Last updated 09/06/2024
Definitions
“Telehealth” or “telemedicine”, the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.
SOURCE: MO Revised Statute Title XII Public Health and Welfare Sec. 208.670 which references Title XII Sec. 191.1145. (Accessed Sept. 2024).
Telemedicine is the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine also includes the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.
SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed Sept. 2024).
Telemedicine services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at the distant site.
SOURCE: MO HealthNet, Telemedicine Overview, (Accessed Sept 2024).
Telemedicine [telehealth] Services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.
SOURCE: MO HealthNet, Physician Manual, 2.65 p. 101 (8/9/24), & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 59 (9/1/23). (Accessed May 2024).
Telemedicine shall mean the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a participant’s health care while such participant is at the originating site and the provider is at the distant site. Telemedicine shall also include the use of telephonic or asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.
SOURCE: MO Code of State Regulations 13 CSR 70-3.330(B)(5), (Accessed Sept. 2024).
Telehealth Services are health care services provided through information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site.
Telehealth offers participants, particularly those in rural areas of the state, access to health care services without having to travel extensive miles for an appointment.
SOURCE: MO HealthNet, Rural Health Clinic, Provider Manual, 1.14, pg. 10 (9/1/23), (Accessed Sept. 2024).
Telemedicine is the delivery of health care services by means of information and communication technologies that facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telemedicine shall also include the use of asynchronous store-and-forward technology. Telemedicine services must be performed with the same standard of care as an in-person, face-to-face service.
SOURCE: MO Division of Behavioral Health, Community Treatment Program, Clarification, July 8, 2022, (Accessed Sept. 2024).
Telemedicine is the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at the distant site. Telehealth or telemedicine shall also include the use of asynchronous store-and-forward technology.
SOURCE: MO HealthNet, Telemedicine, (Accessed Sept. 2024).
Last updated 09/06/2024
Email, Phone & Fax
MHD also allowed the use of telephone for telehealth services, and allowed quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number. MHD did not require additional CMS flexibility for these options, and they will continue.
SOURCE: MO Medicaid Provider Tips, Telehealth services, March 27, 2023, (Accessed Sept. 2024).
Mental Health
Audio-only is real-time, interactive voice-only discussion between an individual and the service provider.
The CR Modifier will be ending on June 30, 2022, regardless of the PHE declaration end date.
Starting July 1, 2022, Audio-Only services shall utilize the FQ Modifier.
The GT modifier will continue to be utilized for Telemedicine, with the exception of CSTAR programs that have transitioned to American Society of Addiction Medicine (ASAM), as this billing structure no longer utilizes modifiers.
Starting July 1, 2022, CSTAR programs that have transitioned to ASAM, will use the 02 Place of Service, instead of the GT modifier.
See bulletin for audio-only service guidance.
SOURCE: MO Division of Behavioral Health, Community Treatment Program, Clarification, July 8, 2022, (Accessed Sept. 2024).
Interprofessional Consultations
MHD’s Physician Program currently covers interprofessional consultation. Effective April 15, 2024, MHD is implementing interprofessional consultation for behavioral health practitioners.
- Interprofessional consultation must be for the direct benefit of the participant. This means the services must be directly relevant to the participant’s diagnosis and treatment, and the consultant must have specialized expertise in the particular health concerns of the participant.
- Interprofessional consultation is intended to expand access to specialty care and foster interdisciplinary input on patient care. It is not intended to replace direct specialty care when such care is clinically indicated. Interprofessional consultation may be delivered via telehealth technology.
- The treating/requesting physician and the consultant must both be MHD enrolled. For consultations that cross state lines, the consulting practitioner must be enrolled in the state where the participant resides.
- An interprofessional telephone/internet/electronic health record (EHR) consultation is an assessment and management service in which a participant’s treating physician requests the opinion and/or treatment advice of another professional with specialty expertise (the consultant) to assist the treating physician in the diagnosis and/or management of the participant’s problem without patient face-to-face contact with the consultant.
- The consultant should not have seen the patient in a face-to-face (or telehealth) encounter within the last 14 days.
- When the telephone/internet/EHR consultation leads to a transfer of care or other face-to-face (or telehealth) service within the next 14 days, the codes are not reported.
- If more than one telephone/internet/EHR contact is required to complete the consultation request, the entirety of the service and the cumulative discussion and information review time should be reported with a single code. Do not report 99446, 99447, 99448, 99449, or 99451 more than once within a seven-day interval.
- The written or verbal request for telephone/internet/EHR advice by the treating/requesting physician must be documented in the participant’s medical record, including the reason for the request.
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Documentation from the consultant must be provided to the treating/requesting provider in writing. Documentation from the consultant must meet the MHD requirements for adequate documentation at 13 CSR 70-3.030(2)(A).
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When the sole purpose of the telephone/internet/EHR communication is to arrange a transfer of care or other face-to-face service, these codes are not reported
Psychiatrists and advanced practice psychiatric nurses bill the below interprofessional consultation codes with no modifier. Rates for the below codes without a modifier are equivalent to the AH modifier rates. For other behavioral health practitioners, see the modifier key below the table for a refresher.
See bulletin for codes.
Independent Rural Health Clinic Billing: When Independent RHCs render any of the services outlined in this bulletin, they must bill according to their standard MHD billing procedures. Specifically, Independent RHCs bill the visit code T1015 on the outpatient claim form. It must be entered in the HCPCS/Rates field of the outpatient claim form in order to receive MHD reimbursement based on the Medicare established all-inclusive rate for each visit. In order to comply with federal guidelines and MHD policies, the services that comprise each visit must also be shown in the Principal Procedure Code and Other Procedure Code fields of the outpatient claim form.
Participant Consent: For all services covered in this bulletin, the treating practitioner must obtain participant consent prior to consulting with relevant specialists, recognizing that any applicable rules continue to apply regarding privacy. Consent may be verbal but must be documented in the medical record.
SOURCE: MO HealthNet, Provider Bulletin, Vo. 46, No. 54, April 19, 2024, (Accessed Sept. 2024).
Behavioral Health Crisis Centers
The center shall be staffed by a multidisciplinary team who is able to respond to the needs of individuals experiencing all levels of crisis. Staff shall include but is not limited to-
- Medical director-a licensed psychiatrist (available via telemedicine or audio-only). The medical director for the BHCC/U-BHCC can be the same individual who serves in this capacity for the CCBHO.
SOURCE: 9 CSR 30-7.010, (Accessed Sept. 2024).
Collateral Contact – CSTAR
A source of information regarding an individual’s health, safety, functional needs or effectiveness of the individual’s plan for services. Communication with a collateral contact may be made in-person, audio-only or by telemedicine.
SOURCE: MO HealthNet, Community Substance Treatment and Rehabilitation/American Society of Addiction Medicine (12/04/2023), p. 99, (Accessed Sept. 2024).
Pharmacy Services
MTM code 99607 can be delivered telemetrically.
SOURCE: MO HealthNet, Pharmacy Manual (7.31/2024), p. 27, (Accessed Sept. 2024).
Collateral contacts are a source of information regarding the individual’s health, safety, functional needs or effectiveness of the individual’s plan for services. Communication with a collateral contact may be made face to face, by phone or by telehealth platforms.
SOURCE: MO HealthNet, Comprehensive Substance Treatment and Rehabilitation Manual p. 44 (9/1/23), (Accessed Sept. 2024).
Optical
The following services are not billable to the participant or to MHD:
- Telephone calls or phone consultations
SOURCE: MO HealthNet Optical Provider Manual, p. 20 (9/1/23). (Accessed Sept. 2024).
Last updated 09/06/2024
Live Video
POLICY
Services provided through telemedicine [or telehealth, as referred to in Rural Health Clinics manual] must meet the standard of care that would otherwise be expected should such services be provided in person.
Prior to the delivery of telehealth services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the school year.
SOURCE: MO HealthNet, Physician Manual, 2.65 p. 101 (8/9/24), Provider Manual, Rural Health Clinics, Section 1,14 p. 9 (9/1/23) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 59 (9/1/23). (Accessed Sept. 2024).
The MO HealthNet Division reimburses for eligible services provided via telemedicine when the service can be performed by a MO HealthNet provider with the same standard of care as a face to face service.
Reimbursement for the distant site provider is equal to the current fee schedule allowed amount for the service provided.
SOURCE: MO HealthNet, Telemedicine Overview, (Accessed Sept. 2024).
The department of social services shall reimburse providers for services provided through telehealth if such providers can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in person. The department shall not restrict the originating site through rule or payment so long as the provider can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in person. Payment for services rendered via telehealth shall not depend on any minimum distance requirement between the originating and distant site. Reimbursement for telehealth services shall be made in the same way as reimbursement for in-person contact; however, consideration shall also be made for reimbursement to the originating site.
SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Sept. 2024).
Reimbursement to the health care provider delivering the telemedicine service at the distant site shall be made at the same amount as the current fee schedule for an in person service.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(5), (Accessed Sept. 2024).
The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023 MO HealthNet, will continue to allow any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.
Telehealth services may be provided to a MHD participant, while the participant is at an originating site, and the provider is at another location (the distant site.) The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.
There is not a separate telehealth fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.
SOURCE: MO HealthNet Provider Hot Tips, March 27, 2023, (Accessed Sept. 2024).
ELIGIBLE SERVICES/SPECIALTIES
Any licensed health care provider shall be authorized to provide telehealth services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. This section shall not be construed to prohibit a health carrier, as defined in section 376.1350, from reimbursing nonclinical staff for services otherwise allowed by law.
Nothing in subsection 3 of this section shall apply to:
- Informal consultation performed by a health care provider licensed in another state, outside of the context of a contractual relationship, and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation;
- Furnishing of health care services by a health care provider licensed and located in another state in case of an emergency or disaster; provided that, no charge is made for the medical assistance; or
- Episodic consultation by a health care provider licensed and located in another state who provides such consultation services on request to a physician in this state
SOURCE: MO Revised Statute Sec. 191.1145. (Accessed Sept. 2024).
Reimbursement to the health care provider delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided. Use the appropriate CPT code for the service along with place of service 02 (telehealth/telemedicine).
Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
When a participant is located in a residential or inpatient place of service (Place of service codes 14, 21, 33, 51, 55, 56 or 61), providers delivering behavioral health services via telemedicine must bill with the GT modifier and with the place of service where the participant is physically located. In these instances, providers must not bill with place of service 02.
SOURCE: MO HealthNet, Physician Manual, Sec. 2.65 p. 101-102 (8/9/24) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 60 (9/1/23). (Accessed Sept. 2024).
Services provided through telemedicine/telehealth must meet the standard of care that would otherwise be expected should such services be provided in person.
Prior to the delivery of telemedicine/telehealth services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via telehealth in the school for the remainder of the school year.
SOURCE: MO HealthNet, Physician Manual, 2.65 p. 101 (8/9/24), Provider Manual, Rural Health Clinics, Section 1,14 p. 9 (9/1/23) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 59 (9/1/23). (Accessed May 2024).
There is not a separate telemedicine fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.
SOURCE: MO Medicaid Provider Tips, Telemedicine, July 18, 2022, (Accessed Sept. 2024).
Billing Requirements:
- All billing requirements required to perform and bill for a service (prior authorizations, pre-certs, forms) apply to telemedicine services.
- Check the MO HealthNet Fee Schedule to ascertain requirements that must be submitted for billing telemedicine services.
SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed Sept. 2024).
Behavioral Health Services
Telemedicine is subject to the same precertification requirements. Claims submitted for behavioral health telemedicine services without a required precertification will be denied.
SOURCE: MO HealthNet Provider Tips (Nov. 22, 2022). (Accessed Sept. 2024).
Behavioral Health Crisis Centers
Direct services shall be provided by a licensed physician (includes psychiatrist) or licensed psychiatric mental health nurse practitioner (PMHNP), advanced practice registered nurse (APRN), physician assistant, resident physician (includes psychiatrist), and/or assistant physician in a written collaborative practice arrangement with a physician and with experience treating the target population. Services may be provided via telemedicine.
SOURCE: 9 CSR 30-7.010, (Accessed Sept. 2024).
Comprehensive Substance Abuse Treatment & Rehabilitation (CSTAR) Program
Communication with a collateral contact may be made face to face, by phone, or by telehealth platforms. See manual for code list.
SOURCE: MO HealthNet, CSTAR Manual, Sec. 2.9 K p. 44 (9/1/23). (Accessed Sept. 2024).
Telemedicine is considered a face-to-face service. Services in all levels of care may be provided via telemedicine, including individual services within residential levels of care such as medication services, individual counseling, and medication services support.
SOURCE: MO HealthNet, Community Substance Treatment and Rehabilitation/American Society of Addiction Medicine (12/04/2023), p. 24, (Accessed Sept. 2024).
Community Psych Rehab Program
Several services are covered if delivered via telehealth. See manual for specific services.
SOURCE: MO HealthNet, Community Psych Rehab Program Manual, (9/1/23), (Accessed Sept. 2024).
Home Health
The face-to-face encounter may occur through telehealth, as allowed by State law.
SOURCE: MO HealthNet, Home Health Manual, Sec. 2.7, p. 12. (11/1/23), (Accessed Sept. 2024).
Teledentistry
MHD covers teledentistry services for participants under the age of 21, blind, pregnant or in a SNF. This benefit allows any licensed dental provider, enrolled with MO HealthNet, to provide teledentistry services if the services are within the scope of practice for which the dental provider is licensed. Teledentistry services must be performed with the same standard of care as an in-person, face-to-face service.
Prior to the delivery of teledentistry services in a school, the parent or guardian of the child shall provide authorization for such service. The authorization shall include the ability for the parent or guardian to authorize services via teledentistry in the school for the remainder of the school year.
The MO HealthNet Dental Program allows reimbursement for CDT codes D9995 (Synchronous; real time encounter) and D9996 (Asynchronous; information stored and forwarded to dentist for subsequent review).
Teledentistry services must be billed by the distant site facility (physical location of the dentist or clinic providing the dental service to an eligible Medicaid participant through teledentistry). Dentists must bill either D9995 or D9996 and the CDT code(s) for services provided. Reimbursement to dental providers delivering the service at the distant site is equal to the current fee schedule amount for the service provided. There is not a separate teledentistry fee schedule. The originating site (physical location of the participant) is where diagnostic data is collected to be communicated to an off-site dentist for diagnosis or where a dental service is performed. The originating site cannot bill MHD for CDT codes D9995 or D9996. The originating site can bill procedure code Q3014 on the CMS-1500 claim form to receive reimbursement for use of the facility where teledentistry services were rendered. The distant site service must be billed on the 2019 ADA Dental Claim Form with the CDT code (D9995 or D9996) and any additional services provided, using place of service code 02 – Telehealth.
Opioid Treatment Programs
Services may be provided via telehealth to enhance accessibility for individuals served.
SOURCE: MO Code of State Regulation, Title 9, Sec. 30-3.132, (Accessed Sept. 2024).
Recovery Support Programs
Recovery coaching shall be a one-to-one service delivered face-to-face or, with department approval, through telehealth.
SOURCE: MO Code of State Regulation, Title 9, Sec. 30-3.310, (Accessed Sept. 2024).
A telemedicine service shall be covered only if it is medically necessary.
A telemedicine service must be performed with the same standard of care as an in-person, face-to-face service. If the same standard of care cannot be met, a telemedicine service shall not be provided.
School Services. Prior to the provision of telemedicine services in a school, the parent or guardian of the child shall provide authorization for the provision of such service. Such authorization shall include the ability for a parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(3), (4)(D), (Accessed Sept. 2024).
Health Assessment and Coordination Services (DD Waiver)
Health Assessment and Coordination (HAC) services are consultative telemedicine services designed for individuals with I/DD receiving Home and Community Based Services (HCBS) waiver services. The services are intended to coordinate care with local emergency departments, urgent cares and primary care physicians to enable real time support, consultation and coordination on health issues. HAC services assist individuals, families and support providers in understanding the health symptoms with which individuals present in order to identify the most appropriate next steps. Services are available 24 hours a day, seven (7) days a week and include immediate evaluations, video-assisted examinations, treatment plans, discussion and coordination with individuals and/or caregivers.
SOURCE: MO HealthNet, DD Waiver, Sec. 6.14, p. 80-81 (5/6/24). (Accessed Sept. 2024).
Certain procedure codes are listed throughout Certified Community Behavioral Health Clinics/Certified Community Behavioral Health Organizations Manual as allowed.
SOURCE: MO HealthNet, Certified Community Behavioral Health Clinics/Certified Community Behavioral Health Organizations Manual (12/28/23), (Accessed Sept. 2024).
Certain procedure codes are listed throughout the Community Psychiatric Rehabilitation Manual as allowed.
SOURCE: MO HealthNet, Community Psychiatric Rehabilitation Manual (9/1/23), (Accessed Sept. 2024).
Personal Care
Performing ongoing monitoring of the provision of services in the plan of care and assessing the quality of care being delivered. Such monitoring shall include:
- At least one (1) annual face-to- face visit in the participant’s home as outlined in RSMo Section 208.918. Face-to -face is defined as an interaction that occurs in person and does not include interactions that occur through telecommunication or electronic technologies.
- Monthly case management activities which must be completed by telephone, videoconference, or in-person with the consumer.
- Other monitoring may include electronic monitoring, telephone checks, written case notes, or other DHSS-approved methods. The ongoing monitoring shall not preclude the provider’s responsibility of ongoing diligence of case management activity oversight.
SOURCE: MO HealthNet Personal Care Manual, p. 39 (4/16/24). (Accessed Sept. 2024).
ELIGIBLE PROVIDERS
Any licensed health care provider shall be authorized to provide telemedicine [or telehealth, as referred to in Rural Health Clinic manual] services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person.
To be reimbursed for telehealth/telemedicine services health care providers treating patients in this state, utilizing telehealth/telemedicine, must be fully licensed to practice in this state and be enrolled as a MO HealthNet/ MHD provider prior to rendering services.
SOURCE: MO HealthNet, Physician Manual, Sec. 2.65 p. 101 (8/9/24), Provider Manual, Rural Health Clinics, Section 1.14, p. 9 (9/1/23) (Accessed Sept. 2024).
Distant site shall mean a telemedicine site where the health care provider providing the telemedicine service is physically located.
Provider Requirements:
- Any licensed health care provider is authorized to provide telemedicine services if the service is within the scope of practice for which the health care provider is licensed and is provided with the same standard of care as services provided in person.
- To be reimbursed for telemedicine services, health care providers treating patients must enroll as a MO HealthNet provider prior to rendering services. Visit Provider Enrollment for more information.
Outpatient Hospital Facility Fee
- Hospitals may bill a facility fee for distant site services provided in their facilities.
- The distant site service must be reported on the UB04 claim form with the procedure code and GT modifier.
- The physician providing the service will bill for their distant site services on the medical claim form.
RHC
RHCs may use either their RHC provider number or their non-provider number when operating as a distant site.
FQHC Cost Report
- The telemedicine charges and costs, including the depreciation cost for equipment, are allowed on the FQHC cost report.
- The clinic must have medical records in their clinic for the person being seen to be able to report these charges on their cost report. If the person being seen is not one of the clinic’s patients, all costs will need to be removed from the cost report
See document for billing scenarios.
SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed Sept. 2024).
Any licensed health care provider may provide telemedicine services if such services are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. Additionally, a health care entity may reimburse nonclinical staff for services otherwise allowed by law. This includes applied behavior analysis services rendered by a registered behavior technician under the supervision of a licensed behavior analyst or licensed psychologist or any individual provider delivering services within a Department of Mental Health (DMH) licensed, contracted, and/or certified organization (13 CSR 70-3.330(2)(A).
To be reimbursed for telemedicine services, health care providers treating patients in this state via telemedicine must be fully licensed to practice in this state and be enrolled as a MO HealthNet provider prior to rendering services.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 1.19 p. 59 (9/1/23), (Accessed Sept. 2024).
The originating site fee and distant site services can be billed by the same provider for the same date of service as long as the distant site is not located in the originating site facility. Review the Telemedicine Overview for additional information on billing for Telemedicine.
SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed Sept. 2024).
MO HealthNet covers Telehealth services. MO HealthNet allows any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.
SOURCE: MO Medicaid Provider Tips, Telehealth services, Jan. 11, 2022, (Accessed Sept. 2024).
Anesthesiologist monitoring telemetry in the operating room is a non-covered service.
SOURCE: MO HealthNet, Physician Manual, p. 41 (8/9/24). (Accessed Sept. 2024).
Health care professional shall mean a physician or other health care practitioner licensed, accredited, or certified by the state of Missouri to perform specified health services consistent with state law.
Health care provider or provider shall mean a health care professional or a health care facility.
Any licensed/enrolled health care professional shall be authorized to provide telemedicine services if such services to MHD participants are within the scope of practice for which the health care provider is licensed and are provided with the same standard of care as services provided in person. This shall not prohibit a health care entity from reimbursing nonclinical staff for services otherwise allowed by law. This includes applied behavior analysis services rendered by a registered behavior technician under the supervision of a licensed behavior analyst or licensed psychologist or any individual provider delivering services within a Department of Mental Health (DMH) licensed, contracted, and/or certified organization.
A health care provider utilizing telemedicine at either a distant site or an originating site shall be enrolled as a MO HealthNet provider pursuant to 13 CSR 65-2.020 and be fully licensed for practice in the state of Missouri. A health care provider utilizing telemedicine must do so in a manner that is consistent with the provisions of all laws governing the practice of the provider’s profession and shall be held to the same standard of care as a provider employing in-person behavioral health or medical health care.
For purposes of the provision of telemedicine services in the MO HealthNet Program, the provider-patient relationship may be established by the following:
- An in-person encounter through a medical interview and physical examination;
- Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the patient’s care; or
- A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Sept. 2024).
Distant Site on School Grounds
The provider must get consent from the parent or guardian to provide telemedicine services. The parent or guardian may authorize services via telemedicine for a whole school year. Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
Rural Health Clinics (RHC)
RHCs may bill with either their non-RHC provider number or their RHC provider number. The provider will use the appropriate procedure code for the service along with place of service 02 (Telehealth).
Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
SOURCE: MO HealthNet, Rural Health Clinic, Sec. 1.14, p. 10 (9/1/23). (Accessed Sept. 2024).
RHCs may use either their RHC provider number or their non-RHC provider number when operating as a distant site.
Use POS 02 when billing the distant site when you use your non-RHC provider number.
SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed Sept. 2024).
Federally Qualified Healthcare Clinics (FQHC)
FQHC providers must remove originating site charges and payments for telemedicine services from their year-end cost reports.
FQHC providers must leave the Rendering Provider ID field (24j on CMS-1500) blank on their claims when billing the Q3014 originating site facility charge.
ELIGIBLE SITES
When a participant is located in a residential or inpatient place of service (Place of service codes 14, 21, 33, 51, 55, 56 or 61), providers delivering behavioral health services via telemedicine must bill with the GT modifier and with the place of service where the participant is physically located. In these instances, providers must not bill with place of service 02.
SOURCE: MO HealthNet, Physician Manual, Sec. 2.65, p. 102 (8/9/24) & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19 p. 60 (9/1/23). (Accessed Sept. 2024).
Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 1.19 p. 60 (9/1/23). (Accessed Sept. 2024).
RHCs must bill with their non-RHC provider number to receive reimbursement for a facility fee for the Telehealth services when operating as the originating site. Claims must be submitted with HCPCS code Q3014 (Telehealth originating site facility fee).
Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
SOURCE: MO HealthNet, Rural Health Clinic, Sec. 1.14, p. 9-10 (9/1/23). (Accessed Sept. 2024).
Originating site is the site where the MO HealthNet participant receives the telemedicine service.
Originating sites include, but are not necessarily limited to health care provider facilities, participants’ homes, and schools. For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location from which the referring provider transfers information to the distant site.
The originating site fee and distant site services can be billed by the same provider for the same date of service as long as the distant site is not located in the originating site facility. Review the Telemedicine Overview for additional information on billing for Telemedicine.
Place of Service:
- POS: 02 – Reimbursement to the health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided. Use the appropriate Current Procedural Terminology (CPT) code for the service along with place of service 02 (with some exceptions) when submitting telemedicine claims for the distant site.
- Behavioral Health: Residential or Inpatient POS: 14, 21, 33, 51, 55, 56 or 61 – Providers delivering behavioral health services via telemedicine for participants located in a residential or inpatient place of service must bill with the GT modifier and with the place of service where the participant is physically located.
Outpatient Hospital Facility Fee
- Hospitals may bill a facility fee for distant site services provided in their facilities.
- The distant site service must be reported on the UB04 claim form with the procedure code and GT modifier.
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The physician providing the service will bill for their distant site services on the medical claim form.
School Grounds
- The provider must get consent from the parent or guardian to provide telemedicine services. The parent or guardian may authorize services via telemedicine for a whole school year.
- Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.
- RHCs, both provider-based and independent, must continue to bill telemedicine services using their non-RHC provider number when operating as an originating site.
Federally Qualified Health Centers
- FQHC providers must remove originating site charges and payments for telemedicine services from their year-end cost reports.
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FQHC providers must leave the Rendering Provider ID field (24j on CMS-1500) blank on their claims when billing the Q3014 originating site facility charge.
FQHC Cost Report
- The telemedicine charges and costs, including the depreciation cost for equipment, are not allowed on the FQHC cost report.
- FQHC providers must remove charges and payments for telemedicine services from their year-end cost reports.
See originating and distant site scenario examples in Reimbursement Scenarios document.
SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed Sept. 2024).
Effective August 19, 2018, the MO HealthNet Division will require Place of Service (POS)02 for Telehealth services. POS 02 is to be used by the provider furnishing telehealth services from a distant site with the exception of services provided on school grounds. Distant site services provided on school grounds should be billed with POS 03 and a GT modifier.
SOURCE: MO Provider Bulletin Volume 41, No. 10, Aug. 17, 2018 (Accessed Sept. 2024).
The department of social services shall reimburse providers for services provided through telehealth if such providers can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in person. The department shall not restrict the originating site through rule or payment so long as the provider can ensure services are rendered meeting the standard of care that would otherwise be expected should such services be provided in person. Payment for services rendered via telehealth shall not depend on any minimum distance requirement between the originating and distant site. Reimbursement for telehealth services shall be made in the same way as reimbursement for in-person contact; however, consideration shall also be made for reimbursement to the originating site. Reimbursement for asynchronous store-and-forward may be capped at the reimbursement rate had the service been provided in person.
SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Sept. 2024).
No originating site for services or activities provided under this section shall be required to maintain immediate availability of on-site clinical staff during the telehealth services, except as necessary to meet the standard of care for the treatment of the patient’s medical condition if such condition is being treated by an eligible health care provider who is not at the originating site, has not previously seen the patient in person in a clinical setting, and is not providing coverage for a health care provider who has an established relationship with the patient.
SOURCE: MO Revised Statute Sec. 191.1145(6). (Accessed Sept. 2024).
Originating site shall mean a telemedicine site where the MO HealthNet participant receives the telemedicine service. Originating sites include, but are not necessarily limited to health care provider facilities, participants’ homes, and schools. For the purposes of asynchronous store-and-forward transfer, the originating site shall also mean the location from which the referring provider transfers information to the distant site.
School Services. Prior to the provision of telemedicine services in a school, the parent or guardian of the child shall provide authorization for the provision of such service. Such authorization shall include the ability for a parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Sept. 2024).
Originating site – Where the patient receiving telemedicine services is physically located.
Originating site fee and distant site services – Billable by same provider for the same date of service as long as the distant site provider is not located in the originating site facility.
Place of Service – Use the appropriate Current Procedural Terminology (CPT) code for the service with place of service (POS) 02 when submitting telemedicine claims for the distant site.
Exceptions to billing POS 02 –
- School Grounds: For distant site services provided on school grounds use POS 03 and GT modifier
- Residential/Inpatient: Behavioral health services at POS codes 14, 21, 33, 51, 55, 56 or 61 must bill with the GT modifier and the POS where the participant is physically located.
- Rural Health Clinics (RHCs): Bill with GT modifier for distant site services billed on the UB04 claim form.
PBRHC/UB04 – Rev code + CPT + GT + billed charge
IRHC/UB04 – Rev code + T1015 + GT
SOURCE: MO HealthNet, Telemedicine Overview, (Accessed Sept. 2024).
Place of Service for CSTAR
SOURCE: MO HealthNet, Community Substance Treatment and Rehabilitation/American Society of Addiction Medicine (12/04/2023), p. 108, (Accessed Sept. 2024).
POS 03 (school) must be used for services provided in the school or on the school grounds. If a school district is providing telehealth services on school grounds, the GT modifier must be used.
SOURCE: MO HealthNet, Therapy Provider Manual, (9/1/2023), p. 22, (Accessed Sept. 2024).
GEOGRAPHIC LIMITS
Payment for services rendered via telehealth shall not depend on any minimum distance requirement between the originating and distant site.
SOURCE: MO Revised Statute Ch. 208 Sec. 208.670. (Accessed Sept. 2024).
FACILITY/TRANSMISSION FEE
The originating site is only eligible to receive a facility fee for the telemedicine service. Claims should be submitted with HCPCS code Q3014 (telemedicine originating site facility fee). Procedure code Q3014 is used by the originating site to receive reimbursement for the use of the facility while telehealth services are being rendered.
SOURCE: MO HealthNet, Physician Manual, 2.65 p. 102 (8/9/24); & MO HealthNet, Provider Manual, Behavioral Services, Section 1.19 p. 60 (9/1/23). (Accessed Sept. 2024).
RHCs must bill with their non-RHC provider number to receive reimbursement for a facility fee for the Telehealth services when operating as the originating site. Claims must be submitted with HCPCS code Q3014 (Telehealth originating site facility fee).
SOURCE: Provider Manual, Rural Health Clinics, Section 1,14, p. 9 (9/1/23). (Accessed Sept. 2024).
The originating site fee and distant site services can be billed by the same provider for the same date of service as long as the distant site is not located in the originating site facility. Review the Telemedicine Overview for additional information on billing for Telemedicine.
Outpatient Hospital Facility Fee
- Hospitals may bill a facility fee for distant site services provided in their facilities.
- The distant site service must be reported on the UB04 claim form with the procedure code and GT modifier.
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The physician providing the service will bill for their distant site services on the medical claim form.
Federally Qualified Health Centers
- FQHC providers must remove originating site charges and payments for telemedicine services from their year-end cost reports.
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FQHC providers must leave the Rendering Provider ID field (24j on CMS-1500) blank on their claims when billing the Q3014 originating site facility charge.
FQHC Cost Report
- The telemedicine charges and costs, including the depreciation cost for equipment, are not allowed on the FQHC cost report.
- FQHC providers must remove charges and payments for telemedicine services from their year-end cost reports.
See originating and distant site scenario examples in Reimbursement Scenarios document.
SOURCE: MO HealthNet Telemedicine Billing Presentation, (Accessed Sept. 2024).
The originating site is eligible to receive an originating site/facility fee.
Reimbursement of the originating site fee will be made according to the MO HealthNet Fee Schedule.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(5), (Accessed Sept. 2024).
The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.
SOURCE: MO Medicaid Provider Tips, Telemedicine, July 18, 2022, (Accessed Sept. 2024).
Originating site fee and distant site services – Billable by same provider for the same date of service as long as the distant site provider is not located in the originating site facility.
Q3014 – CPT code for originating site reimbursement for the use of the facility where telemedicine services are rendered. This code cannot be billed when the participant is receiving services at home.
SOURCE: MO HealthNet, Telemedicine Overview, (Accessed Sept. 2024).
Last updated 09/06/2024
Miscellaneous
No later than July 1, 2022, there shall be established within the department a statewide telehealth network for forensic examinations of victims of sexual offenses in order to provide access to sexual assault nurse examiners (SANE) or other similarly trained appropriate medical providers. A statewide coordinator for the telehealth network shall be selected by the director of the department of health and senior services and shall have oversight responsibilities and provide support for the training programs offered by the network, as well as the implementation and operation of the network. The statewide coordinator shall regularly consult with Missouri-based stakeholders and clinicians actively engaged in the collection of forensic evidence regarding the training programs offered by the network, as well as the implementation and operation of the network.
SOURCE: MO Revised Statute Ch. 192.2520 (Accessed Sept. 2024).
For purposes of the provision of telemedicine services in the MO HealthNet Program, the provider-patient relationship may be established by the following:
- An in-person encounter through a medical interview and physical examination;
- Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the patient’s care; or
- A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.
In order to establish a provider-patient relationship through telemedicine—
- The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
- Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.
See regulation for special documentation and confidentiality and data integrity requirements.
SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330(D) & (E), (Accessed Sept. 2024).
Special documentation requirements apply.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 60 (9/1/23); MO HealthNet, Physician Manual, Sec. 2.65, p. 102 (8/9/24) & MO HealthNet, Rural Health Clinic, Sec. 1.14, p. 10 (9/1/23). (Accessed Sept. 2024).
Precertification and Utilization Review
All services are subject to utilization review for medical necessity and program compliance. Reviews can be performed before services are furnished, before payment is made, or after payment is made.
Certain procedures or services can require precertification from the MO HealthNet Division or its authorized agents. Services for which a precertification was obtained remain subject to utilization review at any point in the payment process. A service provided through Telemedicine is subject to the same precertification and utilization review requirements which exist for the service when not provided through Telemedicine.
SOURCE: MO HealthNet, Provider Manual, Behavioral Services, Section 1.19, p. 60 (9/1/23), (Accessed Sept. 2024).
School-based Therapy Services
Place of service school (03) must be used for services provided in a school or on school grounds. If a school district is providing telehealth services on school grounds, the GT modifier must be used.
SOURCE: MO HealthNet, Therapy Manual, p. 22 (9/1/23). (Accessed Sept. 2024).
A training program is offered for interprofessional telehealth and Teledentistry.
SOURCE: MO HealthNet, MO HealthNet News. 8/16/24, (Accessed Sept. 2024).
Prohibition on Payment to Institutions or Entities Located Outside of the United States
In accordance with the Affordable Care Act of 2010 (the Act), MHD must comply with the Medicaid payment provision located in Section 6505 of the Act, entitled “Prohibition on Payment to Institutions or Entities Located Outside of the United States” effective January 1, 2011.The provision prohibits MHD from making any payments for items or services provided under the State Plan or under a waiver to any financial institutions, telemedicine providers, pharmacies, or other entities located outside of the United States, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. If it is discovered that payments have been made to financial institutions or entities outside of the previously stated approved regions, MHD must recover these payments.
SOURCE: MO HealthNet, General Sections Manual, p. 36 (8/13/24). (Accessed Sept. 2024).
Hospitals
Direct supervision of a nurse practitioner in the hospital setting means the supervising physician must be on the grounds and immediately available to provide assistance and direction throughout the time the nurse practitioner performs the service. Direct supervision of a physician assistant means the supervising physician must be in the same facility 66% of the time for practice supervision and collaboration. Physician assistants must practice within 30 miles of the supervising physician. The supervising physician must be readily available in person or via telecommunication when the physician assistant is providing patient care.
SOURCE: MO HealthNet, Hospital Manual p. 57 (9/9/24). (Accessed Sept. 2024).
