Last updated 07/15/2024
Email, Phone & Fax
Per Nevada Senate Bill (SB) 5 passed during the 81st (2021) Nevada Legislative Session, telehealth visits may be performed using only audio outside of the COVID-19 Public Health Emergency. Effective on claims with dates of service on or after October 1, 2022, the telephone evaluation and management (E&M) codes listed have been opened to allow audio-only telehealth services to be billed by the provider types (PT) listed. No claims will be reprocessed automatically as these are go-forward changes.
SOURCE: NV Medicaid, Audio-Only Services Allowed. Web Announcement 3006. Feb. 13, 2023, (Accessed Jul. 2024).
The telecommunications system used must be appropriate for the service being provided. Facsimile machines, electronic mail, and text messages do not meet this criteria.
SOURCE: NV Medicaid. Telehealth Billing Instructions. 2/22/23. (Accessed Jul 2024).
The following coverage and limitations pertain to telehealth services: …
- Audio only telehealth must be delivered based on medical necessity and clinical appropriateness for the recipient as documented within the recipient’s medical record.
Non-Covered Services
- Images transmitted via facsimile machines (faxes)
- Text messages
- Electronic mail (email)
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.6, (Nov. 28, 2023). (Accessed Jul. 2024).
Per the updated authority, the Division of Health Care Financing and Policy (DHCFP) is making the following changes to allow all behavioral health services to be delivered through audio-only delivery. The following updates are effective with dates of service on or after November 29, 2023:
- Procedure codes H2014 (Skills Training and Development [Basic Skills Training]) and H2017 (Psychosocial Rehabilitation Services) will no longer deny with error code 0679 (This service is not covered under telehealth) when billed with Place of Service code 02 (Telehealth provided in a location other than in a recipient’s home).
- Procedure code H2011 (Crisis Intervention service) cannot be billed with modifier GT (Interactive audio and video telecommunication systems [Institutional claims – Critical Access Hospital only]) by the following provider types (PTs) as the rate does not align with the updated payment authority:
- PT 14 (Behavioral Health Outpatient Treatment) specialties 300 (Qualified Mental Health Professional (QMHP), 305 (Licensed Clinical Social Worker), 306 (Licensed Marriage and Family Therapist), 307 (Clinical Professional Counselor)
- PT 17 (Special Clinics) specialties 188 (Certified Community Behavioral Health Center [CCBHC]) and 215 (Substance Use Agency Model [SUAM])
- PT 20 (Physician, M.D., Osteopath, D.O.)
- PT 26 (Psychologist)
- PT 60 (School Health Services)
- PT 82 (Behavioral Health Rehabilitative Treatment)
See announcement for additional billing instructions.
SOURCE: NV Medicaid Web Announcement 2205, Mar. 13, 2024, (Accessed Jul. 2024).
Time spent in activities that occur outside of the unit or off the floor (e.g., telephone calls, whether taken at home, in the office, or elsewhere in the hospital) may not be reported as critical care since the physician is not immediately available to the patient.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Physician Services Chapter, Section 603, (May 1, 2024) (Accessed Jul. 2024).
Case management services are reimbursable when provided to Medicaid eligible recipients, on a one-to-one (telephone or face-to-face) basis.
Monitoring and follow-up activities include making necessary adjustments in the care plan and service arrangements with providers. Monitoring may involve either face-to-face or telephone contact, at least annually.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Case Management Section 2500, (May 30, 2023) (Accessed Jul. 2024).
Person centered contacts must include … If an LRI is chosen by the recipient to provide paid personal care-like services in their private home, the case manager will conduct more frequent home visits (no less than bi-annually in person and quarterly by telephone) to ensure the recipient is satisfied with the waiver services and caregiver.
NOTE: The link to the manual on the Medicaid Services Manual webpage appears to be broken to this manual. It seems to be working now – should we delete this note?
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Home and Community Based Services (HCBS) Waiver for Persons with Physical Disabilities, Dec. 26, 2023, (Accessed Jul. 2024).
Person-centered contacts must be documented in the recipient’s electronic record and must include at a minimum: …
- Case managers must demonstrate due diligence to hold ongoing contacts as outlined in the POC (frequency and method). Ongoing contacts are required, and every attempt to contact the recipient should be documented. At least three telephone calls must be completed on separate days, if no response is received after the third attempt, a letter must be sent to the recipient requesting a return contact. If the recipient fails to respond by the date indicated in the letter, the recipient may be terminated.
- If an LRI is chosen by the recipient to provide paid personal care like services in their private home, the case manager will conduct more frequent home visits (no less than bi-annually in person and quarterly by telephone) to ensure the recipient is satisfied with the waiver services and caregiver.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Home and Community Based Services (HCBS) Waiver for Frail and Elderly, Dec. 26, 2023, (Accessed Jul. 2024).
A telephonic risk assessment can be used to determine if a recipient is at risk of losing or being unable to return to a community setting because of the need for PCS.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Personal Care Services Program, Dec. 26, 2023, (Accessed Jul. 2024).
Care coordination includes:
- Ensuring access to high-quality physical health care (both acute and chronic) and behavioral health care, as well as social services, housing, educational systems and employment opportunities as necessary to facilitate wellness and recovery of the whole person. This may include the use of telehealth services.
CCBHC and DCO providers must ensure access to high quality behavioral and physical health care. This includes having policies in place that ensure: …
- Initial services will not be denied to those who do not live in the CCBHC catchment area (where applicable), including the provision of crisis services and other services, and coordination and follow-up with providers in the recipient’s catchment area. Telehealth services may be provided;
Crisis behavioral health services include but are not limited to: …
- Telephonic crisis services. The CCBHC must ensure, once the emergency has been resolved, the recipient is seen in-person at the next encounter and the initial evaluation is reviewed
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Certified Community Behavioral Health Center Services, Dec. 27, 2022, (Accessed Jul. 2024).
Telephonic services codes are reimbursable for residential substance use treatment in an institution for mental disease, substance use treatment clinic and opioid treatment program.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines, Residential substance use treatment in an institution for mental disease billing guide, (7/3/24), substance use treatment clinic (7/3/24), opioid treatment program (7/3/24). (Accessed Jul. 2024).
Last updated 07/15/2024
Live Video
POLICY
The Director shall include in the State Plan for Medicaid:
- A requirement that the State shall pay for the nonfederal share of expenses for services provided to a person through telehealth to the same extent and, except for services provided through audio-only interaction, in the same amount as though provided in person or by other means;
- A requirement that the State shall pay the nonfederal share of expenses for services described in paragraph (a) in the same amount as though provided in person or by other means:
- If the services:
- Are received at an originating site described in 42 U.S.C. § 1395m(m)(4)(C) or furnished by a federally-qualified health center or a rural health clinic; and
- Except for services described in subparagraph (2), are not provided through audio-only interaction; or
- For counseling or treatment relating to a mental health condition or a substance use disorder, including, without limitation, when such counseling or treatment is provided through audio-only interaction; and
A provision prohibiting the State from:
- Requiring a person to obtain prior authorization that would not be required if a service were provided in person or through other means, establish a relationship with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to paying for services as described in paragraph (a) or (b). The State Plan for Medicaid may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or through other means.
- Requiring a provider of health care to demonstrate that it is necessary to provide services to a person through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to paying for services as described in paragraph (a) or (b).
- Refusing to pay for services as described in paragraph (a) or (b) because of:
- The distant site from which a provider of health care provides services through telehealth or the originating site at which a person who is covered by the State Plan for Medicaid receives services through telehealth; or
- The technology used to provide the services.
- Requiring services to be provided through telehealth as a condition to paying for such services.
- Categorizing a service provided through telehealth differently for purposes relating to coverage or reimbursement than if the service had been provided in person or through other means.
The provisions of this section do not:
- Require the Director to include in the State Plan for Medicaid coverage of any service that the Director is not otherwise required by law to include; or
- Require the State or any political subdivision thereof to:
- Ensure that covered services are available to a recipient of Medicaid through telehealth at a particular originating site; or
- Provide coverage for a service that is not included in the State Plan for Medicaid or provided by a provider of health care that does not participate in Medicaid.
SOURCE: NV Revised Statute 422.2721, Similar provisions also apply to Managed Care plans in Sec. 695G.162 (Accessed Jul. 2024).
Services provided via telehealth must be clinically appropriate and within the health care professional’s scope of practice as established by its licensing agency. Services provided via telehealth have parity with in-person health care services. Health care professionals must follow the appropriate Medicaid Services Manual (MSM) policy for the specific service they are providing.
- Photographs must be specific to the patient’s condition and adequate for rendering or confirming a diagnosis or a treatment plan. Dermatologic photographs (e.g., photographs of a skin lesion) may be considered to meet the requirement of a single media format under this instruction.
- Reimbursement for the DHCFP covered telehealth services must satisfy federal requirements of efficiency, economy, and quality of care.
- All participating providers must adhere to requirements of the Health Insurance Portability and Accountability Act (HIPAA). The DHCFP may not participate in any medium not deemed appropriate for protected health information by the DHCFP’s HIPAA Security Officer.
Telehealth services follow the same prior authorization requirements as services provided in person. Utilization of telehealth services does not require prior authorization, however, individual services delivered via telehealth may require prior authorization. It is the provider’s responsibility to refer to the individual medical coverage policies through the MSM for coverage requirements.
ESRD visits must include at least one in-person visit to examine the vascular access site by a provider; however, an interactive audio/video telecommunications system may be used for providing additional visits.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403, p. 1; 3403.5, & 3403.7, (Nov. 28, 2023). (Accessed Jul. 2024).
Telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice to provide services that can be appropriately provided via telehealth.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1 (2/22/23). (Accessed Jul. 2024).
ELIGIBLE SERVICES/SPECIALTIES
Telehealth services are also covered by Nevada Medicaid. See MSM Chapter 3400, Telehealth Services for the complete coverage and limitations for Telehealth.
Medical Nutrition Therapy (MNT): May be provided through Telehealth services. See MSM Chapter 3400 for the Telehealth policy.
Podiatry: Telehealth services are covered when deemed medically necessary; refer to MSM Chapter 3400, Telehealth Services for services and prior authorization requirements.
Provider Office Services: Telehealth services are also covered by Nevada Medicaid. See MSM Chapter 3400, Telehealth Services for the complete coverage and limitations for Telehealth.
SOURCE: NV Dept. of Health and Human Svcs., Physician Medicaid Services Manual, Section (Apr. 30, 2024) (Accessed Jul. 2024).
A licensed professional operating within the scope of their practice under state law may provide the following Telehealth services for Medicaid recipients:
- Annual wellness visits;
- Diabetic outpatient self-management;
- Documented psychiatric treatment in crisis intervention (e.g., threatened suicide); and
- Office or other outpatient visits
SOURCE: NV Dept. of Health and Human Svcs., Provider Type 20, 24, and 77 (Physician), (Osteopath) and (APRN) Billing Guide, pgs. 9 & 10 (4/24/23). (Accessed Jul. 2024).
The following services must be provided in-person and are not considered appropriate services to be provided via telehealth:
- Personal care services provided by a Personal Care Attendant (PCA) as identified in provider qualifications found in MSM Chapter 2600, Intermediary Service Organization and MSM Chapter 3500, Personal Care Services;
- Home Health Services provided by a Registered Nurse (RN), Physical Therapist (PT), Occupational Therapist, Speech Therapist, Respiratory Therapist, Dietician or Home Health Aide as identified in provider qualifications found in MSM Chapter 1400, Home Health Agency (HHA); and
- Private Duty Nursing services provided by an RN as identified in provider qualifications found in MSM Chapter 900, Private Duty Nursing.3403.7
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400 Section 3403.6, p. 3 (Nov. 28, 2023). (Accessed Jul. 2024).
A health maintenance organization [or managed care organization] that provides medical services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall provide referrals to providers of dental services who provide services through teledentistry.
A managed care organization that provides dental services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall:
- Maintain a list of providers of dental services included in the network of the managed care organization who offer services through teledentistry;
- At least quarterly, update the list and submit a copy of the updated list to the emergency department of each hospital located in this State;
- Allow such providers of dental services to include on claim forms codes for teledentistry services provided through both real-time interactions and asynchronous transmissions of medical and dental information.
SOURCE: NV Revised Statute Ch. 695G.162 and 695C.1708, [slight variations exist between sections] (Accessed Jul. 2024).
Mental Health and Alcohol/Substance Abuse Services
Scope of Services – Nevada shall ensure that Mobile Crisis Response teams respond in person at the location in the community where a crisis arises or a family’s location of choice. For individuals 18 years of age and younger, responses in urban Clark and Washoe counties will be conducted face-to-face and in-person, with an average response time within one hour; average response times for these individuals in rural areas are within two hours. For adults, responses in urban areas shall be within one hour and within two hours in rural areas. For adults, responses in urban areas shall be within one hour and within two hours in rural areas. Telehealth responses in these locations shall be initiated as soon as possible, within one hour, with face-to-face and in-person team members arriving within one hour in urban areas and within two hours in rural areas. Nevada identifies these Mobile Crisis Response teams that comply with ARPA and the US SSA as DMCT.
Reference Chapter 3400 related to telehealth modality. The use of telehealth shall be
- Dictated by client preference
- Utilized to include additional member(s) of the team not onsite
- Utilized to provide follow-up services to the individual following an initial encounter with the DMCT
- Utilized to include highly trained members of the team, such as psychiatrists, psychiatric nurse practitioners, or others who can prescribe and/or administer medications
Services not eligible for reimbursement when rendered by a DMCT under Nevada Medicaid include: …
- Crisis services delivered solely via telehealth without the availability of an in-person response to the individual in crisis
Provider supervision for DMCT can occur in person or via telehealth.
All engaged DMCT staff shall receive training in the following areas prior to participating in a mobile response to a crisis episode: …
- Use of Telehealth equipment
SOURCE: Nevada Dept. of Health and Human Services, Mental Health and Alcohol/Substance Abuse Manual, (3/24/24) (Accessed Jul. 2024).
HCBS State Plan Option Adult Day Health Care and Habilitation
Assessment: New Referral – If an applicant appears to meet program criteria, a face-to-face assessment or via telehealth under certain circumstances will be scheduled to determine needs-based eligibility using the Comprehensive SocialHealth Assessment (CSHA) tool. The DHCFP HCC will contact the applicant/representative within seven working days of the referral date to schedule a time to conduct an assessment.
SOURCE: Nevada Dept. of Health and Human Services, HCBS State Plan Option Adult Day Health Care and Habilitation, (1/1/24). (Accessed Jul. 2024).
Certified Community Behavioral Health Center Services
Initial services will not be denied to those who do not live in the CCBHC catchment area (where applicable), including the provision of crisis services and other services, and coordination and follow-up with providers in the recipient’s catchment area. Telehealth services may be provided.
Care coordination includes: Ensuring access to high-quality physical health care (both acute and chronic) and behavioral health care, as well as social services, housing, educational systems and employment opportunities as necessary to facilitate wellness and recovery of the whole person. This may include the use of telehealth services.
SOURCE: Nevada Dept. of Health and Human Services, Certified Community Behavioral Health Center Services, (1/1/23) (Accessed Jul. 2024).
School Health Services
Only those services listed in MSM Sections 2803.3 – Preventive Health Screenings and Treatment through 2803.16 – Telehealth of this chapter are covered benefits.
SHS Covered Services include: …
- Telehealth services when clinically appropriate and within the health care professional’s scope of practice as established by its licensing agency. Refer to MSM Sections 2803.2L and 2803.16 of this chapter.
Services provided via telehealth must be clinically appropriate and within the health care professional’s scope of practice as established by its licensing agency.
SOURCE: Nevada Dept. of Health and Human Services, School Health Services, (11/28/23) (Accessed Jul. 2024).
ELIGIBLE PROVIDERS
Telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice to provide services that can be appropriately provided via telehealth.
The distant site is the site where the provider delivering services is located at the time the service is provided via a telecommunications system. The provider at the distant site must use the appropriate Place of Service (POS) code in addition to the appropriate modifier when billing for services provided via telehealth. Note that for distant site services billed under Critical Access Hospital (CAH) method II on institutional claims and billed by outpatient providers on institutional claims, the GT modifier (telehealth service rendered via interactive audio and video telecommunications system) is required.
Note: The distant site may not also be the originating site.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p.1 (2/22/23) (Accessed Jul. 2024).
Indian Health Services and Tribal Clinics must follow guidelines set forth in MSM Chapter 3400 (Telehealth Services)
Distant site: Use encounter code T1015. Distant site Telehealth services may be reimbursable as encounters (see Encounters below).
SOURCE: Nevada Dept. of Health and Human Svcs., Medicaid Services Manual, Indian Health Services and Clinics, pg. 1, (5/1/20), (Accessed Jul. 2024).
Providers must follow guidelines set forth in Medicaid Services Manual (MSM) Chapter 3400, Telehealth Services. Telehealth may be used by a licensed professional operating within the scope of their practice under state law.
SOURCE: Nevada Dept. of Health and Human Svcs., Medicaid Services Manual, Nurse Midwife, pg. 7, (11/14/22), (Accessed Jul. 2024).
The distant site is defined as the location where a provider of health care is providing telehealth services to a patient located at an originating site. The distant site provider must be an enrolled Medicaid provider.
Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.
A provider is not eligible for payment as both the originating and distant site for the same patient, same date of service.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1 3403.2, (Nov. 28, 2023). (Accessed Jul. 2024).
The distant site is the site where the provider delivering services is located at the time the service is provided via a telecommunications system. The provider at the distant site must use Place of Service (POS) Code 02 when billing for services provided via telehealth. Use of the POS code certifies the service meets telehealth requirements. Note that for distant site services billed under Critical Access Hospital (CAH) method II on institutional claims, the GT modifier (telehealth service rendered via interactive audio and video telecommunications system) is required.
SOURCE: Nevada Dept. of Health and Human Services, School Health Services, pg. 77 (8/10/23), (Accessed Jul. 2024).
An FQHC may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating encounter site must bill the telehealth originating Healthcare Common Procedural Coding System (HCPCS) code and the distant encounter site may bill the encounter code. Refer to MSM Chapter 3400 – Telehealth Services.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Federally Qualified Health Centers, Jan. 31, 2024, pg. 11, (Accessed Jul. 2024).
A licensed professional operating within the scope of their practice under state law may provide Telehealth services. Providers must follow guidelines set forth in MSM Chapter 3400 (Telehealth Services).
- Originating Site: The FQHC may bill an encounter rate in lieu of the originating site fee, if the distant site (provider) is providing ancillary services. The originating site code, Q3014, must be used when billing in lieu of an encounter code.
- Distant Site: FQHCs providing services for a recipient from a distant site may bill the appropriate encounter rate with Place of Service (POS) Code 02. Use of the POS code certifies the service meets telehealth requirements.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Federally Qualified Health Centers Billing Instructions, p. 1 (8/30/2019). (Accessed Jul. 2024).
ELIGIBLE SITES
In order to receive coverage for a telehealth facility fee, the originating site must be an enrolled Medicaid provider.
A provider is not eligible for payment as both the originating and distant site for the same patient, same date of service.
If a patient is receiving telehealth services at an originating site not enrolled in Medicaid, the originating site is not eligible for a facility fee from the DHCFP. Examples of this include, but are not limited to, cellular devices, home computers, kiosks and tablets.
Facilities that are eligible for encounter reimbursement (e.g., Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1, (11/28/23). (Accessed Jul. 2024).
Eligible sites:
- Office of provider
- Critical Access Hospital (CAH)
- Rural Health Clinic (RHC)
- Federally Qualified Health Center (FQHC)
- Hospital
- End Stage Renal Disease (ESRD) Facility
- Skilled Nursing Facility (SNF)
- Community Mental Health Centers (CMHC)
- Indian Health Services/Tribal Organization/Urban Indian Organization
- School-Based Health Centers
- Schools
- Family Planning Clinics
- Public Health Clinics
- ·Comprehensive Outpatient Rehabilitation Facilities
- Community Health Clinics (State Health Division)
- Special Children’s Clinics
- Human Immunodeficiency Virus (HIV) Clinics
- Therapy offices
- Chiropractic offices
- Emergency Medical Services (EMS) performing Community Paramedic Services
- Recipient’s smart phone (no facility fee)
- Recipient’s home computer (no facility fee)
- Recipient’s home (no facility fee)
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 1-2 (2/22/23) (Accessed Jul. 2024).
Originating site: Use procedure code Q3014. Originating site Telehealth services are not reimbursable as encounters.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines, Indian Health Services (IHS) and Tribal Clinics, (05/01/2020) (Accessed Jul. 2024).
The following services can be provided within a community paramedicine provider’s scope of practice as part of a community paramedicine visit when requested in plan of care: …
- Telehealth originating site
SOURCE: NV Dept. of Health and Human Services, Medicaid Services Manual, Physician Services Chapter 600 Section 604.2, (Apr. 30, 2024), (Accessed Jul. 2024).
The originating site is the location where an eligible Medicaid/Nevada Check Up recipient is at the time the service is provided via a telecommunications system.
SOURCE: Nevada Dept. of Health and Human Services, School Health Services, pg. 77 (8/10/23), (Accessed Jul. 2024).
An FQHC may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating encounter site must bill the telehealth originating Healthcare Common Procedural Coding System (HCPCS) code and the distant encounter site may bill the encounter code. Refer to MSM Chapter 3400 – Telehealth Services.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Federally Qualified Health Centers, Jan. 31, 2024, pg. 11, (Accessed Jul. 2024).
A licensed professional operating within the scope of their practice under state law may provide Telehealth services. Providers must follow guidelines set forth in MSM Chapter 3400 (Telehealth Services).
- Originating Site: The FQHC may bill an encounter rate in lieu of the originating site fee, if the distant site (provider) is providing ancillary services. The originating site code, Q3014, must be used when billing in lieu of an encounter code.
- Distant Site: FQHCs providing services for a recipient from a distant site may bill the appropriate encounter rate with Place of Service (POS) Code 02. Use of the POS code certifies the service meets telehealth requirements.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Federally Qualified Health Centers Billing Instructions, p. 1 (8/30/2019). (Accessed Jul. 2024).
GEOGRAPHIC LIMITS
A Medicaid Managed Care Organization shall not refuse to provide the coverage described in subsection 1 or the reimbursement described in subsection 2 because of:
- The distant site from which a provider of health care provides services through telehealth or the originating site at which an insured receives services through telehealth; or
- The technology used to provide the services
SOURCE: NV Revised Statute Sec. 695G.162. (Accessed Jul. 2024).
FACILITY/TRANSMISSION FEE
In order to receive coverage for a telehealth facility fee, the originating site must be an enrolled Medicaid provider.
A provider is not eligible for payment as both the originating and distant site for the same patient, same date of service.
If a patient is receiving telehealth services at an originating site not enrolled in Medicaid, the originating site is not eligible for a facility fee from the DHCFP. Examples of this include, but are not limited to, cellular devices, home computers, kiosks and tablets.
Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Telehealth Services Chapter 3400, Section 3403.1, (11/28/23). (Accessed Jul. 2024).
Q3014 – Telehealth originating site facility fee.
In order to bill the Q3014 facility fee, an originating site must be enrolled as a Nevada Medicaid provider. Eligible sites include:
- Office of provider
- Critical Access Hospital (CAH)
- Rural Health Clinic (RHC)
- Federally Qualified Health Center (FQHC)
- Hospital
- End Stage Renal Disease (ESRD) Facility
- Skilled Nursing Facility (SNF)
- Community Mental Health Centers (CMHC)
- Indian Health Services/Tribal Organization/Urban Indian Organization
- School-Based Health Centers
- Schools
- Family Planning Clinics
- Public Health Clinics
- Comprehensive Outpatient Rehabilitation Facilities
- Community Health Clinics (State Health Division)
- Special Children’s Clinics
- Human Immunodeficiency Virus (HIV) Clinics
- Therapy offices
- Chiropractic offices
- Emergency Medical Services (EMS) performing Community Paramedicine Services
Originating sites that cannot bill the facility fee (Q3014):
- Recipient smart phones
- Recipient home computers
- Recipient’s home
Providers that bill per diem or encounter rates may bill an encounter rate in lieu of the originating site fee. Per diem or encounter-based providers would not bill HCPCS code Q3014 and an encounter code, as the facility fee is already included in the per diem/encounter rates. If the telecommunication system used is a recipient’s smart phone or home computer, the facility fee may not be billed.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Telehealth Billing Instructions, p. 2 (2/22/23) (Accessed Jul. 2024).
Some provider types that may bill for an originating site facility fee include:
- Some Special Clinic provider types
- Some Applied Behavior Analysis provider types
- Therapists
- Chiropractors
- Providers at End-Stage Renal Disease Facilities
SOURCE: NV Dept. of Health and Human Svcs. Announcement 1048 & 1202. (Accessed Jul. 2024).
If the originating site is enrolled as a Nevada Medicaid provider, they may bill HCPCS code Q3014. If the telecommunication system used is a recipient’s smart phone or home computer, the facility fee may not be billed.
SOURCE: Nevada Dept. of Health and Human Services, School Health Services, pg. 77 (8/10/23), (Accessed Jul. 2024).
Q3014 is listed as an allowable service for FQHC/CCBHC and CCBHC.
SOURCE: NV Medicaid, CCBHC Allowable Services and FQHC/CCBHC Allowable Services, (Accessed Jul. 2024).
An FQHC may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If, for example, the originating site and distant site are two different encounter sites, the originating encounter site must bill the telehealth originating Healthcare Common Procedural Coding System (HCPCS) code and the distant encounter site may bill the encounter code. Refer to MSM Chapter 3400 – Telehealth Services.
SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Federally Qualified Health Centers, Jan. 31, 2024, pg. 11, (Accessed Jul. 2024).
Q3014 Telehealth Services is listed as an eligible CPT service for registered dietitians, community paramedics, community health workers, residential substance use treatment in an institution for mental disease, substance use treatment clinic and opioid treatment program.
SOURCE: Nevada Dept. of Health and Human Services Billing Guidelines Registered Dietitians Billing Instructions, (12/19/2019), Community Paramedics, Billing Instructions, (11/4/2019), Community Health Workers Billing Guide, (2/1/2022), residential substance use treatment in an institution for mental disease billing guide, (7/3/24), substance use treatment clinic (7/3/24), opioid treatment program (7/3/24). (Accessed Jul. 2024).
