate.
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. When a participant is in the office and receiving virtual care from a provider at their home, out-of-state or elsewhere, box 32 of the CMS-1500 claim form uses the location of the participant, not the provider.
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.
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 code.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (,Aug. 16, 2024) Section 9.12 & 9.12.3 p. 126-127. Idaho MedicAide (May 2023). (Accessed Feb. 2025).
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 Feb. 2025).
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. (Aug. 16, 2024), Sections 9.12 & 9.12.3 p. 126-127, Idaho MedicAide May 2023. (Accessed Feb. 2025).
Physician/Non-Physician Practitioner Services:
Physicians exempted from billing Magellan may provide psychotherapy (CPT® 90839 and 90840) via virtual care to participants in crisis. 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, or their health or safety was at risk. The service must be focused on the participant as demonstrated by the participant being in the room for most of the service. CPT® 90839 is a stand-alone code and is not to be reported with psychotherapy or psychiatric diagnostic evaluation codes, the interactive complexity code, or any other psychiatry section code. Different requirements may apply when services are billed through the Idaho Behavioral Health Plan and Magellan.
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.
SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (Jan. 13, 2025), p. 30, 54, 61, 90, (Accessed Feb. 2025).
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 (Jun. 26. 2024), p. 50. (Accessed Feb. 2025).
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.
Group therapy (CPT® 92508 and 97150) is a covered benefit for participants under occupational and physical therapy, and speech-language pathology. The service must be safe and effective for treating the participant’s condition. This service may be rendered via virtual care. See the Virtual Care Services section of this handbook for additional requirements.
SOURCE: ID Medicaid Provider Handbook, Therapy Services (May 16, 2024) pg 38, 45 , (Accessed Feb. 2025).
Behavioral Health Services
Physicians exempted from billing Magellan may provide psychotherapy (CPT® 90839 and 90840) via virtual care to participants in crisis. 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, or their health or safety was at risk. The service must be focused on the participant as demonstrated by the participant being in the room for most of the service. CPT® 90839 is a stand-alone code and is not to be reported with psychotherapy or psychiatric diagnostic evaluation codes, the interactive complexity code, or any other psychiatry section code. Different requirements may apply when services are billed through the Idaho Behavioral Health Plan and Magellan.
SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (Jan. 13, 2025), p. 30 (Accessed Feb. 2025).
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 (Oct. 29 2024), p. 55. (Accessed Feb. 2025).
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 services in accordance with the Idaho Medicaid Provider Handbook.
SOURCE: SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. 9.9.7, p. 121 (Aug. 16, 2024), (Accessed Feb. 2025).
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. 122 (Aug 16, 2024), (Accessed Feb. 2025).
Home Health and Hospice Services
A face-to-face visit with the participant’s physician, or a non-physician practitioner, is required to initiate home health services. If the visit is conducted by a non-physician practitioner, they must coordinate and provide clinical records to the ordering physician. The visit must be primarily for the condition requiring home health services in order to meet this requirement. The visit may be conducted via telehealth so long as it meets all requirements for telehealth services found in the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook. The ordering physician must document when the visit occurred, and the name and credentials of the professional that conducted the encounter.
SOURCE: ID Medicaid Provider Handbook, Home Health and Hospice Services (Aug 2, 2023), p. 6. ID Administrative Code 16.03.09 Sec. 723 (02)(b), Pg. 101, I(Accessed Feb. 2025).
Controlled Substance Testing
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);
- Is treating the participant for the condition the test is being ordered for; and
- Is enrolled with Idaho Medicaid and/or the IBHP.
SOURCE: ID Medicaid Provider Handbook, Laboratory Services (Jun. 27, 2024), p. 23. (Accessed Feb. 2025).
Diabetes Education and Training
An order and referral from the participant’s primary care provider are required before initiation of services. Services must be conducted between a CDE and the participant via telehealth or in a physician’s office or outpatient hospital department. Reimbursement is limited to 12 hours per participant every five years for individual counseling, and 24 hours per participant every five years for group counseling.
SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician, (Jan. 13, 2025), Sec 4.12, p. 37. (Accessed Feb. 2025).
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. (Aug. 16, 2024), Sections 9.12.3 p. 127, Idaho MedicAide (May 2023). (Accessed Feb. 2025).
Idaho Medicaid therapy services, see manual for specific codes.
SOURCE: ID Medicaid Provider Handbook, Therapy Services (May 16, 2024) pg 38 (Accessed Feb. 2025).
Physicians exempted from billing Magellan may provide psychotherapy (CPT® 90839 and 90840) via virtual care to participants in crisis.
Physicians and non-physician practitioners are eligible to receive reimbursement for telehealth services.
SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician Practitioner. Sec. 4.6, 4.42 Pg. 30, 90 (Jan. 13, 2025), (Accessed Feb. 2025).
FQHCs, RHCs & IHS
Virtual care services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Virtual Care Services section of the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook.
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 code.
SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services, (Jun. 27, 2024), p. 33. Idaho Medicaid Provider Handbook. General Information and Requirements for Providers, Setion 9.12.3, p. 127. (Aug. 16, 2024), Idaho MedicAide (May 2023). (Accessed Feb. 2025).
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. (Aug. 16, 2024), Sections 9.12.3 p. 127, Idaho MedicAide May 2023. (Accessed Feb. 2025).
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 Feb. 2025).
Last updated 02/06/2025
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).
Medicaid Enhance Plan Benefits
Review of the plan of service in a face-to-face contact with the participant to identify the status of programs and changes if needed. The face-to-face encounter may occur via synchronous interaction virtual care, as defined in Title 54, Chapter 57, Idaho Code;
- Contact with service providers to identify barriers to service provision;
- Discuss with participant satisfaction regarding quality and quantity of services; and
- Review of provider status reviews.
Monitoring and follow-up contacts that are necessary to ensure the plan is implemented and adequately address the participant’s needs. These activities may be with the participant, family members, providers, or other entities or individuals and conducted as frequently as necessary. These activities must include at least one (1) face-to-face contact with the participant at least every ninety (90) days. The face-to-face encounter may occur via synchronous interaction virtual care, as defined in Title 54, Chapter 57, Idaho Code, to determine whether the following conditions are met:
- Services are being provided according to the participant’s plan;
- Services in the plan are adequate; and
- Whether there are changes in the needs or status of the participant, and if so, making necessary adjustments in the plan and service arrangements with providers.
The frequency of contact, mode of contact, and person or entity to be contacted must be identified in the plan and meet the needs of the participant. The contacts must verify the participant’s well being and whether services are being provided according to the written plan. At least every ninety (90) days, service coordinators must have face-to-face contact with each participant. The face-to-face encounter may occur via synchronous interaction virtual care, as defined in Title 54, Chapter 57, Idaho Code.
SOURCE: ID Administrative Code, IDAPA 16.03.10. (Accessed Feb. 2025).
