Last updated 06/10/2024
Definitions
Telehealth is the use of telecommunications and information technology to provide access to physical, mental, and behavioral health care across distance.
Digital Health consists of online digital evaluation and management (E/M) services which are patient-initiated services with health care professionals. These are not realtime services. Patients initiate services through HIPAA-compliant secure platforms which allow digital communication with the health care professional. Online digital evaluation and management services are for established patients only. These services do not include nonevaluative electronic communications of test results, scheduling of appointments, or other communication that does not include evaluation and management.
Synchronous Telehealth is two-way, real-time interactive communication between a patient and their health care provider using technology such as interactive video/television, audio/visual secure online digital portals, and videoconferencing. Synchronous telehealth involves two collaborating sites: an “originating site” and a “distant site.” The patient is located at the originating site and the health care professional is located at the distant site.
Telehealth is an umbrella term which includes digital health and synchronous two-way real-time interactive audio/visual services. It does not include store and forward services.
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
Synchronous teledentistry (D9995) is delivery of patient care and education where there is live, two-way interaction between the patient and at least one dental, medical, or health caregiver at one physical location and an overseeing supervising or consulting dentist or dental provider at another location.
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024) & North Dakota Department of Human Services: Teledentistry Policy. (July 2023), (Accessed Jun. 2024).
The communication is real-time and continuous between all participants who are working together as a group. Synchronous teledentistry must use both audio and visual means. The totality of the communication of the information exchanged between the providers or others and the member during the synchronous teledentistry service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via an in-person interaction.
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023), (Accessed Jun. 2024).
Last updated 06/10/2024
Email, Phone & Fax
Audio-Only Telephone Services can be delivered by using older-style “flip” phones or a traditional “land-line” phones that only support audio-based communication. Only certain services are covered using audio-only telephone services (see linked list of covered services below).
Services must be initiated by an established patient or guardian of the established patient.
Do not report this service if:
- It is decided that the patient will be seen within 24 hours or at the next available urgent visit appointment,
- There is an E/M service for the same or a similar problem within the previous seven days
- The patient is within a postoperative period and related to the surgical procedure.
Modifier 93 is allowed: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only (is also allowed on institutional claims).
Audio-only telephone services (CPT™ 99441-99443) are only available through December 31, 2024.
Services that are not covered:
- Store and forward (G2010)
- Virtual check-in (G2012)
- Interprofessional Services
- Digital Assessment and Management Services
Interprofessional Telephone/Internet/Electronic Health Record Consultations: This service allows treating providers to consult with a specialist to assist the treating provider in diagnosis and/or management of a patient’s health condition without requiring the patient to have face-to-face contact with the specialist. Specialists bill for their consultation time with these codes.
Service requirements:
- Both the treating practitioner and the consultant must be enrolled in North Dakota Medicaid.
- Consultations must be:
- directly related to the patient’s diagnosis and treatment and
- for the patient’s direct benefit.
- These must be documented.
- Review of patient records and reports is included in this service.
Treating practitioners and consultants must follow all state and federal privacy laws regarding patient privacy and the exchange of patient information.
Do not report this service if:
- Direct specialty care is clinically indicated
- Consultant has seen the patient in a face-to-face encounter in the last 14 days
- The consultation leads to a transfer of care or other face-to-face service within the next 14 days or next available appointment date of the consultant.
- Greater than 50% of the service time is devoted to data review and/or analysis (for codes 99446-99449 only).
- Limits: Members are limited to four Interprofessional consultations per year. Service authorizations are required to exceed this limit.
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
Dentistry
Non Covered Services
- Examinations via online/email/electronic communication
- Patient contact with dentist who provides the consultation using audio means only (no visual component)
- Virtual check-in
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Jun. 2024).
Medicaid Services Rendered in Schools
Non-Covered Services …
- Communications between the provider and Medicaid member that do not maintain actual visual contact, unless allowed as a telehealth audio-only service
SOURCE: ND Div. of Medical Assistance, School Based Medicaid, p. 5, (Apr. 2024), (Accessed Jun. 2024).
Home Health and Private Duty Nursing
Telephonic encounters are not covered by ND Medicaid.
SOURCE: ND Div. of Medical Services, Home Health and Private Duty Nursing, (Jan. 2024), (Accessed Jun. 2024).
Targeted Case Management
Telephone calls, in person and email contacts are allowable costs under transitional care management (TCM) for making collateral contacts.
SOURCE: North Dakota Department of Human Services: Targeted Case Management – Individuals with a serious mental illness or serious emotional disturbance. (Oct. 2023) P. 8, & Targeted Case Management Child Welfare, (Oct. 2023) p. 6 (Accessed Jun. 2024).
Teledentistry
Noncovered Services:
- Examinations via online/email/electronic communication
- Patient contact with dentist who provides the consultation using audio means only (no visual component)
- Virtual check-in
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Feb. 2024). & North Dakota Department of Human Services: Teledentistry Policy. (July 2023), (Accessed Jun. 2024).
Pharmacy Manual
Allowed for reimbursement:
- Audio-only telephone visits allowed for established patients only (CPT 99606 and 99607)
SOURCE: ND Medicaid Pharmacy Medical Billing Manual, Apr. 2024, (Accessed Jun. 2024).
Last updated 06/10/2024
Live Video
POLICY
All qualified telehealth services must:
- Meet the same standard of care as in-person care.
- Be medically appropriate and necessary with supporting documentation included in the patient’s clinical medical record.
- Be provided via secure and appropriate equipment to ensure confidentiality and quality in the delivery of the service. The service must be provided using a HIPAA-compliant platform.
- Use appropriate coding as noted in the following tables. Health care professionals must follow CPT®/HCPCS coding guidelines.
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
ELIGIBLE SERVICES/SPECIALTIES
See excel document of Telehealth Covered Services in Telehealth Policies section on Manuals Webpage.
Institutional Claims:
- Applicable Revenue Codes(s): 780 – Telehealth – facility charges related to the use of telehealth.
- Applicable Modifiers:
- GT or 95: Via interactive audio and video telecommunication systems. Billed by performing health care professional for real-time interaction between the professional and the patient who is located at a distant site from the reporting professional. Modifiers are not required for Medicare primary claims
Services that are not covered:
- Store and forward (G2010)
- Virtual check-in (G2012)
- Interprofessional Services (99446-99449, 99451)
- Digital Assessment and Management Services (98970-98972)
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
Dentistry
Teledentistry code D9995 or D9996 is required when billing ND Medicaid. Service authorization is not required. See manual for covered services.
Patient records must include the CDT© Code(s) that reflect the teledentistry encounter. The claim submission must include all applicable CDT© codes. ND Medicaid will reimburse CDT© code D9995 or D9996 once per date of service. Claim submissions must be billed using place of service (POS)/place of treatment codes:
- 02 Teledentistry provided in a location other than the patient’s home.
- 10 Telehealth provided in patient’s home.
Claims with any other place of service will be denied.
Non Covered Services
- Examinations via online/email/electronic communication
- Patient contact with dentist who provides the consultation using audio means onlyv(no visual component)
- Virtual check-in
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Jun. 2024).
Medicaid Services Rendered in Schools
Health Services billed by schools can be delivered via telehealth; however, no originating site fee is allowed. See Telehealth policy for additional information.
SOURCE: ND Div. of Medical Assistance, School Based Medicaid, p. 7, (Apr. 2024), (Accessed Jun. 2024).
Home Health Services
A face-to-face encounter for the initial ordering of home health services, must occur no more than 90 days before or 30 days after the start of home health services. Face-to face encounters: …
- May be performed via telehealth or in-person, telephone encounters are insufficient.
SOURCE: ND Div. of Medical Services, Home Health and Private Duty Nursing, (Jan. 2024), (Accessed Jun. 2024).
Behavioral Health
Behavioral Health Manual indicates codes that can be delivered via telehealth.
SOURCE: ND Div. of Medical Assistance, Behavioral Health, (Apr. 2024), (Accessed Jun. 2024).
Substance Use Disorder
Substance use manual indicates codes that can be delivered via telehealth.
Telehealth coverage for partial hospitalization is limited to 50% or 10 hours of the weekly 20 hours of structured programming requirement.
SOURCE: ND Div. of Medical Assistance, Substance Use Disorder, (Apr. 2024), (Accessed Jun. 2024).
Pharmacy Manual
Medication Therapy Management (MTM) services: Face-to-Face (including telehealth) visit is required for new patients (CPT 99605).
Allowed for Reimbursement:
- Synchronous telehealth visits with real-time audio/visual conferencing
SOURCE: ND Medicaid Pharmacy Medical Billing Manual, Apr. 2024, (Accessed Jun. 2024).
1915(I) Medicaid State Plan Amendment Home and Community Based Behavioral Health Services
Remote service delivery is allowable as specified within each service. Remote support/telehealth limits, codes, and modifiers are available at https://www.hhs.nd.gov/sites/www/files/documents/1915i/1915i%20Codes.Rates_.Limits.pdf
SOURCE: ND Medicaid, 1915(I) Medicaid State Plan Amendment Home and Community Based Behavioral Health Services, Feb. 2024, (Accessed Jun. 2024).
Medication for Opioid Use Disorder
For OTPs, a clinical assessment that meets the requirements in 42 CFR § 8.12(f)(4) must be conducted, face to face or by telehealth, as clinically appropriate, at least once every three months for the first year of continuous treatment, and at least once every six months for each subsequent year
The member must require at least one face-to-face or telehealth check‐in per month for prescribing or dispensing OBOT/OTP medication. For those receiving buprenorphine based treatment, the prescriber has deemed it medically necessary to treat the member’s opioid addiction with buprenorphine products.
Telehealth must be provided in accordance with applicable federal and state laws and policies and follow the Controlled Substances Act (CSA) (28 USC Part 802) for prescribing and administration of controlled substances.
SOURCE: ND Medicaid, Medication for Opioid Use Disorder, Jan. 2024, (Accessed Jun. 2024).
Preventative Services and Chronic Disease Management
Preventive medicine counseling and risk factor reduction may be rendered via telehealth. See Telehealth policy for telehealth requirements.
Screening, Brief Intervention and Referral to Treatment (SBIRT)
SBIRT may be rendered via telehealth if providers document member pre-screening and the member’s score which indicates the need for a full screen. Providers must also document the member’s standardized assessment sscore. See Telehealth policy for telehealth requirements.
SOURCE: ND Medicaid, Preventative Services and Chronic Disease Management, Apr. 2024, (Accessed Jun. 2024).
ELIGIBLE PROVIDERS
Payment will be made only to the distant health care professional during the telehealth session. No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site.
Payment is made for services provided by licensed professionals enrolled with ND Medicaid within their licensed scope of practice only. All service limits set by ND Medicaid apply to telehealth services.
Telehealth services provided by an Indian Health Service (IHS) facility or a Tribal 638 Clinic functioning as the distant site, are reimbursed at the All-Inclusive Rate (AIR), regardless of whether the originating site is outside the “four walls” of the facility or clinic.
Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing telehealth services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue codes listed in the FQHC and RHC portions of this manual along with the CPT® or HCPCS code for the service rendered appended with modifier GT or 95.
Refer to the FQHC and RHC portions of this manual for the revenue codes to bill for the various services.
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
FQHCs and RHCs – Dentistry
Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
Revenue Code 512: Dental Clinic.
One dental encounter is allowed per day. The encounter must be a face to face encounter to qualify for payment. Asynchronous teledentistry performed as a stand-alone service does not qualify for an encounter payment. At least one covered service must be performed as a face to face service to qualify for the dental encounter payment.
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Jun. 2024).
Indian Health Services
Coverage and payment of services provided through telehealth is on the same basis as those provided through face-to-face contact.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, (Jan. 2024), (Accessed Jun. 2024).
Federally Qualified Health Center
Encounter in this chapter means a face-to-face visit or synchronous telehealth visit during which a qualifying encounter service is rendered. FQHCs may furnish services that qualify as a medical, dental, or behavior health encounter. Each encounter includes services and supplies incident to the service.
SOURCE: ND Div. of Medical Assistance, Federally Qualified Health Center, (Jan. 2024), (Accessed Jun. 2024).
Indian Health Services and Tribal Health Programs
ND Medicaid covers the same services for members who are enrolled in Medicaid and receiving services at IHS as those members who are enrolled in Medicaid only. Coverage and payment of services provided through telehealth is on the same basis as those provided through face-to-face contact.
SOURCE: ND Div. of Medical Assistance, Indian Health Services and Tribal Health Programs, (Apr. 2024), (Accessed Jun. 2024).
Rural Health Clinic
Payment to RHCs for covered services furnished to members is an all-inclusive rate for each encounter. For RHCs, the term “encounter” is defined as a face-to-face visit with the member during which a RHC service is rendered. Each encounter includes covered services by a medical professional plus related services and supplies. See Telehealth chapter for additional information on services rendered via telehealth.
SOURCE: ND Div. of Medical Assistance, Rural Health Clinic, (Jan. 2024), (Accessed Jun. 2024).
ELIGIBLE SITES
Professional Claims – POS listed:
- 02: Telehealth provided in a location other than the patient’s home.
- 10: Telehealth provided in patient’s home
Payment will be made only to the distant health care professional during the telehealth session. No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
Dentistry
Claim submissions must be billed using place of service (POS)/place of treatment codes:
- 02 Teledentistry provided in a location other than the patient’s home.
- 10 Telehealth provided in patient’s home.
Claims with any other place of service will be denied.
FQHCs and RHCs – Dentistry
Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
Revenue Code 512: Dental Clinic.
One dental encounter is allowed per day. The encounter must be a face to face encounter to qualify for payment. Asynchronous teledentistry performed as a stand-alone service does not qualify for an encounter payment. At least one covered service must be performed as a face to face service to qualify for the dental encounter payment.
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Jun. 2024).
Teledentistry
Claim submissions must be billed using place of service (POS)/place of treatment codes:
- 02 Teledentistry provided in a location other than the patient’s home.
- 10 Telehealth provided in patient’s home.
Claims with any other place of service will be denied.
Place of Service code 02 or 10 is recorded in Box # 38 on the claim form or electronic equivalent.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) – Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
Revenue Code 521: Clinic visit by member to RHC/FQHC.
One dental encounter is allowed per day. The encounter must be a face to face encounter to qualify for payment. Asynchronous teledentistry performed as a stand-alone service does not qualify for an encounter payment. At least one covered service must be performed as a face to face service to qualify for the dental encounter payment.
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023), (Accessed Jun. 2024).
Pharmacy Manual
For services delivered via synchronous telehealth:
- Both the origination site (where the member is located) and the distant site (where the provider is located) must meet the geographic location, privacy, and space requirements outlined above
- Provider is responsible for supplying audio and video equipment permitting two-way, real-time interactive communication between the origination and distant sites
SOURCE: ND Medicaid Pharmacy Medical Billing Manual, Apr. 2024, (Accessed Jun. 2024).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Q3014 is allowed: Telehealth originating site facility fee (If applicable. Cannot be billed if patient is outside of the healthcare facility, or for digital health services).
Institutional Claims: * HCPCS Code Q3014 must be billed in conjunction with Revenue Code 780 to indicate the originating site facility fee.
Payment will be made to the originating site as a facility fee only in the following places of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians, or other technology or personnel utilized in the performance of the telehealth service.
Payment is made for services provided by licensed professionals enrolled with ND Medicaid within their licensed scope of practice only. All service limits set by ND Medicaid apply to telehealth services.
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
Teledentistry
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) – Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023) & North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Jun. 2024).
Medicaid Services Rendered in Schools
Health Services billed by schools can be delivered via telehealth; however, no originating site fee is allowed. See Telehealth policy for additional information.
SOURCE: ND Div. of Medical Assistance, School Based Medicaid, p.6, (Jan. 2024), (Accessed Jun. 2024).
Last updated 06/10/2024
Store and Forward
POLICY
Digital Health consists of online digital evaluation and management (E/M) services which are patient-initiated services with health care professionals. These are not real-time services. Patients initiate services through HIPAA-compliant secure platforms which allow digital communication with the health care professional. Online digital evaluation and management services are for established patients only. These services do not include nonevaluative electronic communications of test results, scheduling of appointments, or other communication that does not include evaluation and management.
Interprofessional Telephone/Internet/Electronic Health Record Consultations: This service allows treating providers to consult with a specialist to assist the treating provider in diagnosis and/or management of a patient’s health condition without requiring the patient to have face-to-face contact with the specialist. Specialists bill for their consultation time with these codes.
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
Teledentistry
Asynchronous (store-and-forward) teledentistry (D9996) is the transmission of recorded health information (i.e., radiographs, photographs, digital impressions) through a HIPAA compliant electronic communications system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Feb. 2024). & North Dakota Department of Human Services: Teledentistry Policy. (July 2023), (Accessed Jun. 2024).
Medical assistance coverage must include payment for the following services: …
- Asynchronous teledentistry to reduce barriers to dental care through outreach programs and to integrate oral health into general health care settings to identify and refer treatment needs.
SOURCE: ND Statute Sec. 50-24.1-45 (Accessed Jun. 2024).
ELIGIBLE SERVICES/SPECIALTIES
Digital Health Evaluation and Management Services
Cumulative online digital evaluation and management (E/M) services occurring within a seven-day period beginning with the health care professional’s review of the patient-generated inquiry. Included services not separately billable:
- For the same or a related problem within seven days of a previous E/M service,
- Related to a surgical procedure occurring within the postoperative period of a previously completed procedure,
- Any subsequent online communication that does not include a separately reported E/M service.
- E/M services related to the patient’s inquiry provided by qualified health care professionals in the same group practice.
Separate reimbursement may be allowed for:
- Online digital inquiries initiated for a new problem within seven days of a previous online digital E/M service.
Permanent documentation storage (electronic or hard copy) of the encounter is required.
Services that are not covered:
- Store and forward (G2010)
- Virtual check-in (G2012)
- Interprofessional Services
- Digital Assessment and Management Services
Interprofessional Telephone/Internet/Electronic Health Record Consultations: This service allows treating providers to consult with a specialist to assist the treating provider in diagnosis and/or management of a patient’s health condition without requiring the patient to have face-to-face contact with the specialist. Specialists bill for their consultation time with these codes.
Service requirements:
- Both the treating practitioner and the consultant must be enrolled in North Dakota Medicaid.
- Consultations must be:
- directly related to the patient’s diagnosis and treatment and
- for the patient’s direct benefit.
- These must be documented.
- Review of patient records and reports is included in this service.
Treating practitioners and consultants must follow all state and federal privacy laws regarding patient privacy and the exchange of patient information.
Do not report this service if:
- Direct specialty care is clinically indicated
- Consultant has seen the patient in a face-to-face encounter in the last 14 days
- The consultation leads to a transfer of care or other face-to-face service within the next 14 days or next available appointment date of the consultant.
- Greater than 50% of the service time is devoted to data review and/or analysis (for codes 99446-99449 only).
- Limits: Members are limited to four Interprofessional consultations per year. Service authorizations are required to exceed this limit.
SOURCE: ND Div. of Medical Assistance, Telehealth, (Apr. 2024), (Accessed Jun. 2024).
Dentistry
Teledentistry code D9995 or D9996 is required when billing ND Medicaid. Service authorization is not required. See manual for covered services.
Patient records must include the CDT© Code(s) that reflect the teledentistry encounter. The claim submission must include all applicable CDT© codes. ND Medicaid will reimburse CDT© code D9995 or D9996 once per date of service. Claim submissions must be billed using place of service (POS)/place of treatment codes:
- 02 Teledentistry provided in a location other than the patient’s home.
- 10 Telehealth provided in patient’s home.
Claims with any other place of service will be denied.
Non Covered Services
- Examinations via online/email/electronic communication
- Patient contact with dentist who provides the consultation using audio means only (no visual component)
- Virtual check-in
SOURCE: North Dakota Human Services Dental Manual, Teledentistry, pg. 12-13 (Jan. 2024), (Accessed Jun. 2024).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
