Last updated 05/13/2024
Live Video
POLICY
A medical professional is not required to be present with the client at the originating site unless medically indicated [not in school-based manual]. However, to be reimbursed, services provided must be appropriate and medically necessary. See manual for examples of physicians/practitioners eligible to bill for professional services.
For Medicaid payment to occur, interactive audio and video telecommunications must be permitting real-time communication between the distant site physician or practitioner and the patient with sufficient quality to assure the accuracy of the assessment, diagnosis, and visible evaluation of symptoms and potential medication side effects. All interactive video telecommunication must comply with HIPAA patient privacy regulations at the site where the patient is located, the site where the consultant is located, and in the transmission process. If distortions in the transmission make adequate diagnosis and assessment improbable and a presenter at the site where the patient is located is unavailable to assist, the visit must be halted and rescheduled. It is not appropriate to bill for portions of the evaluation unless the exam was actually performed by the billing Provider. The billing Provider must comply with all licensing and regulatory laws applicable to the Providers’ practice or business in Wyoming and must not currently be excluded from participating in Medicaid by state or federal sanctions.
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, pgs. 136-137 (Apr. 1, 2024), WY Division of Healthcare Financing Tribal Provider Manual, pg. 134 & 212 (Apr. 1 2024); School Based Services Manual, pg. 16 (Apr. 1, 2024); & Institutional Provider Manual pg. 135. (Apr. 1, 2024). (Accessed May 2024).
ELIGIBLE SERVICES/SPECIALTIES
Telehealth services must be properly documented when offered at the discretion of the provider as deemed medically necessary.
Each site will be able to bill for their own services as long as they are an enrolled Medicaid provider (this includes out-of-state Medicaid providers). Providers shall not bill for both the spoke and hub site; unless, the provider is at one location and the member is at a different location even though the pay to provider is the same. Examples include Community Mental Health Centers and Substance Abuse Treatment Centers. A single pay to provider can bill both the originating site (spoke site) and the distant site provider (hub site) when applicable.
Documentation Requirements
- Quality assurance/improvement activities relative to telehealth delivered services need to be identified, documented and monitored.
- Providers need to develop and document evaluation processes and patient outcomes related to the telehealth program, visits, Provider access, and patient satisfaction.
- All service providers are required to develop and maintain written documentation in the form of progress notes the same as if they originated during an in-person visit or consultation with the exception that the mode of communication (such as, teleconference) should be noted
- Documentation must be maintained at the hub and spoke locations to substantiate the services provided. Documentation must indicate that the services were rendered via telehealth and must clearly identify the location of the hub and spoke sites.
Billing Requirements
Telehealth consent must be obtained if the originating site is the Member’s home
The services must be medically necessary and follow generally accepted standards of care
The service must be a service covered by Medicaid
Claims must be made according to Medicaid billing instructions
The same procedure codes and rates apply for telehealth as in person.
- The modifiers to indicate a telehealth service is “GT” or “95”, which must be used in conjunction with the appropriate procedure code to identify the professional telehealth services provided by the Distant Site Provider (for example, procedure code 90832 billed with modifier GT). The GT or 95 modifier must be billed by the Distant Site. Using the GT or 95 modifier does not change the reimbursement fee.
For ESRD-related services, at least one face-to-face “hands on” visit (not telehealth) must be furnished each month to examine the vascular access site by a qualified provider.
Care Management Entity service providers (CME Providers) are to use Place of Service code 02 Telehealth per their Provider agreement with Magellan Healthcare. CME Providers are NOT to use the “GT” or “95” modifier or “Q3014-Telehealth Originating Site Facility Fee” codes for virtual services.
If the patient or legal guardian indicate at any point that they want to stop using the technology, the service should cease immediately, and an alternative appointment set up.
See manual for billing examples.
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 135-138 (Apr. 1, 2024), WY Division of Healthcare Financing Tribal Provider Manual, pgs. 133-136, 211-214 (Apr. 1, 2024) & Institutional Provider Manual pg. 133-137. (Apr. 1, 2024). (Accessed May 2024).
Group psychotherapy is not a covered service.
SOURCE: WY Division of Healthcare Financing Tribal Provider Manual, pgs. 135 & 213 (Apr. 1, 2024), (Accessed May 2024).
Diabetes Prevention Program (DPP)
The first session of a DPP program cannot be performed via telehealth, but sessions 2-16 can be. The GT modifier should be used.
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual p. 259 (Apr. 1, 2024) & WY Division of Healthcare Financing Tribal Provider Manual, Ch. 18, Covered Services- Dietitian, p. 375 (Apr. 1, 2024), (Accessed May 2024).
Mental Health Services
The following services are excluded:
- Clinical services which are not provided in person or via a telehealth modality, other than collateral contacts necessary to develop or implement a treatment plan.
SOURCE: WY Admin Rules and Regulations, Agency 048, Department of Health-Medicaid, Behavioral Health Services, 37, Ch. 13, (Accessed May 2024).
The “GT” and 95 modifier is an allowable Behavioral Health Modifier.
SOURCE: WY Division of Healthcare Financing Tribal Provider Manual, Ch. 15, Covered Services- Behavioral Health, pg. 342 (Apr. 1, 2024). (Accessed May 2024).
School Based Services (SBS)
All individual services covered under the SBS Program may be billed by participating LEAs when performed via telehealth, except for services that preclude a telehealth modality. Group services are only reimbursable if delivered face-to-face. Telehealth is not an approved modality for group services. For Medicaid payment to occur, interactive audio and video telecommunications must be permitting real-time communication between the distant site physician or practitioner and the student with sufficient quality to assure the accuracy of the assessment, diagnosis, and visible evaluation of symptoms and potential medication side effects.
Non-Covered Services
Telehealth does not include a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a healthcare practitioner and a student, or a consultation between two health care practitioners asynchronous “store and forward” technology. Group services delivered using telehealth are not a covered service for Medicaid reimbursement. In addition, Medicaid will not reimburse for the use or upgrade of technology, for transmission charges, for charges of an attendant who instructs a patient on the use of the equipment or supervises/monitors a patient during the telehealth encounter, or for consultations between professionals.
Services are reimbursable when performed according to telehealth guidelines and billed with the appropriate CPT code. Ancillary costs, such as equipment, technical support, facility fee, and transmission charges incurred while providing telehealth services via audio/video communication are not reimbursable.
SOURCE: WY Division of Health Insurance, School Based Services Manual, pg. 16-17, (Apr 1. 2, 2024). (Accessed May 2024).
Adverse Childhood Experiences
Providers may screen a patient for ACEs or Pediatric Traumatic Stress Screening Tool via telehealth if the provider believes that the screening can be administered in a clinically appropriate manner. Providers must continue to comply with all other billing procedures, Wyoming Medicaid guidelines, and confidentiality laws
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual p. 211 & 307 (Apr. 1, 2024), (Accessed May 2024).
ELIGIBLE PROVIDERS
The location of the physician or practitioner providing the professional services via a telecommunications system is called the Distant Site or Hub Site. A medical professional is not required to be present with the Member at the originating site unless medically indicated. However, to be reimbursed, services provided must be appropriate and medically necessary.
Examples of physicians/practitioners eligible to bill for professional services are:
- Physicians;
- Advanced practice nurses with a specialty of psychiatry/mental health;
- Physician’s assistant;
- Psychologists and neuropsychologists;
- Licensed Mental health professionals (LCSW, LPC, LMFT, LAT);
- Board Certified Behavioral Analysts;
- Speech therapist.
Provisionally licensed mental health professionals cannot bill Medicaid directly, but must provide services through a supervising provider. Services provided by non-physician practitioners must be within their scope(s) of practice and according to Medicaid policy.
The modifiers to indicate a telehealth service is “GT” or “95”, which must be used in conjunction with the appropriate procedure code to identify the professional telehealth services provided by the Distant Site Provider (for example, procedure code 90832 billed with modifier GT). The GT or 95 modifier MUST be billed by the Distant Site. Using the GT or 95 modifier does not change the reimbursement fee.
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 136-138 (Apr. 1, 2024); & WY Division of Healthcare Financing Tribal Provider Manual, pg. 134-136 & 212-214, (Apr. 1, 2024) & Institutional Provider Manual pgs. 135-136. (Apr. 1, 2024). (Accessed May 2024).
Providers shall not bill for both the spoke and hub site; unless the Provider is at one location and the Member is at a different location even though the pay to Provider is the same. Examples include Community Mental Health Centers and Substance Abuse Treatment Centers. A single pay to Provider can bill both the originating site (spoke site) and the distant site Provider (hub site) when applicable. See below for billing and documentation requirements.
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 135 (Jan. 2, 2024), WY Division of Healthcare Financing Tribal Provider Manual, 133 & 211, (Apr. 1, 2024) & Institutional Provider Manual pg. 134. (Apr. 1, 2024). (Accessed May 2024).
ELIGIBLE SITES
Each site will be able to bill for their own services as long as they are an enrolled Medicaid provider (this includes out-of-state Medicaid providers). Providers shall not bill for both the spoke and hub site; unless, the provider is at one location and the client is at a different location even though the pay to provider is the same. Examples include Community Mental Health Centers and Substance Abuse Treatment Centers. A single pay to Provider can bill both the originating site (spoke site) and the distant site Provider (hub site) when applicable.
The Originating Site or Spoke site is the location of an eligible Medicaid client at the time the service is being furnished via telecommunications system occurs.
Authorized originating sites:
- Hospitals;
- Office of a physician or other practitioner (this includes medical clinics)
- Office of a psychologist or neuropsychologist
- Community mental health or substance abuse treatment centers (CMHC/SATC);
- Office of an advanced practice nurse (APN) with specialty of psych/mental health
- Office of a Licensed Mental Health Professional (LCSW, LPC, LMFT, LAT);
- Federally Qualified Health Centers;
- Rural Health Clinics;
- Skilled nursing facilities;
- Indian Health Services Clinics;
- Hospital-based or Critical Access Hospital-based renal dialysis centers (including satellites). Independent renal dialysis facilities are not eligible originating sites;
- Development Center;
- Family Planning Clinics;
- Public Health Offices
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 135-136 (Apr. 1, 2024), WY Division of Healthcare Financing Tribal Provider Manual, 133-134 & 211-212, (Apr. 1, 2024) & Institutional Provider Manual pg. 134-135. (Apr. 1, 2024). (Accessed May 2024).
School Based Services (SBS)
Telehealth claims must indicate that the place of service is “Telehealth” by selecting code “02”. Refer to the “1.2 Location of Services ” for more information. 03 indicates a school.
SOURCE: WY Division of Health Insurance, School Based Services Manual, (Apr. 1, 2024), pg. 17. (Accessed May 2024).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Medicaid will not reimburse for the use or upgrade of technology, for transmission charges, for charges of an attendant who instructs a patient on the use of the equipment or supervises/monitors a patient during the telehealth encounter, or for consultations between professionals.
The originating site fee is not billable if the client uses their own equipment, such as a personal phone, tablet, or computer. [not in school-based manual].
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 137 (Apr. 1, 2024), WY Division of Healthcare Financing Tribal Provider Manual, Ch. 6 Institutional/UB Common Billing Information, pgs. 135 & 213 (Apr. 1, 2024); School Based Services Manual, pg. 16 (Apr. 1, 2024); & Institutional Provider Manual pg. 135-136. (Apr. 1, 2024). (Accessed May 2024).
When billing for the originating site facility fee, use procedure code Q3014. A separate or distinct progress note is not required to bill Q3014. Validation of service delivery would be confirmed by the accompanying practitioner’s claim with the GT or 95 modifier indicating the practitioner’s service was delivered via telehealth. Medicaid will reimburse the originating site provider the lesser of charge or the current Medicaid fee.
Providers cannot bill for Q3014 if clients used their own equipment, such as personal phones or computers.
Additional services provided at the originating site on the same date as the telehealth service may be billed and reimbursed separately according to published policies and the National Correct Coding Initiative (NCCI) guidelines.
Eligible sites include:
- Hospitals
- Office of a physician or other practitioner (this includes medical clinics)
- Office of a psychologist or neuropsychologist
- Community mental health or substance abuse treatment center (CMHC/SATC)
- Office of an advanced practice nurse (APN) with specialty of psych/mental health
- Office of a Licensed Mental Health Professional (LCSW, LPC, LMFT, LAT)
- Federally Qualified Health Center (FQHC)
- Rural Health Clinic (RHC)
- Skilled nursing facility (SNF)
- Indian Health Services Clinic (IHS)
- Hospital-based or Critical Access Hospital-based renal dialysis centers (including satellites).
- Independent Renal Dialysis Facilities are not eligible originating sites
- Developmental Center
- Family Planning Clinics
- Public Health Offices
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, pgs. 135-138 (Apr. 1, 2024), WY Division of Healthcare Financing Tribal Provider Manual, Ch. 6 Tribal, pgs. 133-136 & 211-214, (Apr. 1, 2024) & Institutional Provider Manual pg. 134-136, (Apr. 1, 2024). (Accessed May 2024).
Care Management Entity service providers (CME Providers) are to use Place of Service code 02-Telehealth per their Provider agreement with Magellan Healthcare. CME Providers are NOT to use the “GT” modifier or “Q3014-Telehealth Originating Site Facility Fee” codes for virtual services.
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 138 (Apr. 1, 2024), WY Division of Healthcare Financing Tribal Provider Manual, pg. 136 (Apr. 1, 2024) & Institutional Provider Manual pg. 137. (Apr. 1, 2024). (Accessed May 2024).
Last updated 05/13/2024
Miscellaneous
Mental Health and Substance Use Disorder
“Engagement services” means face-to-face staff contact, which may include delivery through telehealth, with an individual who is waiting to be admitted into treatment for the purpose of maintaining the individual’s motivation and to help prepare them for treatment.
SOURCE: WY Amin Rules and Regulations, Agency 048, Mental Health and Substance Use Disorder Services, Ch. 1, Sec.3. (Accessed May 2024).
Behavioral Health Service Provider Certification
DUI/MIP Service Standards
Provide a minimum of eight (8) hours of client face-to-face services, which may be delivered through telehealth, utilizing evidence based curricula that is appropriate to age and developmental levels.
SOURCE: WY Admin Rules and Regulations, Health Dept., Agency 048, Mental Health and Substance Use Disorder Services, Chapter 2, Sec. 14. (Accessed May 2024)
Interpreter Services
ADA requirements: Title II and Title III of the Americans with Disabilities Act (“ADA”), 42 U.S.C. §§ 12131-34 & 12181-89, prohibits discrimination on the basis of disability in a range of covered areas, including healthcare services. The ADA applies to all types of private and state and local government healthcare providers, including, but not limited to, hospitals, skilled nursing facilities, urgent care centers, physicians, dentists, optometrists, mental health providers, and medical equipment providers. Further, the ADA applies to all services that covered entities provide, including in-person medical services, telehealth appointments and websites.
SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 332 (Apr. 1, 2024), (Accessed May 2024).
