Nebraska

Last updated 04/05/2025

Consent Requirements

Before an initial telehealth consultation, the provider 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.  The client must be aware of their right to refuse the telehealth consultation;
• All existing laws and protections for services received in-person also apply to telehealth, including:
  • Confidentiality of information;
  • Access to medical records and information resulting from the telehealth   consultation; and
  • Dissemination of client identifiable information, which cannot occur without written consent;
• The need for the client to utilize a private location as their originating site to preserve confidentiality;
• 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.

Clients may provide verbal rather than written consent during initial telehealth consultations.  The client must confirm that they understand the information contained in the written consent form.  A signed statement must be collected from the client within ten days of the service being provided and added to the client’s medical record.

If the client is unable to provide consent, then it must be obtained verbally or in writing from the client’s legally authorized representative.

Informed consent is not required if, because of a medical emergency, a client or their authorized representative are unable to provide written or verbal consent prior to the delivery of a service via telehealth.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 004, (Accessed Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

Last updated 04/05/2025

Definitions

Telehealth. The use of telecommunications and information technology to electronically exchange medical information from one site to another at different physical locations, whether synchronously or asynchronously, in order to aid a health care practitioner in the diagnosis or treatment of a client.  Telehealth encompasses telemedicine, store-and-forward, and telemonitoring.  The term also includes audio-only services for the delivery of individual behavioral health services for an established client when appropriate, and crisis management and intervention for an established client as allowed by federal law.

Telehealth consultation. 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.

Telemedicine. The use of two-way, real-time interactive audiovisual technology by a health care practitioner at a distant site to deliver services to a client at an originating site.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 002, (Accessed Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

Last updated 04/05/2025

Email, Phone & Fax

For audio-only services to be covered, they must be individual behavioral health services or crisis management and intervention, clients must have established relationships with their providers, and audio-only services must be clinically appropriate.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 006, (Accessed Apr. 2025).

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 Apr. 2025).

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. 2025).

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 Apr. 2025).

ABA Services

If a provider is not able to provide access to crisis services, they may refer individuals to telephonic, text, and chat crisis intervention call centers that meet 988 Suicide & Crisis Lifeline standards for risk assessment and engagement of individuals at imminent risk of suicide. This has been clarified in the service definitions.

SOURCE: NE Medicaid Program, Bulletin 25-02:  Behavioral Health Providers: Applied Behavior Analysis Service Definitions, January 31, 2025, (Accessed Apr. 2025).

Last updated 04/05/2025

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 Apr. 2025).

For services provided via telehealth to be covered, the telecommunications technology utilized must meet the following requirements:

• The technology must provide a secure audiovisual connection between distant and originating sites enough to ensure service parity with in-person delivery;
• The technology must be Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant; and
• The technology must be sufficient to allow the provider to appropriately complete the service billed to Nebraska Medicaid while adequately maintaining the safety of the client.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 002, (Accessed Apr. 2025).

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 Apr. 2025).

ELIGIBLE SERVICES/SPECIALTIES

All services provided via telehealth must be medically necessary, clinically appropriate, and in compliance with any applicable requirements within Title 471 of the Nebraska Administrative Code (NAC).

• All services provided via telehealth must meet the applicable service code definitions for coverage.
• Payment for services provided via telehealth is made according to the Nebraska Medicaid Practitioner Fee Schedule.  Payment for services provided via telehealth is only available for those services specifically indicated as telehealth eligible services in the fee schedule.

Services requiring hands-on care or in-person contact between the client and provider are not covered if provided via telehealth.

Services maintain the same limitations whether provided in-person or via telehealth, unless otherwise stated within this chapter.

Services allowed to be delivered via telehealth are distinguished on the Nebraska Medicaid Fee Schedule using the coding indicated therein.

Services provided via telehealth must be reimbursed at the equivalent rate for the comparable in-person service and without regard to the distance between the originating and distant sites.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 003 & 007, (Accessed Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

For each client who is a child who is receiving behavioral health services via telehealth, the following protections must be in place:

• 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; and
• In cases in which there is a threat that the child may harm himself or herself or others, before an initial telehealth consultation the health practitioner must work with the child and his or her parent or guardian to develop a safety plan.  Such plan must 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 consultation.  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 Admin. Code Title 471 Ch. 47, Sec. 003, (Accessed Apr. 2025).

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 Apr. 2025).

Interpretation Services

When supplied as part of a visit via telehealth, the patient’s record must reflect the requirements for telehealth and interpretation.

SOURCE: NE Medicaid Program, Bulletin 24-22:  Coverage of Interpretation Services, Oct. 31, 2024, (Accessed Apr. 2025).

ABA Services

Nebraska Medicaid allows for telehealth flexibility for situations where access or transportation are barriers to caregiver involvement. We believe that with these flexibilities in place, a requirement of 2-4 hours per month of caregiver involvement is reasonable.

SOURCE: NE Medicaid Program, Bulletin 25-02:  Behavioral Health Providers: Applied Behavior Analysis Service Definitions, January 31, 2025, (Accessed Apr. 2025).

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 Apr. 2025).

Distant sites health care facilities. To receive reimbursement, health care facilities must have quality of care protocols and patient confidentiality guidelines consistent with the requirements under this chapter.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 005, (Accessed Apr. 2025).

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 Apr. 2025).

ELIGIBLE SITES

Originating sites must provide a place where the client’s right to receive confidential and private services is protected.

There are no geographic restrictions dictating where an originating site may be located.

Originating sites must be compatible with the telecommunications technology necessary for services to be provided via telehealth.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 005, (Accessed Apr. 2025).

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 Apr. 2025).

GEOGRAPHIC LIMITS

No Reference Found

FACILITY/TRANSMISSION FEE

The originating site fee is paid to the health care facility hosting the client for telehealth services at a rate set forth in the Nebraska Medicaid Fee Schedule or under arrangement with the managed care organization (MCO).

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 007, (Accessed Apr. 2025).

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 Apr. 2025).

Last updated 04/05/2025

Miscellaneous

Providers delivering services via telehealth must follow all applicable state and federal laws and regulations governing their practice and the services they provide.

Providers of services delivered via telehealth must comply with all applicable provider participation requirements under 471 NAC Chapters 2 and 3.  In the event that provider participation requirements in 471 NAC Chapters 2 or 3 conflict with requirements outlined in this chapter, the requirements herein shall govern:

• Providers must ensure that services can be safely and effectively delivered using telehealth;
• Providers must consider a beneficiary’s behavioral, physical, and cognitive abilities to participate in services provided using telehealth;
• The beneficiary’s safety must be carefully considered for the complexity of the services provided;
• In situations where a caregiver or facilitator is necessary to assist with the delivery of services via telehealth their ability to assist and safety must also be considered;
• Beneficiaries are not required to seek services through telehealth and must be allowed to access in-person services, if the beneficiary requests; and
• Providers must ensure that beneficiary privacy and confidentiality is protected to the best of their ability.

To deliver services via telehealth, providers must be proficient in the use of applicable telehealth technologies.  Providers are responsible for ensuring that the telecommunications technology requirements within this chapter are met when delivering services via telehealth.

The medical record for telehealth services must follow all applicable statutes and regulations on documentation.  The use of telehealth technology must be documented in the same medical record, and must include the following telehealth information:

• Documentation of which site initiated the call;
• Documentation of the telecommunication technology utilized;
• The time the service began and ended;
• Assurance that services provided via telehealth meet applicable service definitions; and
• Documentation of informed consent.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 004 & 006, (Accessed Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

Last updated 04/05/2025

Out of State Providers

Services provided via telehealth to clients out-of-state are covered if the services meet the regulatory requirements for payment for services provided outside Nebraska.

For services delivered via telehealth to Nebraska Medicaid clients when the provider or the client, or both, is located outside of Nebraska, providers must be enrolled with Nebraska Medicaid and appropriately licensed.

Out-of-state telehealth services are covered 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, if the telehealth services are appropriately provided in accordance with this chapter and otherwise meet any applicable requirements within Title 471 of the Nebraska Administrative Code (NAC).

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 003, 005 & 007, (Accessed Apr. 2025).

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 Apr. 2025).

Last updated 04/05/2025

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 04/05/2025

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 in order to make treatment recommendations.  This requires the use of a device that is defined by the federal Food and Drug Administration as a medical device.

Nebraska Medicaid will reimburse for telemonitoring when all of the following requirements are met:

• The services are from the originating site;
• The client is cognitively capable to operate the equipment or has a willing and able person to assist in the transmission of electronic data;
• The originating site has space for all program equipment and full transmission capability;
• The provider must maintain a client’s medical record containing data supporting the medical necessity of the service, all transmissions and subsequent review received from the client, and how the data transmitted from the client is being utilized in the continuous development and implementation of the client’s plan of care; and
• The service is otherwise reimbursable by Nebraska Medicaid.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 002, (Accessed Apr. 2025).

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 Apr. 2025).

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. 2025).

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 Apr. 2025).

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 Apr. 2025).

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. 2025).

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 Apr. 2025).

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

Telemonitoring is paid at a daily per diem rate set by Nebraska Medicaid and includes the following:

• Provider review and interpretation of 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 provider; and
• Training on the use of equipment and completion of necessary medical records.

No additional or separate payment beyond the fixed payment is allowable.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 007, (Accessed Apr. 2025).

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 Apr. 2025).

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 Apr. 2025).

Last updated 04/05/2025

Store and Forward

POLICY

Store-and-forward. 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 which is then reported back to the referring provider.

SOURCE: NE Admin. Code Title 471 Ch. 47, Sec. 002, (Accessed Apr. 2025).

Asynchronous service is included in the definition for telehealth in Nebraska statutes.

SOURCE: NE Rev. Statute, 71-8503(3) (Accessed Apr. 2025).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found