Last updated 08/06/2024
Consent Requirements
Before an initial telehealth consultation, the health care practitioner must provide the client the following written information which must be acknowledged by the client in writing or via email:
- Alternative options are available, including in-person services. These alternatives are specifically listed on the client’s informed consent statement;
- All existing laws and protections for services received in-person also apply to telehealth, including:
- Confidentiality of information;
- Access to medical records; and
- Dissemination of client identifiable information;
- Whether the telehealth consultation will be or will not be recorded;
- The identification of all the parties who will be present at each telehealth consultation, and a statement indicating that the client has the right to exclude anyone from either the originating or the distant site; and
- The written consent form becomes a part of the client’s medical record and a copy must be provided to the client or the client’s authorized representative.
SOURCE: NE Admin. Code Title 471 Sec. 1-004.04, Ch. 1, (Accessed Aug. 2024).
Once the PHE ends on May 11, 2023: …
- Informed consent prior to providing treatments or services will again be required, and this consent must be kept in the member’s medical record.
SOURCE: NE Medicaid Program, Bulletin 23-08: Guidance on Telehealth, Mar. 23, 2023, (Accessed Aug. 2024).
Prior to an initial telehealth consultation under section 71-8506, a health care practitioner who delivers a health care service to a patient through telehealth shall ensure that the following written information is provided to the patient:
- A statement that the patient retains the option to refuse the telehealth consultation at any time without affecting the patient’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the patient would otherwise be entitled;
- A statement that all existing confidentiality protections shall apply to the telehealth consultation;
- A statement that the patient shall have access to all medical information resulting from the telehealth consultation as provided by law for patient access to his or her medical records; and
- A statement that dissemination of any patient identifiable images or information from the telehealth consultation to researchers or other entities shall not occur without the written consent of the patient.
The patient shall sign a statement prior to or during an initial telehealth consultation, or give verbal consent during the telehealth consultation, indicating that the patient understands the written information provided pursuant to subsection (1) of this section and that this information has been discussed with the health care practitioner or the practitioner’s designee.
If the patient is a minor or is incapacitated or mentally incompetent such that he or she is unable to sign the statement or give verbal consent as required by subsection (2) of this section, such statement shall be signed, or such verbal consent given, by the patient’s legally authorized representative.
This section shall not apply in an emergency situation in which the patient is unable to sign the statement or give verbal consent as required by subsection (2) of this section and the patient’s legally authorized representative is unavailable.
SOURCE: NE Revised Statutes Sec. 71-8505, (Accessed Aug. 2024).
Last updated 08/06/2024
Definitions
Telehealth consultation means any contact between a client and a health care practitioner relating to the health care diagnosis or treatment of such client through telehealth. For the purposes of telehealth services, a consultation includes any service delivered through telehealth.
Telemonitoring means the remote monitoring of a client’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.
SOURCE: NE Admin. Code Title 471 Sec. 1-004.01, (Accessed Aug. 2024).
Telehealth means the use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care practitioner in the diagnosis or treatment of a patient. Telehealth includes
- Services originating from a patient’s home or any other location where such patient is located,
- Asynchronous services involving the acquisition and storage of medical information at one site that is then forwarded to or retrieved by a health care practitioner at another site for medical evaluation, and
- Telemonitoring.
Telehealth also includes audio-only services for the delivery of individual behavioral health services for an established patient, when appropriate, or crisis management and intervention for an established patient as allowed by federal law;
Telehealth consultation means any contact between a patient and a health care practitioner relating to the health care diagnosis or treatment of such patient through telehealth; and
Telemonitoring means the remote monitoring of a patient’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.
SOURCE: NE Rev. Statute, 71-8503 (Accessed Aug. 2024).
Teledentistry is the use of technology, including digital radiographs, digital photos and videos, and electronic health records, to facilitate delivery of oral healthcare and oral health education services from a provider in one location to a patient in a physically different location. Teledentistry is to be used for the purposes of evaluation, diagnosis, or treatment.
SOURCE: NE Admin Code Title 471, Ch. 6, Sec. 002.06. (Accessed Aug. 2024).
Last updated 08/06/2024
Email, Phone & Fax
To bill for services administered through telehealth, please use the following place of service codes and modifiers. Failure to use the place of service codes and modifiers for services provided via telehealth may lead to refunds or further sanctions.
Place of Service codes:
- Place of Service 02 – use when telehealth is administered while the patient is in a location besides their home.
- Place of Service 10 – use when telehealth is administered while the patient is in their home.
Modifiers:
- Multiple modifiers can be added to a single CPT code. The payment modifier goes first, followed by any informational modifiers. The telehealth modifier is an informational modifier and should be placed after any payment modifier.
- 93 – synchronous telemedicine service rendered via telephone or other real-time interactive audio-only.
- 95 – telehealth services are provided in real-time with an audio-visual component Information on telehealth codes will be included in our fee schedules. For more information on Medicaid rates and fee schedules please visit our website: https://dhhs.ne.gov/Pages/Medicaid-Provider-Ratesand-Fee-Schedules.aspx
SOURCE: NE Medicaid Program, Bulletin 23-38: Guidance on Telehealth, Dec. 29, 2023, (Accessed Aug. 2024).
Telehealth also includes audio-only services for the delivery of individual behavioral health services for an established patient, when appropriate, or crisis management and intervention for an established patient as allowed by federal law.
SOURCE: NE Rev. Statute, 71-8503, (Accessed Apr. 2024).
Telephone Consultations
Nebraska Medicaid does not cover telephone calls to or from an individual, pharmacy, nursing home, or hospital. Nebraska Medicaid may cover telephone consultations with another physician if the name of the consulting physician is indicated on or in the claim.
SOURCE: NE Admin. Code Title 471, Ch. 18-005.30, . (Accessed Aug. 2024).
Last updated 08/06/2024
Live Video
POLICY
Ensuring patient safety, accessibility of services, and clinically appropriate care are the key priorities
Follow Applicable Laws
- Health care practitioners providing telehealth services must follow all applicable laws.
- Providers must be enrolled with Nebraska Medicaid and must be licensed (when required).
- Providers must deliver telehealth services safely and effectively.
- All treatments or services must be delivered according to current Medicaid service definitions.
- All treatments and services must be rendered in a clinically appropriate manner and be medically necessary or related to a treatment plan.
SOURCE: NE Medicaid Program, Bulletin 23-38: Guidance on Telehealth, Dec. 29, 2023, (Accessed Aug. 2024).
Medicaid will reimburse a consulting health care practitioner when all of the following requirements are met:
- After obtaining and analyzing the transmitted information, the consulting health care practitioner reports back to the referring health care practitioner;
- The consulting health care practitioner must bill for services using the appropriate modifier; and
- Payment is not made to the referring health care practitioner who sends the medical documentation.
Practitioner consultation is not covered for behavioral health when the client has an urgent psychiatric condition requiring immediate attention by a licensed mental health practitioner.
Telehealth services are reimbursed by Medicaid at the same rate as the service when it is delivered in person in accordance with each service specific chapter in Title 471 NAC.
SOURCE: NE Admin. Code Title 471 Sec. 1-004.08-.09, Ch. 1, (Accessed Aug. 2024).
In-person contact between a health care practitioner and a patient shall not be required under the medical assistance program established pursuant to the Medical Assistance Act and Title XXI of the federal Social Security Act, as amended, for health care services delivered through telehealth that are otherwise eligible for reimbursement under such program and federal act. Such services shall be subject to reimbursement policies developed pursuant to such program and federal act. This section also applies to managed care plans which contract with the department pursuant to the Medical Assistance Act only to the extent that:
- Health care services delivered through telehealth are covered by and reimbursed under the medicaid fee-for-service program; and
- Managed care contracts with managed care plans are amended to add coverage of health care services delivered through telehealth and any appropriate capitation rate adjustments are incorporated.
The reimbursement rate for a telehealth consultation shall, as a minimum, be set at the same rate as the medical assistance program rate for a comparable in-person consultation, and the rate shall not depend on the distance between the health care practitioner and the patient.
The department shall establish rates for transmission cost reimbursement for telehealth consultations, considering, to the extent applicable, reductions in travel costs by health care practitioners and patients to deliver or to access health care services and such other factors as the department deems relevant. Such rates shall include reimbursement for all two-way, real-time, interactive communications, unless provided by an Internet service provider, between the patient and the physician or health care practitioner at the distant site which comply with the federal Health Insurance Portability and Accountability Act of 1996 and rules and regulations adopted thereunder and with regulations relating to encryption adopted by the federal Centers for Medicare and Medicaid Services and which satisfy federal requirements relating to efficiency, economy, and quality of care.
SOURCE: NE Revised Statutes Sec. 71-8506. (Accessed Aug. 2024).
ELIGIBLE SERVICES/SPECIALTIES
See page 3 to 5 for list of services that:
- are no longer available through telehealth after Dec. 31, 2023
- will continue to be covered through telehealth without an end date
- New allowances for telehealth starting Jan. 1, 2024.
To bill for services administered through telehealth, please use the following place of service codes and modifiers. Failure to use the place of service codes and modifiers for services provided via telehealth may lead to refunds or further sanctions.
Place of Service codes:
- Place of Service 02 – use when telehealth is administered while the patient is in a location besides their home.
- Place of Service 10 – use when telehealth is administered while the patient is in their home.
Modifiers:
- Multiple modifiers can be added to a single CPT code. The payment modifier goes first, followed by any informational modifiers. The telehealth modifier is an informational modifier and should be placed after any payment modifier.
- 93 – synchronous telemedicine service rendered via telephone or other real-time interactive audio-only.
- 95 – telehealth services are provided in real-time with an audio-visual component Information on telehealth codes will be included in our fee schedules. For more information on Medicaid rates and fee schedules please visit our website: https://dhhs.ne.gov/Pages/Medicaid-Provider-Ratesand-Fee-Schedules.aspx
SOURCE: NE Medicaid Program, Bulletin 23-38: Guidance on Telehealth, Dec. 29, 2023, (Accessed Aug. 2024).
Federally Qualified Health Centers & Rural Health Clinics
FQHC and RHC payment for telehealth services is the Medicaid rate for the comparable in-person service. FQHC & RHC core services provided via telehealth are not covered under the encounter rate.
SOURCE: NE Admin. Code Title 471, Sec. 29-004.05, Ch. 29, & NE Admin. Code Title 471, Sec. 34-007, Ch. 34, Manual Letter #11-2010. (Accessed Aug. 2024).
Assertive Community Treatment (ACT)
ACT Team interventions may be provided via telehealth when provided according to the regulations 471 NAC 1-006.
SOURCE: NE Admin. Code Title 471 Sec. 35-013.11, Ch. 35, (Accessed Aug. 2024).
Indian Health Service (IHS) Facilities
Encounter: A face-to-face visit, including telehealth services provided in accordance with 471 NAC 1-006, between a health care professional and an individual eligible for the provision of medically necessary Medicaid-defined services in an IHS or Tribal (638) facility within a 24-hour period ending at midnight, as documented in the client’s medical record.
SOURCE: NE Admin. Code Title 471 Sec. 11-001, Ch. 11, (Accessed Aug. 2024).
Children’s Behavioral Health
The Department of Health and Human Services shall adopt and promulgate rules and regulations providing for telehealth services for children’s behavioral health.
The rules and regulations required pursuant to subsection (1) of this section shall include, but not be limited to:
- An appropriately trained staff member or employee familiar with the child’s treatment plan or familiar with the child shall be immediately available in person to the child receiving a telehealth behavioral health service in order to attend to any urgent situation or emergency that may occur during provision of such service. This requirement may be waived by the child’s parent or legal guardian; and
- In cases in which there is a threat that the child may harm himself or herself or others, before an initial telehealth service the health care practitioner shall work with the child and his or her parent or guardian to develop a safety plan. Such plan shall document actions the child, the health care practitioner, and the parent or guardian will take in the event of an emergency or urgent situation occurring during or after the telehealth session. Such plan may include having a staff member or employee familiar with the child’s treatment plan immediately available in person to the child, if such measures are deemed necessary by the team developing the safety plan.
SOURCE: NE Statute Sec. 71-8509, (Accessed Aug. 2024).
An appropriately trained staff member or employee familiar with the child’s treatment plan or familiar with the child must be immediately available in person to the child receiving a telehealth behavioral consultation in order to attend to any urgent situation or emergency that may occur during provision of such service. This requirement may be waived by the child’s parent or legal guardian. The medical record must document the waiver.
SOURCE: NE Admin. Code Title 471, Sec. 1-004.05, Ch. 1, (Accessed Aug. 2024).
Teledentistry follows the requirements of telehealth in accordance with 471 NAC 1. Services requiring hands on professional care are excluded.
SOURCE: NE Admin Code Title 471, Ch. 6, Sec. 006. (Accessed Aug. 2024).
ELIGIBLE PROVIDERS
To bill for services administered through telehealth, please use the following place of service codes and modifiers. Failure to use the place of service codes and modifiers for services provided via telehealth may lead to refunds or further sanctions.
Place of Service codes:
- Place of Service 02 – use when telehealth is administered while the patient is in a location besides their home.
- Place of Service 10 – use when telehealth is administered while the patient is in their home.
Modifiers:
- Multiple modifiers can be added to a single CPT code. The payment modifier goes first, followed by any informational modifiers. The telehealth modifier is an informational modifier and should be placed after any payment modifier.
- 93 – synchronous telemedicine service rendered via telephone or other real-time interactive audio-only.
- 95 – telehealth services are provided in real-time with an audio-visual component Information on telehealth codes will be included in our fee schedules. For more information on Medicaid rates and fee schedules please visit our website: https://dhhs.ne.gov/Pages/Medicaid-Provider-Ratesand-Fee-Schedules.aspx
SOURCE: NE Medicaid Program, Bulletin 23-38: Guidance on Telehealth, Dec. 29, 2023, (Accessed Aug. 2024).
Health care practitioner means a Nebraska medicaid-enrolled provider who is licensed, registered, or certified to practice in this state by the department
SOURCE: NE Rev. Statute, 71-8503(2) (Accessed Aug. 2024).
ELIGIBLE SITES
To bill for services administered through telehealth, please use the following place of service codes and modifiers. Failure to use the place of service codes and modifiers for services provided via telehealth may lead to refunds or further sanctions.
Place of Service codes:
- Place of Service 02 – use when telehealth is administered while the patient is in a location besides their home.
- Place of Service 10 – use when telehealth is administered while the patient is in their home.
Modifiers:
- Multiple modifiers can be added to a single CPT code. The payment modifier goes first, followed by any informational modifiers. The telehealth modifier is an informational modifier and should be placed after any payment modifier.
- 93 – synchronous telemedicine service rendered via telephone or other real-time interactive audio-only.
- 95 – telehealth services are provided in real-time with an audio-visual component Information on telehealth codes will be included in our fee schedules. For more information on Medicaid rates and fee schedules please visit our website: https://dhhs.ne.gov/Pages/Medicaid-Provider-Ratesand-Fee-Schedules.aspx
SOURCE: NE Medicaid Program, Bulletin 23-38: Guidance on Telehealth, Dec. 29, 2023, (Accessed Aug. 2024).
Health care practitioners must ensure that the originating sites meet the standards for telehealth services. Originating sites must provide a place where the client’s right to receive confidential and private services is protected.
SOURCE: NE Admin. Code Title 471 Sec. 1-004.03, Ch. 1, (Accessed Aug. 2024).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Telehealth services and transmission costs are covered by Medicaid when:
- The technology used meets industry standards;
- The technology is Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant; and
- The telehealth technology solution in use at both the originating and the distant site must be sufficient to allow the health care practitioner to appropriately complete the service billed to Medicaid
The originating site fee is paid to the Medicaid-enrolled facility hosting the client at a rate set forth in the Medicaid fee schedule or under arrangement with the Managed Care Organization (MCO).
SOURCE: NE Admin. Code Title 471 Sec. 1-004.06 & 1-004.010, Ch. 1, (Accessed Aug. 2024).
Federally Qualified Health Centers & Rural Health Clinics
Telehealth transmission cost related to non-core services will be the lower of:
- The provider’s submitted charge; or
- The maximum allowable amount
The Department will pay for transmission costs for line charges when directly related to a covered telehealth service. The provider must be in compliance with the standards for real time, two way interactive audiovisual transmissions (see 471 NAC 1-006).
SOURCE: NE Admin. Code Title 471, Sec. 29-004.05A, Ch. 29, Manual Letter #11-2010, & NE Admin. Code Title 471, Sec. 34-007.01, Ch. 34, Manual Letter #11-2010, (Accessed Aug. 2024).
Last updated 08/06/2024
Miscellaneous
NE Medicaid does provide an outpatient cardiac rehabilitation program consisting of physical exercise or conditioning and concurrent telemetric monitoring. When a program is provided by a hospital to its outpatients, the service is covered as an outpatient service.
SOURCE: NE Admin. Code Title 471, Sec. 10-006.16(B) (Accessed Aug. 2024).
The commission may establish a telehealth system to provide access for deaf and hard of hearing persons in remote locations to mental health, alcoholism, and drug abuse services. The telehealth system may (a) provide access for deaf or hard of hearing persons to counselors who communicate in sign language and are knowledgeable in deafness and hearing loss issues, (b) promote access for hard of hearing persons through contacts with counselors in which hard of hearing persons receive both visual cues, or reading lips, and auditory cues, (c) offer remote interpreter services for deaf or hard of hearing persons to interact with counselors who are not fluent in sign language, and (d) promote participation in educational programs.
The commission shall set and charge a fee between the range of twenty and one hundred fifty dollars per hour for the use of the telehealth system. The commission shall remit all fees collected pursuant to this section to the State Treasurer for credit to the Telehealth System Fund.
SOURCE: NE Statute Sec. 71-4728-.04, (Accessed Aug. 2024).
Keep Required Documentation
- The medical record for telehealth services must follow all applicable laws regarding documentation. The use of telehealth technology must be documented in the medical record. Providers are also required to document the reason for the delivery of treatment or services through telehealth.
- Providers are required to have mitigation plans in place and to provide an active and ongoing assessment of their ability to meet patients’ most immediate and critical treatment needs.
- Claims for services provided via telehealth must include the specific telehealth modifiers and place-of-service codes outlined in the fee schedules.
SOURCE: NE Medicaid Program, Bulletin 23-38: Guidance on Telehealth, Dec. 29, 2023, (Accessed Aug. 2024).
The Telehealth System Fund is created. The fund shall be used for any expenses related to the operation and maintenance of the telehealth system established in section 71-4728.04. Any money in the fund available for investment shall be invested by the state investment officer pursuant to the Nebraska Capital Expansion Act and the Nebraska State Funds Investment Act.
SOURCE: NE Statute Sec. 71-4732-.01, (Accessed Aug. 2024).
A health care facility licensed under the Health Care Facility Licensure Act that receives reimbursement under the Nebraska Telehealth Act for telehealth consultations shall establish quality of care protocols and patient confidentiality guidelines to ensure that such consultations meet the requirements of the act and acceptable patient care standards.
SOURCE: NE Statute Sec. 71-8507, (Accessed Aug. 2024).
The department shall adopt and promulgate rules and regulations to carry out the Nebraska Telehealth Act, including, but not limited to, rules and regulations to: (1) Ensure the provision of appropriate care to patients; (2) prevent fraud and abuse; and (3) establish necessary methods and procedures.
SOURCE: NE Statute Sec. 71-8508, (Accessed Aug. 2024).
Last updated 08/06/2024
Out of State Providers
The location of the telehealth service is the physical location of the member. Out-of-state telehealth services are covered if the telehealth services otherwise meet not only the telehealth requirements but also the requirements for payment for services provided outside Nebraska.
SOURCE: NE Medicaid Program, Bulletin 23-38: Guidance on Telehealth, Dec. 29, 2023, (Accessed Aug. 2024).
Payment in fee-for-service and Managed Care may be approved for services provided outside Nebraska in the following situations:
- When an emergency arises from accident or sudden illness while a client is visiting in another state and the client’s health would be endangered if medical care is postponed until the client returns to Nebraska;
- When a client customarily obtains a medically necessary service in another state because the service is more accessible; and
- When the client requires a medically necessary service that is not available in Nebraska.
Prior authorization is required for out-of-state services. See regulation for procedures.
Out-of-State telehealth services are covered if the telehealth services otherwise meet the regulatory requirements for payment for services provided outside Nebraska and:
- When the distant site is located in another state and the originating site is located in Nebraska; or
- When the Nebraska client is located at an originating site in another state, whether or not the provider’s distant site is located in or out of Nebraska.
SOURCE: NE Admin. Code Title 471, Ch. 1, Sec. 1-002.02(E) & 1-004.11, (Accessed Aug. 2024).
Last updated 08/06/2024
Overview
Nebraska Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under some circumstances. Reimbursement for store-and-forward is only specified for teleradiology. Passage of LB 400 expanded the Medicaid definition of telehealth to include audio-only, and Medicaid recently released a bulletin and code list that allows audio-only reimbursement for some specific service codes.
Last updated 08/06/2024
Remote Patient Monitoring
POLICY
Telemonitoring: The remote monitoring of a client’s vital signs, biometric data, or subjective data by a monitoring device which transmits such data electronically to a health care practitioner for analysis and storage.
Medicaid will reimburse for telemonitoring when all of the following requirements are met:
Telemonitoring is paid at a daily per diem rate set by Medicaid and includes the following:
- Health care practitioner review and interpretation of the client data;
- Equipment and all supplies, accessories, and services necessary for proper functioning and effective use of the equipment;
- Medically necessary visits to the home by a health care practitioner; and
- Training on the use of equipment and completion of necessary records.
No additional or separate payment beyond the fixed payment is allowable.
SOURCE: NE Admin. Code Title 471 Sec. 1-004.01(F) & 1-004.07, Ch. 1, (Accessed Aug. 2024).
No later than January 1, 2023, the department shall provide coverage for continuous glucose monitors under the medical assistance program for all eligible recipients who have a prescription for such device.
SOURCE: NE Revised Statute Sec. 68-911, (Accessed Aug. 2024).
Nebraska Medicaid will provide coverage for Continuous Glucose Monitoring (CGM) devices for eligible beneficiaries with diabetes beginning January 1, 2023.
SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Apr. 2024).
The continued use of CGM may be considered medically necessary for someone who is being assessed every 6 months by the prescribing healthcare practitioner for adherence to the CGM regimen and diabetes treatment plan. The initial authorization period for therapeutic CGM is 6 months and is then renewed on a yearly basis. Supplies will be provided for 30 days or up to 90 days at a time.
SOURCE: NE Medicaid, Provider Bulletin 24-17, Update to Continuous Glucose Monitor Policy for Fee-for-Service Members, July 12, 2024, (Accessed Aug. 2024).
CONDITIONS
Outpatient cardiac rehabilitation programs consisting of individually prescribed physical exercise or conditioning and concurrent telemetric monitoring. When a program is provided by a hospital to its outpatients, the service is covered as an outpatient service.
SOURCE: NE Admin. Code Title 471 Ch. 10, Sec. 006.16(B), Hospital Services, (Accessed Aug. 2024).
Nebraska Medicaid will provide coverage for both long-term (therapeutic) and short-term (diagnostic) CGM for eligible beneficiaries who have diabetes mellitus when medically necessary. CGM devices measure interstitial glucose, which correlates well with plasma glucose.
The initial authorization period for therapeutic CGM is 6 months, while the renewal period is yearly. Supplies will be provided for 30 days or up to 90 days at a time. Beneficiaries must meet medical necessity criteria in order to be eligible for coverage. See bulletin for prior authorization requirements.
SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Apr. 2024).
Medicaid fee-for-service members must meet eligibility criteria for the coverage of a long-term CGM for therapeutic purposes. The following criteria are used to determine medical necessity:
- Is insulin-treated, or
- Has a history of problematic hypoglycemia with documentation of at least one of the following:
- Recurrent (more than one) hypoglycemic events with blood glucose <54mg/dL (3.0mmol/L) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan, or
- A history of one hypoglycemic event with blood glucose <54mg/dL (3.0mmol/L) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia.
- And is being assessed every 6 months by the prescribing healthcare practitioner for adherence to a comprehensive diabetes treatment plan.
SOURCE: NE Medicaid, Provider Bulletin 24-17, Update to Continuous Glucose Monitor Policy for Fee-for-Service Members, July 12, 2024, (Accessed Aug. 2024).
PROVIDER LIMITATIONS
No Reference Found
OTHER RESTRICTIONS
Effective February 1, 2024, Nebraska Medicaid’s preferred Continuous Glucose Monitoring (CGM) devices are as follows:
- Dexcom G6
- Dexcom G7
- Freestyle Libre 2
- Freestyle Libre 3
Nebraska Medicaid covers CGM devices for Type 1, Type 2, and gestational diabetes mellitus as medically necessary.
SOURCE: NE Medicaid, Provider Bulletin 24-01, Update to Nebraska Medicaid’s Preferred CGM Devices (Jan. 8, 2024), (Accessed Aug. 2024).
The following devices are covered under Medicaid:
- FreeStyle Libre 2
- Dexcom G6
The Medtronic CGM may be covered for beneficiaries who meet the medical necessity criteria for long-term CGM and are on a Medtronic insulin pump.
CGM devices that use an implantable glucose sensor such as an Eversense CGM system (CPT codes 0046T, 00447T, and 0448T) or a noninvasive glucose sensor (e.g., optical and transdermal sensors) are considered investigational and not medically necessary due to insufficient evidence of clinical efficacy and long-term health outcomes. Any related HCPC codes for implantable or noninvasive glucose sensors are also considered investigational and not medically necessary.
SOURCE: NE Medicaid, Provider Bulletin 22-22, CGM Coverage by Medicaid, Dec. 29, 2022, (Accessed Aug. 2024).
Last updated 08/06/2024
Store and Forward
POLICY
Asynchronous service is included in the definition for telehealth in Nebraska statutes.
SOURCE: NE Rev. Statute, 71-8503(3) (Accessed Aug. 2024).
ELIGIBLE SERVICES/SPECIALTIES
Nebraska Medicaid will reimburse for teleradiology when it meets the American College of Radiology standards for tele-radiology. There is no other reference to reimbursing for other specialties.
SOURCE: NE Admin. Code Title 471 Sec. 1-004.06(B), Ch. 1 (Accessed Aug. 2024).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
