Michigan

Last updated 09/02/2024

Consent Requirements

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2124-2125, Jul. 1, 2024 & Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 (Accessed Sept. 2024).

Last updated 09/02/2024

Definitions

“Telemedicine” means that term as defined in section 3476 of the insurance code of 1956, 1956 PA 218, MCL 500.3476.

“Telemedicine” means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-191, compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.

SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) as amended by HB 4579 and HB 4131, & 400.105h as amended by HB 4213 and HB 4580. Also cited in 330.1100(d)(16), 5501401k(2), 500.3476(2)(b),(Accessed Sept. 2024).

Telemedicine is the use of telecommunication technology to connect a beneficiary with a Medicaid enrolled health care professional in a different location. The Michigan Department of Health and Human Services (MDHHS) covers both synchronous (real-time interactions) and asynchronous (over separate periods of time) telemedicine services.

MDHHS aligns the definition of telemedicine with Section 3476 of the Insurance Code of 1956, 1956 PA 218 MCL 500.3476, as updated on December 20, 2017. Therefore, “Telemedicine” means the use of an electronic media to link beneficiaries with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the beneficiary via a real-time, interactive audio or video (or both) telecommunications system, and the beneficiary must be able to interact with the off-site health care professional at the time the services are provided.

When referenced within MDHHS Telemedicine Policy, face-to-face refers to either an in-person visit, or a visit performed via simultaneous audio/visual technology.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2119 & 2123, July. 1, 2024 &  MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent]. (Accessed Sept. 2024).

Behavioral Health – Assertive Community Treatment Program

Telemedicine is the use of telecommunications and information technologies for the provision of psychiatric services to ACT consumers and is subject to the same service provisions as psychiatric services provided in person. The telemedicine modifier must be used in conjunction with the ACT encounter reporting code when telemedicine is used.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 368, Jul. 1, 2024. (Accessed Sept. 2024).

Telemedicine for MTM Services

Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services. Telemedicine must be obtained through real-time interactions between the beneficiary’s physical location (originating site) and the pharmacist provider’s physical location (distant site). MTM telemedicine audio/visual services are provided to beneficiaries through hardwire or internet connection. It is the expectation that providers and facilitators involved in telemedicine are trained in the use of equipment and software prior to servicing beneficiaries.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1819, Jul. 1, 2024, (Accessed Sept. 2024).

Behavioral Health – Child Therapy

Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services (e.g., access or travel to needed therapy services may be prohibitive). Telemedicine must be obtained through real-time interaction between the child’s/family’s physical location and the provider’s physical location. Telemedicine services are provided to patients through hardwire or internet connection. It is the expectation that providers involved in telemedicine are trained in the use of equipment and software prior to servicing children/families.

The technology used must meet the requirements of audio and visual compliance in accordance with’ current regulations and industry standards. Refer to the General Information for Providers Chapter of this manual for the complete Health Insurance Portability and Accountability Act (HIPAA) compliance requirements.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 342 Jul. 1, 2024, (Accessed Sept. 2024).

Last updated 09/02/2024

Email, Phone & Fax

Last updated 09/02/2024

Live Video

POLICY

Beginning October 1, 2020, telemedicine services are covered under the medical assistance program and Healthy Michigan program if the originating site is an in-home or in-school setting, in addition to any other originating site allowed in the Medicaid provider manual or any established site considered appropriate by the provider. Beginning the effective date of the amendatory act that added subsection (7), telemedicine services are also covered under the medical assistance program and Healthy Michigan program if those services are provided at, or contracted through, a distant site allowed in the Medicaid provider manual.

Telemedicine services are covered both when a distant provider’s synchronous interactions occur using an audio and video electronic media or when using an audio-only electronic media.

The medical assistance program and Healthy Michigan program shall not do any of the following:

• Impose quantity or dollar amount maximums or limitations for services delivered using telemedicine that are more restrictive than those imposed on comparable in-person services.
• Reimburse distant providers for telemedicine services at a lower rate than comparable services rendered in person, except when reimbursing a provider who exclusively provides telemedicine services.
• Impose specific requirements or limitations on the technologies used to deliver telemedicine services, unless necessary to ensure the safety of a recipient, and the technology is compliant with requirements of the health insurance portability and accountability act of 1996, Public Law 104-191.
• Impose additional certification, location, or training requirements on health care professionals who are distant providers as a condition of reimbursing the distant provider for telemedicine services.
• Require a recipient to use telemedicine services in lieu of in-person consultation or contact.

Reimbursement for telemedicine services authorized under this section is contingent upon the availability of federal financial participation for those services in the medical assistance program and the Healthy Michigan program.

The department must seek any necessary waiver or state plan amendment from the United States Department of Health and Human Services to implement the provisions of this section.

Telemedicine services authorized under this section must be incorporated in rate development for any managed care program that is implemented in the medical assistance program and the Healthy Michigan program subject to federal actuarial soundness requirements.

SOURCE: MI Compiled Laws Sec. 400.105h as amended by HB 4213 and HB 4580. (Accessed Sept. 2024).

The Michigan Department of Health and Human Services (MDHHS) covers both synchronous (real-time interactions) and asynchronous (over separate periods of time) telemedicine services. MDHHS requires that all telemedicine policy provisions within this policy and other current policy are established and maintained within all telemedicine services.

Recognizing that telemedicine can never fully replace in-person care, MDHHS has established the following principles to be used by MDHHS-enrolled providers during the provision of telemedicine services:

• Effectual services – a service provided via telemedicine should be as effective as its in-person equivalent, ensuring convenient and high-quality care.
• Improved and appropriate access – the right visit, for the right beneficiary, at the right time by minimizing the impact of barriers to care, such as transportation needs or availability of specialty providers in rural areas.
• Appropriate beneficiary choice – the beneficiary is an active participant in the decision for telemedicine as a means for service delivery as appropriate (e.g., Does the beneficiary prefer telemedicine to an in-person visit? What is the optimal combination of ongoing service delivery for the individual? etc.).
• Appropriate utilization – ensure providers are utilizing telemedicine appropriately and that items listed above are taken into consideration when offering these services.
• Value considerations – telemedicine visits should yield the desired outcomes and quality measures; health outcomes should be improving and remain consistent with in-person care at a minimum.
• Privacy and security measures – providers must ensure the privacy of the beneficiary and the security of any information shared via telemedicine in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other privacy/security regulations as applicable.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2119-2121, Jul. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023. (Accessed Sept. 2024).

The reimbursement rate for allowable telemedicine services will be the same (also known as “at parity”) as in-person services. This means that all providers will be paid the equivalent amount, no matter the physical location of the beneficiary during the visit. To effectuate this policy, the provider must report the place of service as they would if they were providing the service in-person. See the “Telemedicine Billing Requirements” section of this policy for further details.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2126 Jul. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

In-person visits remain the preferred method of service delivery for most healthcare services; however, in cases where this option is not available or in-person services are not ideal or are challenging for the beneficiary, telemedicine may be used as a complement to in-person services. Applicable beneficiary records must contain documentation regarding the reason for the use of telemedicine and the steps taken to ensure the beneficiary was provided utilization guidance in an appropriate manner.

In special situations, depending upon the needs of the beneficiary, providers may opt to deliver the majority of or all services for a specific condition via telemedicine. If this situation occurs, it must be documented in the beneficiary’s record or in their individual plan of service (IPOS). This situation should be the exception, not the norm. (Refer to the program-specific subsections of this policy for specific guidance regarding this benefit.)

All services provided via telemedicine must meet all the quality and specifications as would be if performed in-person. Furthermore, if while participating in the visit the desired goals of the beneficiary and/or the provider are not being accomplished, either party must be provided the opportunity to stop the visit and schedule an in-person visit instead (refer to “Contingency Planning” for such instances). This follow-up visit must be provided within a reasonable time and be as easy as possible to schedule.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2121-2122 Jul. 1, 2024, & MI Medicaid Policy Bulletin MMP 24-06, Apr. 1, 2024, (Accessed Sept. 2024).

SOURCE: MI Dept. of Health and Human Services, Medicaid Bulletin, 7/5/22, (Accessed Sept. 2024).

For behavioral and physical health services provided through managed care or the fee-for-service program, the department shall require, for the nonfacility component of the reimbursement rate, at least the same reimbursement for that service, if that service is provided through telemedicine, as if the service involved face-to-face contact between the health care professional and the patient.

SOURCE: Senate Bill 747, (Accessed Sept. 2024).

Professional Providers

Procedure code and modifier information for all telemedicine services is contained in the MDHHS Telemedicine Services Databases available on the MDHHS website. (Refer to the Directory Appendix for website information.)

Appropriate telemedicine modifiers must be used in conjunction with the appropriate CPT/HCPCS procedure code to identify the professional telemedicine services provided by the distant site provider.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 274,  Jul. 1, 2024  (Accessed Sept. 2024).

Child Therapy

Telemedicine is approved for Individual Therapy or Family Therapy using approved children’s evidence based practices (i.e., Trauma Focused Cognitive Behavioral Therapy, Parent Management TrainingOregon, Parenting Through Change) and utilizes the GT modifier when reporting the service. Qualified providers of children’s evidence-based practices have completed their training in the model, its implementation via telehealth, and are able to provide the practice with fidelity.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 342 Jul. 1, 2024  (Accessed Sept. 2024).

Behavioral Health

Behavioral health services may be delivered via telemedicine in accordance with current Medicaid policy. In compliance with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 548 Jul. 1, 2024 (Accessed Sept. 2024).

Brain Injury – Referral and Admission Process

When appropriate, the evaluation may occur through telecommunication technology (telemedicine). MDHHS requires a real-time interactive system at both the originating and distant sites, allowing instantaneous interaction between the patient and the health care professional via the telecommunication system. Telemedicine should be used primarily when travel is prohibitive for the beneficiary. Providers must ensure the privacy of the beneficiary and the security of any information shared via telemedicine.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 555 Jul. 1, 2024 (Accessed Sept. 2024).

Children’s Special Health Care Services

The primary CSHCS benefits may include: …

• Telemedicine

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 591 Jul. 1, 2024 (Accessed Sept. 2024).

Doula Services

It is the expectation that doula services be provided face-to-face with the beneficiary. Prenatal and postpartum services may be delivered via telehealth. Doula providers will be expected to adhere to current MDHHS telemedicine policy.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 696 Jul. 1, 2024  (Accessed Sept. 2024).

Home and Community Based Services

The HCBS Final Rule includes the following: …

Provides requirements for independent assessment. This is a face-to-face assessment, conducted by a conflict-free individual or agency. The assessment is based on the individual’s needs and strengths and is part of the person-centered planning process. Telemedicine is an acceptable method of assessment.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 851 Jul. 1, 2024, (Accessed Sept. 2024).

Laboratory – Provider Evaluation

The consultation must be documented in the beneficiary’s medical record and, if performed via telemedicine, should follow all the requirements specified in Medicaid’s telemedicine policy.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1104 Jul. 1, 2024  (Accessed Sept. 2024).

Maternal Infant Health Program

MIHP agencies may conduct initial assessment visits and professional visits via telehealth. Agencies will be allowed to provide a maximum of up to 40 percent of their total caseload of visits as telehealth, while 60 percent of visits must remain as in-person visits.  This percentage is applied to the agency and not per beneficiary to allow for telehealth visit flexibility dependent on beneficiary needs.

Telehealth visits must include a dual audio/visual platform. Providers must ensure the privacy of the beneficiary and the security of any information shared via telehealth. MDHHS requires either direct or indirect beneficiary consent for all services provided via telehealth. This consent must be properly documented in the beneficiary’s chart in accordance with applicable standards of practice. Telehealth visits must follow policy guidelines and program requirements for typical MIHP initial assessment and professional visits.

Appropriate use of telehealth will be determined by a combination of beneficiary preference and MIHP provider judgement. Examples of when telehealth is an appropriate option may include, but are not limited to, circumstances such as when a beneficiary:

• Refuses an in-person visit and would benefit from receiving MIHP services,
• Has an illness in their household, or
• Needs to share sensitive information that cannot be discussed in the home environment and a transportation barrier exists for an office visit.

Inappropriate use of telehealth may include, but is not limited to, circumstances such as when a beneficiary has no barrier for an in-person visit and does not request a telehealth visit.

Telehealth visits that occur via telephone-only are allowable only when a beneficiary barrier exists for use of an audio/visual platform (e.g., lack of smart phone or internet access). Documentation in the beneficiary’s chart must include the reason for a telephone-only visit.

MIHP providers are required to follow current Medicaid telemedicine policy requirements as applicable.

SOURCE: MI Medicaid Policy Bulletin, MMP 23-17, Apr. 10, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1136-1137 Jul. 1, 2024  (Accessed Sept. 2024).

All audio-visual MIHP telehealth services must be reported with:

• Modifier 95 for audio-visual services.
• Report the place of service (POS) code that would be reported as if the beneficiary were in person for the visit (e.g., home or office)

See bulletin for recently added covered services and services that may be billed via telemedicine.

SOURCE: MI Medicaid Policy Bulletin, MMP 23-36, Sept. 9, 2024 – effective Oct. 1, 2024. (Accessed Sept. 2024).

Medical Supplier – Face-to-Face (F2F) Visit Requirement

Prior to the initial written order and delivery of selected durable medical equipment and medical supplies (some accessories), the beneficiary must have a face-to-face visit with a physician or NPP within six months prior to the initial written order. The visit must be related to the primary condition that supports the medical need for the equipment or supply. Telemedicine visits (refer to the Telemedicine Chapter) qualify as face-to-face visits.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1178 Jul. 1, 2024, (Accessed Sept. 2024).

Practitioner – CoCM Services

CoCM services must include:

• Initial assessment: Visit occurring either in-person or via audio-visual telemedicine in which the beneficiary sets goals and is screened by a diagnosis-appropriate and consistent validated clinical rating scale, such as the PHQ-9 or GAD-7, which also must be done prior to subsequent CoCM services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1903 Jul. 1, 2024, (Accessed Sept. 2024).

PIHP/CMHSP

Telemedicine is allowed for all services indicated in the Bureau of Specialty Behavioral Health Services Telemedicine Database. The features of what will be counted as a telemedicine visit need to align with the same standards of an in-person visit.

The MDHHS Bureau of Specialty Behavioral Health Services requires all the requirements of Telemedicine policy are attained and maintained during all beneficiary visits. In addition to the Determination of Appropriateness/Documentation section of this policy, the Bureau of Specialty Behavioral Health Services would like to reiterate that services delivered to the beneficiary via telemedicine be done at the convenience of the beneficiary, not the convenience of the provider. In addition, these services must be a part of the person-centered plan of service and available as a choice, not a requirement, to the beneficiary.

If the individual (beneficiary) is not able to communicate effectively or independently, they must be provided appropriate on-site support from natural supports or staff. This includes the appropriate support necessary to participate in assessments, services, and treatment.

The PIHP/CMHSP must guarantee the individual is not being influenced or prompted by others when utilizing telemedicine.

Use of telemedicine should ensure and promote community integration and prevent isolation of the beneficiary. Evidence-based practice policies must be followed as appropriate for all services. For services within the community, in-person interactions must be prioritized.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2129 Jul. 1, 2024  & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

PIHP Telemedicine

The following requirements apply to the child/youth and their parents/primary caregivers. Professional and natural supports may join Child and Family Team meetings either in-person or via simultaneous audio/visual telemedicine during all phases, according to the preference of the child/youth and their parents/primary caregivers.

All Child and Family Team meetings are to be provided in-person during the Hello and Help phases.

Child and Family Team meetings may be provided either in-person or via simultaneous audio/visual telemedicine during the Heal and Hope phases, according to the preference of the child/youth and their parents/primary caregivers, with the following exceptions:

• Development of the transition plan (Hope phase) is to be completed in-person.
• Graduation activities (Hope phase) are to be completed in-person.
• Child and Family Team meetings are to be provided in-person for the first 60 days upon a child/youth transitioning back to their home and community from out-of-home placement.
• In-person Child and Family Team meetings are to be provided once per month, at minimum, for children/youth served under the SEDW during both the Heal and Hope phases.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 362 Jul. 1, 2024, (Accessed Sept. 2024).

Physical Therapy, Occupational Therapy and Speech Therapy Services

MDHHS will allow select therapy services to be provided via telemedicine when performed by Medicaid enrolled private practice and outpatient hospital physical therapy (PT), occupational therapy (OT) and speech therapy (ST) providers. PT, OT and ST services allowed via telemedicine will be represented by applicable CPT/HCPCS codes on the telemedicine fee schedule. Therapy services provided via telemedicine are intended to be an additional treatment tool and complement in-person services where clinically appropriate for the individual beneficiary.

Documentation re-evaluation, performance, and treatment elements that typically require hands-on contact for measurement or assessment must include a thorough description of how the assessment or performance findings were established via telemedicine. This includes, but is not limited to, such elements as standardized tests, strength, range of motion, and muscle tone.

Initial PT and OT evaluations and oral motor/swallowing services are not allowed via telemedicine and should be provided in-person.

Services that require utilization of equipment during treatment and/or physical hands-on interaction with the beneficiary cannot be provided via telemedicine.

Therapy re-evaluations performed via telemedicine must be provided by a therapist whose facility/clinic has previously evaluated and/or treated the beneficiary in-person.

Durable Medical Equipment (DME) re-assessments performed via telemedicine must be provided by a therapist who has previously evaluated and/or treated the beneficiary in-person, otherwise an in-person visit is required.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2130 Jul. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

Audiology Services

MDHHS will allow speech therapy, auditory rehabilitation, select hearing device adjustments, programming, device performance evaluations, and education or counseling to be performed via telemedicine (simultaneous audio/visual). Remote device programming must be provided in compliance with current U.S. Food and Drug Administration (FDA) guidelines. Auditory brainstem response (ABR) and auditory evoked potential (AEP) testing may also be conducted via telemedicine when performed using remote technology located at a coordinating clinical site with appropriately trained staff (i.e., mobile unit, office/clinic, or hospital).

Reimbursable procedure codes are limited to the specific set of audiology codes listed in the telemedicine fee schedule. Audiology services provided via telemedicine are intended to be an additional treatment tool and complement in-person services where clinically appropriate.

Audiological diagnostic tests (other than those mentioned above), hearing aid examinations, surgical device candidacy evaluations, and other audiology and hearing aid services conducted via telemedicine are not reimbursable by Michigan Medicaid and should be provided in-person.

This policy supplements the existing audiology, hearing aid dealer and speech therapy services policies. All current referral, PA, documentation requirements, standards of care, and limitations remain in effect regardless of whether the service is provided through telemedicine. Providers should refer to the Hearing Services chapter of this Manual for complete information.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2131 Jul. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

Dentistry

Services delivered to the beneficiary via telemedicine must be done for the convenience of the beneficiary, not the convenience of the provider. Services must be performed using simultaneous audio/visual capabilities. All services using telemedicine must be documented in the beneficiary’s record, including the date, time, and duration of the encounter, and any pertinent clinical documentation required per CDT code description. The provider is responsible for ensuring the safety and quality of services provided with telemedicine technologies.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2131-2132 Jul. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

School Services Program (SSP)

Billing and reimbursement for telemedicine services are accomplished using the same methodology as other services; however, the service must be billed using POS 03—school and modifier 95 or modifier 93. Telemedicine claims for SSP are paid according to the Centers for Medicare & Medicaid Services (CMS) approved cost-based methodology used for other services provided within the program and not the information provided previously in this policy. SSP providers are not eligible for the facility fee as the facility is an integral part of the service provided and is covered under the service claim. A database of allowable telemedicine services for SSP can be found on the MDHHS website. (Refer to the Directory Appendix for website information.)

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2132 Jul. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

School Services Program (SSP) PT and OT services, as outlined in this policy, will also be allowed via telemedicine. These services must meet all other telemedicine policies as outlined.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2131 Jul. 1, 2024  (Accessed Sept. 2024).

FQHCs and RHCs

Claims for telemedicine services must be submitted using the ASC X 12N 837 5010 form using the appropriate telemedicine HCPCS or CPT code. All telemedicine claims must include the corresponding modifier 95- “Synchronous Telemedicine Service rendered via a real-time interactive audio and video telecommunications system” or 93 – “Synchronous Telemedicine Service rendered via telephone or other real-time interactive audio-only telecommunications system” and the appropriate revenue code.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2133 Jul. 1, 2024  (Accessed Sept. 2024).

Clinics are also permitted to submit for reimbursement telemedicine services (using simultaneous audio/visual technologies) per bulletin MSA 20-09 if all other provisions of telemedicine policy are maintained. Simultaneous audio/visual telemedicine services, as indicated by CPT/HCPCS codes listed on the telemedicine fee schedule and considered qualifying visits, will also be considered face-to-face and will trigger the PPS/AIR if the service billed is listed as a qualifying visit.

Center (THC)/ Tribal Federally Qualified Health Centers (Tribal FQHC) Considerations – PT, OT and ST, when provided in accordance with this policy using both audio/visual modalities, will be considered face-to-face and will trigger the PPS AIR if the service billed is listed as a qualifying visit.

For FQHCs, RHCs, THCs and Tribal FQHCs, the appropriate CPT/HCPCS code, PPS/AIR payment code (if the service generates a Qualifying Visit), and modifier 95 – synchronous telemedicine must be used. Refer to www.michigan.gov/medicaidproviders >> Provider Specific Information for additional information.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

Healthy Michigan Plan – Diabetes Prevention Program (MiDPP)

Sessions may take place in the following modalities and make-up sessions are encouraged:

• In-person
• Distance Learning (synchronous audio-visual or audio-only telemedicine): Lifestyle coaches deliver sessions where the coach is present in one location and participants are participating from another location. Claims for an audio-only session must include the appropriate procedure code, place of service code and modifier 93 and claims for an audio-visual session must include the appropriate
  procedure code, place of service code and modifier 95.
• Online: An asynchronous mode of delivery where participants log into course sessions via a computer, tablet, or smart phone. Per CDC requirements, MiDPP lifestyle coach interaction (in person or via synchronous telemedicine) is required and must be no less than once per week during the first six months and once per month during the second six months.

When billing for a telemedicine session, synchronous or asynchronous, MiDPP providers are expected to adhere to current MDHHS telemedicine policy and modifiers. Refer to the Michigan Medicaid Telemedicine Fee schedule for the list of current codes acceptable for MiDPP telemedicine claims. Claims for an asynchronous session must include the appropriate procedure code and the following remark: “Service provided via an asynchronous telemedicine platform”.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2097 Jul. 1, 2024 & MI Bulletin MMP 23-33, Michigan Diabetes Prevention Program (MiDPP), July 1, 2023, (Accessed Sept. 2024).

Psychiatric Residential Treatment Facilities (PRTF)

The Prepaid Inpatient Health Plan (PIHP) is responsible for managing Medicaid mental health services for all Medicaid beneficiaries residing within the service area covered by the PIHP. This includes the responsibility for timely screening, referral and certification of requests for admission to, PRTF services, defined as follows:

• Screening means the PIHP has been notified of the youth and has been provided enough information to support a referral to a PRTF based on the admission criteria established below.  The screening may be provided on-site, face-to-face by PIHP personnel, the telephone or via a video conference platform.
• Certification means the PIHP has screened the youth and has documented that the services requested seem appropriate. Telephone screening must be followed by the written certification.

SOURCE: MI Bulletin MMP 23-39, Psychiatric Residential Treatment Facilities (PRTF), July 1, 2023, (Accessed Sept. 2024).

Dialysis

MDHHS follows the Medicare billing guidelines for hemodialysis and peritoneal dialysis for both in-person and telemedicine visits.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 978 Jul. 1, 2024, (Accessed Sept. 2024).

Targeted Case Management Services for Recently Incarcerated Beneficiaries

Accessing Services Via In-Reach – The in-reach visit is to be provided face-to-face. Face-to-face is defined as either in-person or via telehealth (i.e., simultaneous audio and visual technology).

SOURCE: MI Bulletin MMP 23-37, Targeted Case Management Services for Recently Incarcerated Beneficiaries, July 1, 2023, (Accessed Sept. 2024).

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ELIGIBLE PROVIDERS

The medical assistance program and Healthy Michigan program must authorize as many types of providers as appropriate per scope of practice to effectively render telemedicine services.

Telemedicine services are covered both when a distant provider’s synchronous interactions occur using an audio and video electronic media or when using an audio-only electronic media.

The distant provider or organization is responsible for verifying a recipient’s identification and program eligibility.

The distant provider or organization must ensure that the information is available to the primary care provider.

The distant provider must encourage the recipient to proceed with the telemedicine service only if the recipient is in a safe and private environment.

The distant provider must follow generally accepted clinical practice guidelines and ensure the clinical appropriateness and effectiveness of services delivered using telemedicine.

A telemedicine service is an allowable encounter for a federally qualified health center, rural health clinic, or tribal health center in the medical assistance program or Healthy Michigan program.

SOURCE: MI Compiled Laws Sec. 400.105h as amended by HB 4213 and HB 4580. (Accessed Sept. 2024).

In alignment with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in their health care profession in the state where the beneficiary is located. The provider at the distant site who is licensed under State law to furnish a covered telemedicine service (as described in telemedicine policy) may bill, and receive payment for, the service when it is delivered via a telecommunications system.

Telemedicine providers must be enrolled in Michigan Medicaid and must have the ability to refer the beneficiary to another provider of the same type or specialty who can see the beneficiary in-person when necessary. If rendering services within a managed care plan, providers must refer beneficiaries to resources within the plan for additional services as needed.

See out of state providers section for information on providers licensed out of state or through PSYPACT.

Telemedicine providers who do not have a physical location for treatment, but are Michigan licensed and meet all other Medicaid enrollment requirements, are considered “virtual-only”, and are permitted to render services for Michigan Medicaid-enrolled beneficiaries.

Virtual-only providers not associated to a Michigan billing provider within the Community Health Automated Medicaid Processing System (CHAMPS) will be subject to out-of-state provider PA requirements. Providers should refer to the Out-of-State/Beyond Borderland Providers subsection in the General Information for Providers chapter of the MDHHS Medicaid Provider Manual for situations where PA could be approved.

Virtual-only providers must report Place of Service (POS) 02 or 10 along with the appropriate modifier when submitting claims/encounters for telemedicine.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2119-2120 Jul. 1, 2024 & MI Medicaid Policy Bulletin MMP 24-06, Apr. 1, 2024, (Accessed Sept. 2024).

Distant site is defined as the location of the provider providing the professional service at the time of the telemedicine visit. This definition encompasses the provider’s office, or any established site considered appropriate by the provider, so long as the privacy of the beneficiary and security of the information shared during the telemedicine visit are maintained.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2123, Jul. 1, 2024  (Accessed Sept. 2024).

Assertive Community Treatment Program

Typically, although not exclusively, physician activities may include team meetings, beneficiary appointments during regular office hours, psychiatric evaluations, psychiatric meetings/consultations, medication reviews, home visits, telephone consultations and telemedicine.  The physician (MD or DO) must possess a valid license to practice medicine in Michigan, a Michigan Controlled Substance License, and a Drug Enforcement Administration (DEA) registration.

Typically, although not exclusively, physician assistant activities may include team meetings, beneficiary appointments during regular office hours, evaluations, psychiatric meetings/consultations, medication reviews, home visits, telephone consultations and telemedicine.

Typically, although not exclusively, nurse practitioner/clinical nurse specialist activities may include team meetings, beneficiary appointments during regular office hours, evaluations, psychiatric meetings/consultations, medication reviews, home visits, telephone consultations and telemedicine.

The telemedicine modifier must be used in conjunction with the ACT encounter reporting code when telemedicine is used.

All telemedicine interactions shall occur through real-time interactions between the ACT consumer and the physician/nurse practitioner/physician’s assistant/clinical nurse specialist from their respective physical location. Psychiatric services are the only ACT services that are approved to be provided in this manner.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 368-369 Jul. 1, 2024  (Accessed Sept. 2024).

Behavioral Health

Behavioral health services may be delivered via telemedicine in accordance with current Medicaid policy. In compliance with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 548 Jul. 1, 2024  (Accessed Sept. 2024).

Federally Qualified Health Centers

An FQHC can be either an originating or distant site for telemedicine services.

An allowable FQHC encounter means a face-to-face medical visit or an interaction using a qualifying telemedicine modality (audio/visual or audio-only) between a patient and the provider of health care services who exercises independent judgment in the provision of health care services. Encounters may be classified as medical, dental, or behavioral health.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 759 & 761, Jul. 1, 2024  (Accessed Sept. 2024).

Hospital

A hospital can be either an originating or distant site for telemedicine services. Refer to the Billing & Reimbursement for Institutional Providers Chapter for specific billing instructions.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1001, Jul. 1, 2024  (Accessed Sept. 2024).

Nursing Facility

A nursing facility can be either an originating or distant site for telemedicine. Refer to the Billing & Reimbursement for Institutional Providers Chapter for information regarding billing the originating site facility fee.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1536, Jul. 1, 2024  (Accessed Sept. 2024).

Rural Health Clinic

An RHC can be either an originating or distant site for telemedicine services. Refer to the Billing & Reimbursement for Institutional Providers Chapter for specific billing instructions.

An encounter is a face-to-face visit or an interaction using a qualifying telemedicine modality (audio/visual or audio-only) between a patient and the provider of health care services who exercises independent judgment in the provision of health care services. For a health service to be defined as an encounter, the provision of the health service must be recorded in the patient’s medical record. Encounters may be classified as medical or behavioral health.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1971-1972, Jul. 1, 2024  (Accessed Sept. 2024).

PIHP/CMHSP

A CMH/PIHP can be either an originating or distant site for telemedicine services. Practitioners must meet the provider qualifications for the covered service provided via telemedicine.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 357 Jul. 1, 2024  (Accessed Sept. 2024).

Telemedicine providers who are rendering services within the specialty behavioral health system must follow all PIHP/CMHSP enrollment procedures. These PIHP/CMHSP providers are required to be affiliated to the beneficiary’s care team (via a shared medical record or a referral relationship) to ensure that the beneficiary has reasonably frequent and periodic in-person evaluations to personally reassess and update the beneficiary’s medical treatment/history, effectiveness of treatment modalities, and current medical/behavioral condition and/or treatment plan.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2129 Jul. 1, 2024 & MI Medicaid Policy Bulletin MMP 24-06, Apr. 1, 2024, Accessed Sept. 2024).

When the outpatient facility provides administrative support for a telemedicine service, the outpatient hospital facility may bill the hospital outpatient clinic visit on the institutional claim with modifier 95 or modifier 93 and the appropriate revenue code.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2129, Jul. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

PIHP/CMHSP providers must submit encounters for audio/visual telemedicine with POS 02 or 10 (as applicable) and for audio-only POS 02 or 10 (as applicable) and Modifier 93.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2128, Jul. 1, 2024 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

Telemedicine is allowed for all services indicated in the Bureau of Specialty Behavioral Health Services Telemedicine Database. The features of what will be counted as a telemedicine visit need to align with the same standards of an in-person visit. Any phone call or web platform used to schedule, obtain basic information or miscellaneous work that would have been billed as a non-face-to-face and therefore non-billable contact, will remain non-billable. Telemedicine visits must include service provision as indicated in the IPOS and should reflect work towards or review of goals and objectives indicated forthwith.

Medicaid beneficiaries whose needs do not render them eligible for specialty services and supports through the PIHPs/CMHSPs may receive outpatient mental health services through Medicaid FFS or MHPs as applicable. These FFS/MHP enrolled non-physician behavioral health services may be provided via telemedicine when performed by Medicaid-enrolled psychologists, social workers, counselors, and marriage and family therapists. Services are covered when performed in a non-facility setting or outpatient hospital clinic. All applicable services are listed in the telemedicine audio/visual and audio-only fee schedules.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2129-2130 Jul. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

Physical Therapy, Occupational Therapy and Speech Therapy Services

This policy supplements existing PT, OT, and ST services policy. All current therapy referral, PA, documentation requirements, standards of care, and limitations remain in effect regardless of whether the service is provided through telemedicine. All telemedicine therapy services will count toward the beneficiary’s therapy service limits. (Refer to the Therapy Services chapter for additional information.)

Modifier 95 should be used in addition to the required modifiers for therapy services as outlined in therapy policy.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2130-2131 Jul. 1, 2024  (Accessed Sept. 2024).

Dentistry

MDHHS will allow dentists to provide the limited oral evaluation (Current Dental Terminology [CDT] code D0140) via telemedicine (simultaneous audio/visual) technology so long as all other telemedicine policy is followed.

All requirements of the general telemedicine policy must be followed when providing the limited oral evaluation via telemedicine, including scope of practice requirements, contingency plan, and the use of both audio/visual service delivery unless otherwise indicated by federal guidance.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2131 Jul. 1, 2024 & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

Billing instructions depend upon the claim format used:

• American Dental Association (ADA) Claim Format: Use POS 02 or POS 10.
• Institutional Claim Format: POS 02 and POS 10 are not required; Use modifier 95.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2132 Jul. 1, 2024  (Accessed Sept. 2024).

Vision

Telemedicine vision services can be provided through a Medicaid-enrolled provider who can report E/M services as listed in the telemedicine fee schedules.

An intermediate ophthalmological exam can be provided via telemedicine for an established patient with a known diagnosis. The provider must have a previous in-person encounter with the beneficiary to ensure the provider is knowledgeable of the beneficiary’s current medical history and condition. For cases in which the provider must refer the beneficiary to another provider, a consulting provider is not required to have a pre-existing provider-patient relationship if the referring provider shares medical history, past eye examinations, and any related beneficiary diagnosis with the consulting provider. Intermediate ophthalmological exam codes should not be used to diagnose eye health conditions (an initial diagnosis). When medically necessary, providers must refer beneficiaries for an in-person encounter to receive a diagnosis and/or care. Telemedicine cannot act as a replacement for recommended in-person interactions.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2132 Jul. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

School Services Program (SSP)

Because of the unique circumstances regarding the delivery of services within the School Services Program (SSP), telemedicine may be the primary delivery modality for some beneficiaries; however, the decision to use telemedicine should be based on the needs or convenience of the beneficiary, and not those of the provider.

In cases where the beneficiary is unable to use telemedicine equipment without assistance, an attendant must be provided by the provider. The attendant must be trained in the use of the telemedicine equipment to the point where they can provide adequate assistance. The attendant must also be available for the entire telemedicine session; however, they should also ensure the beneficiary’s privacy to the greatest extent possible. When the originating site for the service is the student’s home, any cost for an attendant is not reimbursable.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2132 Jul. 1, 2024, & MI Dept. of Health and Human Services., Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

School Services Program

The 95 modifier is used with the appropriate procedure codes to identify when a service is provided via telemedicine using audio and video.

NOTE: Telemedicine Services are covered in the Telemedicine Chapter of this manual. (listed at several points throughout document)

SOURCE:  MI Dept. of Health and Human Services., Bulletin 24-17, School Services Program (SSP) Providers, SSP Chapter Rewrite and Update, Jul. 1, 2024, (Accessed Sept. 2024).

Durable Medical Equipment (DME) Providers

All DME providers must reference the Medical Supplier chapter of this Manual for specific requirements in the provision of services via telemedicine.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2133 Jul. 1, 2024  (Accessed Sept. 2024).

FQHCs and RHCs

All current Medicaid policy for telemedicine services, including definitions, requirements and parameters of telemedicine, apply to FQHCs and RHCs. FQHCs and RHCs are responsible for ensuring compliance with all telemedicine policy.

Distant site services provided by qualified Medicaid enrolled providers may be covered when the qualified provider is employed by the clinic or working under the terms of a contractual agreement with the clinic. FQHCs and RHCs must maintain all practitioner contracts and provide them to MDHHS upon request.

During the Medicaid provider enrollment process, contracted providers must associate to the FQHC or RHC billing NPI. Refer to the Billing & Reimbursement for Institutional Providers chapter of this Manual for further information.

PPS is reimbursed according to the billing rules described below (See manual).

If both the originating and distant sites submit identical procedure code(s) for a telemedicine visit for the same beneficiary on the same date of service, it is considered duplicate billing. MDHHS will recover payment from the appropriate FQHC, RHC, or contracted provider. Recovery will be based on the terms specified in the contract.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2133-2134 Jul. 1, 2024  (Accessed Sept. 2024).

Tribal FQHC

A Tribal facility may choose to enroll as a Tribal FQHC and be reimbursed for outpatient face-to-face visits within the FQHC scope of services provided to Medicaid beneficiaries, including telemedicine and services provided by contracted employees. Tribal FQHCs are eligible to receive the IHS outpatient AIR for eligible encounters.

A THC can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2178 & 2182, Jul. 1, 2024  (Accessed Sept. 2024).

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ELIGIBLE SITES

Beginning October 1, 2020, telemedicine services are covered under the medical assistance program and Healthy Michigan program if the originating site is an in-home or in-school setting, in addition to any other originating site allowed in the Medicaid provider manual or any established site considered appropriate by the provider. Beginning the effective date of the amendatory act that added subsection (7), telemedicine services are also covered under the medical assistance program and Healthy Michigan program if those services are provided at, or contracted through, a distant site allowed in the Medicaid provider manual.

“Originating site” means the location of the eligible recipient at the time the service being furnished by a telecommunications system occurs.

“Distant provider” and “distant site” mean the location of the health care professional providing the service at the time the service is being furnished by a telecommunications system and the health care professional providing those services. Distant site may include the health care professional’s office or any established site considered appropriate by the health care professional as long as the privacy of the recipient and security of the information shared during the telemedicine visit are maintained.

SOURCE: MI Compiled Laws Sec. 400.105h as amended by HB 4213 and HB 4580. (Accessed Sept. 2024).

Originating site is defined as the location of the eligible beneficiary at the time of the telemedicine service.

Authorized originating sites include:

• County mental health clinic or publicly funded mental health facility
• Federally Qualified Health Center (FQHC)
• Hospital (inpatient, outpatient, or critical access hospital)
• Office of a physician or other provider (including medical clinics)
• Hospital-based or Critical Access Hospital (CAH)-based Renal Dialysis Centers (including satellites)
• Rural Health Clinic (RHC)
• Skilled nursing facility
• Tribal Health Center (THC)
• Local Health Department (LHD) as defined in Sections 333.2413, 333.2415 and 333.2421 of the Michigan Public Health Code (PA 368 of 1978 as amended)
• Home, as defined as a location, other than a hospital or other facility, where the beneficiary receives care in a private residence
• Other established site considered appropriate by the provider (in accordance with clinical judgement)

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2123, Jul. 1, 2024, & MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Sept. 2024).

MDHHS does not recognize the following place of service codes for reimbursement by the program: …

• 10 – Telehealth Provided in Patient’s Home (added 7/1/24)

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 255, Jul. 1, 2024, (Accessed Sept. 2024).

Effective March 1, 2020. The distant site is defined as the location of the practitioner, providing the professional service at the time of the telemedicine visit. The definition encompasses the providers office or any established site, considered appropriate by the provider so long as the privacy of the beneficiary and security of the information shared during the telemedicine visit are maintained.

Telemedicine services where “home” or another “establish site, considered appropriate by the provider” are utilized as the originating site or not eligible to receive the telehealth facility fee. Distant site providers in these situations are instructed to bill the appropriate current procedural term analogy HCPCS code for the services provided.

Neither the originating site or the distant side is permitted to bill both the telehealth facility and the code for the professional service for the same beneficiary at the same time.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Sept. 2024).

All audio/visual telemedicine services, as allowable on the telemedicine fee schedule and submitted on the professional invoice, must be reported with the Place of Service (POS) code that would be reported as if the beneficiary were in-person for the visit along with modifier 95—”Synchronous Telemedicine Service rendered via a real-time interactive audio and video telecommunications system”.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127, Jul. 1, 2024 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

PIHP/CMHSP providers must submit encounters for audio/visual telemedicine with POS 02 or 10 (as applicable) and for audio-only POS 02 or 10 (as applicable) and Modifier 93.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2128, Jul. 1, 2024 & Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Sept. 2024).

For PIHP/CMHSP service providers, refer to the MDHHS Bureau of Specialty Behavioral Health Services Telemedicine Database and the Audio-Only Telemedicine Database on the MDHHS website for services allowed via both audio/visual and audio-only telemedicine.

This information should be used in conjunction with the Billing & Reimbursement for Professionals and the Billing & Reimbursement for Institutional Providers Chapters as well as the Medicaid Code and Rate Reference tool and other related procedure databases/fee schedules located on the MDHHS website.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2128, Jul. 1, 2024, (Accessed Sept. 2024).

For services submitted on the institutional invoice, the appropriate National Uniform Billing Committee (NUBC) revenue code, along with the appropriate telemedicine CPT/HCPCS procedure code and modifier 95 or modifier 93, must be used.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127, Jul. 1, 2024, (Accessed Sept. 2024).

An FQHC can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 759 Jul. 1, 2024  (Accessed Sept. 2024).

Hospital

A hospital can be either an originating or distant site for telemedicine services. Refer to the Billing & Reimbursement for Institutional Providers Chapter for specific billing instructions.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1001, Jul. 1, 2024. (Accessed Sept. 2024).

Nursing Facility

A nursing facility can be either an originating or distant site for telemedicine. Refer to the Billing & Reimbursement for Institutional Providers Chapter for information regarding billing the originating site facility fee.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1536, Jul. 1, 2024. (Accessed Sept. 2024).

Pharmacy

In the event that the beneficiary is unable to physically access an in-person (revised per bulletin MMP 23-20) care setting, an eligible pharmacist may provide MTM services via telemedicine. Telemedicine is the use of telecommunications and information technologies for the exchange of encrypted patient data for the provision of services. Telemedicine must be obtained through real-time interactions between the beneficiary’s physical location (originating site) and the pharmacist provider’s physical location (distant site). MTM telemedicine audio/visual services are provided to beneficiaries through hardwire or internet connection. It is the expectation that providers and facilitators involved in telemedicine are trained in the use of equipment and software prior to servicing beneficiaries. The arrangements for telemedicine will be made by the pharmacist. The administration of telemedicine services is subject to the same provision of services that are provided to a beneficiary in person. Providers must ensure the privacy of the beneficiary and secure any information shared via telemedicine. Refer to the Telemedicine chapter for additional information regarding telemedicine service provision.

For services provided through telemedicine, each procedure code must include the modifier 95.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1819, Jul. 1, 2024. (Accessed Sept. 2024).

Rural Health Clinic

An RHC can be either an originating or distant site for telemedicine services. Refer to the Billing & Reimbursement for Institutional Providers Chapter for specific billing instructions.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1971, Jul. 1, 2024. (Accessed Sept. 2024).

Dentistry

Billing instructions depend upon the claim format used:

• American Dental Association (ADA) Claim Format: Use POS 02 or POS 10.
• Institutional Claim Format: POS 02 and POS 10 are not required; Use modifier 95.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2132 Jul. 1, 2024. (Accessed Sept. 2024).

FQHC/RHC

If both the originating and distant sites submit identical procedure code(s) for a telemedicine visit for the same beneficiary on the same date of service, it is considered duplicate billing. MDHHS will recover payment from the appropriate FQHC, RHC, or contracted provider. Recovery will be based on the terms specified in the contract.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2134 Jul. 1, 2024. (Accessed Sept. 2024).

Tribal Health Centers

A THC can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2182, Jul. 1, 2024  (Accessed Sept. 2024).

Tribal FQHCs are eligible to receive all-inclusive rate (AIR) reimbursement for clinic services provided outside of the four walls of the facility, including telemedicine and services provided by contracted employees.

SOURCE: MI Medical Services Administration Bulletin MSA 20-60, Sept. 1, 2020. (Accessed Sept. 2024).

Speech Hearing and Language

A CMH/PIHP can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 357 Jul. 1, 2024  (Accessed Sept. 2024).

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GEOGRAPHIC LIMITS

No Reference Found

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FACILITY/TRANSMISSION FEE

Allowable originating sites are permitted to submit claims for the telehealth facility fee. This fee is intended to reimburse the provider for the expense of hosting the beneficiary at their location. To submit this code, the originating site must ensure the technology is functioning, the privacy of the beneficiary is secured, and that the information is shared confidentially.

Telemedicine services where “home” or another “established site considered appropriate by the provider” are utilized as the originating site are not eligible to receive the telehealth facility fee. Distant site providers in these situations are instructed to bill the appropriate Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code (as represented by the Telemedicine database) for the service(s) provided.

Neither the originating site nor the distant site is permitted to bill both the telehealth facility fee and the code for the professional service for the same beneficiary at the same time.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127 Jul. 1, 2024, & MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Sept. 2024).

Institutional Providers

To be reimbursed for the originating site facility fee, the hospital must bill the appropriate telemedicine NUBC revenue code with the appropriate telemedicine facility fee code and modifier.

To be reimbursed for the originating site facility fee, the hospital must bill the telemedicine facility fee code and modifier. Refer to the Telemedicine Chapter for additional information.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 190 & 204 Jul. 1, 2024. (Accessed Sept. 2024).

Professional Providers

To be reimbursed for the originating site facility fee, the originating site provider must bill the telehealth facility fee. MDHHS will reimburse the originating site provider the current Medicaid fee screen. Additional services provided at the originating site on the same date as the telemedicine service may be billed and reimbursed separately according to published policy.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 274 Jul. 1, 2024. (Accessed Sept. 2024).

Nursing Facility

To be reimbursed for the originating site facility fee, the NF must bill the appropriate telemedicine NUBC revenue code with the appropriate telemedicine facility fee and modifier.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 217 Jul. 1, 2024. (Accessed Sept. 2024).

FQHCs and RHCs

The telehealth facility fee does not qualify as a face-to-face visit and does not generate the PPS payment. Telemedicine service(s) provided at the distant site that qualify as a face-to-face visit may generate the PPS payment. All current PPS rules and encounter criteria apply to telemedicine visits. Refer to the Federally Qualified Health Centers and the Rural Health Clinics chapters of this Manual and the FQHC and RHC reimbursement lists on the MDHHS website for further information. (Refer to the Directory Appendix for website information.)

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2133 Jul. 1, 2024. (Accessed Sept. 2024).

Last updated 09/02/2024

Miscellaneous

MDHHS requires a HIPAA compliant real-time interactive system at both the originating and distant sites, allowing instantaneous interaction between the beneficiary and provider via the telecommunication system.

When providing services via telemedicine, sufficient privacy and security measures must be in place and documented to ensure confidentiality and integrity of beneficiary-identifiable information. This includes, but is not limited to, ensuring any tracking technologies used by websites, mobile applications, or any other technology used, comply with applicable law regarding use or disclosure of beneficiary-identifiable information. Transitions, including beneficiary email, prescriptions, and laboratory results, must be secure within existing technology (i.e., password protected, encrypted electronic prescriptions, or other reliable authentication, techniques). All beneficiary-physician email, as well as other beneficiary-related electronic communications, should be stored and filed in the beneficiary’s medical record, consistent with transitional recordkeeping policies and procedures.

There are no prior authorization (PA) requirements when providing services via telemedicine for Fee-for-Service (FFS) beneficiaries or for those accessing Behavioral Health Services through Prepaid Inpatient Health Plans (PIHPs)/Community Mental Health Services Programs (CMHSPs) unless the equivalent in-person service requires PA. Authorization requirements for beneficiaries enrolled in Medicaid Health Plans (MHPs) may vary. Providers must refer to individual MHPs for any authorization or coverage requirements.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2122 Jul. 1, 2024, & MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Sept. 2024).

The Michigan Department of Health and Human Services requires a health insurance, portability and accountability act of 1986 compliant real time interactive system at both the originating and distant sites, allowing simultaneous interaction between the beneficiary and practitioner via the telecommunication system. The technology used must meet the needs for audio and visual compliance in accordance with state and federal standards. Practitioners must ensure the privacy of the beneficiary and the security of any information shared via telemedicine.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 20-09, General Telemedicine Policy, Mar. 12, 2020, [Provider Bulletin 23-10 indicates policy is permanent] (Accessed Sept. 2024).

A contingency plan, including referral to an acute care facility or Emergency Room (ER) for treatment as necessary for the safety of the beneficiary, is required when utilizing telemedicine technologies. This plan must include a formal protocol appropriate to the services being rendered.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2122 Jul. 1, 2024, (Accessed Sept. 2024).

Covered services for community health workers includes health system navigation and resource coordination, including helping a beneficiary with a telehealth appointment and/or educating a beneficiary on the use of telehealth technology.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 23-74, Medicaid Coverage of Community Health Worker (CHW)/Community Health Representative (CHR) Services, Dec. 1, 2023, (Accessed Sept. 2024).

To restrain cost increases in the autism services line item, the department shall do all of the following: …

• Allow and expand the utilization of telemedicine and telepsychiatry to increase access to diagnostic evaluation services.

From the funds appropriated in part 1 for medical care and treatment, the department may spend the funds to continue developing and expanding telemedicine capacity to allow families with children in the children’s special health care services program to access specialty providers more readily and in a more timely manner. The department may spend funds to support chronic complex care management of children enrolled in the children’s special health care services program to minimize hospitalizations and reduce costs to the program while improving outcomes and quality of life. As used in this section, “children’s special health care services program” or “program” means the program established under section 5815 of the public health code, 1978 PA 368, MCL 333.5815.

The department shall continue, and expand where appropriate, utilization of telemedicine and telepsychiatry as strategies to increase access to services for Medicaid recipients.

SOURCE: Senate Budget Bill 747, (Accessed Sept. 2024).

Last updated 09/02/2024

Out of State Providers

In alignment with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in their health care profession in the state where the beneficiary is located. The provider at the distant site who is licensed under State law to furnish a covered telemedicine service (as described in telemedicine policy) may bill, and receive payment for, the service when it is delivered via a telecommunications system.

Telemedicine providers must be enrolled in Michigan Medicaid and must have the ability to refer the beneficiary to another provider of the same type or specialty who can see the beneficiary in-person when necessary. If rendering services within a managed care plan, providers must refer beneficiaries to resources within the plan for additional services as needed.

Michigan Medicaid telemedicine policy permits providers who are licensed in another state to render/be reimbursed for telemedicine services for Michigan Medicaid-enrolled beneficiaries if the beneficiary is in the state where the provider is licensed. Unless otherwise specified in policy, telemedicine providers associated to a billing provider located outside of Michigan must obtain prior authorization (PA) for services.

Providers should refer to the Out-of-State/Beyond Borderland Providers subsection in the General Information for Providers chapter for situations where PA could be approved. Refer to the PSYPACT subsection for specific situations where an out-of-state licensed provider is otherwise authorized to render/be reimbursed for telemedicine services.

Telemedicine providers who do not have a physical location for treatment, but are Michigan licensed and meet all other Medicaid enrollment requirements, are considered “virtual-only” and are permitted to render services for Michigan Medicaid-enrolled beneficiaries.

Virtual-only providers not associated to a Michigan billing provider within the Community Health Automated Medicaid Processing System (CHAMPS) will be subject to out-of-state provider PA requirements. Providers should refer to the Out-of-State/Beyond Borderland Providers subsection in the General Information for Providers chapter for situations where PA could be approved.

Virtual-only providers must report Place of Service (POS) 02 or 10 along with the appropriate modifier when submitting claims/encounters for telemedicine.

Telemedicine providers who have an Authority to Practice Interjurisdictional Telepsychology (APIT) certificate from the Psychology Interjurisdictional Compact (PSYPACT) Commission are eligible to render/be reimbursed for telemedicine services for Medicaid beneficiaries as authorized under PSYPACT and allowed by Medicaid telemedicine policy.

PSYPACT providers must abide by the same telemedicine requirements as all other telemedicine providers. Services performed by PSYPACT providers are subject to PA requirements that would apply if the provider were located in-state. Providers should refer to the CHAMPS Code Rate and Reference tool for service-specific in-state authorization requirements.

PSYPACT providers must report POS 02 or 10 along with the appropriate modifier when submitting claims/encounters for telemedicine.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 2119-2120,  Jul. 1, 2024 & MI Medicaid Policy Bulletin MMP 24-06, Apr. 1, 2024, (Accessed Sept. 2024).

Behavioral health services may be delivered via telemedicine in accordance with current Medicaid policy. In compliance with the Michigan Insurance Code of 1956 (Act 218 of 1956), telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in their health care profession in the state where the patient is located. Refer to the Telemedicine Chapter for additional information regarding telemedicine services.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 548,  Jul. 1, 2024 (Accessed Sept. 2024).

Asynchronous Interprofessional Consultations

In consultations that cross state lines, consulting providers must be an enrolled Medicaid provider in the state in which the beneficiary resides, though they need only be licensed/credentialed in the state in which they are practicing. Interprofessional consultations that occur across state lines require prior authorization. Refer to the MDHHS Medicaid Provider Manual for further information regarding out-of-state/beyond borderland providers and the prior authorization process.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125-2126, Jul. 1, 2024 (Accessed Sept. 2024).

Assertive Community Treatment Programs (ACT)

Typically, although not exclusively, physician activities may include team meetings, beneficiary appointments during regular office hours, psychiatric evaluations, psychiatric meetings/consultations, medication reviews, home visits, telephone consultations and telemedicine.

The physician (MD or DO) must possess a valid license to practice medicine in Michigan, a Michigan Controlled Substance License, and a Drug Enforcement Administration (DEA) registration.

SOURCE: Dept. of Health and Human Services, Medicaid Provider Manual, p. 368, Jul. 1, 2024 (Accessed Sept. 2024).

Last updated 09/04/2024

Overview

Michigan Medicaid reimburses for live video telemedicine for certain healthcare professionals for specific services.  Medicaid reimburses for asynchronous telemedicine services, including store and forward services, interprofessional consultations and remote patient monitoring services under certain circumstances. Audio-only is allowed for the provision of a specific set of procedure codes when beneficiaries cannot access services via live video.

Last updated 09/02/2024

Remote Patient Monitoring

POLICY

“Remote patient monitoring” means digital technology to collect medical and other forms of health data from an individual in 1 location and electronically transmit that information via a health insurance portability and accountability act of 1996, Public Law 104-191 compliant, secure system to a health care provider in a different location for assessment and recommendations.

SOURCE: MI Compiled Laws Sec. 400.105g (Accessed Sept. 2024).

Remote Patient Monitoring (RPM) is a covered service under Michigan Compiled Law (MCL) 400.105g. RPM means using digital technology to collect medical and other forms of health data from an individual in one location and electronically transmit that information via a secure, HIPAA-compliant system to a provider in a different location for assessment and recommendations. RPM is covered for both acute and chronic conditions.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2126, Jul. 1, 2024, (Accessed Sept. 2024).

The department must provide coverage for remote patient monitoring services through the medical assistance program and Healthy Michigan program under this act.

SOURCE: MI Compiled Laws Sec. 400.105g (Accessed Sept. 2024).

Continuous Glucose Monitoring

CGMS may be non-adjunctive/therapeutic (CGMS can be used to make treatment decisions without the need to confirm test results using a blood glucose monitor [BGM]); or adjunctive/non-therapeutic (beneficiary must use a BGM to test the results displayed on the CGMS prior to making a treatment decision).

SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1216 Jul. 1, 2024, (Accessed Sept. 2024).

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CONDITIONS

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PROVIDER LIMITATIONS

Continuous Glucose Monitoring

Personal use CGMS are covered for beneficiaries with diabetes when all the following are met:

• The beneficiary is under the care of one of the following:
  • An endocrinologist; or
  • A physician or non-physician practitioner (nurse practitioner, physician assistant or clinical nurse specialist) who is managing the beneficiary’s diabetes.
• The beneficiary has diabetes requiring the administering of insulin or is currently using an insulin pump.
• The beneficiary or their caregiver is educated on the use of the device and is willing and able to use the CGMS.

Note: CGMS reduce the frequency of fingerstick blood glucose testing but do not eliminate the need to fingerstick test entirely. Glucometers and testing supplies must be made available. These supplies are billed separately (following frequency rules) for adjunctive/non-therapeutic CGMS. Glucometers and testing supplies are included in the monthly supply HCPCS code for non-adjunctive/therapeutic CGMS. Refer to the Payment Rules section of this policy.

Although not required for coverage consideration, physicians/non-physician practitioners are encouraged to refer patients who are willing and able to attend a certified diabetes self-management education training program. A map identifying Medicaid enrolled diabetes self-management education and support (DSME) providers can be found on the MDHHS website. (Refer to the Directory Appendix for website information.)

SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1216 Jul. 1, 2024, (Accessed Sept. 2024).

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OTHER RESTRICTIONS

All RPM devices, including mobile medical applications, must meet the U.S. Food & Drug Administration (FDA) definition of a medical device. Personal tablets, computers, cell phones, software intended for administrative support or support of healthy lifestyles/general wellness, and electronic health records are not medical devices or durable medical equipment and are not covered as part of RPM services.

Reimbursement for the device used for remote monitoring, and programming of the device, is generally included in the reimbursement of RPM services and not separately reimbursable. For items or devices separately reimbursed to a medical supplier, such as personal use continuous glucose monitoring systems (CGMs), refer to the Medical Supplier chapter of the MDHHS Medicaid Provider Manual.

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2126 Jul. 1, 2024, (Accessed Sept. 2024).

See bulletin/manual for documentation, prior authorization and eligible CGM codes.

SOURCE: MI Bulletin 23-31, Revisions to Continuous Glucose Monitoring Systems Policy, June 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 1217-1218 Jul. 1, 2024, (Accessed Sept. 2024).

Last updated 09/02/2024

Store and Forward

POLICY

The Michigan Department of Health and Human Services (MDHHS) covers both synchronous (real-time interactions) and asynchronous (over separate periods of time) telemedicine services. MDHHS requires that all telemedicine policy provisions within this policy and other current policy are established and maintained within all telemedicine services.

Asynchronous telemedicine services include the transmission of a beneficiary’s medical or other personally identifiable information through a secure, Health Insurance Portability and Accountability Act (HIPAA)-compliant, electronic communications system to a provider, often a specialist, at a distant site without the beneficiary present. Such communications, including store and forward services, interprofessional telephone/Internet/electronic health record consultations, and RPM services, involve contact between two parties (beneficiary to provider or provider to provider) in a way that does not require real-time interaction. Services must be medically necessary or essential for behavioral health and part of a provider-directed treatment plan.

Asynchronous telemedicine services must be performed under the general or direct supervision of a Medicaid-enrolled physician or practitioner who has an active role in the management of the beneficiary’s physical and/or behavioral health. The analysis and interpretation of the beneficiary’s data must contribute to the development and/or monitoring of the beneficiary’s treatment plan. Asynchronous telemedicine services do not include telephone calls, images transmitted via facsimile machines, and text messages without visualization of the beneficiary. Photographs visualized by a telecommunications system must be specific to the beneficiary’s physical and/or behavioral health condition and adequate for furnishing or confirming a diagnosis and/or treatment plan.

Asynchronous telemedicine services generally may not be separately reported on the same day the beneficiary presents for an evaluation and management (E/M) or other related service to the same provider. These services are typically considered part of the E/M or other related service and are not separately reimbursed. Activities performed in the facility setting under the general or direct supervision of the provider are bundled with the facility services on the UB-04 claim form and cannot be reported on the CMS 1500 claim form or billed under the provider’s National Provider Identifier (NPI).

Store and forward services are asynchronous electronic transmissions of physical and/or behavioral health information from the beneficiary to a Medicaid-enrolled physician or practitioner at the distant site when video or face-to-face contact is not necessary. Information transmitted to the provider is analyzed and used in the diagnosis, development, or maintenance of an individualized treatment plan. Information may include, but is not limited to, digital images, documents, video clips, still images, x-rays, magnetic resonance images (MRIs), electrocardiograms (EKGs) and electroencephalograms (EEGs), and audio clips.

Store and forward services include interpretation and follow-up with the beneficiary. Services must not originate from or result in a related E/M service.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2119 & 2124-2125, Jul. 1, 2024 & Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 (Accessed Sept. 2024).

Asynchronous telemedicine service codes are listed on the corresponding provider specific fee schedules. Additional program-specific coverage will be represented on individual program fee schedules and will be indicated in the program-specific sections below as indicated.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2127 Jul. 1, 2024, (Accessed Sept. 2024).

In accordance with Section 16284 of Public Act No. 359 of 2016, telemedicine services, including asynchronous telemedicine, must be provided only with direct or indirect beneficiary consent and this consent must be properly documented in the beneficiary’s medical record in accordance with applicable standards of practice.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2124-2125, Jul. 1, 2024 & Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Sept. 2024).

Interprofessional consultations (including eConsults), are defined as a type of asynchronous telemedicine service in which the beneficiary’s Medicaid-enrolled treating provider (e.g., attending or primary) requests the opinion and/or treatment advice of a Medicaid-enrolled consulting provider with the specialty expertise to assist in the diagnosis and/or management of the beneficiary’s condition without beneficiary face-to-face contact with the consulting provider. The service must be for the direct benefit of the beneficiary, directly relevant to the individual beneficiary’s original evaluation, diagnosis, and/or treatment, and must conclude with a written report from the consulting provider to the treating provider.

The beneficiary for whom the service is requested may be either a new or established patient to the consulting provider. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology reports, is included in the service and should not be separately reported. The written or verbal request for the consultation must be documented in the beneficiary’s medical record by the treating provider. Additional documentation requirements (within the medical record of the beneficiary) include date of service; name of provider agency or person providing the service; nature, extent, or units of service; and the place of service, along with all record keeping requirements as outlined in the MDHHS Medicaid Provider Manual.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125, Jul. 1, 2024 (Accessed Sept. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

The beneficiary for whom the service is requested may be either a new or established patient to the consulting provider. Service time is based on the total review and interprofessional communication time. The review of beneficiary information, including but not limited to medical records, laboratory studies, imaging studies, medications, and pathology reports, is included in the service and should not be separately reported. The written or verbal request for the consultation must be documented in the beneficiary’s medical record by the treating provider. Additional documentation requirements (within the medical record of the beneficiary) include date of service; name of provider agency or person providing the service; nature, extent, or units of service; and the place of service, along with all record keeping requirements as outlined in the MDHHS Medicaid Provider Manual. Providers must also consult with the American Medical Association (AMA) coding guidelines to ensure appropriate reporting of these services. Providers should not report interprofessional telephone/Internet/electronic health record consultations when the sole purpose of the communication is to arrange a transfer of care or other face-to-face service. In consultations that cross state lines, consulting providers must be an enrolled Medicaid provider in the state in which the beneficiary resides, though they need only be licensed/credentialed in the state in which they are practicing. Interprofessional consultations that occur across state lines require prior authorization. Refer to the General Information for Providers chapter for further information regarding out-of-state/beyond borderland providers and the prior authorization process.

SOURCE:  MI Dept. of Health and Human Services., Bulletin 23-60, Asynchronous Telemedicine: Interprofessional Telephone / Internet / Electronic Health Record Consultations (eConsults), Updated Requirements, Nov. 1, 2023, & MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2125-2126, Jul. 1, 2024 (Accessed Sept. 2024).

Diabetes Prevention Program (MiDPP)

Sessions may take place in the following modalities and make-up sessions are encouraged:

• In-person
• Distance Learning (synchronous audio-visual or audio-only telemedicine): Lifestyle coaches deliver sessions where the coach is present in one location and participants are participating from another location. Claims for an audio-only session must include the appropriate procedure code, place of service code and modifier 93 and claims for an audio-visual session must include the appropriate procedure code, place of service code and modifier 95.
• Online: An asynchronous mode of delivery where participants log into course sessions via a computer, tablet, or smart phone. Per CDC requirements, MiDPP lifestyle coach interaction (in person or via synchronous telemedicine) is required and must be no less than once per week during the first six months and once per month during the second six months.

When billing for a telemedicine session, synchronous or asynchronous, MiDPP providers are expected to adhere to current MDHHS telemedicine policy and modifiers. Refer to the Michigan Medicaid Telemedicine Fee schedule for the list of current codes acceptable for MiDPP telemedicine claims. Claims for an asynchronous session must include the appropriate procedure code and the following remark: “Service provided via an asynchronous telemedicine platform”.

SOURCE: MI Bulletin MMP 23-33, Michigan Diabetes Prevention Program (MiDPP), July 1, 2023, (Accessed Sept. 2024).

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GEOGRAPHIC LIMITS

No Reference Found

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TRANSMISSION FEE

No Reference Found