Last updated 11/04/2024
Live Video
POLICY
Ohio Medicaid covers live video telehealth for certain eligible providers wherever the covered individual is located.
Telehealth is the interaction with a patient via synchronous, interactive, real-time electronic communication that includes both audio and video elements; OR -The following activities that are asynchronous or do not have both audio and video elements:
- Telephone calls
- Remote patient monitoring
- Communication with a patient through secure electronic mail or a secure patient portal
For services rendered by behavioral health providers as defined in rule 5160-27-01 of the Administrative Code, telehealth is further defined in rule 5122-29-31 of the Administrative Code.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 3-4. & OAC 5160-1-18. (Accessed Nov. 2024).
The department of Medicaid shall establish standards for Medicaid payments for health care services the department determines are appropriate to be covered by the Medicaid program when provided as telehealth services. The standards shall be established in rules adopted under section 5164.02 of the Revised Code.
In accordance with section 5162.021 of the Revised Code, the Medicaid director shall adopt rules authorizing the directors of other state agencies to adopt rules regarding the Medicaid coverage of telehealth services under programs administered by the other state agencies. Any such rules adopted by the medicaid director or the directors of other state agencies are not subject to the requirements of division (F) of section 121.95 of the Revised Code.
SOURCE: OH Revised Code, Sec. 5164.95.(B) (Accessed Nov. 2024).
Individuals who meet the definition of inmate in a penal facility or a public institution as defined in rule 5160:1-1-03 of the Administrative Code are not eligible for telehealth services under this rule.
SOURCE: OH Admin Code 5160-1-18(E)(6). (Accessed Nov. 2024).
Mental Health
No initial in person visit is necessary to initiate services using telehealth modalities. The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.
SOURCE: OH Admin Code 5122-29-31 (Accessed Nov. 2024).
Office of Mental Health and Addiction Services
OhioMHAS-certified behavioral health centers are not subject to the Ohio Medicaid Telehealth rule 5160-1-18. However, if you are a behavioral health provider or other health care entity and are not certified by OhioMHAS, you are/or may be required to follow Ohio Medicaid rule 5160-1-18.
SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Nov. 2024).
Teledentistry
The department is required to establish standards for Medicaid payment for services provided through teledentistry.
SOURCE: OH Revised Code, Sec. 5164.951. (Accessed Nov. 2024).
Managed Care
Medicaid Managed Care Organizations (MCOs), MyCare Ohio Plans (MCOPs) and the OhioRISE plan (hereinafter referred to collectively as managed care entities or MCEs) will use the guidelines outlined in this document to allow their Ohio Department of Medicaid (ODM) members to continue using telehealth as an option for services.
SOURCE: OH Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, July 15, 2022, (Accessed Nov. 2024).
ELIGIBLE SERVICES/SPECIALTIES
If the practitioner site does not bill the Ohio Department of Medicaid (ODM) directly (i.e., holds a contractual agreement with the practice), the patient site or practice who holds the contractual agreement may instead bill for the service delivered using telehealth.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 12. (Accessed Nov. 2024).
The following services are eligible for payment when delivered through telehealth from the practitioner site:
- When provided by a patient centered medical home, or behavioral health providers, evaluation and management of a new patient described as “office or other outpatient visit” with medical decision making not to exceed moderate complexity.
- Evaluation and management of an established patient described as “office or other outpatient visit” with medical decision making not to exceed moderate complexity.
- Inpatient or office consultation for a new or established patient when providing the same quality and timeliness of care to the patient other than by telehealth is not possible
- Mental health or substance use disorder services described as “psychiatric diagnostic evaluation” or “psychotherapy”
- Remote evaluation of recorded video or images submitted by an established patient.
- Virtual check-in by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient.
- Online digital evaluation and management service for an established patient.
- Remote patient monitoring.
- Audiology, speech-language pathology, physical therapy, and occupational therapy services, including services provided in the home health setting.
- Medical nutrition services.
- Lactation counseling provided by dietitians.
- Psychological and neuropsychological testing.
- Smoking and tobacco use cessation counseling.
- Developmental test administration.
- Limited or periodic oral evaluation.
- Hospice services.
- Private duty nursing services.
- State plan home health services.
- Dialysis related services.
- Services under the specialized recovery services (SRS) program as defined in rule 5160-43-01 of the Administrative Code.
- Notwithstanding paragraph (D)(2) of this rule, behavioral health services covered under Chapter 5160-27 of the Administrative Code.
- Optometry services.
- Pregnancy education services.
- Diabetic self-management training (DSMT) services.
- Other services if specifically authorized in rule promulgated under agency 5160 of the Administrative Code.
SOURCE: OH Admin Code 5160-1-18(D). (Accessed Nov. 2024).
Mental Health
The following are the services that may be provided via telehealth:
- General services
- CPST service
- Therapeutic behavioral services and psychosocial rehabilitation service
- Peer recovery services
- SUD case management service
- Crisis intervention service
- Assertive community treatment service
- Intensive home-based treatment service
- Mobile response and stabilization service
Individuals receiving residential and withdrawal management substance use disorder services as defined in rule 5122-29-09 of the Administrative Code or mental health day treatment service as defined in rule 5122-29-06 of the Administrative Code may receive any of the component services listed in paragraph (E) of this rule through telehealth.
SOURCE: OAC 5122-29-31. (Accessed Nov. 2024).
Services are allowed to be provided through telehealth pursuant to rule 5122-29-31 of the Administrative Code, and these services are to be documented in accordance with paragraph (G) of rule 5122-29-31 of the Administrative Code. Telehealth services including induction of any form of medication assisted treatment will only be allowed in accordance with federal and state standards.
SOURCE: OAC 5122-40-09(C). (Accessed Nov. 2024).
Medication units may also provide telecounseling services if they provide appropriate privacy and adequate space with appropriately credentialed staff in accordance with all federal and state regulation. Telecounseling services may include individual or group sessions. Medication units that choose to provide telecounseling will:
- Provide telecounseling services with appropriate application of clinical judgment to best meet patient treatment needs;
- Be in compliance with paragraphs (H)(3) and (H)(4) of rule 5122-40-09 of the Administrative Code; and,
- Ensure that every patient has a designated counselor who is the primary contact for behavioral health treatment and care coordination. While the patient may utilize other counselors for emergencies, all counseling, including telecounseling, will be handled by the primary counselor. All patients, whether seen in person or via telehealth, count equally toward the staffing ratio specified in paragraph (F)(1) of rule 5122-40-09 of the Administrative Code, and opioid treatment programs will maintain clear and accurate caseload records for auditing purposes.
SOURCE: OAC 5122-40-15, (Accessed Nov. 2024).
Mobile Response and Stabilization Service
MRSS is intended to be delivered in-person where the young person or family is located, such as their home or a community setting. There are instances where MRSS can be delivered using a telehealth modality. Common times that telehealth would be appropriate are:
- When the young person or family requests MRSS service delivery using telehealth modalities,
- There is a contagious medical condition present in the home, or
- Inclement weather that prevents or makes it dangerous for the MRSS team to travel to the young person or family.
SOURCE: OAC 5122-29-14 (Accessed Nov. 2024).
Managed Care
Many clinically appropriate services that can be delivered virtually will be eligible for telehealth coverage, including but not limited to: sick visits, well visits, prenatal and postpartum care, behavioral health, and monitoring of chronic conditions. This is especially important for Medicaid members who experience a variety of access related barriers to care and social determinants of health. All Telemedicine/Telehealth services must be medically necessary and documented and in the applicable medical record in order to be reimbursable. Documentation may be requested to support medical necessity reviews.
See guide for telehealth visit code set.
SOURCE: Managed Care Plan Provider Telehealth Resource Guide, pg. 3-7, (Accessed Nov. 2024).
Managed Care Organizations must allow Applied Behavioral Analysis (ABA) services to be available through telehealth under the current guidelines that were established in June 2018. If the provider is not enrolled with Medicaid, a single case agreement would be needed.
See document for complete code list for different professions.
SOURCE: OH Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, July 15, 2022, (Accessed Nov. 2024).
Office of Mental Health and Addiction Services
Services that may be provided using real-time, interactive videoconferencing as a certified community behavioral health center are:
- Telehealth
- General Services
- Assessments
- Counseling and therapy including groups up to 12
- Medical Activities including prescribing as allowed by the State of Ohio Medical Board and practitioner’s
licensure
- CPST Services
- Therapeutic behavioral services and psychosocial rehabilitation services
SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Nov. 2024).
Behavioral Health
See Behavioral Health manual for telehealth modifier and Place of Service allowed for the different types of services.
SOURCE: Ohio Department of Medicaid, Medicaid Behavioral Health State Plan Services, Provider Requirements and Reimbursement Manual, Version 1.25, Effective 8/27/24, (Accessed Nov. 2024).
Intensive Home Based Treatment (IHBT) Service
IHBT is an intensive service that consists of multiple in person contacts per week with the child/adolescent and family, which includes collateral contacts related to the behavioral health needs of the child/adolescent as documented in the individual client record (ICR) as required by Chapter 5122-27 of the Administrative Code. IHBT can be provided via telehealth in accordance with rule 5122-29-31 of the Administrative Code.
SOURCE: OH Administrative Code 5122-29-28. (Accessed Nov. 2024).
Payment may be made for IHBT services rendered face-to-face in person or via telehealth in accordance with rule 5122-29-31 of the Administrative Code.
SOURCE: OH Administrative Code 5160-59-03.3. (Accessed Nov. 2024).
Outpatient Hospital
Hospital providers are eligible to bill for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill a professional claim. See guide for instructions.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 8. (Accessed Nov. 2024).
Outpatient Hospital Behavioral Health Services (OPHBH)
Hospitals are eligible to provide outpatient behavioral health services via telehealth to the extent they appear on the OPHBH fee schedule.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 8. (Accessed Nov. 2024).
Federally Qualified Health Center and Rural Health Clinics
For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived, and payment is made in accordance with Chapter 5160-28 of the Administrative Code.Medical nutrition therapy and lactation services rendered by eligible FQHC and RHC practitioners will be paid under the PPS.
Group therapy will continue to be paid through FFS as a covered non-FQHC/RHC service under the clinic provider type 50 (using ODM’s payment schedules).
Services under the Specialized Recovery Services (SRS) program are not currently covered FQHC or RHC services.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 9. (Accessed Nov. 2024).
Federally Qualified Health Center
A visit may be conducted through telehealth if the service is rendered in accordance with rule 5160-1-18 of the Administrative Code.
SOURCE: OH Administrative Code 5160-28-01. (Accessed Nov. 2024).
Dental/Teledentistry
Dentists may provide a limited problem-focused oral exam (CDT D0140) or periodic oral evaluation (D0120) through telehealth during this state of emergency. Dental services furnished through telehealth at FQHCs are covered under 5160-1-18 and are paid as covered FQHC dental services.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 9-10. (Accessed Nov. 2024).
“Teledentistry” means the delivery of dental services through the use of synchronous, real-time communication and the delivery of services of a dental hygienist or expanded function dental auxiliary pursuant to a dentist’s authorization as defined in section 4715.43 of the Revised Code.
In order to qualify as teledentistry activities, both the originating site(s) (location of the patient) and the approved practice site(s) must be located in dental health resource shortage areas.
All teledentistry activities must be conducted at the practice site(s) specified in the dentist’s contract.
SOURCE: OAC 3701-56-03. (Accessed Nov. 2024).
Hospice
According to 42 CFR § 418.204 (d), Hospice services may be provided using telehealth when clinically appropriate during a public health emergency. In order to track the services that are provided through telehealth, the appropriate procedure codes below in addition to using the modifier GT must be used on any claims that include at least one telehealth component for that date of service. See guide for codes.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 10. (Accessed Nov. 2024).
Home Health Services
Home health services, the RN assessment service and the RN consultation service can be provided using telehealth when clinically appropriate. These services should be billed using the procedure codes below. The value “02” should be used to indicate telehealth as the “Place of Service” on all claims for services provided using telehealth. See guide for codes.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 11. (Accessed Jun. 2024).
The face-to-face encounter may be completed using telehealth.
SOURCE: Ohio Administrative Code 5160-12-01, (Accessed Nov. 2024).
Nursing Facilities
Nursing facilities (NF) are reimbursed for all telehealth related services through the NF per diem rate. Nursing Facilities do not bill for the telehealth related services they provide. Per the telehealth rule 5160-1-18, physicians and other eligible providers may bill for the services they provide to nursing facility residents from the practitioner’s site in accordance with the rule. When nursing facilities provide telehealth related services to their residents, they report the costs they incur for those services on the Medicaid NF cost report. See guide for codes.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 11-12. (Accessed Nov. 2024).
In accordance with rule 5160-1-18 of the Administrative Code, physician visits may be provided via telehealth.
SOURCE: Ohio Administrative Code 5160-3-19(4). (Accessed Nov. 2024).
Home Health and Private Duty Nursing
Reimbursement of home health or private duty nursing (PDN) services in accordance with this chapter are on a per visit basis. A “visit” is the duration of time that a covered home health service or private duty nursing (PDN) service is provided during an in-person or telehealth encounter to one or more individuals receiving medicaid at the same residence on the same date during the same time period.
A visit begins with the provision of a covered service and ends when the in-person or telehealth encounter ends.
SOURCE: Ohio Administrative Code 5160-12-04, (Accessed Nov. 2024).
Registered Nurse Assessment and Registered Nurse Consultation Services
The RN assessment may be completed using telehealth.
SOURCE: Ohio Administrative Code 5160-12-08, (Accessed Nov. 2024).
Comprehensive Maternal Care (CMC) Program
It is the responsibility of the CMC entity to:
- Offer at least one alternative to traditional office visits to increase access to the patient care team and clinicians in ways that best meet the needs of the population. This may include e-visits, telehealth, phone visits, group visits, home visits, alternate location visits, or expanded hours in the early mornings, evenings, or weekends.
SOURCE: OAC 5160-19-03. (Accessed Nov. 2024).
Enhanced Ambulatory Patient Groups (EAPG)
List of CPT and HCPCS codes covered for EAPG when telehealth is used.
SOURCE: OH Dept. of Medicaid. (Accessed Nov. 2024).
Nursing Facility-Based Level Care of Home and Community-Based Services: Home Care Attendant Services
All other RN home care attendant service visits may be conducted via telehealth, unless the individual’s needs necessitate an in-person visit.
“RN home care attendant service visit” means the visit every ninety days between the RN and the individual receiving home care attendant services as required by paragraph (G)(8) of this rule. The visit may be conducted by via telehealth, unless the individual’s needs necessitate in-person visit.
SOURCE: OAC 5160-44-27, (Accessed Nov. 2024).
Nursing facility-based level of care home and community-based services programs: waiver nursing services
Non-agency LPNs, at the direction of an RN will: Conduct a visit with the directing RN at least every sixty days after the initial visit to evaluate the provision of waiver nursing services and LPN performance, and to ensure that waiver nursing services are being provided in accordance with the approved plan of care and within the LPN’s scope of practice. The visit may be conducted via telehealth.
SOURCE: OAC 5160-44-22, (Accessed Nov. 2024).
Ohio home care waiver
At least twice per year, the RN will conduct RN assessment visits in-person. All other RN assessment service visits may be conducted via telehealth, unless the individuals needs necessitate an in-person visit. When the RN performs an RN assessment visit, the RN will bill the state plan nursing assessment code set forth in appendix A to rule 5160-12-08 of the Administrative Code.
SOURCE: OAC 5160-46-04, (Accessed Nov. 2024).
Doula Services
During a coverage period, payment may be made for the following doula services: …
- Antepartum and postpartum support services, including consultation and telehealth visits, provided in fifteen-minute units up to a maximum of forty-eight units
SOURCE: OAC 5160-8-43, (Accessed Nov. 2024).
ELIGIBLE PROVIDERS
Eligible providers:
- Physicians, Psychiatrists
- Ophthalmologist (in billing guide only)
- Podiatrist (in billing guide only)
- Psychologist
- Physician Assistant
- Dentist
- Advanced Practice Registered Nurses:
- Clinical Nurse Specialists
- Certified Nurse Midwives
- Certified Nurse Practitioners
- Licensed Independent Social Workers
- Licensed Independent Chemical Dependency Counselors, Supervised practitioners, trainees, residents, and interns
- Licensed Independent Marriage and Family Therapists
- Licensed Professional Clinical Counselors
- Dietitians
- Audiologist, speech-language pathologists, speech-language pathology aides, audiology aides, and individuals holding a conditional license
- Occupational and physical therapists and occupational and physical therapist assistants
- Speech-Language Pathologist
- Home health aide and hospice aides (in admin code only)
- Practitioners who are supervised or cannot practice independently (see billing guide for list but many are listed above as well (i.e. physical therapist assistant)
- Non-Agency Nurses (in billing guide only)
- Medicaid school program (MSP) practitioners
- Behavioral health practitioners (in admin code only)
- Optometrists
- Pharmacists
- Chiropractors (in billing guide only)
- Other practitioners if specifically authorized in rule promulgated under Agency 5160 of the Administrative Code.
Types of providers able to bill: Rendering practitioners listed above, except:
- Supervised practitioners
- Occupational therapy assistant
- Physical therapist assistant
- Speech-language pathology and audiology aides
- Individuals holding a conditional license
- Registered Nurses (RN) and Licensed Practical Nurses (LPN) working in a hospice or home health setting (in billing guide only)
Other providers able to bill include:
- Professional Medical or Dental Group
- Federally Qualified Health Center
- Rural Health Clinic
- Ambulatory health care clinics
- Outpatient hospitals on behalf of licensed psychologists and independent practitioners not eligible to separately bill when practicing in an outpatient hospital setting.
- Psychiatric Hospitals providing OPHBH services
- Medicaid school program (MSP)
- Private duty or non-Agency nurses
- Pharmacies (submitted on a professional claim)
- Chiropractors (in billing guide only)
- Home health and hospice agencies (in admin code only)
- Behavioral health providers (in admin code only)
- Hospitals operating an outpatient hospital behavioral health program (in admin code only)
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 4-5 & OH Administrative Code 5160-1-18, (Accessed Nov. 2024).
To the extent permitted under rules adopted under section 5164.02 of the Revised Code and applicable federal law, the following practitioners are eligible to provide telehealth services covered pursuant to this section:
- A physician licensed under Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery;
- A psychologist, independent school psychologist, or school psychologist licensed under Chapter 4732. of the Revised Code;
- A physician assistant licensed under Chapter 4730. of the Revised Code;
- A clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner licensed under Chapter 4723. of the Revised Code;
- An independent social worker, independent marriage and family therapist, or professional clinical counselor licensed under Chapter 4757. of the Revised Code;
- An independent chemical dependency counselor licensed under Chapter 4758. of the Revised Code;
- A supervised practitioner or supervised trainee;
- An audiologist or speech-language pathologist licensed under Chapter 4753. of the Revised Code;
- An audiology aide or speech-language pathology aide, as defined in section 4753.072 of the Revised Code, or an individual holding a conditional license under section 4753.071 of the Revised Code;
- An occupational therapist or physical therapist licensed under Chapter 4755. of the Revised Code;
- An occupational therapy assistant or physical therapist assistant licensed under Chapter 4755. of the Revised Code.
- A dietitian licensed under Chapter 4759. of the Revised Code;
- A chiropractor licensed under Chapter 4734. of the Revised Code;
- A pharmacist licensed under Chapter 4729. of the Revised Code;
- A genetic counselor licensed under Chapter 4778. of the Revised Code;
- An optometrist licensed under Chapter 4725. of the Revised Code to practice optometry;
- A respiratory care professional licensed under Chapter 4761. of the Revised Code;
- A certified Ohio behavior analyst certified under Chapter 4783. of the Revised Code;
- A practitioner who provides services through a medicaid school program;
- Subject to section 5119.368 of the Revised Code, a practitioner authorized to provide services and supports certified under section 5119.36 of the Revised Code through a community mental health services provider or community addiction services provider;
- Any other practitioner the medicaid director considers eligible to provide telehealth services.
In accordance with division (B) of this section and to the extent permitted under rules adopted under section 5164.02 of the Revised Code and applicable federal law, the following provider types are eligible to submit claims for medicaid payments for providing telehealth services:
- Any practitioner described in division (C)(1) of this section, except for those described in divisions (C)(1)(g), (i), and (k) of this section;
- A professional medical group;
- A federally qualified health center or federally qualified health center look-alike, as defined in section 3701.047 of the Revised Code;
- A rural health clinic;
- An ambulatory health care clinic;
- An outpatient hospital;
- A medicaid school program;
- Subject to section 5119.368 of the Revised Code, a community mental health services provider or community addiction services provider that offers services and supports certified under section 5119.36 of the Revised Code;
- Any other provider type the medicaid director considers eligible to submit the claims for payment.
When providing telehealth services under this section, a practitioner shall comply with all requirements under state and federal law regarding the protection of patient information. A practitioner shall ensure that any username or password information and any electronic communications between the practitioner and a patient are securely transmitted and stored.
When providing telehealth services under this section, every practitioner site shall have access to the medical records of the patient at the time telehealth services are provided.
SOURCE: Ohio Revised Statue Sec. 5164.95, (Accessed Nov. 2024).
Outpatient Hospitals
Hospital providers are eligible to bill for telehealth services provided by licensed psychologists and independent practitioners not eligible to separately bill a professional claim. Ohio Medicaid will pay according to the Enhanced Ambulatory Patient Grouping (EAPG) pricing as described in OAC rule 5160-2-75.
Federally Qualified Health Center and Rural Health Clinics
For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived.
Nursing Facilities
Nursing facilities (NF) are reimbursed for all telehealth related services through the NF per diem rate. Nursing Facilities do not bill for the telehealth related services they provide. Per the telehealth rule 5160-1-18, physicians and other eligible providers may bill for the services they provide to nursing facility residents from the practitioner’s site in accordance with the rule. When nursing facilities provide telehealth related services to their residents, they report the costs they incur for those services on the Medicaid NF cost report.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 8-11. (Accessed Nov. 2024).
Hospitals
Telehealth services billed by hospitals under the Outpatient Hospital Behavioral Health Services (OPHBH) benefit package are billed in accordance with OAC rule 5160-2-76. ODM will accept an institutional claim and pay according to EAPG pricing when a telehealth service is rendered by a licensed independent behavioral health practitioner. The procedure code must be reported with the “GT” modifier, one of the designated modifiers indicating the location of the patient when applicable, and any other required modifiers. Also, the rendering practitioner NPI is not reported on this claim form; report only the attending practitioner NPI. Lastly, only one professional or institutional claim may be paid for a service delivered using telehealth.
SOURCE: The Ohio Department of Medicaid. Office of Policy Hospital Billing Guidelines. pg. 49, Revised 7/26/2021. (Accessed Nov. 2024).
Teledentistry
“Teledentistry” means the delivery of dental services through the use of synchronous, real-time communication and the delivery of services of a dental hygienist or expanded function dental auxiliary pursuant to a dentist’s authorization as defined in section 4715.43 of the Revised Code.
All teledentistry activities must be conducted at the practice site(s) specified in the dentist’s contract.
SOURCE: OAC 3701-56-03. (Accessed Nov. 2024).
Managed Care
Eligible Practitioners
- Physician as defined in Chapter 4731. of the Revised Code.
- Psychologist as defined in Chapter 4732. of the Revised Code.
- Physician assistant as defined in Chapter 4730. of the Revised Code.
- Clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner as defined in Chapter 4723. of the Revised Code.
- Licensed independent social worker, licensed independent marriage and family therapist, or licensed professional clinical counselor as defined in Chapter 4757. of the Revised Code.
- Licensed independent chemical dependency counselor as defined in Chapter 4758. of the Revised Code.
- Supervised practitioners, trainees, residents, and interns as defined in rules 5160-4-05 and 5160-8-05 of the Administrative Code.
- Audiologist, speech-language pathologist, speech-language pathology aides, audiology aides and individuals holding a license as defined in Chapter 4753. of the Revised Code.
- Occupational and physical therapist and occupational and physical therapist assistants as defined in Chapter 4755. of the Revised Code.
- Home health and hospice aides.
- Private Duty Nursing as defined in Chapter 5160-12 of the Administrative Code Dentists as defined in Chapter 4715. of the Revised Code.
- Medicaid school program (MSP) practitioners as described in Chapter 5160-35 of the Administrative Code.
- Dietitians as defined in Chapter 4759. of the Revised Code.
- Behavioral health practitioners as defined in rule 5160-27-01 of the Administrative Code.
- Optometrists as defined in Chapter 4725. of the Revised Code
- Other practitioners if specifically authorized in rule promulgated under Agency 5160 of Administrative Code
- Pharmacists as defined in Chapter 4729:1-1 of the Administrative Code
- Chiropractors as defined in Chapter 4734.60 of the Revised Code
Practitioner Site – the physical location of the treating practitioner at the time a health care service is provided through the use of telehealth. There is no limitation on the practitioner site, except for penal facilities or public institutions such as jail or prison
For behavioral health agencies certified by the Ohio Department of Mental Health and Addiction Services (OhioMHAS), allowable places of service are included in the BH Manual.
Eligible providers to submit claim, or bill for services rendered
- A professional medical group.
- An individual dentist or a professional dental group.
- A federally qualified health center (FQHC) or rural health clinic (RHC) as defined in Chapter 5160-28 of the Administrative Code (using a professional claim form).
- Ambulatory health care clinics (AHCC) as described in Chapter 5160-13 of the Administrative Code.
- Outpatient hospitals (facility claim can only be submitted when services are provided by licensed psychologists, and independent practitioners not allowed to separately bill when providing services in an outpatient hospital setting.)
- Hospitals operating an outpatient behavioral health program in accordance with rule 5160-2-76 of the Administrative Code
- Medicaid school program (MSP) providers as defined in Chapter 5160-35 of the Administrative Code.
- Private duty or non-agency nurses.
- Home health and hospice agencies.
- Licensed independent behavioral health providers as defined in rule 5160-27-01 of the Administrative Code.
- Occupational therapist, physical therapist, speech-language pathologist, audiologist.
- Dietitian
- Physician, psychiatrist, ophthalmologist
- Optometrist
- Psychologist
- Physician Assistant
- Advanced Practice Registered Nurse
- Pharmacists as defined in 4729:1-1 of the Administrative Code.
- Pharmacy as defined in rule 5160-9-01 of the Administrative Code.
- Chiropractor
- Care Management Entities
If the practitioner site does not bill the MCE directly (i.e., holds a contractual agreement with the practice), the patient site or practice who holds the contractual agreement may instead bill for the service delivered using telehealth.
- In such cases, ODM recommends the place of service (POS) code reported on the professional claim should reflect the location of the billing provider if the rendering practitioner’s location is unknown.
SOURCE: OH Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, July 15, 2022, (Accessed Nov. 2024).
ELIGIBLE SITES
“Patient site” is the physical location of the patient at the time a health care service is provided through the use of telehealth.
If the patient is at one of the following locations, a specific modifier identifying the type of location is required:
- The patient’s home (including homeless shelter, assisted living facility, group home, and temporary lodging);
- School;
- Inpatient hospital;
- Outpatient hospital;
- Nursing facility;
- Intermediate care facility for individuals with an intellectual disability.
The “practitioner site” is the physical location of the treating practitioner at the time a health care service is provided through the use of telehealth.
The place of service (POS) code reported on a professional claim must reflect the physical location of the practitioner. See billing guide for more information.
SOURCE: Ohio Administrative Code 5160-1-18. The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 4-9 (Accessed Mar. 2023).& Appendix B (July 5, 2022). (Accessed Nov. 2024).
Medicaid covered individuals can access telehealth services wherever they are located. Locations include, but are not limited to:
- Home
- School
- Temporary housing
- Homeless shelter
- Nursing Facility
- Hospital
- Group home
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)
Penal facility or public institution such as a jail or prison are excluded places of service.
In most cases, the “GT” modifier is required to identify the service delivery through telehealth. See instructions for your specific program area or provider type for further clarification.
In most cases, the place of service code reported on the claim must be the location of the practitioner. See instructions for your specific program area or provider type for further clarification.
Telehealth place of service codes 02 and 10 will not be accepted unless stated otherwise in provider specific billing guidelines.
See billing guidance for appropriate modifiers depending on the place of service.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 4-6. (Accessed Nov. 2024).
Modifiers recognized by Ohio Medicaid:
- GT Identifies a service as telehealth
- U1 Used to identify the patient location of “home” when a telehealth service was delivered
- U2 Used to identify the patient location of “school” when a telehealth service was delivered
- U3 Used to identify the patient location of “inpatient hospital” when a telehealth service was delivered
- U4 Used to identify the patient location of “outpatient hospital” when a telehealth service was delivered
- U5 Used to identify the patient location of “nursing facility” when a telehealth service was delivered
- U6 Used to identify the patient location of “Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)” when a telehealth service was delivered
SOURCE: Ohio Department of Medicaid, Modifiers Recognized by Ohio Medicaid, Jan. 28, 2022, (Accessed Nov. 2024).
For services delivered via telehealth, providers may use either the place of service code that reflects the location of the practitioner or the location of the patient. The appendix to OAC 5160-27-03 includes a list of allowable places of service codes for each procedure code. Please note, place of service code 02 is not allowed. Providers should use the GT modifier to identify telehealth services.
SOURCE: Ohio Department of Medicaid, Medicaid Behavioral Health State Plan Services, Provider Requirements and Reimbursement Manual, Version 1.25, Effective 8/27/24, pg. 97 (Accessed Nov. 2024).
Teledentistry
All teledentistry activities must be conducted at the practice site(s) specified in the dentist’s contract.
SOURCE: OAC 3701-56-03. (Accessed Nov. 2024).
Managed Care
Patient Site – The physical location of the patient at the time a health care service is provided through the use of telehealth. There is no limitation on the patient site except for penal facilities or public institutions such as jail or prison. Medicaid covered individuals can access telehealth services in the following locations, but are not limited to:
- Home
- School
- Temporary housing
- Homeless shelter
- Assisted Living Facility
- Nursing Facility
- Outpatient Hospital
- Group home
- Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
- Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC)
- Ambulatory Health Care Clinics
- Pharmacy/ Pharmacies
The place of service (POS) code reported on a professional claim must reflect the physical location of the practitioner. The POS code set is maintained by the Centers for Medicare and Medicaid Services (CMS) and can be found here: https://www.cms.gov/Medicare/Coding/place-of-servicecodes/Place_of_Service_Code_Set
Place of service 02 (Telehealth) will not be accepted on claims where Medicaid is the primary payer.
- The exception to the POS 02 limitation is for home health claims. Home Health claims will still require the POS 02.
- While FFS does not accept POS 02 and POS 10, MCOs may choose to allow these codes to identify telehealth services.
SOURCE: OH Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, July 15, 2022, (Accessed Nov. 2024).
GEOGRAPHIC LIMITS
There is no limitation on the practitioner or patient site.
SOURCE: The Ohio Department of Medicaid. Telehealth Billing Guide. Revised 7/15/2022, p. 4. (Accessed Nov. 2024).
FACILITY/TRANSMISSION FEE
No Reference Found
