Email, Phone & Fax

CY 2024 Physician Fee Schedule notes that section 4113 of Division FF, Title IV, Subtitle A of the Consolidated Appropriations Act, 2023 (CAA, 2023) (Pub. L. 117-328, December 29, 2022) extends the telehealth policies enacted in the Consolidated Appropriations Act, 2022 (CAA, 2022) (Pub. L. 117-103, March 15, 2022) through December 31, 2024, if the PHE ends prior to that date, as discussed in section II.D.c. of this final rule. These provisions included:

• Temporarily removing the geographic and site requirements for the patient location at the time the telehealth interaction takes place
• Temporarily allowing a more expansive list of eligible providers in Medicare to provide services via telehealth such as physical and occupational therapists and federally qualified health centers (FQHCs) and rural health clinics (RHCs)
• Temporarily allowing some services to continue to be provided via audio-only
• Temporarily suspending the in-person service requirement prior to the delivery of mental and behavioral services via telehealth or audio-only in cases where the geographic requirement does not apply, the service takes place in the home and the patient was not being treated for a substance use disorder

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Jul. 2024).

Also see Table 11 for list of eligible codes (including those eligible for audio-only) in CY 2024 Physician Fee Schedule.

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Jul. 2024).

For most non-behavioral or mental telehealth, you must use 2-way, interactive, audio-video technology.  Section 4113 of the Consolidated Appropriations Act, 2023 allows you to use audio-only telehealth for some non-behavioral or mental telehealth through December 31, 2024.

For behavioral or mental telehealth, you may use 2-way, interactive, audio-only technology.

Starting January 1, 2023, you may voluntarily report the use of telehealth technology in providing home health (HH) services on HH payment claims. See MLN Matters Article MM12805 for more information.

Starting July 1, 2023, you must include on HH claims:

• G0320: Home health services you furnish using synchronous telehealth you render via real-time audio video telehealth
• G0321: Home health services you furnish using synchronous telehealth you render via telephone or another real-time, interactive, audio-only telehealth
• G0322: The collection of physiologic data the patient digitally stores or transmits to the HH agency

See fact sheet for additional details.

Based on several telehealth-related provisions of the Consolidated Appropriations Act (CAA), 2023 and the CY 2024 PFS final rule, we’re: …

• Allowing teaching physicians to use audio or video real-time communications technology when the resident provides Medicare telehealth services in all residency training locations through the end of CY 2024

SOURCE: Centers for Medicare and Medicaid Services (CMS), Telehealth Services MLN Fact Sheet, Feb. 2024, (Accessed Jul. 2024).

Temporary Policy – Ends Dec. 31, 2024

In the case that the emergency period described in section 1320b–5(g)(1)(B) of this title ends before December 31, 2024, the Secretary shall continue to provide coverage and payment under this part for telehealth services identified in paragraph (4)(F)(i) as of March 15, 2022, that are furnished via an audio-only communications system during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024. For purposes of the previous sentence, the term “telehealth service” means a telehealth service identified as of March 15, 2022, by a HCPCS code (and any succeeding codes) for which the Secretary has not applied the requirements of paragraph (1) and the first sentence of section 410.78(a)(3) of title 42, Code of Federal Regulations, during such emergency period.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) (Accessed Jul. 2024).

This waiver allows the use of audio-only equipment to furnish services described by the codes for audio-only telephone evaluation and management services, and behavioral health counseling and educational services. Unless provided otherwise, other services included on the Medicare Telehealth Services List must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site. Additionally, after the PHE ends, the Consolidated Appropriations Act, 2023 extends availability of the telehealth services that can be furnished using audio-only technology through December 31, 2024. In the CY 2022 Physician Fee Schedule Rule, CMS revised the regulation at 42 CFR § 410.78(a)(3) to permit the use of audio-only equipment for telehealth services furnished to patients in their homes under certain circumstances for purposes of diagnosis, evaluation, or treatment of a mental health disorder (including substance use disorder).

Telephone Evaluation, Management/Assessment and Management Services, and Behavioral Health and Education Services

• During the PHE, a broad range of clinicians, including physicians, have been able to provide certain services by telephone to their patients.
• Medicare payment for the telephone evaluation and management visits (CPT codes 99441-99443) is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020. After the PHE ends, the Consolidated Appropriations Act, 2023 provides for an extension for this flexibility through December 31, 2024.
• When clinicians have furnished an evaluation and management (E/M) service that otherwise would have been reported as an in-person or telehealth visit, using audio-only technology, practitioners have been able to bill using these telephone E/M codes provided that it is appropriate to furnish the service using audio-only technology and all of the required elements in the applicable telephone E/M code (99441-99443) description are met.
• Using section 1135 waiver authority, CMS has been allowing many behavioral health and education services to be furnished via telehealth using audio-only communications. The full Medicare Telehealth Services List notes which services are eligible to be furnished via audio-only technology, including the telephone evaluation and management visits: https://www.cms.gov/Medicare/Medicare-GeneralInformation/Telehealth/Telehealth-Codes.

After the PHE ends, the Consolidated Appropriations Act, 2023 extends availability of the telehealth services that can be furnished using audio-only technology through December 31, 2024.

In the CY 2022 Physician Fee Schedule Rule, CMS revised the regulation at 42 CFR § 410.78(a)(3) to permit the use of audio-only equipment permanent policy for telehealth services furnished to patients in their homes under certain circumstances for purposes of diagnosis, evaluation, or treatment of a mental health disorder (including a substance use disorder).

Opioid Treatment Programs (OTPs): In the CY 2023 PFS final rule, we extended the flexibility for OTPs to furnish periodic assessments via audio-only (telephone) interactions under certain circumstances through the end of 2023.

SOURCE: Centers for Medicare and Medicaid Services, Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19, 11/6/23, (Accessed Jul. 2024).

Periodic Assessments for Opioid Use Disorder (OUD) by Opioid Treatment Provider (OTP) – CMS will extend periodic assessments by OTPs to the end of 2024. The audio-only option will only be available if video is not and to the extent audio-only is permitted by SAMHSA and Drug Enforcement Administration (DEA) and all other relevant requirements.

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Jul. 2024).

Interactive telecommunications system means, except as otherwise provided in this paragraph, multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner. For services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology. A modifier designated by CMS must be appended to the claim for services described in this paragraph to verify that these conditions have been met.

SOURCE: 42 CFR Sec. 410.78 (Accessed Jul. 2024).

Mental Health Services

CMS revised definition of ‘interactive telecommunications system’ above to include audio-only communication technology.  They will create a service-level modifier for use to identify mental health telehealth services furnished to a beneficiary in their home using audio-only communications technology.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215, (Accessed Jul. 2024).

The 2 additional modifiers for CY 2022 relate to telehealth mental health services. The modifiers are:

• FQ – A telehealth service was furnished using real-time audio-only communication technology
• FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology

SOURCE: CY2022 Telehealth Update Medicare Physician Fee Schedule, MLN Matters 12549, (Jan. 1, 2022), (Accessed Jul. 2024).

FQHCs & RHCs Mental Health Services

Mental health visit includes audio-only interaction in cases where beneficiaries are not capable of, or do not consent to, the use of devices that permit a two-way, audio/video interaction for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

RHCs and FQHCs can report and be paid for furnishing those visits in the same way they currently do when these services are furnished in-person. RHCs and FQHCs will be paid for mental health visits furnished via telecommunications technology at the same rate they are paid for in-person mental health visits (that is, the AIR or FQHC PPS).

There must be an in-person mental health service furnished within 6 months prior to the furnishing of the telecommunications service and that in general, there must be an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders.  This applies only to patients receiving services at home.  If the patient and practitioner consider the risks and burdens of an in-person service and agree that, on balance, these outweigh the benefits, and the practitioner documents the basis for that decision in the patient’s medical record, then the in-person visit requirement is not applicable for that 12-month period.

In person requirement delayed under Medicare until on or after January 1, 2025.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215 & delay in implementation in HR 2617 (2022 Session).  (Accessed Jul. 2024).

RHCs and FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. You may use audio-only technology in situations when your patient can’t access or doesn’t consent to use audio-video technology. You can report and get paid in the same way as in-person visits.

• Audio-video visits: Use modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System).
• Audio-only visits: Use new service-level modifier FQ or 93.

These in-person visit requirements apply only to a patient getting mental health visits via telecommunications at home:

• There must be an in-person mental health visit 6 months before the telecommunications visit
• In general, there must be an in-person mental health visit at least every 12 months while the patient is getting services from you via telecommunications to diagnose, evaluate, or treat mental health disorders

NOTE: Section 4113 of the Consolidated Appropriations Act (CAA), 2023, delayed the in-person visit requirements under Medicare for mental health visits that RHCs and FQHCs provide via telecommunications technology. For RHCs and FQHCs, we won’t require in-person visits until January 1, 2025.

SOURCE: Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health Centers, MLN Matters SE22001, (May 23, 2023), (Accessed Jul. 2024).

We may cover these behavioral health and wellness services:

• Interactive telecommunications, including 2-way, interactive audio-only technology to diagnose, evaluate, or treat certain mental health or SUDs using telehealth services if the patient is in their home
  • Hospital clinical staff must have the capability to provide 2-way, interactive, audio-video technology services but may use audio-only technology given an individual patient’s technological limitations, abilities, or preferences
  • You can provide telehealth using 2-way, interactive, audio-only technology through December 31, 2024
  • Telehealth services provided to people in their homes will be paid at the non-facility PFS rate through December 31, 2024
• Marriage and family therapist (MFT) services (also available through telehealth)
• Mental health counselor (MHC) services (also available through an acceptable telehealth mental health disorder service site)
  • Addiction counselors or alcohol and drug counselors who meet the applicable MHC requirements can enroll in Medicare as MHCs
• SUD treatment in a patient’s home (an acceptable telehealth substance use treatment or a co-occurring mental health disorder service site)

Beginning in 2025, in-person visit requirements will apply for mental health services provided by telehealth.

This includes a required in-person visit within the 6 months before the initial telehealth treatment as well as the required subsequent in-person visits at least every 12 months.

We’ll continue to define direct supervision to permit the immediate availability of the supervising practitioner through real-time audio and visual interactive telecommunications through December 31, 2024.

The regulations at 42 CFR 410.78(b)(3)(xiv) describe 2 exceptions to the in-person requirements that take effect on January 1, 2025:

1. Patients who already get telehealth behavioral health services and have circumstances where in-person care may not be appropriate
2. Groups with limited availability for in-person behavioral health visits have the flexibility to arrange for practitioners to provide in-person and telehealth visits with different practitioners, based on availability The telehealth policies described above also apply to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

The telehealth policies described above also apply to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

Beginning January 1, 2024, MHCs and MFTs can provide and bill Medicare telehealth services.

Exceptions to the in-person visit requirement require a clear justification documented in the patient’s medical record. Hospitals must also document that patients have a regular source of general medical care and can get any needed point-of-care testing, including vital sign monitoring and lab studies.

We created 3 Outpatient Prospective Payment System (OPPS)-specific HCPCS codes to describe that the patient must be in their home and that no associated professional service is billed under the PFS. Hospital staff must be licensed to provide these services consistent with all applicable state scope of practice laws. We exempt these services from having staff physically located in the hospital or outpatient department when providing services remotely using communication technology.  See booklet for list of codes.

SOURCE: Centers for Medicare and Medicaid Services, Medicare Learning Network Booklet 1986542, Medicare & Mental Health Coverage, Jan. 2024, (Accessed Jul. 2024).

A mental health visit is a medically-necessary face-to-face encounter between an RHC or FQHC patient and an RHC or FQHC practitioner during which time one or more RHC or FQHC mental health services are rendered. Effective January 1, 2022, a mental health visit is a face-to-face encounter or an encounter furnished using interactive, real-time, audio and video telecommunications technology or audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

The CAA, 2023 extends the telehealth policies of the CAA, 2022 through December 31, 2024 if the PHE ends prior to that date. The in-person visit requirements for mental health telehealth services and mental health visits furnished by RHCs and FQHCs begin on January 1, 2025 if the PHE ends prior to that date. There must be an in-person mental health service furnished within 6 months prior to the furnishing of the mental health service furnished via telecommunications and that an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reasons for this decision in the patient’s medical record.

RHCs and FQHCs are instructed to append modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) in instances where the mental health visit was furnished using audio-video communication technology and to append modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System) in cases where the service was furnished using audio-only communication.

Mental health services that qualify as stand-alone billable visits in an FQHC are listed on the FQHC center website, http://www.cms.gov/Center/Provider-Type/FederallyQualified-Health-Centers-FQHC- Center.html. Services furnished must be within the practitioner’s state scope of practice.

Medicare-covered mental health services furnished incident to an RHC or FQHC visit are included in the payment for a medically necessary mental health visit when an RHC or FQHC practitioner furnishes a mental health visit. Group mental health services do not meet the criteria for a one-one-one, face-to-face encounter in an FQHC or RHC.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, Jan. 26, 2023, pg. 38 (Accessed Jul. 2024).

Communication Technology-Based Services (CTBS)

‘Brief communication technology-based service, e.g. virtual check-in’ allows for real-time audio-only telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Jul. 2024).

Interprofessional consultations are reimbursable by CMS as part of their CTBS services (CPT codes include 99451, 99452, 99446, 99447, 99448, and 99449). Cost sharing will apply. These interprofessional services may be billed only by practitioners that can bill Medicare independently for evaluation and management services.  Includes telephone and internet assessments.

SOURCE CY 2019 Final Physician Fee Schedule. CMS, p. 31-40 (Accessed Jul. 2024).

Online digital evaluation services (e-visit) are reimbursable for physicians and qualified non-physician health care professionals.  These are non-face-to-face codes that describe patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.

SOURCE: CY 2020 Final Physician Fee Schedule. CMS, p. 799 (Accessed Jul. 2024).

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes these services to an RHC or FQHC patient. RHCs and FQHCs receive payment for communication technology-based services or remote evaluation services when an RHC or FQHC practitioner provides at least 5 minutes of communications-based technology or remote evaluation services to a patient who has been seen in the RHC or FQHC within the previous year.

RHCs and FQHCs may only bill for these services when the medical discussion or remote evaluation is for a condition not related to an RHC or FQHC service provided within the previous 7 days, and does not lead to an RHC or FQHC service within the next 24 hours or at the soonest available appointment, since in those situations, Medicare already pays for the services as part of the RHC or FQHC per-visit payment.

RHCs and FQHCs can bill G0511, G0512, and G0071 alone or with other payable services on an RHC or FQHC claim.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, (Accessed Jul. 2024).

RHCs and FQHCs are not eligible for reimbursement of interprofessional consultation services, as only practitioners that can bill Medicare independently for evaluation and management services are eligible.

SOURCE CY 2019 Final Physician Fee Schedule. CMS, p. 31-40 (Accessed Jul. 2024).

Home Health Agencies

An individualized plan of care must be established and periodically reviewed by the certifying physician or allowed practitioner. The plan of care must include all of the following: … Any provision of remote patient monitoring or other services furnished via telecommunications technology (as defined in § 409.46(e)) or audio-only technology. Such services must be tied to the patient-specific needs as identified in the comprehensive assessment, cannot substitute for a home visit ordered as part of the plan of care, and cannot be considered a home visit for the purposes of patient eligibility or payment.

Telecommunications technology, as indicated on the plan of care, can include: remote patient monitoring, defined as the collection of physiologic data (for example, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient or caregiver or both to the home health agency; teletypewriter (TTY); and 2-way audio-video telecommunications technology that allows for real-time interaction between the patient and clinician. The costs of any equipment, set-up, and service related to the technology are allowable only as administrative costs. Visits to a beneficiary’s home for the sole purpose of supplying, connecting, or training the patient on the technology, without the provision of a skilled service, are not separately billable.

SOURCE:  42 CFR Sec. 409.43 & 409.46, (Accessed Jul. 2024).

Starting on or after January 1, 2023, they may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. CMS will require this information on HH claims starting on July 1, 2023. Home Health Agencies will submit the use of telecommunications technology on the HH claim using the following 3 G-codes:

• G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
• G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
• G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)

SOURCE: Telehealth Home Health Services: G-Codes, MLN Matters MM12805, (Effective Date: Jan. 1, 2023), (Accessed Jul. 2024).

Teleradiology

Interpretation Provided Telephonically by Wireless Remote: Teleradiology services (radiology services that do not require a face-to-face encounter with the patient furnished through the use of a telecommunications system) are discussed in Pub. 100-02, Medicare Benefit Policy Manual, chapter 15, section 30. The interpretation of an x-ray, electrocardiogram, electroencephalogram and tissue samples are listed as examples of these services.

In cases where the face-to-face requirement is obviated such as those when a physician/practitioner provides the PC/interpretation of a diagnostic test, from a distant site, the POS code assigned by the physician /practitioner shall be the setting in which the beneficiary received the TC service. The POS code for a teleradiology interpretation is generally the place where the beneficiary received the TC, or face-to-face encounter. The POS code representing the setting where the beneficiary received the TC is entered in the ASC X12 837 professional claim format or in item 24B on the paper claim Form CMS 1500. In cases where it is unclear which POS code applies, the Medicare contractor can provide guidance.

SOURCE: Centers for Medicare and Medicaid Services, Medicare Claims Processing Manual, Ch. 13: Radiology Services and Other Diagnostic Procedures, 11/16/23, pg. 62, (Accessed Jul. 2024).

Opioid Treatment Programs

During the Public Health Emergency (PHE) for the COVID-19 pandemic, as well as after the conclusion of the PHE, therapy and counseling may be furnished using audio-only telephone calls rather than via two-way interactive audio-video communication technology if two-way audio/video communications technology is not available to the beneficiary, provided all other applicable requirements are met, including circumstances in which the beneficiary is not capable of or does not consent to the use of devices that permit a two-way audio/video interaction

OTPs are allowed to furnish the substance use counseling, individual therapy, and group therapy included in the bundle via two-way interactive audio-video communication technology, as clinically appropriate, in order to increase access to care for beneficiaries. In addition, initiation of treatment with buprenorphine (but not methadone) via the OTP intake add-on code may be furnished via two-way audio-video communications technology to the extent that the use of audio-video telecommunications technology to initiate treatment with buprenorphine is authorized by DEA and SAMHSA at the time the service is furnished. For additional information please refer to Section 20 – Definitions relating to OTPs, C. Opioid use disorder treatment service. During the Public Health Emergency (PHE) for the COVID-19 pandemic, as well as after the conclusion of the PHE, therapy and counseling may be furnished using audio-only telephone calls rather than via two-way interactive audio-video communication technology if two-way audio/video communications technology is not available to the beneficiary, provided all other applicable requirements are met, including circumstances in which the beneficiary is not capable of or does not consent to the use of devices that permit a two-way audio/video interaction.

Beginning January 1, 2021, OTPs are allowed to use two-way interactive audio-video communication technology, as clinically appropriate, to furnish the periodic assessment add-on code. Additionally, during the PHE which expired on May 11, 2023, in cases where a beneficiary did not have access to two-way audio-video communications technology, periodic assessments could be furnished using audio-only telephone calls if all other applicable requirements were met. Through the end of CY 2024, in cases where a beneficiary does not have access to two-way audio-video communications technology, periodic assessments can be furnished using audio-only telephone calls if all other applicable requirements are met.

Beginning January 1, 2023, OTPs are allowed to furnish the OTP intake add-on code via two-way audio- video communication technology when billed for the initiation of treatment with buprenorphine, to the extent that the use of audio-video telecommunications technology to initiate treatment with buprenorphine is authorized by DEA and SAMHSA at the time the service is furnished. OTPs are also allowed to use audio- only communication technology to initiate treatment with buprenorphine in cases where audio-video technology is not available to the beneficiary, including circumstances in which the beneficiary is not capable of or has not consented to the use of devices that permit a two-way, audio/video interaction.

OTPs providing intensive outpatient services to Medicare beneficiaries with an OUD shall not receive payment under Medicare part B if the intensive outpatient services are furnished via audio-video or audio-only communications technology.

Telemedicine services should not, under any circumstances, expand the scope of practice of a healthcare professional or permit practice in a jurisdiction (the location of the patient) where the provider is not licensed.

Counseling or therapy furnished via communication technology as part of OUD treatment services furnished by an OTP must not be separately billed by the practitioner furnishing the counseling or therapy because these services would already be paid through the bundled payment made to the OTP.

SOURCE: Centers for Medicare and Medicaid Services, Medicare Benefit Policy Manual, Ch. 17: Opioid Treatment Programs (OTPs), 12/21/23, (Accessed Jul. 2024).

No reference found for email and fax.

* The US Health and Human Services Administration maintains a website that summarizes Medicare policies that includes audio-only allowances.

The telemedicine visit includes synchronous audio or audio-visual communication using HIPAA compliant equipment with the prescriber.

Providers meeting the telemedicine provider requirements listed above must append one of the following modifiers indicating the mode of telemedicine service delivery:

• GT for covered telemedicine services delivered via audio and visual telecommunications.
• FQ for covered telemedicine services delivered via audio only telecommunications.

Additional modifiers may be required. Refer to the chapter of the Provider Billing Manual that describes services provided for further information.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Oct. 2024, (Accessed Nov. 2024).

In a Provider ALERT issued on April 26, 2023, the Alabama Medicaid Agency (Medicaid) indicated audio-only telecommunications would be reimbursed at parity with services delivered face-to-face for dates of services through September 30, 2023, and on October 1, 2023, new rates for audio-only would be established.

Effective immediately, Medicaid will continue to reimburse services rendered via audio-only telecommunications at parity with approved services delivered face-to-face and will continue to monitor utilization.

Providers should refer to Chapter 112 – Telemedicine Services for more information. Claims not billed correctly are subject to post-payment review and recoupments.

SOURCE: AL Medicaid, Provider Alert, Reimbursement for Services Delivered via Audio-Only Telecommunications, 9/11/23, (Accessed Nov. 2024).

Telephone consultations are not covered.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p. 24). Oct. 2024. (Accessed Nov. 2024).

Telephone consultations are not authorized.

SOURCE:  AL Admin. Code r. 560-X-6-.14, (Accessed Nov. 2024).

Therapy Services

*Effective June 1, 2023, procedure codes 92507, 92508, and 92523 can be reimbursed for Audio-Only Telecommunication and only be used in lieu of the audio and video telecommunication where telemedicine is approved by Medicaid.

Providers must place the “FQ” modifier on the claim to designate that the service was rendered via audio only telecommunication method.

Services must be administered via an interactive audio and video telecommunications system which permits two-way communication between the distant site provider and the origination site where the recipient is located (this does not include a telephone conversation, electronic mail message, or facsimile transmission between the provider, recipient, or a consultation between two providers).

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy Services, Oct. 2024, pg. 9 & 17, (Accessed Nov. 2024).

Rehabilitative Services (ASD) – DMH

Acceptable service provision that qualify as Mental Health Care Coordination includes but is not limited to: Telephone or face to face consultation with a contract provider, doctor, therapist, school teacher, school counselor and/or other professional that is working with the child external to your agency regarding the treatment needs of the child.

SOURCE:  AL Medicaid Management Information system Provider Manual, Rehabilitative Services (ASD) – DMH, Oct. 2024, Ch. 110, p. 9, (Accessed Nov. 2024).

Family Planning

For any telephonic encounter a verbal consent is required. A recipient consent for services must be obtained at each Family Planning visit.

SOURCE:  AL Medicaid Management Information system Provider Manual, Appendix C Family Planning, Oct. 2024, C-1, (Accessed Nov. 2024).

Targeted Case Management

Some core elements of targeted case management can be provided through telephone.  See manual.

SOURCE:  AL Medicaid Management Information system Provider Manual, Targeted Case Management, Oct. 2024, Ch. 106, (Accessed Nov. 2024).

Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP)

Care management activities can be provided in person, virtually and telephonically as indicated in each population’s Care Management Activity Schedule, Care Management Activity Criteria, and the ACHN Payment, Activity, & staffing documents.

Examples of duties to be completed by these staff members include but are not limited to assessments, reassessments, care plan development and monitoring, referrals, case documentation, face-to-face and virtual or telephonic encounters with recipients.

The following components of care management visits/encounters maybe provided telephonically, face to face, or virtually according to the applicable Care Management Activity Schedule. Below is more information on these components.

Telephonic Encounters

The Agency’s expectation for telephonic encounters requires a team approach to the delivery of thorough, conscientious, and person-centered care management that is consistent with that of face-to-face visits. Telephonic encounters may be provided as outlined in each population’s Care Management Activity Schedule.

Prior to providing services a verbal consent to receive care management services shall be discussed and obtained from the recipient. Documentation of a verbal consent shall be maintained in the HIMS for each date of service for which payment is requested.

Some case management tasks can be completed via text messages (e.g., texting a recipient to notify them of a scheduled call, or to advise them of your attempts to reach). However, no paid care management activity is allowed via text messaging. The PCCM-e must adhere to all HIPAA standards regarding texting recipients for the provision of health care services.

See manual for more details.

SOURCE:  AL Medicaid Management Information system Provider Manual, Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP), Oct. 2024, Ch. 40,(Accessed Nov. 2024).

Early Intervention Services

The 6 month review can be done via telephone with the parent by the therapist or special instructor. A sign-in sheet is required as documentation for billing the 6 month review

Service may be provided in the child’s natural environment or via telephone or various videoconference mediums.

* An exception to face-to-face contacts is the 6 month review of the treatment plan. The 6 month review plan is allowable to be billed when the service plan is reviewed by telephone. It may still be done face-to-face if preferred by the parent.

SOURCE:  AL Medicaid Management Information system Provider Manual, Early Intervention Services, Oct. 2024, Ch. 108, (Accessed Nov. 2024).

Waiver Services

Personal Emergency Response System Services (PERS) (S5160Modifier UD – LAH) (S5160Modifier UC – ID) (S5160Modifier UD/HW – LAH) (S5160Modifier UC/HW – ID) (S5161Modifier UD – LAH) (S5161Modifier UC – ID) (S5161Modifier UD/HW – LAH) (S5161Modifier UC/HW – ID) Personal Emergency Response System (PERS) Services provides a direct telephonic or other electronic communications link between waiver recipients and health professionals to secure immediate assistance in the event of a physical, emotional or environmental emergency. PERS may also include cellular telephone service used when a conventional PERS is less cost-effective or is not feasible. PERS may include installation, monthly fee (if applicable), upkeep and maintenance of devices or systems as appropriate.

SOURCE:  AL Medicaid Management Information system Provider Manual, Waiver Services, Oct. 2024, Ch. 107, p. 39, (Accessed Nov. 2024).

Pharmacy

Prescriptions dispensed by telephone for drugs other than Schedule II drugs are acceptable without subsequent signature of the practitioner.

Over-the-counter medications require a prescription from a physician or other practitioner legally licensed by the State of Alabama to prescribe the drugs authorized under the program. Telephone prescriptions are acceptable for OTCs.

Hemophilia Management Standards of Care: A pharmacist, nurse, and/or a case representative assigned to each patient.  A case representative shall maintain, at a minimum, monthly telephone contact with the patient or family/caregiver.

SOURCE:  AL Medicaid Management Information system Provider Manual, Pharmacy Services, Oct. 2024, Ch. 27, p. 5, 14, 25, (Accessed Nov. 2024).

Procedure Code Modifier:

• Two-Way Audio-Video Technology: GT or 95
• Store-and-Forward: GQ
• Two-Way Audio Only Technology : FQ and 93

Procedure Codes Defined as Audio Only: Failure to include either modifier FQ or modifier 93 will result in denial of payment for audio only services.

Patient Initiated Online Digital Services: Do not use telehealth modifiers when billing CPT codes 98970 – 98972 and 99421 – 99423.

Telehealth for Acute Stroke: Use procedure code modifier G0 (G-Zero) and the appropriate telehealth modifier (GT, 95, GQ, or FQ).

Helpful Hint: Modifier G0 (G-Zero) often gets confused with GO (G-Oh). Please ensure the appropriate modifier is utilized when billing either G0 (G-Zero) or GO (G-Oh).

If my business limits telehealth to two-way audio only and online digital services, do I need to register my business on the Telehealth Registry?

Yes: Two-way audio only and online digital services are considered forms of telehealth and require your business to be on the telehealth registry.

Does Medicaid cover patient-initiated telephone services?

Yes: Medicaid covers patient-initiated telephone services for established patients. Refer to the Telehealth Services Temporary Fee Schedule, for more information on who can be reimbursed for these services.

What is a patient-initiated telephone service?

Patient-initiated telephone service CPT codes are meant to be used when an evaluation, management, or assessment is done over the phone with a patient who has contacted the provider for a healthcare related reason.

• Separately Reimbursable Communications: Patient-initiated telephone-based communication for evaluation, management, or assessment of a patient who has reported a healthcare problem. Documentation must include the healthcare discussion that occurred, and the evaluation, management, or assessment provided.
• Non-Covered Communications: Patient-initiated telephone-based communication for healthcare reasons that do not involve an evaluation, management, or assessment of the patient and administrative functions such as updating the patient’s insurance, scheduling, and appointments.
• Provider Initiated Communications: Providers are not prohibited from initiating telephone-based communication, but these functions are not reimbursable services.

What provider types are authorized to bill for patient-initiated telephone services?

CPT Codes 98966-98968: Covered for behavioral health aides under the direction of a physician, psychologists, and school districts enrolled as a school-based services provider. Federally Qualified Health Centers and Rural Health Centers may be reimbursed at their encounter rate for services provided by licensed clinical social workers, marital and family therapists, professional counselors, and psychologists.

CPT Codes 99441-99443: Covered for advanced practice registered nurses, audiologists, Community Health Aides, direct entry midwives, optometrists, physicians, physician assistants, and podiatrists. Federally Qualified Health Centers and Rural Health Clinic may be reimbursed at the facility’s encounter rate for services provided by a rendering providers listed here.

When are patient-initiated telephone services separately reimbursable?

Two-Way Audio Only services that are patient-initiated are separately reimbursable when billed using CPT codes 98966-98968 or 99441-99443. Per AMA coding guidelines, patient-initiated telephone services are separately reimbursable if the communication meets all of the below criteria:

Established Patient: Member is an established patient

Evaluative in Nature: Service is to evaluate, assess, or manage the member’s health

Patient-Initiated: Call must be patient initiated without prompting

No other Affiliated Service: Not separately reimbursable if affiliated to another evaluation and management service, assessment, or procedure. The online digital service is not reimbursable if the communication:

• leads to another in-person or telehealth (asynchronous or synchronous) visit related to the illness, injury, or other reason within 24 hours or soonest available,
• is related to an in-person or telehealth (asynchronous or synchronous) during the previous 7 days, or
• is related to a surgery or procedure occurring within the post-operative or global period.

Is there a limit to how many patient-initiated telephone services may be reimbursed?

Yes: Alaska Medicaid will reimburse up to 1 patient-initiated telephone service per day, per member.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Nov. 2024).

The department shall pay for all services covered by the medical assistance program provided through telehealth in the same manner as if the services had been provided in person, including …

• Services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio

SOURCE: AK Statute Sec. 47.07.069, (Accessed Nov. 2024).

Alaska Medicaid will not pay for

• The use of telemedicine equipment and systems
• Services delivered by telephone when not part of a dedicated audio conference system
• Services delivered by facsimile

Note: Manual is under review.

SOURCE: State of AK Dept. of Health and Social Svcs., Alaska Medical Assistance Provider Billing Manuals for Physician, ARNP, PA Services (5/13), p. 31, (Accessed Nov. 2024).

Subject to the requirements of 7 AAC 110.620 – 7 AAC 110.639, the department will pay for a service delivered by means of one of the following telehealth modalities if the modality and use of the modality meet the requirements of P.L. 104 – 191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA)):

• synchronous: live or interactive, through a real-time, interactive …
  • two-way audio-only technology that allows for oral communication between the provider and the recipient

SOURCE: AK Admin Code, Title 7, 625 (Accessed Nov. 2024).

Tribal FQHC

Will my facility be able to continue to provide telemedicine (video-audio synchronous) and telephonic (audio-only) behavioral health services as a Tribal FQHC?

Refer to the most current guidance document on telehealth: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Updates/20230919_Telehealth_FAQs.pdf.

Telehealth Services. Will my facility be able to provide telemedicine (video-audio synchronous), telephonic (audio-only), and store and forward telehealth services and be reimbursed for those services as a Tribal FQHC?

Yes, telehealth services regulations were effective 9/1/2023. Refer to the most current guidance on telehealth services: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Sites/Telehealth.html

SOURCE:  Alaska Medicaid, FAQs on Tribal FQHCs, (Accessed Nov. 2024).

Telehealth – Audio Only: The practice of synchronous (real-time) health care delivery, through interactive audio-only communications.

SOURCE: AZ Health Cost Containment System, AHCCCS Contract and Policy Dictionary, 9/24, pg. 109, (Accessed Oct 2024).

The Contractor and FFS Programs shall cover audio-only services if a telemedicine encounter is not reasonably available due to the member’s functional status, the member’s lack of technology or telecommunications infrastructure limits, as determined by the provider. To submit a claim for an audio-only service, the provider shall make the telehealth services generally available to members through telemedicine.

The Contractor and FFS Programs shall reimburse providers at the same level of payment for equivalent in-person office/facility setting for mental health and substance use disorder services, as identified by HCPCS, if provided through telehealth using an audio-only format.

The AHCCCS Telehealth code set defines which codes are billable as an audio-only service and the applicable modifier(s) and place of service providers shall use when billing for an audio-only service.

SOURCE: AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. 300, (320-I pg. 4). Approved 8/29/23, p. 4. (Accessed Oct. 2024).

AHCCCS covers all major forms of telehealth services. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Telephonic services (audio-only) use a traditional telephone to conduct health care appointments. Telemedicine involves interactive audio and video, in a real-time, synchronous conversation. AHCCCS also covers telehealth for remote patient monitoring and teledentistry.

A list of reimbursable codes for permanent telephonic delivery is linked on the AHCCCS Telehealth Services webpage.

SOURCE: AZ Health Care Cost Containment System. Telehealth Services, (Accessed Oct. 2024).

Two HCPCS codes are included in this section of the 2022/2023 Fee Schedule:

• G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
• G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

SOURCE: AZ Administrative Code Title 20, Ch. 5, pg. 424-425. (Accessed Oct. 2024).

Telephonic Crisis Intervention Services (Telephone Response) (H0030):  H0030 can only be utilized by a provider that is part of the state crisis system and contracted with an ACC-RBHA to provide telephonic crisis intervention services. Claims submitted to DFSM will be denied with instructions to bill to the ACC-RBHA.

SOURCE: Fee-for-Service Provider Billing Manual Behavioral Health Services, Ch. 19, p. 21 (Revised 7/8/24), (Accessed Oct. 2024).

Effective 7/1/2020, HCPCS code H0030 (Behavioral Health Hotline Service) shall replace T1016 as the dedicated crisis telephone billing code. The applicable rates and modifiers for crisis telephone billing that were valid for T1016 will now be valid for H0030. This includes modifiers HO (Master’s Degree level), HN (Bachelor’s Degree level) and ET (Emergency Services).

Note: Providers rendering telephonic crisis services to Tribal ALTCS members shall also bill for these services with H0030.

SOURCE:  Fee for Service Provider Billing Manual, IHS/Tribal Billing Manual, Ch. 12 Behavioral Health, (Revised 2/11/23) pg. 11-12, (Accessed Oct. 2024).

Behavioral Health Crisis Services and Care Coordination

Crisis services are provided in a variety of settings, such as face-to-face at an individual’s home, in the community or via telehealth (inclusive of services provided via text, chat, and phone).

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Behavioral Health Crisis Services and Care Coordination, Ch 590, (pg. 3), Approved 7/10/24. (Accessed Oct. 2024).

Ongoing support to maintain employment may be provided individually or in a group setting, as well as telephonically.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Title XIX/XXI Behavioral Health Service Benefit, Ch 310-B, (pg. 6), Approved 9/15/22. (Accessed Oct. 2024).

Direct Care Services

The initial supervisory/monitoring visit is required by the 5th day from the initial service provision and shall not occur on the same day as the initial service provision. For homemaker services only, the 5th day supervisory/monitoring visit (depending on the nature of the care being performed) may be conducted telephonically.

SOURCE: AZ Medical Policy for AHCCCS Covered Services. Direct Care Services, Ch 1240-A, (pg. 8), Approved 5/21/24. (Accessed Oct. 2024).

A health benefit plan (includes Medicaid) may voluntarily reimburse for healthcare services provided through Sec. 23-79-1601(7)(C).  See below.

For the purposes of this subchapter, “telemedicine” does not include the use of:

• Audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan.
• As with other medical services covered by a health benefit plan, documentation of the engagement between patient and provider via audio-only communication shall be placed in the medical record addressing the problem, content of conversation, medical decision-making, and plan of care after the contact.
• The documentation described in subdivision (7)(C)(i)(b) of this section is subject to the same audit and review process required by payers and governmental agencies when requesting documentation of other care delivery such as in-office or face-to-face visits;
• A facsimile machine;
• Text messaging; or
• Email.

SOURCE: AR Code 23-79-1602 & 1601(7)(c). (Accessed Oct. 2024).

Telemedicine does not include the use of:

• Audio-only communication unless the audio-only communication is in real-time, is interactive, and substantially meets the requirements for a health care service that would otherwise be covered by the health benefit plan:
  • Documentation of the engagement between patient and provider via audio-only communication shall be placed in the medical record addressing the problem, content of the conversation, medical decision-making, and plan of care after the contact;
  • Medical documentation is subject to the same audit and review process required by payers and governmental agencies when requesting documentation of other care delivery such as in-office or face-to-face visits;
• A facsimile machine;
• Text messaging; or
• Email

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190. Updated Jan. 1, 2022, (Accessed Oct. 2024).

Provider-Led Arkansas Shared Savings Entity (PASSE) Program

The following activities will not be considered a reportable encounter when delivered to a member of the PASSE:

• Audio-only communication including without-limitation, interactive audio;
• A facsimile machine;
• Text messaging; or
• Electronic mail systems

SOURCE: PASSE Program, (1/1/23).  (Accessed Oct. 2024).

Targeted Care Management – Covered Case Management Services

Face to face or telephone contacts with the beneficiary and/or other individuals for the purpose of assisting in the beneficiary’s needs being met

1. Communications through FAX or email are covered when the purpose of the communication is to gather information from an individual other than the beneficiary AND the purpose of the communication meets the TCM service definition.
2. Billable communication is limited to time spent sending emails and/or faxes. Receiving faxes and/or emails is not a billable TCM service.  Hard copies of emails and faxes must be maintained in the beneficiary’s file for audit purposes by the Arkansas Medicaid Program or its representatives.  Documentation must support all claims for Medicaid reimbursement, as is currently required by the Medicaid Program.
3. Communications through fax or email is not billable when communication is with the beneficiary.

SOURCE: Targeted Case Management, 213.000 p. II-8, (Updated 10/1/12, overall manual updated 8/1/21).  (Accessed Oct. 2024).

Life360 HOMES

The Rural Life360 will provide the following care coordination supports: … Provide intensive care coordination and coaching supports for enrolled clients. Intensive care coordination and coaching include: … Providing supports through any of the following:

1. Home visits in such frequency as is necessary to assist the client meet his/her documented PCAP goals
2. Office visits
3. Video-supported visits
4. Telephone or text message contacts in conjunction with in-person visits

SOURCE: AR Medicaid Provider Manual. Section II Life360 HOMES.  Rule 210.500 & 210.600, Updated 11-1-23. (Accessed Oct. 2024).

Life Choices Lifeline and Continuum of Care Program

Program services may be provided, as appropriate, in person through existing facilities or remotely through a telephonic system or other comparable technological system. Any technological or telephonic system used must maintain the confidentiality of Participant information obtained while providing Program services, including security of data in compliance with HIPAA and HITECH, and all state or federal privacy laws.

SOURCE:  AR Rules for Life Choices Lifeline and Continuum of Care Program, Sec. 102, (Lexis Nexis: 016 Dep of Human Services, 29 Div. of Medical Services, 009 Developmental Screens for Children),  (Accessed Oct. 2024).

For services or benefits provided via synchronous telephone or other real-time interactive audio-only telecommunications systems, the health care provider bills with modifier 93.

Modifier 93 must be used for Medi-Cal covered benefits or services delivered via synchronous, telephone or other interactive audio-only telecommunications systems. Only the portion(s) of the telehealth service rendered at the distant site are billed with modifier 93. The use of modifier 93 does not alter reimbursement for the CPT or HCPCS code.

Health care providers must use an interactive audio-only telecommunications system that permits real-time communication between the provider at the distant site and the patient at the originating site. The audio telehealth system used must, at a minimum, have the capability of meeting the procedural definition of the code provided through telehealth. The telecommunications equipment must be of a quality or resolution to adequately complete all necessary components to document the level of service for the CPT code or HCPCS code billed.

The totality of the communication of information exchanged between the provider and the patient during the audio-only service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

Providers must document in the patient’s medical file that the patient has given a written or verbal consent to the audio-only telehealth encounter.

See Telehealth Modifier Reference Sheet- Organized by Delivery System​​ ​for more information on modifiers.

Brief Virtual Communications and Check-ins

Virtual or telephonic communication includes a brief communication with an established patient not physically present (face-to-face). Medi-Cal providers may be reimbursed using HCPCS codes G2010 and G2012 for brief virtual communications.

HCPCS code G2012: Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5 to 10 minutes of medical discussion. G2012 can be billed when the virtual communication via a telephone call.

Establishing a Relationship

Providers may establish a relationship with new patients via audio-only synchronous interaction only if one or more of the following applies:

• The visit is related to sensitive services as defined in subsection (n) or Section 56.06 of the Civil Code. Section 56.06 of the Civil Code defines “sensitive services” as all health care services related to mental or behavioral health, sexual and reproductive health, sexually transmitted infections, substance use disorder, gender-affirming care, and intimate partner violence, and includes services described in Sections 6924 through 6930 of the Family Code, and Sections 121020 and 124260 of the Health and Safety Code, obtained by a patient at or above the minimum age specified for consenting to the service specified in the section.
• The patient requests an audio-only modality.
• The patient attests they do not have access to video.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth (Mar. 2024). Pg. 3, 8-9, 12. (Accessed Jun. 2024).

The department shall reimburse health care providers of applicable health care services delivered via synchronous audio-only modality at payment amounts that are not less than the amounts the provider would receive if the services were delivered via in-person, face-to-face contact, so long as the services or settings meet the applicable standard of care and meet the requirements of the service code being billed.

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a Medi-Cal provider furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice. The department may provide specific exceptions to this requirement specified in subparagraph based on a Medi-Cal provider’s access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, a provider furnishing services through video synchronous interaction or audio-only synchronous interaction shall also maintain and follow protocols to do one of the following:

• Offer those services via in-person, face-to-face contact.
• Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care. (This clause does not require a provider to schedule an appointment with a different provider on behalf of the patient.)
• In implementing this subdivision, the department shall consider additional recommendations from affected stakeholders regarding the need to maintain access to in-person services without unduly restricting access to telehealth services.

A health care provider shall not establish a new patient relationship with a Medi-Cal beneficiary via telephonic (audio-only) synchronous interaction except:

• when the visit is related to sensitive services, as defined in subdivision (n) of Section 56.05 of the Civil Code, and when established in accordance with department specific requirements and consistent with federal and state law, regulations and guidance
• when the patient requests an audio-only modality or attests they do not have access to video, and when established in accordance with department specific requirements and consistent with federal and state laws, regulations and guidance.

SOURCE: Welfare and Institutions Code 14132.725. (Accessed Jun. 2024).

Patient Choice of Telehealth Modality

Medi-Cal providers can offer a variety of telehealth modalities for covered Medi-Cal services to the extent that the service can be appropriately rendered via the allowable telehealth modalities. For Medi-Cal providers who do offer telehealth modalities, they are required to offer Medi-Cal recipients the ability to choose whether they want to receive covered Medi-Cal services via:

• Synchronous, interactive audio/visual telecommunication systems (for example, video) or
• Synchronous, telephone or other interactive audio-only telecommunications systems.

While Medi-Cal providers are required to offer both video and telephone telehealth modalities, Medi-Cal recipients may freely choose, and change at any time, their desired telehealth modalities, which includes the ability to decline video modalities and select audio-only (telephone) modalities if preferred and/or necessary given the recipient’s needs. For example, if the visit is related to sensitive services as defined in subsection (s) of Section 56.05 of the Civil Code, then the Medi-Cal recipient may prefer to utilize an audio-only (telephone) modality. Medi-Cal recipients shall be given the choice of how they receive their covered Medi-Cal services.

Exception to Telehealth Modalities Provider Requirement

Since broadband is necessary to ensure quality and effective communication between Medi-Cal providers and recipients, Medi-Cal providers are exempt from the requirement to offer both telehealth modalities if the Medi-Cal provider does not have access to broadband. Note: Broadband refers to high-speed internet access that is always on and faster than traditional dial-up access. Broadband includes several high-speed transmission technologies, such as fiber, wireless, satellite, digital subscriber line, and cable. For the purposes of delivering telehealth services to patients, DHCS uses the Federal Communications Commission’s (FCC) definition of broadband and the FCC minimum mbps upload/download speeds. Medi-Cal providers claiming this exception must maintain appropriate supporting documentation, which should be made available to DHCS upon request. For example, supporting documentation might include confirmation from an internet services provider regarding the lack of broadband service in a particular coverage area.

Right to In-person Services 

Medi-Cal providers furnishing services to Medi-Cal recipients through telehealth modalities must also either offer services in-person or have a documented process in place to link Medi-Cal recipients to in-person care within a reasonable time if in-person services are unavailable from the provider.

If the Medi-Cal provider chooses to link the Medi-Cal recipient to in-person care to satisfy this requirement, then they must provide a referral to and facilitation of in-person care that does not require a recipient to independently contact a different Medi-Cal provider to arrange for such care. The Medi-Cal provider may initiate a process by which a different Medi-Cal provider in their office or an affiliated in-person care site contacts the Medi-Cal recipient directly to schedule an in-person visit.

The referring Medi-Cal provider or a member of their staff must confirm the referred Medi-Cal provider has at least attempted to contact the recipient to schedule an in-person appointment. However, the Medi-Cal referring provider is not required to schedule an appointment with a different provider on behalf of the Medi-Cal recipient. The Medi-Cal provider must offer referral and facilitation support that is minimally burdensome to the Medi-Cal recipient. Medi-Cal providers must maintain documentation of their process to link Medi-Cal recipients to in-person care, which should be made available to DHCS upon request.›

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth (Mar. 2024). Pg. 6-7. (Accessed Jun. 2024).

FQHCs/RHCs 

An audio-only synchronous interaction is eligible for reimbursement if provided by a billable provider and FQHC or RHC patient.

Medi-Cal benefits or services being provided are clinically appropriate and meet the procedural and billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter.

A patient may not be “established” using an audio-only synchronous interaction unless the visit is related to a “sensitive service”, as defined in the California Civil Code, section 56.05, subdivision (n), or if the patient requests “audio only” or does not have access to video.

SOURCE: CA Dept. Health Care Services, Medi-Cal Part 2 RHCs and FQHCs Manual, (Mar. 2024), p 16. (Accessed Jun. 2024).

Visits shall also include an encounter between an FQHC or RHC patient and a physician, physician assistant, nurse practitioner, certified nurse-midwife, clinical psychologist, licensed clinical social worker, visiting nurse, comprehensive perinatal services program practitioner, dental hygienist, dental hygienist in alternative practice, or marriage and family therapist using audio-only synchronous interaction, when services delivered through that modality meet the applicable standard of care. A visit described in this clause shall be reimbursed at the applicable FQHC’s or RHC’s per-visit PPS rate to the extent the department determines that the FQHC or RHC has met all billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter.

An FQHC or RHC may not establish a new patient relationship using an audio-only synchronous interaction. Notwithstanding this prohibition, the department may provide for specific exceptions to this prohibition, which shall be developed in consultation with affected stakeholders and published in departmental guidance. Exceptions shall include but not be limited to:

• An FQHC or RHC may establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services, as defined in subdivision (n) of Section 56.05 of the Civil Code, or when the patient requests an audio-only modality or attests they do not have access to video – in accordance with department-specific requirements and consistent with federal and state laws, regulations, and guidance.

Pursuant to an effective date designated by the department that is no sooner than January 1, 2024, an FQHC or RHC furnishing applicable health care services via audio-only synchronous interaction shall also offer those same health care services via video synchronous interaction to preserve beneficiary choice. The department may provide specific exceptions to the requirement based on an FQHC’s or RHC’s access to requisite technologies, which shall be developed in consultation with affected stakeholders and published in departmental guidance.

Effective on the date designated by the department pursuant to above, an FQHC or RHC furnishing services through video synchronous interaction or audio-only synchronous interaction shall also do one of the following:

• Offer those services via in-person, face-to-face contact.
• Arrange for a referral to, and a facilitation of, in-person care that does not require a patient to independently contact a different provider to arrange for that care.

SOURCE: Welfare and Institutions Code 14132.100. (Accessed Jun. 2024).

In regard to patient choice of telehealth modality and right to in-person services requirements, FQHC/RHC providers are directed to refer to the policies found in more detail in the Telehealth Manual.

SOURCE: CA Dept. of Health Care Services, Part 2 Manual, Medi-Cal Rural Health Clinics and Federally Qualified Health Centers (Mar. 2024), p. 15.  (Accessed Jun. 2024).

Telehealth services, telephonic services and other specified services must be reimbursed when provided by specific entities during or immediately following an emergency, subject to the Department obtaining federal approval and matching funds and Department guidance.

SOURCE: Welfare and Institutions Code Sec. 14132.723. (Accessed Jun. 2024).

The department shall seek any federal approvals it deems necessary to extend the approved waiver or flexibility implemented pursuant to subdivision (a), as of July 1, 2021, that are related to the delivery and reimbursement of services via telehealth modalities in the Medi-Cal program, including audio-only. The department shall implement those extended waivers or flexibilities for which federal approval is obtained, to commence on the first calendar day immediately following the last calendar day of the federal COVID-19 public health emergency period, and through December 31, 2022.

For purposes of informing the 2022–23 proposed Governor’s Budget, released in January 2022, the department shall convene an advisory group consisting of consultants, subject matter experts, and other affected stakeholders to provide recommendations to inform the department in establishing and adopting billing and utilization management protocols for telehealth modalities to increase access and equity and reduce disparities in the Medi-Cal program. The advisory group shall analyze the impact of telehealth in increased access for patients, changes in health quality outcomes and utilization, best practices for the appropriate mix of in-person visits and telehealth, and the benefits or liabilities of any practice or care model changes that have resulted from telephonic visits.

SOURCE: AB 133, Sec. 380 (2021 Session). (Accessed Jun. 2024).

IHS-MOA/Tribal FQHC

An audio-only visit is eligible for reimbursement if provided by a billable provider, regardless of the location of the patient or provider.

SOURCE: DHCS IHS Manual. May 2023. Pg. 9; Tribal FQHC May 2023, p. 13. (Accessed Jun. 2024).

Vision Services

Asynchronous telecommunications system (store and forward telehealth) in single media format does not include telephone calls, images transmitted via facsimile machine, and text messages without visualization of the patient (electronic mail).

SOURCE: CA Department of Health Care Services. Medi-Cal Professional Services Manual. Page 6. (Dec. 2022). (Accessed Jun. 2024).

LEA Services

Allowable services delivered via telehealth must be synchronous telehealth service rendered via a real-time interactive audio and video telecommunications system only. LEA-BOP does not currently allow audio-only telehealth (Modifier 93).

SOURCE: CA Department of Health Care Services. Medi-Cal Local Educational Agency (LEA) Telehealth Manual. Page 3. (Jun. 2023); DHCS Telehealth Modifier Reference Sheet. (Accessed Jun. 2024).

SOURCE: CA Department of Health Care Services. Family PACT Clinical Services manual. May 2024. Pg. 8, 10. (Accessed Jun. 2024).

A Family PACT provider may enroll and recertify clients through synchronous video or audio-only synchronous telehealth modalities. See manual for more information.

SOURCE: CA Department of Health Care Services. Family PACT Client Eligibility Manual. Apr. 2023. Pg. 1. (Accessed Jun. 2024).

Children’s Services Program

CCS providers must request prior authorization services from CCS paneled physicians (22, CCR Section 41412) who are available to provide telehealth services. Prior authorization requests are also authorized to CCS-approved hospitals and outpatient special care centers. GHPP providers must be Medi-Cal enrolled providers.

Physical and Occupational Therapy may be offered through appropriate telehealth modalities. Medical Therapy Unit therapists may offer remote/virtual teletherapy services as an alternative to in-person visits, as appropriate and directed by the Medical Therapy Conference and directing physicians. CCS clients receiving services through a Special Care Center and/or Medical Therapy Program Medical Therapy Conference must have an annual in-person evaluation by a CCS-paneled physician. GHPP clients require an annual evaluation to ensure continued program coverage.

Billing for telehealth services is contingent upon the CCS Program or GHPP clients meeting all eligibility criteria, with an approved CCS Program/GHPP SAR, and in conformance with required Medi-Cal claims submission procedures as outlined in the DHCS Medi-Cal Telehealth Policy.

• When submitting a SAR for synchronous telemedicine services, the provider must use codes provided in the American Medical Association (AMA’s) CPT Manual, Appendix P.
• Telehealth modifiers (93, 95 or GQ) are required on SARs to differentiate the telehealth service from the equivalent in-person service.
• For services or benefits provided via synchronous, telephone or other interactive audio-only telecommunications systems, the health care provider bills with modifier 93.
• For services or benefits provided via asynchronous store-and-forward telecommunications systems, the health care provider bills with modifier GQ.

For Whole Child Model (WCM) counties, the client’s managed care plan (MCP) shall be responsible for authorizing, coordinating, and covering CCS telehealth services.

For eligible California Children’s Services (CCS) Service Code Grouping (SCG) codes, see the California Children’s Services (CCS) Program Service Code Groupings excel sheet.

SOURCE: Department of Health Care Services. Numbered letter 03-0723 to the Children’s Services Program and Genetically Handicapped Persons Program (GHPP). Jul. 7, 2023 – supersedes Department of Health Care Services. Numbered letter 16-1217 to the CA Children’s Services Program and Genetically Handicapped Persons Program (GHPP).  Dec. 22, 2017. (Accessed Jun. 2024).

Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat as long as the technologies are compliant with HIPAA.  The health care or mental health care services are subject to reimbursement policies developed pursuant to the medical assistance program. Reimbursement rate must be, at minimum, the same as a comparable in-person services.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Aug. 2024).

No reimbursement for provider-to-provider consultations provided by telephone (interactive audio), email or facsimile machines.

All rendering providers must bill the appropriate procedure code using Place of Service code 02 or 10 and the appropriate modifiers FQ or FR on the CMS 1500 paper claim form or as an 837P transaction.

Modifiers FQ, FR, 93, and 95 can be added to POS 02 and 10:

• FQ: The service was furnished using audio-only communication technology.
• FR: The supervising practitioner was present through two-way, audio/video communication technology.
• 93: Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System
• 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

FQHCs/RHCs/IHS

Health First Colorado allows telemedicine visits to qualify as billable encounters for Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs), and Indian Health Services (IHS). Services allowed under telemedicine may be provided via telephone, live chat, or interactive audiovisual modality for these provider types.

Physical Therapy, Occupational Therapy, Home Health, Hospice and Pediatric Behavioral Health Providers

Physical therapists, occupational therapists, hospice, home health providers and pediatric behavioral health providers are eligible to deliver telemedicine services.

1. Home Health Agency services and therapies, Hospice, and Pediatric Behavioral Treatment may be provided via telephone-only.
2. Outpatient Physical, Occupational, and Speech Therapy services must have an interactive audio/visual connection with the member to be provided via telemedicine.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 5/24. (Accessed Aug. 2024).

Behavioral Health

“Telehealth” means delivery of services through telecommunications systems that are compliant with all federal and state protections of individual privacy, to facilitate individual assessment, diagnosis, consultation, treatment, and/or service planning/case management when the individual and the person providing services are not in the same physical location. Telecommunications systems used to provide telehealth include information, electronic, and communication technologies. Telehealth may include audio-only methods in accordance with state and federal regulation unless noted otherwise.

“Session” means a face-to-face, telehealth, or audio-only interaction of the individual and personnel. Session may include but is not limited to individual therapy, group therapy, medication-assisted treatment education and/or monitoring, family therapy, peer professional services, educational/occupational groups, recreational therapy, intake, discharge, service planning, and other therapies.

Services may be provided through synchronous audio-visual methods but must not include text-only methods such as text message or email. Some services may be provided through audio-only methods according to state and federal regulations. If audio-only methods are used, the following must be noted in the individual record:

• The reason that audio-visual methods were not utilized.
• The clinical determination of appropriateness for service delivery method.

Screenings should be conducted in-person unless contraindicated. If contraindicated, screenings may be conducted via audio-visual or audio only telehealth. Clinical rationale must be documented in the case of a telehealth screening.

A peer support professional may provide services in a variety of settings, if permitted access, that may include but are not limited to audio-visual or audio-only telehealth.

Outpatient services may be delivered via in-person, audio-visual telehealth, or audio-only telehealth format in accordance with part 2.9 of these rules.

For purposes of Criminal Justice-Involved Individuals, services do not include consistent and regular in-session use of audio-only telehealth.

“Face-to-Face clinical assessment” means a formal and continuous process of collecting and evaluating information about an individual for service planning, treatment, referral, and funding eligibility as outlined in 21.190, and takes place at a minimum upon a request from the responsible person for funded services through the Children and Youth Mental Health Treatment Act. This information establishes justification for services and Children and Youth Mental Health Treatment Act funding. The child or youth must be physically in the same room as the professional person during the Face-to-Face clinical assessment. If the child is out of state or otherwise unable to participate in a Face- to-Face assessment, video technology may be used. If the Governor or local government declares an emergency or disaster, telephone may be used. Telephone shall only be used as necessary because of circumstances related to the disaster or emergency.

SOURCE: 2 CO Code of Regulation 502-1, 1.2, p. 18, 2.9, p. 40, 10.1, p. 174, 21.200.41, p. 357. (Accessed Aug. 2024).

Effective for dates of service on and after May 12, 2023, which is the first day after the federal COVID-19 public health emergency declaration ends, in accordance with sections 17b-245e and 17b-245g of the Connecticut General Statutes, the Department of Social Services (DSS) is issuing new guidance for services eligible for reimbursement under the Connecticut Medical Assistance Program (CMAP) when rendered via telehealth. DSS will continue to reimburse for specified services when rendered via telehealth as detailed in Provider Bulletin 2023-38 and on the CMAP Telehealth Table. This guidance applies to services rendered under CMAP for all HUSKY Health members.

Telehealth includes:

• telemedicine (synchronized audio-visual two-way communication services) and,
• where specified by DSS, audio-only two-way synchronized communication services delivered via telephone.

Comprehensive information regarding the specific procedure codes eligible are posted on the CMAP Telehealth Webpage. This web page will provide information on telehealth requirements, approved procedure codes, required modifiers, specific policy criteria and/or limitations, effective dates, and other telehealth policy information, including the Telehealth FAQs. Providers are responsible for verifying coverage of a specific procedure code as a telehealth service as well as a covered service on their applicable fee schedule prior to delivering and billing CMAP for the service.

The department shall not pay for information or services provided to a client over the telephone except for case management behavioral health services for patients aged 18 and under.

SOURCE: CT Provider Manual. Clinic. Sec. 17b-262-823. Oct. 1, 2020. Ch. 7, pg. 20; Behavioral Health. Sec. 17b-262-918. Oct. 2020 Ch. 7, Pg. 6; CT Provider Manual. Physician and Psychiatrist. Sec. 17b-262-342 & 17b-262-456. Oct. 2020 Pg. 9 & 20; CT Provider Manual. Psychologist. Sec. 17b-262-472. Oct. 2020. Ch. 7, pg. 7; CT Provider Manual. Hospital Inpatient Services. Sec. 150.2(E)(III)(l). Oct. 2020. Ch. 7, pg. 44; CT Provider Manual. Chiropractic. Sec. 17b-262-540. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Dental. Sec. 17b-262-698. Oct. 2020. Ch. 7, Pg. 44; CT Provider Manual. Home Health. Sec. 17b-262-729. Oct. 2020. Ch. 7, pg. 12; CT Provider Manual. Naturopath. Sec. 17b-262-552. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Nurse Practitioner/Midwife. Sec. 17b-262-578. Oct. 2020. Ch. 7, pg. 7; CT Provider Manual. Podiatry. Sec. 17b-262-624. Oct. 2020. Ch. 7, pg. 6; CT Provider Manual. Vision Care. Sec. 17b-262-564. Oct. 2020. Ch. 7, pg. 4. (Accessed Jul. 2024).

The price for any supply listed in the fee schedule published by the department shall include and the department shall pay the lowest: … information furnished by the provider to the client over the telephone.

SOURCE: CT Provider Manual. Medical Services, Sec. 17b-262-720. Oct. 2020, p. 7. (Accessed Jul. 2024).

Person-Centered Medical Home (PCMH) Program

Effective for April 1, 2024 and forward, specific to the Person-Centered Medical Home (PCMH) Program, the Department of Social Services (DSS) will update the list of procedure codes eligible for the PCMH add-on payment. The following Evaluation/Management (E/M) codes have been added to the PCMH add-on payment list: Procedure Code Description 99442 – Telephone medical discussion with physician 11-20 minutes; 99443 – Telephone medical discussion with physician 21-30 minutes. PCMH providers should refer to the PCMH Codes for Enhanced Reimbursement chart at HUSKY Health Program | Providers | PCMH Codes for Enhanced Reimbursement (huskyhealthct.org) for a complete list of eligible procedure codes for the PCMH add-on payment.

SOURCE: CMAP Policy Bulletin 2024-21. Mar. 2024. (Accessed Jul. 2024).

Telephones are an acceptable mode to deliver telehealth if the following conditions are met:

• It is determined that Interactive Telehealth Services are unavailable, and
• Telephonic Services are medically appropriate for the underlying covered service.

When billing the DMAP for telephonic services that have been determined to be an acceptable mode to deliver telehealth, per 16.5.3, but that do not meet the full requirements of an E/M CPT® code, the provider must use the appropriate CPT® procedure codes under Telephone Services (Non-Face-to-Face Services) or Telephone Services (Non-Face-to-Face Nonphysician Services).

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.5.3.2, 16.6.5.2.3.4, pg. 76, 80. (Accessed Jul. 2024).

Chart reviews, electronic mail messages, facsimile transmissions, or internet services for online medical evaluations are not considered telehealth.

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.6.3, pg. 79, (Accessed Jul. 2024).

Adult Behavioral Health

Telephone calls, internet services for online medical evaluations, electronic mail messages or facsimile transmissions between a health care practitioner and a patient or a consultation between two health care practitioners are non-covered services.

SOURCE: DE Medical Assistance Program. Adult Behavioral Health Service Certification and Reimbursement Provider Specific Policy Manual (12/1/16), 1.8, p. 14. (Accessed Jul. 2024).

When billing for any audio-only telemedicine services, distant site providers shall enter the “93” procedure modifier on the claim.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 2023, p. 4,  Physicians Billing Manual.  DC Medicaid.  (Jan. 2024) Sec. 15.4. P. 52, Clinic Billing Manual, DC Medicaid (Sept. 2023), Sec. 15.4, P. 50. FQHC Billing Manual, DC Medicaid 15.4 P. 52. (Oct. 2023), Behavioral Health Billing Manual (Feb. 2024) 14.4, p. 69, Inpatient Hospital Billing Guide, 11.4, p. 61 (Apr. 2024), Long-Term Care Billing Manual, 15.4, p. 52 (Sept. 2023). (Accessed Jun. 2024).

Under recently effective final regulations, DHCF added audio-only communication as an allowable method of telemedicine services.

A telemedicine provider that utilizes audio-only communication methods is required to use audio equipment that ensures clear communication and includes echo cancellation.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.2. & 910.13 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 2023, p. 6. (Accessed Jun. 2024).

DC Medicaid does not reimburse for service delivery using e-mail messages or facsimile transmissions.

SOURCE: DC Code Sec. 31-3861 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 2023, p. 1. (Accessed Jun. 2024).

Services delivered through audio-only telephones, electronic mail messages or facsimile transmission are not included under telehealth services.

SOURCE: Physicians Billing Manual.  DC Medicaid.  (Jan. 2024) Sec. 15. P. 51, Clinic Billing Manual, DC Medicaid (Sept. 2023), Sec. 15, P. 49. FQHC Billing Manual, DC Medicaid 15 P. 51. (Oct. 2023), Behavioral Health Billing Manual (Feb. 2024) 14, p. 68, Outpatient Hospital Billing Guide, 15.8, p. 74 (Apr. 2024), Inpatient Hospital Billing Guide, 11, p. 60 (Apr. 2024), Long-Term Care Billing Manual, 15, p. 51 (Sept. 2023). (Accessed Jun. 2024).

Florida Medicaid will cover telehealth services in accordance with the Agency’s promulgated Telemedicine rule and will no longer cover audio-only telehealth services.

SOURCE: FL Medicaid, Alert, Ending of Federal Public Health Emergency: Updated Co-Payment and Telemedicine Guidance for Medical and Behavioral Health Providers, May 4, 2023, (Accessed Nov. 2024).

No reimbursement for telephone, chart review, electronic mail messages or facsimile transmissions.

SOURCE: FL Admin Code 59G-1.057. (Accessed Nov. 2024).

Laboratory Services – Specific Non-Covered Criteria

• Telephone communications with recipients, their representatives, caregivers, and other providers, except for services rendered in accordance with Rule 59G-1.057, F.A.C.

SOURCE: FL Medicaid, Laboratory Services, Jan. 2024, (Accessed Nov. 2024).

Non-covered Services Modalities

• Telephone conversations.
• Electronic mail messages.
• Facsimile.
• Services rendered via a webcam or internet-based technologies (i.e., Skype, Tango, etc.) that are not part of a secured network and do not meet HIPAA encryption compliance.
• Video cell phone interactions.
• The cost of telehealth equipment and transmission.
• Failed or unsuccessful transmissions.

SOURCE: GA Dept. of Community Health, GA Medicaid Telemedicine Guidance Handbook, p. 10 (Apr. 1, 2024). (Accessed May 2024).

Behavioral Health Clinical Consultation

Interprofessional telephone consultation and certain other services are covered, see manual.

SOURCE: FY 24 – Quarter 2 Provider Manual for Community Behavioral Health Providers, p. 21 & 129. (Apr  1, 2024), (Accessed May 2024).

Traditional/Enhanced Elderly and Disabled Waiver (EDWP) Traditional/Enhanced Case Management

Some case management and screening services may be provided telephonically.

SOURCE: GA Department of Community Health, Division of Medicaid, Policies and Procedures for Elderly and Disabled Waiver EDWP – (CCSP) Traditional/Enhanced Case Management, p. 31. (Apr. 1, 2024).  (Accessed May 2024).

Federally Qualified Health Centers

Except for services that meet the criteria for a TCM visit, telephone or electronic communication between a physician and a patient, or between a physician and someone on behalf of a patient, are considered physicians’ services and are included in an otherwise billable visit. They do not constitute a separately billable visit.

Telephone or electronic communication between a CP or CSW and a patient, or between such practitioner and someone on behalf of a patient, are considered CP or CSW services and are included in an otherwise billable visit

SOURCE: GA Department of Community Health, Division of Medicaid, Federally Qualified Health Centers Services and Rural Health Clinic Services, p. 17, 29 (Apr. 1, 2024). (Accessed May 2024).

Community Behavioral Health and Rehabilitation Services

While some CBHRS services allow telephonic interactions, telephonic interventions do not qualify as telemedicine.

SOURCE: GA Department of Community Health, Division of Medicaid, Community Behavioral Health and Rehabilitation Services, p.  1010  (Apr. 1, 2024).  (Accessed May 2024).

Comprehensive Supports Waiver Program

Telephone calls and store and forward (asynchronous) modalities are not allowed for billable therapy evaluation and services.

SOURCE: GA Dept. of Community Health, Division of Medicaid, Comprehensive Supports Waiver Program Chapters 1300-3700. (Apr. 1, 2024).  (Accessed May. 2024).

Psychology and Therapy Services

Non-covered services include telephone referrals and consultations.

SOURCE: GA Dept. of Community Health, Division of Medicaid, Psychology and Therapy Services, p. 12. (Apr. 1, 2024).  (Accessed Jan. 2024).

Recently Passed Legislation – Effective until December 31, 2025.

Med-QUEST Division (MQD) supports the medically appropriate use of interactive telecommunications system using two-way, real-time audio-only communication technology (audio-only) to increase access to healthcare and promote continuity of care. MQD will continue to reimburse select healthcare services delivered through audio-only communication technology after the Federal PHE expires. The following guidance is in effect until December 31, 2025, which aligns with the amended Hawaii Revised Statute 346-59.1 as amended by 2023 Hawaii legislative session Act 107 (HB 907).

Hawai’i Revised Statute (HRS) 346-59.1 amended during the 2023 Hawai’i legislative session (Act 107 (HB 907)) updated definitions and reimbursements:

HRS 346-59.1 as amended specifically states: (b) Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78.

SOURCE:  HI Med-Quest Memo No: QI-2338, CCS-2311, FFS 23-22 (Nov 17, 2023).  (Accessed Jun. 2024).

Newly Amended Statute, Will be Repealed Dec. 31, 2025

Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for the diagnosis, evaluation, or treatment of a mental health disorder delivered through an interactive telecommunications system using two-way, real-time audio-only communication technology shall meet the requirements of title 42 Code of Federal Regulations section 410.78.  Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.

Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services.

SOURCE: HI Revised Statute, Sec. 346-59.1 as amended by HB 907HD 2/SD 2 (Accessed Jun. 2024).

Audio-only real-time communication technology (Audio-only) – For services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology.

SOURCE:  HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311. (Accessed Jun. 2024).

No Reimbursement for:

• Telephone
• Facsimile machine
• Electronic mail

SOURCE: Code of HI Rules 17-1737.-51.1(c) p. 69 (Accessed Feb. 2024).  (NOTE:  Temporarily suspended by HI Dept of Human Services, Med-QUEST, Memo No. QIk-2338/FFS 23-22, CCS-2311.) (Accessed Jun. 2024).

Conditions for reimbursement of interactive telecommunications system using two-way, realtime audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient includes the following:

The provider must have the capacity to furnish two-way, audio-video telehealth services;

Audio-only mode must be the preference of the patient;

The patient’s medical record must document the reason for the patient’s preference for audio-only mode (examples: broadband access is unsatisfactory, audio-visual technology is not available or is available and the patient does not know how or does not wish to use the technology); and

In-person visit requirements with the provider furnishing a service by use of interactive telecommunications system using two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient includes:

• An in-person visit must occur six months prior to the initial audio-only service furnished;
• After the initial 6 month in-person visit, a minimum of one medically necessary service must be furnished in-person within 12 months and every twelve months thereafter if services continue to be furnished by interactive telecommunications system. If no medically necessary service is required within 12 months of the previous in-person visit, the next medically necessary service must be furnished inperson. The patient’s medical record must document the reason why an in-person visit was not furnished within that particular 12-month period.
• The provider furnishing the medically necessary service may be the same provider who furnished services through interactive telecommunications system or may be a provider of the same specialty or subspeciality in the same group practice.

Limitation: A clinical psychologist and a clinical social worker may bill and receive payment for individual psychotherapy via a telecommunications system but may not seek payment for medical evaluation and management services.

Modifier “FQ-service furnished using audio-only communication technology” must be used when billing for services furnished by real-time audio-only communication technology. U

For FQHCs:

FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap around non-billable services, and this may mean delivering care to the patient’s location as one way to ensure services are received. Wrap-around non-billable services may or may not occur on the same day as services provided through telehealth modality and the eligible FQHC provider delivering services through the telehealth modality must provide clear instructions to the patient on how and when the wrap-around non-billable services will be provided. Wrap-around non-billable services must be documented in the patient’s medical record.

See Appendix B for more information including coding guidelines and codes.

SOURCE:  HI Med-Quest Memo No: QI-2338, CCS-2311, FFS 23-22 (Nov 17, 2023).  (Accessed Jun. 2024).

Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection

For on-treatment monitoring, an in-person or telehealth/phone visit may be scheduled, if needed, for patient support, assessment of symptoms, and/or new medications.

SOURCE: HI Med-Quest Memo No. QI-2227/FFS 22-08 (December 30, 2022). (Accessed Jun. 2024).

Telephone services, including consultation, medical advice, and course of treatment (including long distance calls), are not recognized as a valid medical service(s) and may not be claimed as a Medicaid service.

SOURCE: HI Med-Quest Provider Manual, Ch. 2: Provider Requirements, Revised Apr. 2010, pg. 16, (Accessed Jun. 2024).

Medical/Surgical Services

Telephone calls, including long-distance calls, are not covered and cannot be billed to the Medicaid Program or to the patient.

SOURCE: HI Med-Quest Provider Manual, Ch. 6: Medical/Surgical Services, Revised Jan. 2011, pg. 34, (Accessed Jun. 2024).

Behavioral Health Services

Telephone Consultation. Telephone services, including long distance calls, are not recognized as valid medical services and may not be billed to Medicaid as an office visit.

SOURCE: HI Med-Quest Provider Manual, Ch. 15: Behavioral Health Services, Revised Oct. 18, 2002, pg. 3, (Accessed Jun. 2024).

Virtual care or telehealth means providing medically necessary health care services without actual physical contact, through the use of electronic means. Under Idaho Medicaid this means the participant and the provider are interacting in real-time or “live” from two physically different locations, by video or telephone.

Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers:

• FQ – A telehealth service was furnished using real-time audio-only communication technology.
• GT – A telehealth service was furnished using real-time audio-visual communication technology.

SOURCE:  Idaho Medicaid Provider Handbook. General Information and Requirements for Providers.  (Jan. 30, 2024), Sections 9.12 7 9.12.3 p. 133-134, Idaho MedicAide May 2023.  (Accessed Jun. 2024).

Certain CPT/HCPCS codes are covered.  See bulletin for specific codes.

SOURCE: Idaho MedicAide August 2023, p. 9, Idaho MedicAide October 2023, p. 9. (Accessed Jun. 2024).

Audio-Only

Modifier 93 is a new modifier used to identify services that are provided via telephone or other real-time interactive audio-only telecommunication systems. It does not replace modifier GT, which should continue to be used to identify telehealth interactions using both audio and video telecommunications systems. When using modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of a face-to-face interaction. Modifier 93 is effective with dates of service beginning July 1, 2022.

SOURCE: IL Dept. of Healthcare and Family Services, Provider Notice 03/21/2022, Delay in Implementation of Modifier 93 and Place of Service 10 Implementation July 1, 2022. (Accessed Jul. 2024).

Interprofessional Consultation Codes for Psychiatric Services

Specific Interprofessional Consultation codes will be billable for psychiatric services.  See bulletin for specific codes.

SOURCE: IL Dept. of Healthcare and Family Services Provider Bulletin (Feb. 3, 2023).  (Accessed Jul. 2024).

Diabetes Prevention Program (DPP) & Diabetes Self-Management Education and Support (DSMES)

New Modifier 93 – Synchronous Telemedicine Service rendered via telephone or other real-time interactive audio-only telecommunications system, is billable effective with dates of service beginning July 1, 2022. Refer to informational notices dated March 31, 2022, and March 21, 2022.

SOURCE: IL. Dept. of Healthcare and Family Services, Provider Notice 7/29/2022, Billing Update for Diabetes Prevention and Management Programs. (Accessed Jul. 2024).

No reimbursement for telephone.

No reimbursement for FAX.

No reimbursement for text or email.

SOURCE: IL Dept. of Healthcare and Family Services, Handbook for Practitioners Rendering Medical Services, Chapter 200 (June 2021). 220.5.7 p. 25; Handbook for Podiatrists, F-200, 220.6 p. 27 (Oct. 2016); Handbook for Encounter Clinic Services, Chapter D-200 Policy & Procedures, p. 17 (Aug 2016) & IL Administrative Code, Title 89 ,140.403. (Accessed Jul. 2024).

See regulations for exceptions during a public health emergency.

SOURCE: IL Admin. Code, Title 89,140.403. (Accessed Jul. 2024). 

Care Coordination and Support Organization (CCSO)

Care Coordination and Support (CCS) services are reimbursed if certain requirements met, including completing two oral communications with family within the calendar month via telephonic, video or in-person.

SOURCE: IL Dept. of Healthcare and Family Services, Care Coordination and Support Organization Provider Handbook (Oct. 5, 2022), p. 56-57.  (Accessed Jul. 2024).

The IHCP is updating the telehealth and virtual services code set to allow additional services to be reimbursed when rendered via telephone or other audio-only telecommunications systems. Effective for dates of service (DOS) on and after Dec. 9, 2022, the procedure codes in Table 1 (located in the memo) will be allowable when provided as audio-only telehealth.

As published in IHCP Bulletin BT202239, for a practitioner to receive reimbursement for telehealth services, the procedure code must be listed in the telehealth and virtual services code set (see Telehealth and Virtual Services Codes, accessible from the Code Sets page), and must be a service for which the member is eligible. Additionally, the claim detail must have:

One of the following place of service (POS) codes:

• 02 – Telehealth provided other than in patient’s home
• 10 – Telehealth provided in the patient’s home

One of the following modifiers:

• 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
• 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system

Modifier 93 (audio-only) is allowable only for certain, designated telehealth services.

SOURCE: IN Health Coverage Programs “IHCP expands and clarifies telehealth coverage” BT202297 (Nov. 8, 2022), p. 1.  (Accessed Aug. 2024).

Most telehealth services must be provided via video and audio, although a few designated telehealth services can be provided via audio only. Audio-only delivery is allowable for all nonhealthcare virtual services.

Nonhealthcare virtual services must be billed with POS code 02 or 10. These services and do not require modifiers 93 or 95. All services in this category can be provided either through audio and video technology or via audio only.

Unless the practitioner has an established relationship with the patient, telehealth does not include the use of electronic mail, an instant messaging conversation, facsimile, internet questionnaire or an internet consultation.

Intensive Outpatient Treatment (IOT) delivered via telehealth must have a video component. Telehealth IOT cannot be audio-only (for example, via telephone). Telehealth IOT cannot be billed with modifier 93. Cameras must be on and used by IOT participants for the entire duration of the session, with camera-off time documented and not billable.

Dental services cannot be delivered via audio-only telehealth.

No Applied Behavioral Analysis services are reimbursable when delivered via audio-only telehealth.

SOURCE:  Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Feb. 29, 2024) p. 1, 7.  (Accessed Aug 2024).

For certain telehealth services, an audio-only modifier (93) can be used to signify when a service is delivered via audio-only telehealth. Services eligible for reimbursement when billed with this new modifier are identified within this finalized code set. All other codes must be delivered via video and audio telehealth.  See Bulletin for code set.  Effective July 21, 2022 through end of 2022 at which point they will be re-evaluated for 2023.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT 202239 (May 19, 2022). (Accessed Aug. 2024).

The IHCP will continue to allow and offer reimbursement for audio-only telehealth. The IHCP will continue to explore the option of audio-only telehealth and its effectiveness in delivering healthcare services and provide updates when more specific policy details have been determined. Until further notice, audio-only telehealth services should be billed according to the guidance released in BT2020106 and used only when the care can be properly delivered via audio-only telehealth.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Aug. 2024).

Physical Therapy

The physical therapy assistant (PTA) is precluded from performing or interpreting tests, conducting initial or subsequent assessments, or developing treatment plans. See the Covered Procedures for Physical Therapist Assistants section for details. The PTA is required to meet with the supervising physical therapist each working day to review treatment, unless the physical therapist or physician is on the premises to provide constant supervision. The consultation can be either face-to-face or by telephone.

SOURCE: IN Therapy Services Module, Jan. 26, 2023, p. 5, (Accessed Aug. 2024).

Home and Community-Based Services

Caregiver Coaching provided in the home of the participant, virtually or telephonically and through Health Insurance Portability and Accountability Act (HIPAA) secure communication platforms that allow for real time and asynchronous communication between caregivers and caregiver coaches and collaboration with waiver care managers/service coordinators.

Caregiver Coaching services may be delivered telephonically and through HIPPA secure electronic communication platforms that enable a caregiver coach and a caregiver to communicate efficiently and in a manner convenient to the caregiver.

SOURCE: IHCP Office of Medicaid Policy and Planning, Home and Community Based Services: Indiana PathWays for Aging Waiver, p. 50-51.  (Accessed Aug. 2024).

Adult Mental Health Habilitation Services

Habilitation and support is not permissible via audio-only telehealth modalities. The IHCP reimburses for H2014 – Skills training and development, per 15 minutes (see Table 2) when the service is rendered through an audiovisual telehealth modality.

If behavioral health assistance needs to be rendered via audio-only telehealth modalities, the following procedure codes are reimbursable via audio-only telehealth per IHCP policy and may be used in place of habilitation and support:

• H0038 – Self-help/peer service, per 15 minutes
• H2011 – Crisis intervention service, per 15 minutes For more information, see Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.

These services (specific HPCCS Codes listed on pages 70, 74-75, 87) cannot be delivered via audio-only telehealth per IHCP policy, but can be delivered via audiovisual telehealth. If a member has eligibility to receive these services in person through the IHCP, then they are eligible to receive these services via telehealth. For more information, see Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.

SOURCE: Division of Mental Health and Addiction, Adult Mental Health Habilitation Services Module (July 25, 2024), p. 64, 70,74- 75, 87. (Accessed Aug. 2024).

Mobile Crisis Intervention

Follow-up stabilization services: Follow-up contacts in-person, via phone, or telehealth up to 14 days following initial crisis intervention and can be billable up to 90 days.

SOURCE: ICHP Bulletin BT 2023173 (Dec. 12, 2023), p. 3.  (Accessed Aug. 2024).

Federally Qualified Health Centers/Rural Health Clinics

Dental services do not require a modifier indicating the method of telehealth delivery. Dental services cannot be provided via audio-only telehealth. The only dental service that FQHCs and RHCs can bill as telehealth is D0140 – Limited oral evaluation – problem focused.

SOURCE: IHCP Federally Qualified Health Centers and Rural Health Clinics, p. 6 (May 7, 2024).  (Accessed Aug. 2024).

Telephone codes and G2025 listed as exempt from Healthy Indiana Plan (HIP) copayment, effective for DOS on or after July 1, 2024.

SOURCE: ICHP Bulletin BT 202476 (June 4, 2024).  (Accessed Aug. 2024).

See approved procedure code list. Includes column that identifies if codes can be provided via audio-only interaction.  Certain codes include telephone services in their descriptions as well.

SOURCE: IA Medicaid. Telehealth Approved Codes [see under quarterly codes dropdown], 8/8/24, (Accessed Dec. 2024).

Note that in almost all program-specific manuals, telephonic interpretive services are allowed.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Physician Services. Dec. 3, 2021, p. 64 .  For other manuals, see:  Medicaid Provider Manuals. (Accessed Dec. 2024).

Targeted Case Management, Case Management, and Care Coordination

Case management can occur by face-to-face contact or by telephone.

This contact may be face-to-face or by telephone. The contact may also be by written communication, including letters, email, and fax, when the written communication directly pertains to the needs of the member. A copy of any written communication must be maintained in the case file.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Targeted Case Management. May 1, 2018, p. 10 (Accessed Dec. 2024).

Home and Community-Based Services (HCBS)

BI case management services shall consist of the following components as detailed in IAC Chapter 90: …

• One contact per month with the member, the member’s legally authorized representative, this contact may be face-to-face or by telephone.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Home- and Community-Based Services (HCBS) . June 24, 2022, p. 38 (Accessed Dec. 2024).

Hospice

A hospice claim will be eligible for a SIA payment if the following criteria are met: …

• The service is not provided by a social worker via telephone.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Hospice.  Oct. 2, 2020, p. 13 (Accessed Dec. 2024).

Telemedicine services (including telephonic contact) can be made when there is verbal consent received from the patient (to be followed up by written approval) in the medical record. Tele-video communication can only be utilized if that contact is HIPAA compliant.

See manual for eligible codes.

Telemedicine does not include communication between:

• A healthcare provider to another healthcare provider that consists solely of a telephone voice-only conversation, email, or facsimile transmission.
• A physician and a patient that consists solely of an email or facsimile transmission.

SOURCE:  Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, (Nov 2024), pg. 2-28 to 29 (Accessed Nov. 2024).

COVID allowance for telephonic coverage for Consultative Clinical and Therapeutic Services (CCTS) and Intensive Individual Support (IIS), and Select Speech Therapy codes was discontinued effective May 11, 2023.

SOURCE:  KMAP General Bulletin 23118 (May 2023), & KMAP General Bulletin 23115 (May 2023), (Accessed Nov. 2024).

Effective on and retroactive to May 1, 2022, the Telephone Evaluation and Management codes listed below must be billed with Place of Service (POS) code 02 (Telehealth Provided Other than in Patient’s Home) or 10 (Telehealth Provided in Patient’s Home) when services are provided within a Certified Community Behavioral Health Clinic (CCBHC):

• 99441
• 99442
• 99443

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, Bulletin 24170, CCBHC PPS Code Clarification for E&M Services, (Aug. 2024), (Accessed Nov. 2024).

Hospital E&M

A “comprehensive exam” is considered a “hands on” specialist examination. Telephone consultation with a specialist is not the equivalent of comprehensive exam.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospital, p. 8-4 (Sept. 2024). (Accessed Nov. 2024).

Hospice

Providers can submit claims for SIA end of life care if the following criteria are met: … The service is not covered if provided by a social worker via telephone.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Hospice, (Jun. 2024), pg. 8-11. (Accessed Nov. 2024).

Certified Community Behavioral Health Clinic (CCBHC) Services

Telephone evaluation and management service provided by a qualified healthcare professional to an established patient, parent, or guardian. National coding guidelines specify the criteria for appropriately billing these three codes.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Certified Community Behavioral Health Clinic (CCBHC) Services, May 2024, pg. 8-6. (Accessed Nov. 2024).

Local Education Agencies

Not all services provided by LEAs are billable. Examples include but are not limited to: …

• Telephone calls/conferences/contacts

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, FFS Provider Manual, Learning Education Agencies, (Oct. 2024), pg. 8-7. (Accessed Nov. 2024).

CBST, Mental Health Assessment, and Psychiatric Diagnostic Evaluation

Note: Codes 90791 and 90792 can only be billed once per day, and both codes cannot be billed on the same day. Services listed shall be provided face-to-face as defined in the KMAP General Benefits Fee-for-Service Provider Manual for telemedicine. These services are excluded from Telephonic provision. Visual observation of the child, and (as appropriate) the child actively participating in the meeting is required.

SOURCE:  KS Dept. of Health and Environment, Kansas Medical Assistance Program, Bulletin 24163, Mental Health Assessment, and Psychiatric Diagnostic Evaluation, (Aug. 2024), (Accessed Nov. 2024).

Telehealth services and telehealth consultations shall not be reimbursable under this section if they are provided through the use of a facsimile machine, text, chat, or electronic mail unless the Department for Medicaid Services determines that telehealth can be provided via these modalities in ways that enhance recipient health and well-being and meet all clinical and technology guidelines for recipient safety and appropriate delivery of services.

Medicaid-participating practitioners and home health agencies are strongly encouraged to use audio-only encounters as a mode of delivering telehealth services only when no other approved mode of delivering telehealth services is available.

SOURCE: KY Revised Statute Sec. 205.559. (Accessed Nov. 2024).

Any recipient, upon being offered the option of an asynchronous or audio-only telehealth visit, shall have the opportunity or option to request to be accommodated by that provider in an in-person encounter or synchronous telehealth encounter.

If a telehealth service is delivered as an audio-only encounter and a telephonic code exists for the same or similar service, the department shall reimburse at the lower reimbursement rate between the two (2) types of services.

Telephonic Services. Telephonic code reimbursement shall be:

• An alternative option for telehealth care providers to deliver audio-only telecommunications services, and shall not supersede reimbursement for an audio-only telehealth service as established pursuant to KRS 205.559 or 205.5591;
• For a service that has an evidence base establishing the service’s safety and efficacy;
• Subject to any relevant licensure board restrictions of the telehealth care provider;
• Subject to any synchronous telehealth limits of this administrative regulation or other state or federal law; and
• For a service that is listed on the most recent version of the Medicaid Physician Fee Schedule, as established by 907 KAR 3:010, Section 1(17).

SOURCE: KY 907 KAR 3:170. (Accessed Nov. 2024).

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

• Live or real-time audio and video synchronous telehealth technology;
• Asynchronous store-and-forward telehealth technology;
• Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
• Audio-only telecommunications systems; or
• Clinical text chat technology when:
  • Utilized within a secure, HIPAA compliant application or electronic health record system; and

• • Meeting:
    • The scope of the provider’s professional licensure; and
    • The scope of practice of the provider; and
    • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
      • False Claims Act, 31 U.S.C. § 3729-3733;
      • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
      • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 (Accessed Nov. 2024).

Rural Health Clinic

The following services or activities shall not be covered under this administrative regulation: …

• A telephone call, an email, a text message, or other electronic contact that does not meet the requirements stated in the definition for telehealth established pursuant to KRS 205.510(16) and implemented pursuant to 907 KAR 3:170

SOURCE: KY Admin Regs. Title 907 KAR 1:082, (Accessed Nov. 2024).

Hospices may report some social worker calls as a visit. Hospices may not report any other types of phone calls.

SOURCE: LA Medicaid, Chapter 24: Hospice, Sec. 24.9, Medicaid Svcs. Manual, p. 62, (As issued on 3/22/24), (Accessed Nov. 2024).

Rural health clinics (RHC) and federally qualified health clinics (FQHC) are required to indicate the appropriate place of service, either 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of and append modifier 95 for the billing of telemedicine/telehealth services. Services delivered via an audio/video system and via an audio-only system are to be coded the same way.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Nov. 2024).

Early and Periodic Screening, Diagnostics and Treatment Health Services (EPSDT)

Permissible Telecommunications Systems: …

• For use of an audio-only system, the same standard of care must be met, and the need and rationale for employing an audio-only system must be documented in the clinical record; and
• Please note, some telemedicine/telehealth services require delivery through an audio/video system due to the clinical nature of these services. Where applicable, this requirement is noted explicitly.

SOURCE: LA Dept. of Health, EPSDT Health and IDEA Related Services, Ch. 20, Sec. 20.1, (As issued on 3/14/24), (Accessed Nov. 2024).

Supports Waiver

At a minimum, support coordinators (SCs) are required to make the following contacts with each beneficiary:

• Monthly telephone phone calls; and
• Quarterly face-to-face visits.

At a minimum, all initial and annual POC meetings and one additional visit must be delivered face-to-face in the beneficiary’s home during each POC year. If a beneficiary participates in day service and/or employment service, the SC should observe the beneficiary in the environment during at least one of the quarterly face-to-face visits. The two additional required face-to-face visits may be delivered virtually if agreed upon by the beneficiary and/or legal guardian and all of the requirements necessary for virtual visits are met.

SOURCE: LA Dept. of Health, Support Services, Ch. 43.4, (As issued on 10/7/24), (Accessed Nov. 2024).

Telephonic Services: The use of audio-only telephone communication by a Health Care Provider to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment.

Receiving (provider) Site: When billing for Telehealth Services, Health Care Providers at the Receiving (Provider) Site must bill for the underlying Covered Service using the same claims they would if it were delivered face-to-face and must add the GT modifier for Interactive Telehealth Services and the 93 modifier for Telephonic Services.

Remote Consultation Between a Treating Provider and Specialist

A Specialist provides interprofessional telecommunications assessment and management services to a Treating Provider. The interaction includes discussion (via telephone or internet) of a written report by the Specialist to assess the Member’s Electronic Health Record and/or diagnoses/treatment. Duration of this service must be a minimum of five minutes and no greater than thirty minutes. The Treating Provider must document that they have informed the Member as to results and conclusions following the Remote Consultation. The Treating Provider must document in the Member’s medical record the Member’s written, electronic, or verbal consent for each Remote Consultation. Billing for interprofessional services is limited to those practitioners who can independently bill MaineCare for evaluation and management services. Remote Consultation may be utilized as often as medically necessary, per the terms of these rules.

Virtual Check-In

Virtual Check-in is a brief communication where an established patient checks in with a Health Care Provider using a telephone or other telecommunications device for 5-10 minutes to determine the status of a chronic clinical condition(s) and to determine whether an office visit is needed. Modalities permitted for Virtual Check-Ins include Telephonic Services or Interactive Services to deliver clinical services at a distance for the purpose of diagnosis, disease monitoring, or treatment.

Communications exclusively by email, text, or voicemail are not reimbursable.

The Health Care Provider must document a Virtual Check-In in the Member’s record, including the length of the Virtual Check-In, an overview and outcome of the conversation, and the modality of the interaction.

If the Virtual Check-In takes place within seven (7) days after an in-person visit or triggers an in-person office visit within 24 hours (or the soonest available appointment), the Virtual Check-In is not billable under this Section.

Telephone Evaluation and Management Services

The Department will reimburse providers for Telephone Evaluation and Management Services provided to members.

Telephone Evaluation and Management Services are not to be billed if clinical decision-making dictates a need to see the member for an office visit within 24 hours or at the next available appointment. In those circumstances, the telephone service shall be considered a part of the subsequent office visit. If the telephone call follows an office visit performed and reported within the past seven (7) days for the same diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. (Nov. 6, 2023).  Adopted 10-144 C.M.R. Chapter 101, Chapter I, Section 4, Telehealth Services. (Nov. 6, 2023).  (Accessed Oct. 2024).

Interprofessional Codes for Medication Management Providers

Medication management providers and other treating providers of Section 65 of the MaineCare Benefits Manual (MBM) may deliver and bill MaineCare for interprofessional consultations in alignment with MBM Chapter 1, Section 4.04-2(B). As described in CMS state health official letter #23-001, interprofessional consultations are assessments and management services in which a patient’s treating provider requests the opinion and/or treatment advice of a consultant with specific specialty expertise to assist the treating provider in the diagnosis and/or management of the patient’s condition without the need for the patient’s face-to-face contact with the consultant.

The consulting provider and the provider requesting the consultation must be able to independently bill for evaluation and management services. Examples of these provider types include physicians, nurse practitioners, clinical nurse specialists, physician assistants, and licensed clinical social workers. A registered nurse, for example, is not an eligible provider type.

The following examples illustrate when medication management providers may deliver and bill for interprofessional consultations:

• A medication management provider provides consultation to a primary care provider (PCP) on cross-tapering a patient from one antidepressant to another due to concerning side-effects.
• A medication management provider provides consultation to a PCP regarding antipsychotic medications because the PCP has a symptomatic patient who has been off of medications, and the PCP has never prescribed antipsychotic medication before.
• The PCP has been treating a behavioral health patient who was previously stabilized and who is now reporting increased symptoms with active substance use. The PCP is not sure of what to do about medications in the context of active substance use and consults a medication management provider.

Providers must bill for interprofessional consultations using common procedural terminology (CPT) codes 99446-99449, 99451, and 99452. However, CPT code 99452 is different. Interprofessional consultation code 99452 applies when the patient’s PCP or other qualified health professional interacts with a consultant via telephone, the Internet, or an electronic health record to provide the consultant with the patient’s clinical data so that the consultant can form an opinion regarding further management of the patient’s condition. For example, a PCP would bill CPT code 99452 if they send a patient to a medication management provider and the PCP provided background information.

SOURCE: State of Maine Department of Health and Human Services, Bulletin:  Interprofessional Codes for Medication Management Providers, Nov. 13, 2023, (Accessed Oct. 2024).

When there is a direct effect to Indian Health Services the second tier of consultation will be utilized. The second tier consultation consists of the following:

• Face-to-face meetings
• Direct email communications
• Written notification via the Interested Parties List
• Listserv updates
• Any other correspondence that pertains to general changes
• Telephone communications

SOURCE: MaineCare Benefits Manual, Indian Health Services, 10-144 Ch. II, Sec. 9, p. 5 (March 21, 2012). (Accessed Oct. 2024).

Under Targeted Case Management, monitoring and follow-up activities may involve either face-to-face or telephone contact.

See clarification below regarding text messaging.

SOURCE:  MaineCare Benefits Manual, Targeted Case Management Services, 10-144 Ch. 101, Sec. 13.02, p. 6 (Mar. 20, 2014). (Accessed Oct. 2024).

The Department of Health and Human Services (DHHS) wants to inform providers of TCM services under Section 13 of the MaineCare Benefits Manual (MBM) of the accepted methods for delivering services via Telehealth. Communication with MaineCare members by Short Message Service (SMS), Multimedia Messaging Service (MMS), or any other type of mobile or text messaging is not an accepted form of substantive contact.

All MaineCare services delivered via Telehealth must comply with Chapter I, Section 4 of the MBM. Please refer to this section of the MBM for applicable service definitions.

Text messaging is not a form of audio-only telephone communication, nor is it a form of real-time, interactive visual and audio telecommunication. Since text messaging does not meet the standard for Telephone or Interactive Telehealth Services, text messaging is not an approved form of delivering services via Telehealth.

SOURCE:  MaineCare Provider Bulletin, Text Messaging Not Accepted Method of Substantive Contact for Section 13, Targeted Case Management (TCM) Services, Aug. 19, 2024, (Accessed Oct. 2024).

Crisis Resolution Services

Covered services include direct telephone contacts with both the member and the member’s Parent or Guardian or adult’s member’s guardian when at least one face-to-face contact is made with the member within seven (7) days prior to the first contact related to the crisis resolution service. The substance of the telephone contact(s) must be such that the member is the focus of the service, and the need for communication with the Parent or Guardian without the member present must be documented in the member’s record.

Telephonic collateral contacts covered for Multi-Systemic Therapy and telephone outreach and team meetings for functional family therapy.

SOURCE:  MaineCare Benefits Manual, Behavioral Health Services, 10-44 Ch. II, Sec. 65, p. 4, 12 (Nov. 2022). (Accessed Oct 2024).

When a telephonic consult occurs, the physician, or nurse practitioner must examine the member in person within the following time constraints:

• Within one (1) hour of when the registered nurse requests an examination;
• Within one (1) hour of when information relayed is suggestive of causes leading to physical harm to the member;
• Within one (1) hour if an examination has not yet occurred during the member’s stay; or
• Within six (6) hours in all other circumstances.

SOURCE:  MaineCare Benefits Manual, Psychiatric Residential Treatment Facility Services, 10-44 Ch. II, Sec. 107, p. 32 (Oct. 3, 2018). (Accessed Oct. 2024).

MaineMOM Services and Reimbursement

The MaineMOM provider shall ensure twenty-four (24) hour availability of information for triage and referral to treatment for medical emergencies.  This requirement may be fulfilled through an after-hours telephone number.

The following do not constitute adequate coverage:

• A twenty-four (24) hour telephone number answered only by an answering machine without the ability to arrange for interaction with the MaineMOM provider or their covering provider

SOURCE:  MaineCare Benefits Manual, MaineMOM Services and Reimbursement, 10-44 Ch. II, Sec. 89, p. 21 (Dec. 6, 2023). (Accessed Oct. 2024).

In accordance with SB 534, Preserve Telehealth Access Act of 2023 (Ch. 382 of the Acts of 2023), telehealth flexibilities, including coverage of audio-only phone conversations, will continue through at least June 30, 2025. The use of non-HIPAA compliant technology products previously authorized through the end of the federal PHE at the discretion of the federal Office of Civil Rights (OCR) and subsequent 90- calendar day transition period for covered health care providers to come into compliance with the HIPAA Rules expired as of August 9, 2023. Regular policies are in effect at this time. For more information, visit HHS’s HIPAA and Telehealth webpage. Guidance previously issued in PT 56-23 as it relates to telehealth including dental services delivered via telehealth (teledentistry), SBHC services, and well-child visits delivered via telehealth is still in effect. Please refer to PT 56-23 for this guidance.

SOURCE: MD Medicaid Provider Transmittal 43-25, Post-PHE and COVID-19 Guidance, Oct. 29, 2024. (Accessed Nov. 2024).

“Telehealth” includes, from July 1, 2021, to June 30, 2025, both inclusive, an audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service.

“Telehealth” does not include the provision of health care services solely through:

• Except as provided above, an audio–only telephone conversation;
• An e–mail message; or
• A facsimile transmission.

SOURCE: MD Health General Code 15-141.2. (Accessed Nov. 2024).

To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service. Services delivered via telehealth using two-way audio-visual technology assisted communication should be billed using the “-GT” modifier. Billing with these modifiers will not affect Medicaid reimbursement rates. The use of audio-only telehealth services is permitted for services that can be fully and appropriately rendered with no video component. Any memorandum issued after the posting of this manual will supersede the guidance in this document.

SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 25-26, 82-83. Updated Oct. 2024. (Accessed Nov. 2024).

A service delivered via telehealth does not include:

• An audio-only telephone conversation between a health care provider and a patient unless provided on dates of service between July 1, 2021, and June 30, 2025, inclusive;
• An electronic mail message between a health care provider and a patient;
• A facsimile transmission between a health care provider and a patient; or
• A telephone conversation, electronic mail message, or facsimile transmission between providers without direct interaction with the patient.

SOURCE: Code of Maryland Admin. Regs., Sec. 10.09.49.07, as proposed to be amended by Final Action (effective July 24 2023). (Accessed Nov. 2024).

Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) Services

MDH Will reimburse IEP and IFSP providers for certain procedure codes via telehealth. Providers must identify telehealth services on the child’s IEP/IFSP and bill using the appropriate modifier (GT or UB). Service coordination procedures (T1023, T1023-TG, T2022, W9322, W9323, and W9324) and individual psychotherapy services (90791, 90832 and 90834) may continue with an audio-only component. See Provider Transmittal for approved Maryland Medicaid Fee-for-Service approved IEP/IFSP Telehealth Services.

SOURCE: MD Medical Assistance Program. Early Intervention and School Health Service Providers Transmittal No. 3. Sept. 23, 2021. (Accessed Nov. 2024).

IEP Service Coordination may be rendered in person, in writing, by telephone or via telehealth.

SOURCE: MD Dept. of Health, Division of Children’s Services, Medicaid Policy & Procedure Manual, For Services Delivered Through the IEP/IFSP (updated Sept. 2024). p 14. (Accessed Nov. 2024).

Therapy Services (Physical Therapists, Occupational Therapists, Speech Therapists, Therapy Groups, EPSDT Providers, Managed Care Organizations)

MDH will reimburse providers for certain procedure codes when provided via audio-visual telehealth. MDH will not reimburse for services provided via an audio-only delivery model or for codes not included on the Provider Transmittal regarding approved therapy telehealth services when provided via any method of telehealth.

SOURCE: MD Medical Assistance Program. Guidance on the Continuation of Telehealth for Therapy Services. PT 09-22. Oct. 7, 2021. (Accessed Nov. 2024).

School-Based Health Centers (SBHCs)

When billing for services rendered via audio-video or audio-only modalities, SBHC sponsoring agencies must adhere to the following:

1. Federal Rules (Clinic Services): SBHCs must adhere to federal Medicaid regulations governing clinics (42 CFR § 440.90 – Clinic Services). Medicaid may not reimburse SBHCs or other clinics if neither the practitioner nor patient is physically located within the clinic. This requirement applies to all freestanding clinics participating in the Maryland Medicaid program, regardless of whether they are community-based clinics or SBHCs.
   1. During the PHE, CMS granted MDH an 1135 waiver permitting services provided via telehealth from clinic practitioners’ homes (or another location) to be considered to be provided at the clinic for purposes of 42 C.F.R. § 440.90(a). Under this authority, SBHCs were permitted to receive Medicaid reimbursement for services rendered if both the practitioner and the patient are in their homes for the duration of the federal government’s declared public health emergency. The waiver has a retroactive effective date of March 1, 2020, and will terminate when the federal public health emergency ends on May 11, 2023
2. Modifiers: When billing Medicaid or a HealthChoice MCO for an audio-video telehealth visit or an audio-only visit, sponsoring agencies should bill using the usual procedure code with the appropriate modifier.
   1. To bill for services delivered via two-way audio-visual telehealth technology assisted communication, providers must bill for the appropriate service code and use the “-GT” modifier.
   2. To bill for audio-only telephonic services, providers must bill for the appropriate service code and use the “-UB” modifier to identify the claim as a telephonically delivered service.

3. Place of Service (POS): SBHC sponsoring agencies should bill using the same POS code that would be appropriate for a non-telehealth claim.
   1. If conducting a telehealth visit with a student enrolled with a SBHC (or family member who is also enrolled) who would normally be eligible to receive in-person care at the SBHC, sponsoring agencies should use POS code 03 (School). Sponsoring agencies should use POS code 03 for such visits regardless of the physical location of the student.
   2. If a SBHC location adds or maintains telehealth services and wishes to use their telehealth service model to see patients they would not normally see (i.e., patients that are not associated with the student population), the sponsoring agency should not bill for the services as a SBHC. For such visits, sponsoring agencies should use POS code 11 (Office). Services to these recipients are not considered to be self-referred under COMAR 10.67.06.28. SBHCs should not use the 03 (School) POS when billing for services rendered to patients who would otherwise not be able to receive in-person care at the SBHC. MCOs also are not required to reimburse for such services if the sponsoring agency has not contracted with the MCO.
   3. SBHCs may NOT bill using the 02 (Telehealth) code in the POS field.

SOURCE: MD Medicaid Provider Transmittal 56-23 PHE Unwinding, May 30, 2023. (Accessed Nov. 2024).

ABA Services

The ABA provider may not bill the Program for services rendered by mail or telephone or telehealth services that don’t meet the requirements in COMAR 10.09.49.

SOURCE: MD Department of Health, Maryland Medical Assistance Program Applied Behavior Analysis (ABA) Provider Manual (Jul. 2024), p. 10-11. (Accessed Nov. 2024).

Behavioral Health Mobile Crisis Services

Mobile crisis team services are covered and shall include mobile crisis follow-up services by means of telephone, telehealth, or in-person contact with the individual served, family members, caregivers, or referred providers. A mobile crisis team program shall include at least one licensed mental health professional available at all times, either via telehealth or face-to-face.

SOURCE: COMAR 10.09.16 as proposed to be added by Final Regulation; COMAR 10.63.03.20 as proposed to be added by Final Regulation. (Accessed Nov. 2024).

“Telehealth”, the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

The rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same service delivered by other telehealth modalities.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Dec. 2024).

Under this policy, MassHealth will continue to allow MassHealth-enrolled providers to deliver a broad range of MassHealth-covered services via telehealth. MassHealth will reimburse for such services at parity with their in-person counterparts, including services provided through live-video, audio-only, or asynchronous visits that otherwise meet billing criteria, including use of required modifiers. All providers delivering services via telehealth must comply with the policy detailed in this bulletin.

This bulletin applies to members enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) Plan, a Managed Care Organization (MCO), an Accountable Care Partnership Plan (ACPP), or a Primary Care Accountable Care Organization (PCACO). Information about coverage through MassHealth Managed Care Entities (MCEs) and the Program for All-inclusive Care for the Elderly (PACE) will be issued in a forthcoming MCE bulletin.

As under All Provider Bulletin 355, Section B of this bulletin identifies specific categories of service that MassHealth has deemed inappropriate for delivery via any telehealth modality. Except for those services identified in Section B in this bulletin, and notwithstanding any regulation to the contrary, including the physical-presence requirement at 130 CMR 433.403(A)(2), a MassHealth enrolled provider may deliver medically necessary MassHealth-covered services on an outpatient basis to a MassHealth member via the telehealth modalities of audio-only, live video, and asynchronous visits, if:

• the provider has determined that it is clinically appropriate to deliver such service via telehealth, including the telehealth modality and technology employed, including obtaining member consent;
• such service is payable under that provider type;
• the provider satisfies all requirements set forth in this bulletin, including in Appendix A, and any applicable program-specific bulletin;
• the provider delivers those services in accordance with all applicable laws and regulations (including M.G.L. c. 118E, § 79 and MassHealth program regulations); and
• the provider is appropriately licensed or credentialed to deliver those services.

MassHealth will continue to monitor telehealth’s impacts on quality of care, cost of care, patient and provider experience, and health equity to inform the continued monitoring and iteration of its telehealth policy. Based on the results of this monitoring, and its analysis of relevant data and information, MassHealth may adjust its coverage policy, including by imposing limitations on the use of certain telehealth modalities for various covered services or provider types.

As under All Provider Bulletin 355, MassHealth has deemed these following categories of service ineligible for delivery via any telehealth modality.

• Ambulance Services
• Ambulatory Surgery Services
• Anesthesia Services
• Certified Registered Nurse
• Anesthetist Services
• Chiropractic Services
• Hearing Aid Services
• Inpatient Hospital Services
• Laboratory Services
• Nursing Facility Services
• Orthotic Services
• Personal Care Services
• Prosthetic Services
• Renal Dialysis Clinic Services
• Surgery Services
• Transportation Services
• X-Ray/Radiology Services

Providers must include the place of service (POS) code 02 when submitting a professional claim for telehealth provided in a setting other than in the patient’s home. They must include POS code 10 when submitting a professional claim for telehealth provided in the patient’s home. Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

Telehealth and Children’s Behavioral Health Initiative (CBHI) Services

As under All Provider Bulletin 355, existing performance specifications for Children’s Behavioral Health Initiative (CBHI) services allow for the telephonic delivery of services, other than for initial assessments. Notwithstanding any requirements that initial assessments be conducted in person, where appropriate, services for new clients may be initiated by telephone or other telehealth modality. CBHI providers must use the regular CBHI codes, as well as the POS code and modifiers described above, as appropriate, when billing for CBHI services delivered via approved telehealth modalities.

Billing and Payment Rates for Services

Providers billing under an 837I/UB-04 form must include the modifier GT when submitting claims for services delivered via telehealth. Providers billing under an 837P/1500 form must include the place of service (POS) code 02 or 10 when submitting claims for services delivered via telehealth.

Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telehealth;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GQ to indicate services rendered via asynchronous telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications; and/or
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology.

Rates of payment for services delivered via telehealth will be the same as the rates of payment for services delivered via traditional (i.e., in-person) methods as set forth in the applicable regulations.

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Dec. 2024).

Managed Care Entities:

This bulletin, which supersedes Managed Care Entity Bulletin 95 and will remain in effect until superseding guidance is issued, requires managed care entities to maintain a telehealth policy consistent with All Provider Bulletin 379, including but not limited to maintaining policies for coverage of telehealth services no more restrictive than those described in All Provider Bulletin 379.

SOURCE: MassHealth Managed Care Entity Bulletin 115 [replaced Bulletin 95], Apr. 2024, (Accessed Dec. 2024).

Telephonic codes are listed in the Substance Use Disorder Treatment Manual (98966, 98967, 98968, 99441, 99442, 99443).

SOURCE: Mass Health Substance Use Disorder Treatment Manual, Service Codes and Descriptions, Transmittal Letter SUD-22, (Accessed Dec. 2024).

Home Health Agencies

MassHealth is not imposing specific requirements for technologies used to deliver services via telehealth and will allow reimbursement for MassHealth home health services delivered through telehealth, as long as such services are medically necessary and clinically appropriate and comply with the guidelines established in this bulletin. Providers are encouraged to use appropriate technologies to communicate with individuals and should, to the extent feasible, ensure the same rights to confidentiality and security as provided in face-to-face services. Providers must inform members of any relevant privacy considerations.

Home health telehealth visits may be used for home health services that

• the member has provided consent for;
• are follow-up visits that do not require any hands-on care;
• pertain to any ongoing review of the member’s assessment, including the member’s 60-day recertification for home health services; or
• pertain to the discharge visit.

Follow-up visits do not include initial evaluations or certifications for home health services and may be conducted by telephone if appropriate, but live video is preferred.
Home health telehealth visits may not be used for

• any service that requires hands-on care;
• any start of care (SOC) assessment visit; or
• any resumption of care visit.

SOURCE:  MassHealth Home Health Agencies, Bulletin 87, Jul. 2023, (Accessed Dec. 2024).

Durable Medical Equipment

Federal regulations require that, for certain DME services, physicians or certain authorized nonphysician practitioners must document a face-to-face meeting with the Medicaid-eligible beneficiary. See 42 CFR 440.70. Through the end of the FPHE, and as described in 42 CFR 440.70 (f) (6), any required face-to-face meeting may be delivered via telehealth (including telephone and live video)according to the standards in All Provider Bulletin 314.

This is consistent with Centers for Medicare & Medicaid Services (CMS) Interim Final Rules with Comment Period (CMS-1744-IFC (April 6, 2020) and CMS-5531-IFC (May 8, 2020) which provide that the face-to-face meeting requirement does not apply for DME for the duration of the COVID-19 emergency, except for power mobility devices (PMDs) with a statutory requirement for a face-to-face meeting. For those PMDs, a telehealth face-to-face meeting may satisfy the requirement. See  CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing Question AA.

On May 12, 2023, consistent with 42 CFR 440.70, providers may use telehealth for face-to-face meetings. Providers must follow the federal DME Face-to-Face Requirements identified in 42 CFR 440.70 and maintain the required documentation in the member’s record. See 130 CMR 409.430(C) and DME Bulletin 26. All documentation, recordkeeping, and other applicable provisions of 130 CMR 450.000 and 130 CMR 409.000 apply.

STATUS: MassHealth Durable Medical Equipment, Bulletin 32, Apr. 2023, (Accessed Dec. 2024).

Oxygen and Respiratory Therapy

Federal regulations require that, for certain oxygen services, physicians or certain authorized nonphysician practitioners, must document a face-to-face meeting with the Medicaid-eligible beneficiary. See 42 CFR 440.70. Through the end of the FPHE, and as described in 42 CFR 440.70(f)(6), any required face-to-face meetings may be delivered via telehealth (including telephone and live video) according to the standards in All Provider Bulletin 314.

This is consistent with Centers for Medicare & Medicaid Services (CMS) Interim Final Rules with Comment Period (CMS-1744-IFC (April 6, 2020) and CMS-5531-IFC (May 8, 2020), which provide that the face-to-face meeting requirement does not apply for oxygen and respiratory equipment for the duration of the COVID-19 emergency, except for power mobility devices (PMDs) with a statutory requirement for a face-to-face meeting. For those PMDs, a telehealth face-to-face meeting may satisfy the requirement. See the CMS COVID-19 Frequently Asked Questions on Medicare Fee-for-Service Billing.

On May 12, 2023, consistent with 42 CFR 440.70, providers may use telehealth for face-to-face meetings. Providers must follow the federal oxygen Face-to-Face Requirements identified in 42 CFR 440.70. Providers must also maintain the required documentation in the member’s record. See Oxygen and Respiratory Therapy Equipment Provider Bulletin 17. All documentation, recordkeeping, and other applicable provisions of 130 CMR 450.000 and 130 CMR 427.000 apply.

STATUS: MassHealth Oxygen and Respiratory Therapy, Bulletin 26, Apr. 2023, (Accessed Dec. 2024).

Therapy

Live video telehealth must be used, with the member’s consent, to conduct the comprehensive evaluation or reevaluation under 130 CMR 430.601(A)(9) for members receiving therapy. Telephone-only telehealth is not permitted to conduct the comprehensive evaluation or reevaluation.

STATUS: MassHealth Rehabilitation Center Bulletin 16, Apr. 2023; Speech and Hearing Center Bulletin 16, Apr. 2023, (Accessed Dec. 2024).

Mental Health Centers

Case Consultation:  intervention, including scheduled audio-only telephonic, audio-video, or in person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

The MassHealth agency pays only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

Crisis Intervention Services:  Each center must provide clinic coverage to respond to members experiencing a crisis 24 hours per day, seven days per week. …  After hours crisis intervention services must include live telephonic access to qualified professionals and, if indicated, triage in real-time to an appropriate provider to determine whether a higher level of care and/or additional diversionary services are necessary. A pre-recorded message will not fulfill the requirement for access to a qualified professional.

SOURCE: MassHealth Mental Health Center Manual, Ch. 6, 1/1/23, (Accessed Dec. 2024).

Psychologists – Case Consultation

The MassHealth agency pays only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

The MassHealth agency pays for case consultation delivered in person or via telephonic or audio-visual methods only when written communication alone, and other non-reimbursable forms of communication, clearly will not suffice. Such circumstances must be documented in the member’s record. Such circumstances are limited to situations in which both the provider and the other party are actively involved in treatment or management programs with the member (or family members) and where a lack of direct communication would impede a coordinated treatment program

SOURCE: MassHealth Psychologist Manual, Sec. 411.405, (1/1/23), (Accessed Dec. 2024).

Substance Use Disorder Treatment 

Case Consultation: intervention, including scheduled audio-only telephonic, audio-video, or in-person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

The MassHealth agency will pay a provider only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

SOURCE: MassHealth Substance Use Disorder Treatment Manual, 418.412, (1/1/23), (Accessed Dec. 2024).

Physician

Case Consultation: The MassHealth agency pays for case consultation only when telephone contact, written communication, and other nonreimbursable forms of communication clearly will not suffice. Such circumstances must be documented in the member’s record. Such circumstances are limited to situations in which both the physician or PCNS and the other party are actively involved in treatment or management programs with the member (or family members) and where a lack of face to face communication would impede a coordinated treatment program.

Psychotherapy for Crisis Services:  This service is limited to face-to-face contacts with the member; psychotherapy for crisis service via telephone contact is not a reimbursable service.

After-Hours Telephone Service. The physician or PCNS must provide telephone coverage during the hours when the physician or PCNS is unavailable, for members who are in a crisis state.

SOURCE: MassHealth Physician Manual, 433.429, (7/7/23), (Accessed Dec. 2024).

Acute Outpatient Hospital

The MassHealth agency will pay for case consultation only when telephone contact, written communication, and other nonreimbursable forms of communication clearly will not suffice. Such circumstances must be documented in the member’s record. Such circumstances are limited to situations in which both the hospital outpatient department and the other party are actively involved in treatment or management programs with the member (or family members) and where a lack of face-to-face communication would impede a coordinated treatment program.

SOURCE: MassHealth Acute Outpatient Hospital Manual, 410.479, (7/7/23), & MassHealth Chronic Disease and Rehabilitation Hospital Manual, 410.479 (7/28/17). (Accessed Dec. 2024).

The following service code modifiers are allowed for billing under the MassHealth Acute Outpatient Hospital Manual for payable services:

93 – Services rendered via audio-only telehealth.

SOURCE: MassHealth Provider Manual Series, Acute Outpatient Hospital Manual, p. 19 (Dec. 5, 2024). (Accessed Dec. 2024).

Chronic Disease and Rehabilitation Inpatient Hospital

Screening Program for Chronic-Disease and Rehabilitation Hospitals – To initiate admission or conversion screening, the hospital must telephone the MassHealth agency or its agent prior to the proposed admission or anticipated conversion and must:

• describe the medical condition that necessitates a chronic-disease or rehabilitation hospital admission or continued stay; and
• state the anticipated length of stay

Discharge – The hospital must have written procedures for arranging posthospital services for members. At a minimum, these procedures must include frequent, systematic contacts (usually three times weekly) by telephone or in person to all nursing facilities and community-service providers within a 25-mile minimum radius of the hospital.

SOURCE: MassHealth Chronic Disease Rehabilitation Inpatient Manual, 435.408, 435.417, (4/17/15), (Accessed Dec. 2024).

Acute Inpatient Hospital 

Discharge – Whenever possible, the discharge-planning staff or primary-care team must contact the member’s family to encourage its involvement in planning the member’s discharge. To this end, family members must be informed of the discharge options and community resources available to the member and provided with lists of nursing facilities and community resources in the area. When possible, these meetings or telephone consultations with the family must be held once every two weeks until the member is discharged. The dates of these meetings and other contacts with family, matters discussed, problems identified, and agreements reached must be entered on the member’s discharge-planning record.

SOURCE: MassHealth Acute Inpatient Hospital Manual, 415.419, (1/2/15), (Accessed Dec. 2024).

Chronic Disease and Rehabilitation Hospital

Noncovered Services

• telephone conversations and consultations;

Source:  Mass Health Chronic Disease and Rehabilitation Outpatient Hospital Manual, Regs. 410.472, (1/24/22), (Accessed Dec. 2024).

Podiatry

Noncovered Services

• telephone consultations;

Source:  MassHealth Podiatrist Manual, Regs. 424.405, (8/12/16), (Accessed Dec. 2024).

Psychiatric Outpatient Hospital

Nonreimbursable Services

• telephone conversations and telephone consultations;

SOURCE: MassHealth Psychiatric Outpatient Hospital Manual, Reg. 434.406, (12/26/08), (Accessed Dec. 2024).

Social Work

Case Consultation – intervention, including scheduled audio-only telephonic, audio-video, or in person meetings, for behavioral and medical management purposes on a member’s behalf with agencies, employers, or institutions which may include the preparation of reports of the member’s psychiatric status, history, treatment, or progress (other than for legal purposes) for other physicians, agencies, or insurance carriers.

Case Consultation – The MassHealth agency pays only for a case consultation that involves a personal meeting with a professional of another agency. Personal meetings may be conducted via audio-only telephonic, audio-video, or in person meetings.

Source:  MassHealth Podiatrist Manual, Regs. 462.402 & 411, (1/1/23), (Accessed Dec. 2024).

Telephone contacts are listed as a noncovered service in multiple manuals.

Telehealth does not include communication between health care providers, or between a health care provider and a patient that consists solely of an audio-only communication, email, or facsimile transmission or as specified by law

SOURCE: MN Statute Sec. 256B.0625, Subsection 3(b)(e)(1). (Accessed Nov. 2024).

Child Welfare Targeted Case Management (CW-TCM)

Case management activities are those that help the eligible member gain access to needed medical, social, educational and other services as identified in an individual service plan. Only services delivered on a face-to-face or interactive video basis are claimable as CW-TCM unless the client is in placement more than 60 miles beyond county or reservation boundaries. If a client is in placement more than 60 miles beyond county or reservation boundaries, a provider may deliver services using telephone or interactive video contact for two consecutive months. There must be a face-to-face contact in the month before the eligible telephone or ITV contacts when children have been and continue to be in placement.

See manual for examples.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Child Welfare Case Management Services, As revised Jan. 11, 2024. (Accessed Nov. 2024).

Audio only (until July 1, 2025)

Audio only is the delivery of health care services or consultations through telephone communication while the patient is at one site and the qualified health care provider is at a distant site.

Audio-only communication will be covered if:

New Telehealth Modifier and Use of Current Telehealth Modifiers

Modifier 93, Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires this modifier when audio-only telehealth is used.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Telehealth Delivery of Mental Health Services, Revised Oct. 2022 (Accessed Nov. 2024).

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Providers must have documentation of services provided and have followed all clinical standards to bill for services via telehealth or telephonic (audio-only) telehealth. Refer to the Telehealth Services section of the MHCP Provider Manual under Billing for information about billing for services provided via telehealth.

SOURCE: MN Dept. of Human Services, Screening, Brief Intervention and Referral to Treatment, Dec. 29, 2022 (Accessed Nov. 2024).

Smoking Cessation

Medical assistance covers telephone cessation counseling services provided through a quitline. Notwithstanding section 256B.0625, subdivision 3b, quitline services may be provided through audio-only communications. The commissioner of human services may utilize volume purchasing for quitline services consistent with section 256B.04, subdivision 14.

SOURCE: MN Statute Sec. 256B.0625, (Accessed Nov. 2023).

Program HH (HIV/AIDS) Services – MTMS Covered Services

In addition to the covered services included under MTMS in the MHCP Provider Manual, Program HH also covers services provided by telephone. Providers should follow the MHCP Telehealth Services policy.

SOURCE: MN Dept. of Human Services, Program HH (HIV/AIDS) Services, May 23, 2024 (Accessed Nov. 2024).

IEP Services

MHCP telehealth coverage will not pay the following:  …

• Communication via telephone, email or fax

SOURCE: MN Dept. of Human Svcs., Provider Manual, IEP Services, As revised May 19, 2022 ; MN Dept. of Human Svcs. Provider Manual Rehabilitation Services, Jan. 25, 2022.  (Accessed Nov. 2024).

Telehealth Delivery of Substance Use Disorder Services

Modifier 93, Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires modifier 93 when audio-only telehealth is used.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Substance Use Disorder Telehealth, May 23, 2023, (Accessed Nov. 2024).

Federally Qualified Health Center and Rural Health Clinic

Effective July 1, 2025, audio-only communication will end as part of a face-to-face encounter payment methodology.

SOURCE: MN Dept of Human Services, Federally Qualified Health Center and Rural Health Clinic, Mar. 18, 2024, (Accessed Nov. 2024).

Remote Reassessments

Assessments performed according to subdivisions 17 to 20 and 23 must be in person unless the assessment is a reassessment meeting the requirements of this subdivision. Remote reassessments conducted by interactive video or telephone may substitute for in-person reassessments.

SOURCE:  MN Statute Sec. 256B.0911 & Senate File 4399 (2024 Session), (Accessed Nov. 2024).

Long Term Care Options Counseling at Critical Care Transitions

Counseling must be delivered by Senior LinkAge Line either by telephone or in-person.

See statute for requirements.

SOURCE:  MN Statute Sec. 256.975 & Senate File 4399 (2024 Session), (Accessed Nov. 2024).

Mental Health Services – Noncovered Services

• Telephone calls that do not follow all Telehealth Delivery of Mental Health Services requirements

SOURCE: MN Dept. of Human Svcs., Provider Manual, Mental Health Services, Apr. 17, 2024 (Accessed Nov. 2024)

Behavioral Health Home Services

To submit claims for delivery of BHH services, certified providers must:

• Have personal contact with the person or the identified support at least once per month. Personal contact may include face-to-face, telephone contact or interactive video. An email, letter, voicemail or text alone does not meet the requirement for monthly personal contact.
• At a minimum, offer a face-to-face visit with the member at least every six months. If the member declines the offer of a face-to-face visit, the visit may be completed by telephone contact or interactive video.

SOURCE:  MN Dept. of Human Svcs. Provider Manual Behavioral Health Home Services Sept. 13, 2024.  (Accessed Nov 2024).

Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM)

AMH-TCM case managers may meet with the member via face-to-face, ITV or telephone. Telephone contact may occur for up to two months before ITV or face-to-face contact must be made. It is best practice to see the person every month.

SOURCE: MN Dept. of Human Svcs, Provider Manual Adult Mental Health Targeted Case Management (AMH-TCM) and Children’s Mental Health Targeted Case Management (CMH-TCM) Nov. 13, 2023.  (Accessed Nov. 2024).

Vulnerable Adult/Developmental Disability Targeted Case Management (VA/DD-TCM)

Any provider who uses Social Services Information System (SSIS) uses the following SSIS workgroups, services, activities and contact methods for document and billing purposes:

• Client contact; contact method either face-to-face, interactive video or by telephone
• Collateral contact; contact method either face-to-face, interactive video or by telephone

SSIS contact methods:

• Face-to-face.
• Interactive video.
• Phone.

SOURCE:  MN Dept. of Human Svcs, Provider Manual Vulnerable Adult/Developmental Disability Targeted Case Management (VA/DD-TCM) Oct. 3, 2023.  (Accessed Nov. 2024).

Long Term Care Options Counseling at Critical Care Transitions

Counseling must be delivered by Senior LinkAge Line either by telephone or in-person.

See statute for requirements.

SOURCE:  MN Statute Sec. 256.975 & Senate File 4399 (2024 Session), (Accessed Nov. 2024).

Dialectical Behavior Therapy (DBT) (for adolescent ages 12 to 17)

Components of DBT must include the following: …

• Telephone coaching: Provides support between therapy sessions.

SOURCE:  MN Dept. of Human Svcs, Provider Manual Mental Health Services in Special Education (MH-SPED) (School Social Work Services), Oct. 15, 2024.  (Accessed Nov. 2024).

The following are not considered telehealth services:

• Telephone conversation
• Chart reviews
• Electronic mail messages
• Facsimile transmission
• Internet services for online medical evaluation, or
• Communication through social media or,
• Any other communication made in the course of usual business practices including, but not limited to,

1. 1. Calling in a prescription refill, or
   2. Performing a quick virtual triage.

SOURCE: MS Admin. Code 23, Part 225, Rule. 1.4. (Accessed Dec. 2024).

During a state of emergency, Telehealth services are expanded to include use of telephonic audio that does not include video when authorized by the State of Mississippi.

A beneficiary may use the beneficiary’s personal telephonic land line in addition to a cellular device, computer, tablet, or other web camera-enabled device to seek and receive medical care in a synchronous format with a distant-site provider.

SOURCE: MS Admin. Code Title 23, Part 225, Rule. 1.7. (Accessed Dec. 2024).

MHD also allowed the use of telephone for telehealth services, and allowed quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number. MHD did not require additional CMS flexibility for these options, and they will continue.

SOURCE:  MO Medicaid Provider Tips, Telehealth services, March 27, 2023, (Accessed Sept. 2024).

Mental Health

Audio-only is real-time, interactive voice-only discussion between an individual and the service provider.

The CR Modifier will be ending on June 30, 2022, regardless of the PHE declaration end date.

Starting July 1, 2022, Audio-Only services shall utilize the FQ Modifier.

The GT modifier will continue to be utilized for Telemedicine, with the exception of CSTAR programs that have transitioned to American Society of Addiction Medicine (ASAM), as this billing structure no longer utilizes modifiers.

Starting July 1, 2022, CSTAR programs that have transitioned to ASAM, will use the 02 Place of Service, instead of the GT modifier.

See bulletin for audio-only service guidance.

SOURCE:  MO Division of Behavioral Health, Community Treatment Program, Clarification, July 8, 2022, (Accessed Sept. 2024).

Interprofessional Consultations

MHD’s Physician Program currently covers interprofessional consultation. Effective April 15, 2024, MHD is implementing interprofessional consultation for behavioral health practitioners.

Behavioral Health Crisis Centers

The center shall be staffed by a multidisciplinary team who is able to respond to the needs of individuals experiencing all levels of crisis. Staff shall include but is not limited to-

• Medical director-a licensed psychiatrist (available via telemedicine or audio-only). The medical director for the BHCC/U-BHCC can be the same individual who serves in this capacity for the CCBHO.

SOURCE: 9 CSR 30-7.010, (Accessed Sept. 2024).

Collateral Contact – CSTAR

A source of information regarding an individual’s health, safety, functional needs or effectiveness of the individual’s plan for services. Communication with a collateral contact may be made in-person, audio-only or by telemedicine.

SOURCE: MO HealthNet, Community Substance Treatment and Rehabilitation/American Society of Addiction Medicine (12/04/2023), p. 99, (Accessed Sept. 2024).

Pharmacy Services

MTM code 99607 can be delivered telemetrically.

SOURCE: MO HealthNet, Pharmacy Manual (7.31/2024), p. 27, (Accessed Sept. 2024).

Collateral contacts are a source of information regarding the individual’s health, safety, functional needs or effectiveness of the individual’s plan for services. Communication with a collateral contact may be made face to face, by phone or by telehealth platforms.

SOURCE: MO HealthNet, Comprehensive Substance Treatment and Rehabilitation Manual p. 44 (9/1/23), (Accessed Sept. 2024).

Optical

The following services are not billable to the participant or to MHD:

• Telephone calls or phone consultations

SOURCE: MO HealthNet Optical Provider Manual, p. 20 (9/1/23).  (Accessed Sept. 2024).

All Montana Medicaid covered services delivered via telemedicine/telehealth are reimbursable if the services:

• Are medically necessary and clinically appropriate for delivery via telemedicine/telehealth;
• Follow the guidelines set forth in the applicable Montana Healthcare Programs provider manual; and
• Are not a service specifically required to be face-to-face as defined in the applicable Montana Healthcare Programs provider manual.

There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.

Rates of payment for services delivered via telemedicine/telehealth will be the same as rates of payment for services delivered via traditional (e.g., in-person) methods set forth in the applicable regulations. Please refer to the fee schedules posted on the Provider Information website for current rates.

SOURCE:  MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Oct. 2024).

Despite the above more recent guidance, the General Information for Providers Telemedicine Manual still seems to restrict audio-only coverage:

Telemedicine reimbursement does not include:

• Consultation by telephone
• Facsimile machine transmissions
• Crisis hotlines

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, General Information for Providers, Telemedicine (Feb. 2020). (Accessed Oct. 2024).

Medicaid does not cover services that are not direct patient care such as the following:

• Telephone services in home

SOURCE: MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., Telemedicine (Feb. 2020) & Critical Access Hospital, Covered Services, 3/18/20, (Accessed Oct. 2024).

Telehealth services may be provided using secure portal messaging, secure instant messaging, telephone communication, or audiovisual communication.

SOURCE: Montana Code Annotated 53-6-122 (Accessed Oct. 2024)

Children’s Mental Health Bureau

A Peer-to-Peer Review is a telephonic review between an advocating clinician, chosen by either the parents/legal representative or the authorized representative, and the physician reviewer who rendered the adverse determination.

• The Peer-to-Peer Review is based upon the original clinical documentation and may consider clarification or updates.
• The Peer-to-Peer Review must be:
  • Requested within 10 business days of the adverse determination date; and
  • Scheduled by the physician reviewer within five business days of the request.

SOURCE: MT Dep. of Public Heath and Human Services, Children’s Mental Health Bureau Medicaid Services, Provider Manual, May 12, 2023,  pg. 60, (Accessed Oct. 2024).

Tribal Health Improvement Manual (T-HIP)

Tier 1 Activities:

• Telephone calls and in-person visits to check on member progress and status

The T-HIP PCCMes also provide the following as defined in 42 CFR 438.2 in addition to primary care case management services:

• Provision of intensive telephonic case management.

SOURCE: MT Dep. of Public Heath and Human Services, Tribal Health Improvement Manual (T-HIP), Provider Manual, 6/26/24,  (Accessed Oct. 2024).

Mental Health Centers and Therapeutic Group Homes – Children’s Mental Health Services

With the finalization of the rulemaking MAR 37-1031, the following face-to-face flexibilities were made permanent effective May 12, 2023:

• Comprehensive School and Community Treatment (CSCT)
  • Face-to-face service delivery is preferred. Telehealth may be substituted if clinically indicated or if the youth does not have access to face-to-face services. Case notes must include reason, including documentation of attempts to identify local supports, if related to access.
• Community Based Psychiatric Rehabilitation Services (CBPRS)
  • Face-to-face service delivery is preferred. Telehealth may be substituted if clinically indicated or if the youth does not have access to face-to-face services. Case notes must include reason, including documentation of attempts to identify local supports, if related to access
• Home Support Services (HSS)
  • Maintain minimum weekly units at 8, allow up to 4 of the 8 units to be telehealth service delivery.
  • Maintain bi-weekly clinical lead requirements, allow up to 1 telehealth meeting per month.
  • Face-to-face services delivery is preferred. Telehealth may be substituted if clinically indicated or if the youth does not have access to face-to-face services. Case notes must include reason, including documentation of attempts to identify local supports, if related to access.
• Therapeutic Foster Care
  • Maintain 2 scheduled treatment sessions in each four-week period, allow for 1 visit in the four week period to be telehealth delivery.
  • Face-to-face service delivery is preferred. Telehealth may be substituted if clinically indicated or if the youth does not have access to face-to-face services. Case notes must include reason, including documentation of attempts to identify local supports, if related to access.
• Targeted Case Management – Youth with Serious Emotional Disturbance
  • No permanent updates; pre-PHE Administrative Rules of Montana apply

There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and it can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.

SOURCE:  Montana Healthcare Programs Provider Notice, Telehealth Policy Clarification for Children’s Mental Health Services, Effective May 12, 2023, Revised April 2, 2024. (Accessed Oct. 2024).

Telephone medical discussion codes listed as reimbursable (98966-98968 and 99441-99442) in provider procedure code list dated Oct. 1, 2024.

SOURCE:  MT Plan First, Procedures and Service Codes, Effective Oct. 1, 2024, (accessed Oct. 2024).

To bill for services administered through telehealth, please use the following place of service codes and modifiers. Failure to use the place of service codes and modifiers for services provided via telehealth may lead to refunds or further sanctions.

Place of Service codes:

• Place of Service 02 – use when telehealth is administered while the patient is in a location besides their home.
• Place of Service 10 – use when telehealth is administered while the patient is in their home.

Modifiers:

• Multiple modifiers can be added to a single CPT code. The payment modifier goes first, followed by any informational modifiers. The telehealth modifier is an informational modifier and should be placed after any payment modifier.
  • 93 – synchronous telemedicine service rendered via telephone or other real-time interactive audio-only.
  • 95 – telehealth services are provided in real-time with an audio-visual component Information on telehealth codes will be included in our fee schedules. For more information on Medicaid rates and fee schedules please visit our website: https://dhhs.ne.gov/Pages/Medicaid-Provider-Ratesand-Fee-Schedules.aspx

SOURCE: NE Medicaid Program, Bulletin 23-38:  Guidance on Telehealth, Dec. 29, 2023, (Accessed Dec. 2024).

Telehealth also includes audio-only services for the delivery of individual behavioral health services for an established patient, when appropriate, or crisis management and intervention for an established patient as allowed by federal law.

SOURCE: NE Rev. Statute, 71-8503, (Accessed Dec. 2024).

Telephone Consultations

Nebraska Medicaid does not cover telephone calls to or from an individual, pharmacy, nursing home, or hospital. Nebraska Medicaid may cover telephone consultations with another physician if the name of the consulting physician is indicated on or in the claim.

SOURCE: NE Admin. Code Title 471, Ch. 18-005.30, . (Accessed Dec. 2024).

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 Dec. 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 Dec. 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 Dec. 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 Dec. 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, (Aug. 27, 2024) (Accessed Dec. 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 Dec. 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.

SOURCE: NV Dept. of Health and Human Svcs., Medicaid Services Manual, Home and Community Based Services (HCBS) Waiver for Persons with Physical Disabilities, Jan. 1, 2024, (Accessed Dec. 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 Jan. 1, 2024, (Accessed Dec. 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, Jan. 1, 2024, (Accessed Dec. 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, Jan. 1, 2023, (Accessed Dec. 2024).

Certain telephone discussion 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, (10/29/24), substance use treatment clinic (10/29/24), opioid treatment program (10/29/24). (Accessed Dec. 2024).

Medical providers described in He-C 5004.03(a) above, shall be permitted to perform health care services through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media.

Source: NH Admin Rules, HE-C 5004.03, (Accessed Dec. 2024).

“Telehealth services” shall comply with 42 C.F.R. section 410.78, except for 42 C.F.R. section 410.78(b)(4).

SOURCE: NH Revised Statutes 167:4-d & 42 CFR Sec. 410.78. (Accessed Dec. 2024).

The Medicaid program shall provide reimbursement for all modes of telehealth, including video and audio, audio-only, or other electronic media provided by medical providers to treat all members for all medically necessary services.

Eligible medical providers shall be allowed to perform health care services through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media.

SOURCE: NH Revised Statutes Annotated, 167:4-d, (Accessed Dec. 2024).

Effective as of 4/1/2022, FQ modifier identifying the service was furnished using audio-only communication technology has been added to MMIS.

SOURCE: NH Medicaid Provider Bulletin, New Modifiers and Telehealth POS (Mar. 25, 2022), (Accessed Dec. 2024).

Care Coordination for behavioral health includes Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge*

SOURCE: NH Medicaid Provider Provider Communication, To NH Medicaid Enrolled Providers, July 12, 2024, (Accessed Dec. 2024).

Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system. Sessions may not be recorded.

The telehealth law requires that telehealth be provided using interactive, real-time, two-way communication technologies. The law specifically prohibits, by themselves, the use of audio-only telephone calls, electronic mail, instant messaging, phone texts or images transmitted via facsimile machines.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 28, No. 17, Sept. 2018, p. 1-2 (Accessed Aug. 2024).

Telemedicine does not include the use, in isolation, of electronic mail, instant messaging, phone text or facsimile transmission.

In no case shall the State Medicaid and NJ FamilyCare Programs:

• Restrict the ability of a provider to use any electronic or technical platform to provide services using telemedicine or telehealth, including but no limited to interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:
  • Allows the provider to meet the same standard of care as would be provided if the services were provided in person’
  • Is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164.

SOURCE: NJ Statute C.30:4D-6K(e) – cites: NJ Statute C.45:1-61. (Accessed Aug. 2024). 

Statewide Mobile Behavioral Health Crisis Response Team

Mobile crisis response teams shall be community-based and may incorporate the use of: emergency medical technicians and other health care providers, to the extent a medical response is needed; law enforcement personnel, to the extent that the crisis cannot be resolved without the presence of law enforcement, provided that, whenever possible, the mobile crisis response team shall seek to engage the services of law enforcement personnel who have completed training in behavioral health crisis response; and other professionals as may be necessary and appropriate to provide a comprehensive response to a behavioral health crisis.

Notwithstanding the requirement that mobile crisis response teams be community based, nothing in this section shall be construed to prohibit the provision of crisis intervention services via telephone, video chat, or other appropriate communications media, if the use of these media are necessary to provide access to a needed service in response to a particular behavioral health crisis, and the provision of services using telephone, video chat, or other media is consistent with the needs of the person experiencing the behavioral health crisis.

Each mobile crisis response team shall submit a monthly report to the Department of Human Services identifying, for the preceding month: the number of dispatch calls the team received; the number of dispatch calls the team responded to; the number of dispatch calls that included a response by emergency medical services providers, law enforcement, or both; the proportion of total services that were provided in person, via telephone, via video call, and via other means; the number of mobile crisis responses that resulted in referrals for services and the types of services that were referred; the number of responses that did not result in a referral or follow-up service; to the extent possible, information regarding the nature of the mobile crisis responses that did and did not result in a referral or follow-up service; and any other information as shall be required by the Commissioner of Human Services.

SOURCE: NJ Statute C.26:2MM-7. (Accessed Aug. 2024).

MAD will reimburse eligible providers for limited professional services delivered by telephone without video. No additional reimbursement is made to the originating-site for an interactive telemedicine system fee.

SOURCE: NM Administrative Code 8.310.2.12 M(2). (Accessed Nov. 2024).

MAD covers service plan updates through the participation of interdisciplinary teams.

The six elements of teaming may be performed by using a variety of media (with the person’s knowledge and consent) e.g., texting members to update them on an emergent event; using email communications to ask or answer questions; sharing assessments, plans and reports; conducting conference calls via telephone; using telehealth platforms conferences; and, conducting face-to-face meetings with the person present when key decisions are made. Only the last element, that is, conducting the final face-to-face meeting with the recipient present when key decisions that result in the updates to the service plan, is a billable event.

SOURCE: NM Administrative Code 8.321.2.9 (L)(3c). (Accessed Nov. 2024).

Multi Systemic Therapy: Weekly supervision must also include one hour of local group supervision and one hour of telephone consultation per week with the MST systems supervisor.

Crisis Stabilization: Services include telephone crisis services; face-to-face crisis intervention in a clinic setting; and outpatient crisis stabilization services.

Community-based Mobile Crisis Intervention Services: Services may also include telephonic follow-up interventions for up to 72 hours after the initial mobile response.

SOURCE: State Plan Amendment, Supplement A to Attachment 3.1A, (Accessed Nov. 2024).

Mobile Crisis Intervention

Mobile crisis intervention services include telephonic follow-up for up to 72 hours after the initial mobile response, which may include, where appropriate, additional intervention and de-escalation services and coordination with and referrals to health, social, emergency services, and other services and supports, as needed.

See supplement for codes for mobile crisis providers.

Crisis providers cannot bill a mobile crisis unit code (H2011), mobile crisis per diem (S9485) and/or MRSS stabilization (S9482) rate on the same day. Crisis providers cannot bill a mobile crisis per diem (S9485) and a telephonic follow-up call (H0030) in the same day.

Authorization for Telephonic Follow-up (H0030) is not required if it follows a mobile crisis intervention service.

SOURCE: NM Medical Assistance Program Supplement, Mobile Crisis Providers, Number 24-14, Oct. 7, 2024, (Accessed Nov. 2024).

“Audio-only visits” means the use of telephone and other audio-only technologies to deliver services.

“eConsults” means the asynchronous or synchronous, consultative, provider-to-provider assessment and management services conducted through telephone, internet, or electronic health records.

“Virtual Check-in” means a brief communication via a secure, technology-based service initiated by the patient or patient’s guardian/caregiver, e.g., virtual check-in by a physician or other qualified healthcare professional.

Payment for telehealth services shall be made in accordance with section 538.3 of this Part only if the provision of such services appropriately reduces the need for on-site or in-office visits and the following standards are met:

• An “audio-only visit” is reimbursable when the service can be effectively delivered without a visual or in-person component; and it is the only available modality or is the patient’s preferred method of service delivery; and the patient consents to an audio-only visit; and it is determined clinically appropriate by the ordering or furnishing provider; and the provider meets billing requirements, as determined and specified by the commissioner in administrative guidance. Services provided via audio-only visits shall contain all elements of the billable procedures or rate codes and must meet all documentation requirements as if provided in person or via an audio-visual visit.
•  “eConsults” are intended to improve access to specialty expertise through consultations between consulting providers and treating providers. eConsults are reimbursable when the providers meet minimum time and billing requirements, as determined and specified by the commissioner in administrative guidance.
• “Virtual Check-in” visits are intended to be used for brief medical discussions or electronic communications between a provider and a new or established patient, at the patient’s request. Virtual check-ins are reimbursable when the provider meets certain billing requirements, as determined and specified by the commissioner in administrative guidance.

As required by Social Services Law § 367-u and, except for services paid by State only funds, contingent upon federal financial participation, reimbursement shall be made in accordance with fees determined by the commissioner based on and benchmarked to in-person fees for equivalent or similar services.

SOURCE: NY Code of Rules and Regs. Title 18, Sec. 538.1-3, as proposed by Final rule per Notice Of Adoption. (Accessed Dec. 2024).

Telehealth shall not include delivery of health care services by means of facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, remote patient monitoring and audio-only telephone communication, except that with respect to the medical assistance program shall include audio-only telephone communication only to the extent defined in regulations as may be promulgated by the commissioner.

SOURCE: NY Public Health Law Article 29 – G Section 2999-cc, (Accessed Dec. 2024).

The commissioner may specify in regulation additional acceptable modalities for the delivery of health care services via telehealth, including but not limited to audio-only or video-only telephone communications, online portals and survey applications, and may specify additional categories of originating sites at which a patient may be located at the time health care services are delivered to the extent such additional modalities and originating sites are deemed appropriate for the populations served.

SOURCE: NY Public Health Law Article 29 – G Section 2999-ee. (Accessed Dec. 2024).

Telephonic service uses two-way electronic audio-only communications to deliver services to a patient at an originating site by a telehealth provider. For complete billing instructions for telephonic services, providers can refer to the “Billing Rules for Telehealth Services”, “Telephonic (Audio-only) Reimbursement Overview” section of the Medicaid Telehealth Provider Manual.

NYS Medicaid expanded coverage of remote services to include audio-only visits, to increase access to services, eliminate barriers, supplement oversight of chronic conditions, and improve outcomes. Decisions on what type of visit the NYS Medicaid member receives should be based on their choice and best interest. Provider preference or convenience are not relevant. Providers must use professional judgment to determine whether audio-only services meet patient needs and whether a visit is eligible for audio-only based on criteria below. NYS DOH anticipates only rare occasions when audio-only visits are appropriate for non-behavioral health (BH) services. For example, during weather emergencies when the patient is unable to use audio-visual technologies or when the visit could not occur unless provided via audio-only telehealth. NYS DOH will monitor audio-only billing and take steps to limit overuse and prevent misuse of audio-only services.

NYS Medicaid covers audio-only visits for NYS Medicaid members when all the following conditions are met:

• audio-visual telehealth is not available to the patient due to lack of patient equipment or connectivity or audio-only is the preference of the patient;
• the provider must make either audio-visual or in-person appointments available at the request of the patient;
• the service can be effectively delivered without a visual or in-person component, unless otherwise stated in guidance issued by the NYS DOH (this is a clinical decision made by the provider); and
• the service provided via audio-only visits contains all elements of the billable procedures or rate codes and meets all documentation requirements as if provided in person or via an audio-visual visit.

Additional programmatic guidance may be published that specifically allows or prohibits the use of audio-only telehealth by type of service. Additional agency-issued guidance outlines the appropriateness of audio-only visits for their specific populations. See billing rules in Section 9.6 “Telephonic (Audio-Only) Reimbursement Review.”

When audio-only telehealth is used in accordance with the policy outlined in “Telehealth Definitions”, “Telephonic (Audio-only),” providers may bill NYS Medicaid in two ways:

1. As they would for an in-person or audio-visual telehealth visit (using the appropriate procedure or rate code) with the addition of a telehealth modifier to indicate delivery by audio-only.
2. Using the telephonic (audio-only) E&M procedure codes “99441” through “99443” with the addition of a telehealth modifier to indicate audio-only.
   1. These codes will continue to be billable through December 31, 2024, in accordance with the Consolidation Appropriations Act 2023 and Medicare Physician Fee Schedule Final Rule 2024.

Services provided via audio-only visits shall contain all elements of the billable procedures or rate codes and must meet all documentation requirements as if provided in person or via an audiovisual visit.

The telephonic rate codes “7961” through “7968” were retired effective November 1, 2023. FQHCs can bill the Prospective Payment System (PPS) rate code “4012” or “4013”, depending on on-site presence as outlined in “Billing Rules for Telehealth Services”, “FFS Billing for Telehealth by Site and Location.” Wrap payments are available for any telehealth services, including telephonic services reimbursed by an MMC Plan, under qualifying PPS and off-site rate codes.

All audio-only claims and encounters must include the “93” or “FQ” modifier unless modifiers are not allowable (e.g., teledentistry). The “UA” modifier should no longer be used to indicate the service as delivered via audio-only.

When a POS is allowable on a claim or encounter, providers should report POS “02” for telehealth provided other than in patient’s home, “10” for telehealth provided in the home of the patient, except in cases where POS “11” is typically submitted (private practice or office setting); POS “11” providers should continue to report POS “11” and use telehealth modifiers on the claim or encounter to identify it as telehealth.

NYS Medicaid does not prescribe a list of services deemed appropriate or prohibited for audio-only telehealth, but other payors, programs, or agencies may issue additional guidance that supplements or supersedes this policy (see “Restrictions for Specific Services or Populations”). For example, CMS publishes a List of Telehealth Services which includes services allowable via audio-only for Medicare claims. MMC Plans may have separate detailed billing guidance that supplements the billing guidance outlined in this issue, but must cover all services appropriate to deliver through telehealth, including audio-only telehealth. Further detail on FFS code coverage is provided in specialized guidance for mental health, substance use, and NYS OPWDD services.

Virtual Check-Ins

Virtual check-ins are brief medical interactions between a physician or other qualified health care professional and a patient. Virtual check-ins may be especially helpful for patients with ongoing chronic conditions that would benefit from recurring check-ins with their provider. A virtual check-in can be conducted via several technology-based modalities, including communication by telephone or by secure text-based messaging, such as electronic interactions via patient portal, secure email, or secure text messaging.

Communication must be Health Insurance Portability and Accountability Act (HIPAA)-compliant and don’t relate to an Evaluation and Management (E&M) visit the patient had within the past seven days, nor lead to a related E&M visit within 24 hours (see “Billing Rules for Telehealth Services” for specific information on code and modifiers).

Virtual check-ins must be patient-initiated and allow patients to communicate with their provider in order to avoid an unnecessary visit; however, practitioners may need to inform and educate beneficiaries on the availability of the service prior to patient initiation. A parent or caregiver may initiate a virtual check-in on behalf of a patient. The patient must consent to receive virtual checkin services and the provider must document the consent of the patient in their chart at least once annually while the patient receives virtual check-in services.

Expanding on previous policy, NYS Medicaid-enrolled providers (physician or other qualified health care professional who report E&M services) can bill CPT codes “G2012” or “G2252” for reimbursement for virtual check-ins. The virtual check-in must be reported on the claim with the appropriate telehealth modifier (“93”, “95”, “FQ”, “GT”, and “GQ”). Communications reported with a virtual check-in CPT code must meet the criteria outlined in the Medicaid Telehealth Provider Manual.

Additional agency-issued guidance may be available for specific populations. NYS OPWDD, OASAS, and OMH providers should review their respective guidance to ensure compliance.

Telemental Health

Audio-only or audio-video communication is an acceptable option only when determined appropriate by the provider of service, in accordance with guidelines established by the Office, and with informed consent from the recipient. Where the recipient is a minor, consent shall also be provided by the parent/guardian or other person who has legal authority to consent to health care on behalf of the minor.

Audio-only or audio-video communication is covered by Medicaid and the Child Health Insurance Plan to the extent consistent with regulations promulgated by the New York State Commissioner of Health pursuant to Section 2999-cc of the Public Health Law.

Telehealth services do not include an electronic mail message, text message, or facsimile transmission between a provider and a recipient, services provided where the originating and distant sites are the same location, or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support teleealth services.

SOURCE: NY Code of Rules and Regs. Title 14, Sec. 596.1(d)(e) & 596.4(r), as amended by Final Rule and Notice Of Adoption. (Accessed Dec. 2024).

SOURCE: NY State Office of Mental Health Telehealth Services Guidance for OMH Providers (April 2023), p. 4-6, 8, 12. (Accessed Dec. 2024).

Crisis Services for Individuals with Intellectual and/or Developmental Disabilities (CSIDD)

Effective May 12, 2023, with the end of the Public Health Emergency (PHE), the State of New York will continue to allow the remote delivery of CSIDD through telephonic or other technology in accordance with State, Federal, and Health Insurance Portability and Accountability Act (HIPAA) requirements. Other technology means any two-way, real-time communication technology that meets HIPAA requirements. See Telehealth Allowance Attachment which will serve as an addendum to CSIDD ADM #2021-04R and outlines the allowance of the remote delivery of Crisis Services for Individuals with Intellectual and/or Developmental Disabilities (CSIDD).

SOURCE: OPWDD ADM#2021-04R Telehealth Allowance Attachment, Jul. 2024. (Accessed Dec. 2024).

Office for People with Developmental Disabilities (OPWDD) Article 16 Clinics – Individuals with Intellectual/Developmental Disabilities (I/DD)

Various procedure codes are approved by OPWDD for use in Article 16 clinics via telehealth, designated as allowed for either or both live video and audio-only. See Article 16 APG Crosswalk for codes.

SOURCE: OPWDD A16 APG Crosswalk 2024. (Accessed Dec. 2024).

Teledentistry

Virtual communications is the use of technologies other than video to enable remote evaluation and consultation support between a provider and a beneficiary or a provider and another provider. As outlined in Attachment A and program specific clinical coverage policies, covered virtual communication services include: telephone conversations (audio only); virtual portal communications (secure messaging); and store and forward (transfer of data from beneficiary using a camera or similar device that records (stores) an image that is sent by telecommunication to another site for consultation).

Virtual communication, including:

• online digital evaluation and management codes;
• telephonic evaluation and management;
• telephonic evaluation and management and virtual communication codes; and
• interprofessional assessment and management codes.

Covered virtual communication services include telephone evaluation and management codes (audio only): 99441-99443 and G2012.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, June 1, 2023. (Accessed Dec. 2024).

Telephonic Claims: Modifier KX must be appended to the CPT or HCPCS code to indicate that a service has been provided via telephonic, audio-only communication.

Telehealth and telephonic claims should be filed with the provider’s usual place of service code(s).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8F, Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD), Amended Apr. 1, 2023.  (appears in multiple additional manuals), (Accessed Dec. 2024).

As outlined in Attachment A, select services within this clinical coverage policy can be provided via the telephonic, audio-only communication method. Telephonic services must be transmitted between a beneficiary and provider in a manner that is consistent with the CPT code definition for those services. This service delivery method is reserved for circumstances when:

• physical or behavioral health status prevent the beneficiary from participating in-person or telehealth services; or
• access issues (transportation, telehealth technology) prevent the beneficiary from participating in-person or telehealth services.

24-Hour Coverage for Behavioral Health Crises:  This coverage must incorporate the ability for the beneficiary to speak with the licensed clinician on call either in-person, via telehealth, or telephonically.

Specific criteria for services delivered telephonically are outlined in the manual.

Medicaid shall require prior approval for services provided via the telephonic, audio-only communication method.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, Nov. 1, 2023. (Accessed Dec. 2024).

FQHCs/RHCs

FQHCs and RHCs may conduct telephonic evaluation and management services using HCPCS code G0071. Eligible providers include physicians, nurse practitioners, psychiatric nurse practitioners, physician assistants, and certified nurse midwives.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, p. 19, Aug. 15, 2023. (Accessed Dec. 2024).

Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD)

As outlined in Attachment A, select services within this clinical coverage policy may be provided via the telephonic, audio-only communication method. Telephonic services may be transmitted between a patient and provider in a manner that is consistent with the CPT code and definition for those services.

This service delivery method is reserved for circumstances when:

• the caregiver’s physical or behavioral health status prevents them from participating in in-person or telehealth services; or
• access issues (e.g., transportation, telehealth technology) prevent the caregiver from participating in in-person or telehealth services.

Refer to Subsection 3.2.5 for Telephonic-Specific Criteria; Subsections 5.1 and 5.2 for Prior Approval requirements; and Subsection 7.1 for Compliance requirements.

Telephonic-Specific Criteria

• Providers shall ensure that services can be safely and effectively delivered using telephonic, audio-only communication;
• Providers shall consider the caregiver’s abilities to participate in services provided using telephonic, audio-only communication;
• Delivery of services using telephonic, audio-only communication must conform to professional standards of care including but not limited to ethical practice, scope of practice, and other relevant federal, state and institutional policies and requirements including Practice Act and Licensing Board rules;
• Providers shall obtain and document verbal or written consent. In extenuating circumstances when consent is unable to be obtained, this should be documented;
• Providers shall verify the caregiver’s identity using two points of identification before initiating a telephonic, audio-only encounter; and
• Providers shall ensure that the beneficiary and caregivers’ privacy and confidentiality is protected.

Transition and discharge planning from a treatment program must document a written plan that specifies details for monitoring and follow-up as appropriate for the beneficiary and family or caregiver. The treatment plan is not to be used to provide respite, day care, or educational services and is not to be used to reimburse a parent for participating in a treatment program. The treatment or discharge plan must be available to a health plan upon request. A unit of service is defined according to the Current Procedural Terminology (CPT) approved code set unless otherwise specified.

See list of telephonic billable services on page 20-21.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8F, Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder (ASD), Amended Apr. 1, 2023, (Accessed Dec. 2024). 

Peer Support Services

As outlined in Attachment A, select services within this clinical coverage policy may be provided via the telephonic, audio-only communication method. Telephonic services may be transmitted between a beneficiary and provider in a manner that is consistent with the CPT and HCPCS code definition for those services.

Refer to subsection 3.2.5.1 for Telephonic-Specific Criteria; and subsection 7.1 for Compliance requirements.

The intent of the service is to be community-based rather than office-based. Service may be provided via telehealth or telephonic, audio-only communication. Telehealth or telephonic, audio-only communication time is supplemental rather than a replacement of in-person contacts and is limited to twenty (20) percent or less of total service time provided per beneficiary per fiscal year. Documentation of service rendered via telehealth or telephonic, audio-only communication with the beneficiary or collateral contacts (assisting beneficiary with rehabilitation goals) must be documented according to Subsection 5.5 of this policy.

Telehealth and telephonic, audio-only communication claims should be filed with the provider’s usual place of service code(s).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8G, Peer Support Services pgs. 5, 7 &17  & Attachment A, pgs. 20-21, Amended Apr. 15, 2023. (Accessed Dec. 2024).

Enhanced Mental Health and Substance Abuse Services

As outlined in Attachments A and D, select services within this clinical coverage policy may be provided via telehealth and telephonically. Services delivered via telehealth and telephonically must follow the requirements and guidance in clinical coverage Policy 1-H, Telehealth, Virtual Communications, and Remote Patient Monitoring, at https://medicaid.ncdhhs.gov/.

Mobile Crisis Management (MHDDSA) – Mobile Crisis Management (MCM) services include immediate telephonic or telehealth response to assess the crisis and determine the risk, mental status, medical stability, and appropriate response.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Enhanced Mental Health and Substance Abuse Services Amended Oct. 1, 2024, (Accessed Dec. 2024).

Community Alternatives Program

Providers can utilize telephony and other automated systems to document the provision of CAP/C services as subject to NC Medicaid guidelines on telephony, telehealth, and the CAP/DA policy guidance on electronic engagement.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Community Alternatives Program for Children, Amended Nov. 15, 2024, and Community Alternatives Program for Disabled Adults, Nov. 15, 2024, (Accessed Dec. 2024).

Opioid Treatment Program

Necessary support systems within the OTP include: … 

• Behavioral health crisis response (de-escalation or coordination of care), when clinically appropriate, 24-hours a day, seven days a week telephonically or via telehealth.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8A-9, Opioid Treatment Program Services, Oct. 15, 2023. (Accessed Dec. 2024).

CPT 99401 can be billed at only one visit for each beneficiary per day, but there are no quantity limits for the number of times this education can be provided to an individual beneficiary. Counseling may be provided in person, through live audio/video (telehealth) or telephonically. Additionally, this service can be billed by multiple providers and can be billed multiple times on different days.

There is no requirement for a specific diagnosis code. The following coding criteria will apply:

• Requires 25 modifier if in addition to OV E&M, if applicable.
• Requires GT modifiers if provided via telehealth.
• Requires KX modifiers if provided telephonically.

SOURCE: NCDHHS NC Medicaid Division of Health Benefits, Update:  COVID-19 Vaccine and Reimbursement Guidelines for 2023-2024 for NC Medicaid, Dec. 14, 2023, (Accessed Dec. 2024).

Obstetrical Services

Note: Prenatal and postpartum visits conducted via telehealth (interactive audio and video) shall count as a visit within a global or package service. Telephone calls or online communications do not replace a telehealth or in person visit for prenatal care and do not count towards global or package services. The postpartum delivery period should not be confused with the twelve-month postpartum MPW coverage.

Billing Prenatal and Postpartum Services Via Telehealth – Eligible providers, including physicians, nurse practitioners, physician assistants, and certified nurse midwives may conduct antepartum and postpartum care visits via telehealth. These visits may not be conducted via virtual patient communication (for example, telephone conversations). To promote early initiation of prenatal care, providers shall conduct the initial antepartum visit and pregnancy risk screen via telehealth or in-person in the office or clinic setting. When the initial visit is conducted via telehealth, a follow-up visit must be conducted in person within the first trimester of pregnancy.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 1E-5, Obstetrical Services Amended June 15, 2024, (Accessed Dec. 2024).

Community Support Team

CST also contains telephone time with the beneficiary and collateral contact with persons who assist the beneficiary in meeting the beneficiary’s rehabilitation goals specified in the PCP.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 8A-6, Community Support Team Amended Apr. 1, 2023, (Accessed Dec. 2024).

Inpatient Behavioral Health Services

Medically Managed Intensive Inpatient Services:  Medically Managed Intensive Inpatient Withdrawal Management Services are staffed by nonpsychiatric physicians and psychiatrists who are available 24 hours a day by telephone, conduct assessments within 24 hours of admission, and are active members of an interdisciplinary team of appropriately trained professionals, and who medically manage the care of the beneficiary.

A physician shall be available 24 hours a day by telehealth or telephone.

Inpatient Hospital Psychiatric Treatment (MH):  Inpatient Hospital Psychiatric Services are staffed by non-psychiatric physicians and psychiatrists, who are available 24 hours a day by telephone and who conduct assessments within 24 hours of admission.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy 8-B, Inpatient Behavioral Health Services Amended June 1, 2023, (Accessed Dec. 2024).

Dietary Evaluation and Counseling

For infant weight element for diagnostic lactation assessment, the weight cannot be conducted via telephone and audio/video.

SOURCE:  NC Div. of Medical Assistance, Clinical Coverage Policies Dietary Evaluation and Counseling and Medical Lactation Services Amended Aug. 15, 2023, pg.  18, (Accessed Dec. 2024).

Children’s Developmental Service Agencies (CDSAs)

See page 19-20 for telehealth eligible services.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No. 8-J, Children’s Developmental Service Agencies (CDSAs) Amended Nov. 1, 2023, (Accessed Dec. 2024).

See NC Medicaid’s bulletin on temporary flexibilities to support providers and members as a result of Hurricane Helene.

SOURCE:  NC Div. of Medical Assistance, Bulletin: Hurricane Helene Policy Flexibilities to Support Providers and Members – Oct. 11, 2024, (Accessed Dec. 2024).

Respiratory Syncytial Virus

Counseling may be provided in person, through live audio/video (telehealth) or telephonically. Additionally, this service may be billed by multiple providers and may be billed multiple times on different days. Different than for COVID-19 counseling, use of this code for Beyfortus counseling is limited to beneficiaries 0 to 19 months of age.

There is no requirement for a specific diagnosis code. The following coding criteria will apply:

• Requires 25 modifier if in addition to OV E&M, if applicable.
• Requires GT modifiers if provided via telehealth.
• Requires KX modifiers if provided telephonically.

SOURCE: NC Div. of Medical Assistance, Bulletin: NC Medicaid Respiratory Syncytial Virus (RSV) Guidelines for 2024-2025, September 6, 2024, (Accessed Dec. 2024).

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).

SOURCE: ND Div. of Medical Assistance, Telehealth, (Jul. 2024) and Indian Health Services and Tribal Health Programs Manual (Oct. 2024), (Accessed Nov. 2024).

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)
• 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, (Jul. 2024), (Accessed Nov. 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 (Jul. 2024) & North Dakota Department of Human Services: Teledentistry Policy. (Accessed Nov. 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, (Oct. 2024), (Accessed Nov. 2024).

Home Health and Private Duty Nursing

Noncovered services include:

• Telephonic services

SOURCE: ND Div. of Medical Services, Home Health and Private Duty Nursing, (Oct. 2024), (Accessed Nov. 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 Nov. 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 Nov. 2024).

Behavioral Health

Screening, Triage, and Referral Leading to Assessment – This service includes the brief assessment of an individual’s need for services to determine whether there are sufficient indications of behavioral health issues to warrant further evaluation. This service also includes the initial gathering of information to identify the urgency of need. This information must be collected through a face-to-face interview with the individual and may also include a telephonic interview with the family/guardian as necessary. This service includes the process of obtaining cursory historical, social, functional, psychiatric, developmental, or other information from the individual and/or family seeking services to determine whether a behavioral health issue is likely to exist and the urgency of the need. Services are available 24 hours per day, seven days per week. This service also includes the provision of appropriate triage and referrals to needed services based on the individual’s presentation and preferences as identified in the screening process.

SOURCE: ND Medicaid Behavioral Health Billing Manual, Jul. 2024, (Accessed Nov. 2024).

“Telehealth” is the direct delivery of health care services to a patient related to diagnosis, treatment, and management of a condition.

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

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022, p. 3-4 & OAC 5160-1-18.  (Accessed Nov. 2024).

The American Medical Association has formally adopted modifier 93 for reporting audio-only telehealth services. ODM, however, is not adopting this modifier at this time.

SOURCE: OH Medicaid, Medicaid Advisory Letter (MAL) No 667 (Jan. 3, 2023).  (Accessed Nov. 2024).

Office of Mental Health and Addiction Services

Services must be provided using interactive, secure, real-time audiovisual communications of such quality to permit accurate and meaningful interaction between at least two persons, one of which is a certified provider of the service being provided pursuant to Chapter 5122-25 of the Administrative Code. This expressly excludes telephone calls, images transmitted via facsimile machine, and text messages with visualization of the other person. Services that may be provided by certified community behavioral health centers by telephone contact are CPST and SUD case management.

SOURCE: Office of Mental Health and Addiction Services, Guidance for Providing Behavioral Health Services via Telehealth. March. 2020, (Accessed Nov. 2024).

Pre-admission Screening and Resident Review

Pre-admission Screenings and Resident Reviews (PASRR) should be completed via the electronic HENS system as they are today as these screenings are primarily via desk review. In instances where a face-to-face is required, a telephonic and/or desk review is permissible. Level II evaluations can be provided either by telephone or desk review when appropriate. There is no system or reimbursement impact as these functions are supported by the level II entities and the applicable contractor.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  Revised 7/15/2022, p. 12.  (Accessed Nov. 2024).

Managed Care

The following is considered telehealth:

• Direct delivery of health care services to a patient via synchronous, interactive, real-time electronic communication that includes both audio and video elements; OR
• Activities that are asynchronous and activities that do not have both audio and video elements such as:
  • Telephone calls
  • Remote patient monitoring; and
  • Communication with a patient through secure electronic mail or secure patient portal
• For behavioral health providers eligible under rule 5160-27-01 of the OAC, telehealth is defined in rule 5122-29-31 of the OAC.

SOURCE: OH Department of Medicaid, Telehealth Services: Guidelines for Managed Care Entities, July 15, 2022, (Accessed Nov. 2024).

“Telehealth” means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information by means of a two-way, real-time interactive communication, not to exclude store and forward technologies, between a patient and a healthcare provider with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit. Telehealth shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure video conference, or facsimile transmission.

“Audio-only health service delivery” means the delivery of healthcare services through the use of audio-only telecommunications, permitting real-time communication between a patient and the provider, for the purpose of diagnosis, consultation, and/or treatment. Audio-only health service delivery does not include the use of facsimile, email, or health care services that are customarily delivered by audio-only telecommunications and not billed as separate services by the provider, such as the sharing of laboratory results. This definition includes health services delivered via audio-only when audio-visual is unavailable or when a member chooses audio-only.

Health services delivered via audio-only telecommunications are intended to improve access to healthcare services, while complying with all applicable state and federal laws and regulations. Audio-only telecommunications is an option for the delivery of certain covered services and is not an expansion of SoonerCare-covered services.

Health service delivery via audio-only telecommunications is applicable to medically necessary covered primary care and other approved health services. Refer to the Oklahoma Health Care Authority (OHCA) website, www.okhca.org, for a complete list of the SoonerCare-reimbursable audio-only health services codes.

If there are technological difficulties in performing medical assessment through audio-only telecommunications, then hands-on-assessment and/or in-person care must be provided for the member.

Any service delivered using audio-only telecommunications must be appropriate for audio-only delivery and be of the same quality and otherwise on par with the same service delivered in person.

Confidentiality and security of protected health information in accordance with applicable state and federal law, including, but not limited to, 42 Code of Federal Regulations (CFR) Part 2, 45 CFR Parts 160 and 164, and 43A Oklahoma Statutes (O.S.) § 1-109, must be maintained in the delivery of health services by audio-only telecommunications.

For purposes of SoonerCare reimbursement, audio-only health service delivery is the use of interactive audio technology for the purpose of diagnosis, consultation, and/or treatment that occurs in real-time and when the member is actively participating during the transmission.

Requirements. The following requirements apply to all services rendered via audio-only health service delivery:

• Interactive audio telecommunications must be used, permitting real-time communication between the physician or practitioner and the SoonerCare member. As a condition of payment, the member must actively participate in the audio-only telecommunications health service visit.
• The audio telecommunications technology used to deliver the services must meet the standards required by state and federal laws governing the privacy and security of protected health information (PHI).
• The provider must be contracted with SoonerCare and appropriately licensed and/or certified, and in good standing. Services that are provided must be within the scope of the practitioner’s license and/or certification.
• Either the provider or the member must be located at the freestanding clinic that is providing services pursuant to 42 CFR § 440.90 and Oklahoma Administrative Code (OAC) 317:30-5-575.
• If the member is a minor, the provider must obtain the prior written consent of the member’s parent or legal guardian to provide services via audio-only telecommunications, that includes, at a minimum, the name of the provider; the provider’s permanent business office address and telephone number; and an explanation of the services to be provided, including the type, frequency, and duration of services. Written consent must be obtained annually, or whenever there is a change in the information in the written consent form, as set forth above. The parent or legal guardian need not attend the audio-only telecommunications session unless attendance is therapeutically appropriate.
• The member retains the right to withdraw at any time.
• All audio-only health service delivery activities must comply with Oklahoma Health Care Authority (OHCA) policy, and all other applicable State and Federal laws and regulations.
• A health service delivered via audio-only telecommunications is subject to the same SoonerCare program restrictions, limitations, and coverage which exist for the service when not delivered via audio-only telecommunications.
• A health service delivered by audio-only telecommunications must be designated for reimbursement by SoonerCare.
• Where there are established service limitations, the use of audio-only telecommunications to deliver those services will count towards meeting those noted limitations. Service limitations may be set forth by Medicaid and/or other third-party payers.

Reimbursement.  Health care services delivered via audio-only telecommunications must be compensable by OHCA in order to be reimbursed.

Services delivered via audio-only telecommunications must be billed with the appropriate modifier.

Health care services delivered via audio-only telecommunications are reimbursed pursuant to the fee-for-service fee schedule approved under the Oklahoma Medicaid State Plan.

An RHC and an FQHC shall be reimbursed for services delivered via audio-only telecommunications at the fee-for-service rate per the fee-for-service fee schedule.

An I/T/U shall be reimbursed for services delivered via audio-only telecommunications at the Office of Management and Budget (OMB) all-inclusive rate.

The cost of audio-only telecommunication equipment and other service related costs are not reimbursable by SoonerCare.

See rule for documentation details.

The OHCA has discretion and final authority to approve or deny any services delivered via audio-only telecommunications based on agency and/or SoonerCare members’ needs.

SOURCE: OK Admin. Code Sec. 317:30-3-27.1. (Accessed Nov. 2024).

Audio- only modifiers listed as allowable including FQ and 93.

SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 27, 2024. (Accessed Nov. 2024).

See medical audio-only codes allowed after 5/11/23.

SOURCE: OK Health Care Authority, Audio-only Codes Allowed after 5/11/23, (Accessed Nov. 2024).

See behavioral health services audio only codes as of 5/12/23.

SOURCE: OK Health Care Authority, Audio-only Codes, 5/12/23, Accessed Nov. 2024).

Oklahoma Health Care Authority issued letter regarding HIPAA Compliancy for Telehealth and Audio-Only Services.

SOURCE: OK Health Care Authority, Letter 2023-10 RE: Post-PHE HIPAA Compliancy for Telehealth & Audio-only Services, May 19, 2023, (Accessed Nov. 2024).

Videoconferencing for Mental Illness (MI) PASRR Level II after PHE expires 5/11/2023

Telephonic evaluations should be used as a last resort if this is the only means of communication and, if due to a geographic or resource limitation, it would prevent the evaluation from being completed within 7 to 9 business days. The evaluation should only be completed with approval by OHCA and the Oklahoma Department of Mental Health and Substance Abuse Services.

SOURCE: OK Healthcare Authority, 2023 Global Messages, Videoconferencing for Mental Illness (MI) PASRR Level II after PHE expires 5/11/2023, 5/9/23, (Accessed Nov. 2024).

Case Management Services

Case management services shall be provided in accordance with Chapter 50 of this Title and shall include planned referral, linkage, monitoring and support, and advocacy assistance provided in partnership with a person served to support that individual in self-sufficiency and community tenure. Activities include: …

• Crisis diversion (unanticipated, unscheduled situation requiring supportive assistance, face-to-face or telephone, to resolve immediate problems before they become overwhelming and severely impair the individual’s ability to function or maintain in the community) to prevent progression to a higher level of care.

SOURCE: OK Admin. Code Sec. 450:70-6-1. (Accessed Nov. 2024).

Clinic Services

Teleheath and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to 42 Code of Federal Regulations (CFR) § 440.90. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Nov 2024).

Rural Health Center Services

RHC services are covered when medically necessary and furnished at the clinic or other outpatient setting, including the member’s place of residence, delivered via telehealth, or via audio-only telecommunications pursuant to Oklahoma Administrative Code (OAC) 317:30-3-27 and OAC 317:30-3-27.1.

SOURCE: OK Admin Code Sec. 317.30-5-355.2, (Accessed Nov. 2024).

Indian Health Services

“Audio-only health service delivery” means the delivery of healthcare services through the use of audio-only telecommunications, permitting real-time communication between a patient and the provider, for the purpose of diagnosis, consultation, or treatment, and does not include the use of facsimile or email nor the delivery of health care services that are customarily delivered by audio-only telecommunications and customarily not billed as separate services by the provider, such as the sharing of laboratory results. This definition includes health services delivered via audio-only when audio-visual is unavailable or when a member chooses audio-only.

SOURCE: OK Admin Code Sec. 317.30-5-1087, (Accessed Nov. 2024).

An I/T/U encounter means a face to face, a telehealth contact, or an audio-only telecommunications contact between a health care professional and an Indian Health Services (IHS) eligible SoonerCare member for the provision of medically necessary Title XIX or Title XXI covered services through an IHS or Tribal 638 facility or an urban Indian clinic within a twenty-four (24) period ending at midnight, as documented in the patient’s record.

SOURCE: OK Admin Code Sec. 317.30-5-1098, (Accessed Nov. 2024).

“Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include the delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE: OAR 410-141-3566. Health Systems Division: Medical Assistance Programs. Oregon Health Plan and 410-120-1990 (Accessed Dec. 2024).

“Audio only” means the use of audio technology, permitting real-time communication between a health care provider and a member for the purpose of diagnosis, consultation or treatment. “Audio only” does not include health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

SOURCE:  OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions, (Accessed Dec. 2024).

“Audio only” does not include:

• The use of facsimile, electronic mail or text messages.
• The delivery of health services that are customarily delivered by audio telephone technology and customarily not billed as separate services by a health care provider, such as the sharing of laboratory results.

To encourage the efficient use of resources and to promote cost-effective procedures in accordance with ORS 413.011 (Duties of board) (1)(L), the Oregon Health Authority shall reimburse the cost of health services delivered using telemedicine, including but not limited to:

• Health services transmitted via landlines, wireless communications, the Internet and telephone networks;
• Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices; and
• Communications between providers or between one or more providers and one or more patients, family members, caregivers or guardians.

The authority shall pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Ch. 414.723, (Accessed Dec. 2024).

Covered telephonic and online services include services related to evaluation, assessment and management as well as other technology-based services (CPT 98966-98968, 99441-99443, 99421-99423, 98970-98972, G2012, G2061-G2063, G2251-G2252).

Covered telephone and online services billed using these codes do not include either of the following:

• Services related to a service performed and billed by the physician or qualified health professional within the previous seven days, regardless of whether it is the result of patient-initiated or physician-requested follow-up.
• Services which result in the patient being seen within 24 hours or the next available appointment.

Covered interprofessional consultations include consultations delivered online, through electronic health records or by telephone (CPT 99446-99449, 99451-99452).

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the Oct. 1, 2024 Prioritized List of Health Services, p. AD-3. (11/19/24). (Accessed Dec. 2024).

“Asynchronous” means not simultaneous or concurrent in time. For the purpose of this rule, asynchronous telecommunication technologies for telemedicine or telehealth services may include audio and video, audio, or member portal and may include transmission of data from remote monitoring. “Asynchronous” does not include voice messages, facsimile, electronic mail or text messages.

“Telecommunication technologies” means the use of devices and services for telemedicine or telehealth delivered services. These technologies include video conferencing, store-and-forward imaging, streaming media including services with information transmitted using landlines, and wireless communications, including the Internet and telephone networks.

SOURCE: OR OAR 140-120-0000, Medical Assistance Program: Acronyms and Definitions; OR OAR 410-120-1990 & OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Telehealth. [slight variations exist], (Accessed Dec. 2024).

Intent to Submit a State Plan Amendment:

The Authority reimbursement of patient to clinician telephonic and electronic services for established patients are based upon the maximum allowable fees are established using the CMS Resource Based Relative Value (RBRVS) methodology as published in the Federal Register annually with periodic updates, multiplied by the Oregon specific conversion factor. Oregon conversion factors as listed on Attachment 4.19-B, page 1 of this state plan.

Except as otherwise noted in the state plan, state developed fee schedule rates are the same for both governmental and private providers. The agency’s fee schedule rate was set as of 10/1/24 and is effective for services provided on or after that date. State-wide fee schedules are published on the agency’s web at https://www.oregon.gov/oha/HSD/OHP/Pages/Fee-Schedule.aspx

SOURCE:  Oregon Health Authority, Public Notice, July 31, 2024, (Accessed Dec. 2024).

Behavioral Health

Patient consultations using telephone and online or electronic mail (e-mail) are covered when billed services comply with the practice guidelines set forth by the Health Evidence Review Commission and the applicable HERC-approved code requirements, delivered consistent with the HERC Evidence-Based Guidelines;

Behavioral health services specifically identified as allowable for telephonic delivery are listed on the Behavioral Health Fee schedule published by the Authority.

Unless expressly authorized in OAR 410-120-1200 (Exclusions), other types of telecommunications are not covered such as images transmitted via facsimile machines and electronic mail when:

• Those methods are not being used in lieu of videoconferencing, due to limited videoconferencing equipment access; or
• Those methods and specific services are not specifically allowed pursuant to the Oregon Health Evidence Review Commission’s Prioritized List of Health Services and Evidence Based Guidelines.

SOURCE: OR OAR 410-172-0850, Health Systems Division: Medical Assistance Programs, Medicaid Payment for Behavioral Health Services, Telemedicine for Behavioral Health. (Accessed Dec. 2024).

Teledentistry

Mobile communication devices such as cell phones, tablet computers, or personal digital assistants may support mobile dentistry, health care, public health practices, and education.

Unless authorized in OAR 410-120-1200 Exclusions or OAR 410-120-1990, other types of telecommunications such as telephone calls, images transmitted via facsimile machines, and electronic mail are not covered:

• When those types are not being used in lieu of teledentistry, due to limited teledentistry equipment access; or
• When those types and specific services are not specifically allowed in this rule per the Oregon Health Evidence Review Commission’s Prioritized List of Health Services.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Dec. 2024).

School Based Health Services

For school-based telehealth service claims:

• A service provided using synchronous audio and video must include modifier GT;
• A service provided using synchronous audio, without video, (e.g., telephone) must include modifier 93.

SOURCE: OR OAR 410-133-0070, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Telehealth (Accessed Dec. 2024).

Indian Health Services

For the provision of services defined in Titles XIX and XXI and provided through an IHS or Tribal 638 facility, an “encounter” is defined as a face-to-face, telephone contact, or a prescription fill as defined in OAR 410-146-0085(8) between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. Section (7) of this rule outlines limitations for telephone contacts that qualify as encounters. For purposes of this rule, face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per 410-130-0610.

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management; OAR 410-146-0200, Tribal Pharmacy; and OAR 410-130-0190, Tobacco Cessation (OAR 410-120-1200). Except as set forth below, Providers may not make telephone contacts at the exclusion of face-to-face visits.

• Telephone encounters must include all the same components of the service as if provided face-to-face.
• During a state of emergency of an epidemic outbreak of an infectious disease impacting the safety of public health, in accordance with the Health Evidence Review Commission’s Prioritized List, guideline notes, and OAR 410-130-0610 (for dates of service on or before December 31, 2020) and OAR 410-120-1990 (for dates of service on or after January 1, 2021), telephonic evaluation management services, assessment and management services, and psychotherapy are appropriate to ensure access to care while avoiding and preventing unnecessary potential infectious exposure, and may be made in place of a face-to-face visit.

SOURCE: OR OAR 410-146-0085, Health Systems Division: Medical Assistance Programs American Indian/Alaska Native.  (Accessed Dec. 2024).

Federally Qualified Health Center and Rural Health Clinics

For the provision of services defined in Titles XIX and XXI and provided through an FQHC or RHC, an “encounter” is defined as a face-to-face or telephone contact between a health care professional and an eligible OHP client within a 24-hour period ending at midnight, as documented in the client’s medical record. Section (4) of this rule outlines limitations for telephone contacts that qualify as encounters. For purposes of this rule, a face-to-face “encounter” includes services provided via a synchronous two-way audiovisual link between a patient and a provider per OAR 410-130-0610.

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management (MCM) and 410-130-0190, Tobacco Cessation (see also OAR 410-120-1200). Except as set forth below, providers may not make telephone contacts at the exclusion of face-to-face visits.

• Telephone encounters must include all the same components of the service as if provided face-to-face.
• During a state of emergency of an epidemic outbreak of an infectious disease impacting the safety of public health, in accordance with the Health Evidence Review Commission’s Prioritized List, guideline notes, and OAR 410-130-0610 (for dates of service on or before December 31, 2020) and OAR 410-120-1990 (for dates of service on or after January 1, 2021), telephonic evaluation management services, assessment and management services, and psychotherapy are appropriate to ensure access to care while avoiding and preventing unnecessary potential infectious exposure, and may be made in place of a face-to-face visit.

SOURCE: OR OAR 410-147-0120, Healthy Systems Division: Medical Assistance Programs, Federally Qualified Health Center and Rural Health Clinics Services.  (Accessed Dec. 2024).

• Clinic visits, psychotherapy, diagnostic psychological evaluations, psychiatric evaluations and comprehensive medical evaluations conducted over the telephone, that is, any clinic service conducted over the telephone.

SOURCE:  PA 55 Code 1223.14 (Accessed Sept. 2024).

• A covered psychiatric outpatient clinic, MMHT or partial hospitalization outpatient service conducted over the telephone.

The consultation must be in real time, making the interaction is almost the same as a face-to-face consultation, ensuring that patients are evaluated and treated appropriately, with the only exception that the professional and patient are not in the same place.

SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 5, Section 5.1 & Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 5, Section 5.1.  (Accessed Sept. 2024).

“Telemedicine” means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate the assessment, diagnosis, counseling and prescribing treatment, and care management of a patient’s health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. Telemedicine does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.

SOURCE: Rhode Island General Laws Sec. 27-81-3, (Accessed Oct. 2024).

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Oct. 2024).

The Medicaid Program does not pay for: …

• information provided over the telephone

SOURCE: RI Medicaid Provider Reference Manual – Vision, Jan. 2023, pg. 7, (Accessed Oct. 2024).

Are telephone calls Medicaid billable?  Providers would have to check their contracts with the managed care organizations to see if telehealth is covered.

SOURCE: RI Medicaid, Peer Based Recover Support Services, FAQs, (Accessed Oct. 2024).

Concurrent Reviews:  Concurrent reviews are performed for all individuals who have been admitted to an acute care facility for the treatment of mental illness or substance abuse.

Concurrent review will be conducted on-site or by telephone for in-state facilities and by telephone for out-of-state facilities.

SOURCE: RI Medicaid, Provider Manual, Inpatient Services, (Accessed Oct. 2024).

Recover Navigation Program (RNP)

All providers delivering RNP services must: …

• Ensure the on-site presence of all necessary practitioners to implement RNP services including a Registered Nurse, Case Manager and Peer Recovery Specialist. An On-call physician must be available to the RNP provider for telephonic consultation as needed.

SOURCE: RI Medicaid, RNP Certification Standards, (Accessed Oct. 2024).

Vision Services

The Medicaid Program does not pay for: …

• information provided over the telephone

SOURCE:  RI Medicaid, Provider Reference Manual, Vision, pg. 7, 1/2023, & Vision Coverage Guidelines,  (Accessed Oct. 2024).

When audio/visual telehealth is not available, SCDHHS will continue to reimburse providers for one year beyond the end date of the current federal PHE for the audio-only CPT codes included in the source referenced below (see bulletin).*

Reimbursement for the CPT codes included will continue to be limited to encounters with established patients as described in Medicaid bulletin 20-004 when rendered by a physician, nurse practitioner, physician assistant or licensed independent practitioner (LIP). Additional services that can be provided via audio-only during this extended time period include certain services for BabyNet-enrolled Children.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023); SC Dept. of Health and Human Services. Medicaid Bulletin 24-010. (Mar. 2024). (Accessed Aug. 2024).

Services that are eligible for telehealth reimbursement include consultation, office visits, individual psychotherapy, pharmacologic management, and psychiatric diagnostic interview examinations and testing, delivered via a telecommunication system, and audio-only (telephonic) care is available for established patients only.

While SC Medicaid includes the above mention of audio-only coverage, and certain telephonic codes are also noted as covered in the Telehealth Fee Schedule, the manual also states that the following interactions under evaluation and management services do not constitute reimbursable telehealth or telepsychiatry services and will not be reimbursed:

• Telephone conversations
• Email messages
• Video cell phone interactions
• Facsimile transmissions
• Services provided by allied health professionals

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 34, 144-146 (Sept. 2024). (Accessed Aug. 2024).

FQHCs/RHCs Behavioral Health Services

Family Therapy: Billing for telephone calls is not allowed.

SOURCE: SC Health and Human Svcs. Dept. Federally Qualified Health Center Behavioral Health Services Provider Manual, p. 27, (Sept. 2023) & Rural Health Clinic Behavioral Health Services Provider Manual, p. 30, (Sept. 2020), (Accessed Aug. 2024).

Despite the above exclusion, according to a recent Medicaid bulletin, telehealth services rendered through an FQHC or RHC for certain audio-only CPT codes will be reimbursed.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2024).

Medicaid Targeted Case Management

Electronic visual encounters (e.g., Skype, teleconferencing or other media) with the beneficiary are not considered a face-to-face contact and will be reimbursed at the T1016 MTCM encounter rate.

• A telephone contact is in lieu of a face-to-face contact when environmental considerations preclude a face-to-face encounter, for the purpose of rendering one or more MTCM components. Documentation must include details precluding a face-to-face encounter.
• A relevant email contact via secured transmittal, on behalf of the beneficiary for the purpose of rendering one or more MTCM components.

For Medicaid purposes, a face-to-face contact is preferable with phone and/or email contact being acceptable if necessary.

SOURCE: SC Health and Human Svcs. Dept., Medicaid Targeted Case Management Provider Guide, p. 31 (Jul. 2024). (Accessed Aug. 2024).

For distant site services billed on a CMS 1500 or 837P providers must bill;

• “02” for telemedicine services provided other than in patient’s home;
• “10” for telemedicine services provided in the patient’s home; or
• “77” for audio-only services.

Telemedicine Modifiers – Telemedicine provided at a distant site must be billed with the GT modifier in the first modifier position to indicate the service was provided via telemedicine/audio-only. Failure to comply with this requirement may lead to payment recoupment or other action as decided by South Dakota Medicaid.

Audio-Only Modifier

• CMHC and SUD Agencies: Bill modifier GT in addition to the POS code 77.
• All other providers allowed to bill audio only services: Bill modifier 93 in addition to the POS code 77.

Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, (Nov. 2024) (Accessed Dec. 2024).

Audio-Only Behavioral Health Services

South Dakota Medicaid covers real time, two-way audio-only behavioral health services delivered by a Substance Use Disorder (SUD) Agency or a Community Mental Health Center (CMHC) when the recipient does not have access to face-to-face audio/visual telemedicine technology.

South Dakota Medicaid covers real-time, two-way audio-only behavioral health services delivered by an Independent Mental Health Practitioner (IMHP) when the recipient does not have access to face-to-face audio/visual telemedicine technology.

SUD agencies and CMHCs, and IMHPs must utilize traditional audio/visual telemedicine technology when possible. Audio-only services are not covered when used for the convenience of the provider or recipient.  The provider must document in the medical record that the use real time video/audio technology was not possible or was unsuccessful.

Covered Services – CMHCs may provide all covered services via audio-only technology when coverage requirements are met. SUD agencies may only provide covered SUD agency services listed in the Audio-Only Procedure Code table in the Appendix via audio-only technology when the coverage requirements are met. Contact the Division of Behavioral Health for questions regarding unlisted codes.

For the purpose of this manual, an IMHP includes mental health providers who meet the requirements in ARSD 67:16:41:03 and licensed physicians or psychiatrists that provide behavioral health services. IMHPs may provide applicable services listed in the Audio-Only Procedure Code table in the Appendix via audio-only technology when the coverage requirements are met. Services not listed in the table are not allowed to be provided via telemedicine or audio-only technology. An IMHP cannot bill the following CPT codes: 98966, 98967, and 98968.

FQHCs/RHCs and IHS/Tribal 638 Providers – SUD agency services may also be provided via audio-only if the provider is an accredited and enrolled agency. Audio-only behavioral health services are reimbursed at the encounter rate.

Non-covered Services – Services other than those specifically stated as covered when provided via an audio-only modality are considered non-covered if provided via an audio-only modality and must not be billed to South Dakota Medicaid.

Claim Instructions – Audio-only services will need the GT modifier and place of service 77. Any additional modifiers must be coded alphabetically as shown on the CMHC and SUD fee schedules.

Audio-Only Community Health Worker Services – Community Health Worker (CHW) services must be related to an intervention outlined in the individual’s CHW Service Plan. Service may be provided via two-way audio-only when the recipient does not have access to audio/visual telemedicine technology. The limitation necessitating audio-only services must be documented in the recipient’s record.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, (Nov. 2024), pg. 9-10, (Accessed Dec. 2024).

Audio-Only Evaluation and Management Services

Audio-only evaluation and management services are covered for established patients if the recipient does not have access to face-to-face audio/visual telemedicine technology. The provider must document in the medical record that the use of real time video/audio technology was not possible or was unsuccessful.

The service must be initiated by the recipient. The service should include patient history and/or assessment, and some degree of decision making. Telephonic evaluation and management services are only allowed to be provided by a physician, podiatrist, nurse practitioner, physician assistant, or optometrist. The service must be 5 minutes or longer. Services may be provided via telephone or via another device or service that allows real-time audio communication.

Audio-only evaluation and management services are not to be billed if clinical decision-making dictates a need to see the patient for an office visit, including a telemedicine office visit, within 24 hours or at the next available appointment time. In those circumstances, the telephone service is considered a part of the subsequent office visit. If the telephone call follows a billable office visit performed in the past seven calendar days for the same or a related diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable. Telephone services provided by an RN or LPN are not billable.

Non-Covered Services: Audio-only services are only covered if initiated by a recipient and the recipient did not have access to face-to-face audio/visual telemedicine technology.

Claims Instructions:  Services must be billed using CPT codes 98966, 98967, and 98968. Providers should select the appropriate code based on the time associated with the service. Do not bill for these services using CPT codes 99441, 99442, or 99443 even if you believe the code description is more applicable. Billing with 99441, 99442, or 99443 will result in your claim being denied.

Reimbursement – Payment for services is limited to the lesser of the provider’s usual and customary charge or the fee contained on South Dakota Medicaid’s Physician Services fee schedule. FQHC/RHC and IHS/Tribal 638 providers may bill for audio-only evaluation and management services using codes 98966, 98967, and 98968 and be reimbursed at the fee schedule rate. These services must be submitted using the FQHC/RHCs non-PPS billing NPI. For more information regarding billing with a non-PPS NPI please refer to the FQHC/RHC Service Manual.

Billing a Recipient – There is no cost share for this service. Please refer to our Billing a Recipient Manual for additional requirements a provider must meet to bill a recipient.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 10-11 (Nov. 2024), (Accessed Dec. 2024).

Crisis assessment and intervention services. An immediate therapeutic response available 24 hours a day 7 days a week that involves direct telephone or face-to-face contact with a recipient exhibiting acute psychiatric symptoms and/or inappropriate behavior that left untreated, presents an immediate threat to the recipient or others.

SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 5 (Apr. 2024), (Accessed Dec. 2024).

Collateral Contacts are telephone, telemedicine or face-to-face contact with an individual other than the recipient receiving treatment in an outpatient setting. The contact may be with a spouse, family member, guardian, friend, teacher, healthcare professional, or other individual who is knowledgeable of the recipient receiving treatment. Collateral must be for the direct benefit of the beneficiary.

SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 8 (Apr. 2024) & Substance Use Disorder Agency Services, p. 8 (Dec. 2023) (Accessed Dec. 2024).

Physician Services:

• Anticoagulant management (CPT codes 93792 and 93793), physician telephone patient services (CPT codes 99441-99443), online medical evaluation (CPT code 99444), interprofessional telephone/internet/electronic health record consultations (CPT codes 99446-99449 and 99451-99452), disability evaluation services (CPT codes 99450, 99455, 99456), care management services (CPT codes 99487-99496), and behavioral health integration care management (CPT code 99484);

SOURCE: SD Medicaid Billing and Policy Manual: Physician Services, p. 12 (Aug. 2024), (Accessed Dec. 2024).

Teledentistry

Synchronous teledentistry services may not be provided via email, audio-only, or facsimile transmissions.

SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 4, (Jun. 2023), (Accessed Dec. 2024).

Primary Care Provider Program

PCPs must provide 24-hour, 7 day a week access by telephone which will immediately page an on-call medical professional to handle medical situations during non-office hours. If affiliated with a calling network to serve as the non-office hour’s contact, this may not be utilized for PCP referral. Any referrals given to recipients through these calling networks (e.g., referring individuals to seek medical attention at the emergency room) must be approved by the recipient’s PCP or the Designated Covering Provider (DCP). Referrals may be made by the recipient’s PCP or DCP retroactively if appropriate. Refer to the Referrals manual for additional information.

SOURCE: SD Medicaid Billing and Policy Manual, Primary Care Provider Program, p. 2, (Jun. 2024), (Accessed Dec. 2024).

CHOICES Waiver

Supported living services are reimbursed at a 15-minute unit rate. Please refer to the CHOICES Fee Schedule for detailed rates.

A portion of this service can be delivered virtually, which includes but is not limited to:

• The use of telephonic/virtual supports through FaceTime, Zoom, Echo or other means of telecommunication to provide verbal prompting for a participant and/or their support person to provide personal care supports to perform activities of daily living.
• The use of telephonic/virtual supports through FaceTime, Zoom, or Echo other means of telecommunication to continue to support participants with medication management.
• Check-in phone calls are considered a case management function and would not be considered telephonic/virtual habilitative supports.

Remote Day Services are reserved for outstanding circumstances that restrict a participant’s access to Facility and/or Community Support Day Services. The following examples are types of virtual day services:

• The use of telephonic/virtual supports through Facetime, Zoom, Echo, or means of telecommunication to promote socialization that aligns with ISP goals. CSPs can use technology to promote and support social interaction through “virtual hangouts” for participants to engage with their friends and other natural supports.
• Utilizing technology to support individuals to access community events that they previously engaged in. Examples of this may include supporting participants to access online church services, remote book clubs, etc.

SOURCE: SD Medicaid Billing and Policy Manual, CHOICES Waiver, p. 5-6 & 10, (Feb. 2024), (Accessed Dec. 2024).

Inpatient Hospital Services

An individual’s psychiatric care is a covered service if the hospital received authorization for the admission under ARSD 67:16:40:04 and the following conditions are met:

• A physician completed a medical assessment of the individual and had at least a telephone consultation with a psychiatrist. The psychiatric consultation or diagnosis must include a treatable mental health condition. An admission is not allowed on the basis of a previous diagnosis if symptoms associated with the diagnosis are not active at the time of the admission (see manual for more requirements)

SOURCE: SD Medicaid Billing and Policy Manual, Inpatient Hospital Services, p. 7, (Sept. 2024), (Accessed Dec. 2024).

Independent Mental Health Practitioners

Collateral Contacts are telephone, telemedicine, or face-to-face contact with an individual other than the recipient receiving treatment in an outpatient setting. The contact may be with a spouse, family member, guardian, friend, teacher, healthcare professional external to behavioral health, or other individual who is knowledgeable of the recipient receiving treatment. Collateral must be for the direct benefit of the beneficiary.

IMHP Non-Covered Services

• Mental health treatment provided without the recipient physically present in a face-to-face or telehealth session with the mental health provider except for telehealth treatment and collateral contacts. …
• Telephone consultations with or on behalf of the recipient except for collateral contact.

SOURCE: SD Medicaid Billing and Policy Manual: Independent Mental Health Practitioners (Apr. 2024), (Accessed Dec. 2024).

Pharmacy Services

South Dakota regulation does not require a pharmacist to document counseling that was accepted or offered. The absence of a record signifies counseling was accepted and provided or that an offer was made. Failure to complete counseling shall be recorded for the following instances. …

• Counseling could not be accomplished by telephone contact.

SOURCE: SD Medicaid Billing and Policy Manual: Pharmacy Services (Sept. 2024), pg. 6, (Accessed Dec. 2024).

“Provider-based telemedicine” does not include:

• • An audio-only conversation;
  • An electronic mail message or phone text message;
  • A facsimile transmission;
  • Remote patient monitoring; or
  • Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity’s business.

Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of:

• Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and
• Healthcare services when the means described in subdivision (a)(6)(A) are unavailable;

A healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting for reimbursement of an audio-only encounter under subdivision (a)(6)(C)(ii) shall:

• Confirm and maintain documentation that the patient:
  • Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter;
  • Is at a location where an audio-video encounter cannot take place due to lack of service; or
  • Has a physical disability that inhibits the use of video technology; and
• Notify the patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person or video encounters, prior to the audio-only telemedicine encounter.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Aug. 2024).

Telehealth does not include:

• An audio-only conversation;
• An electronic mail message; or
• A facsimile transmission

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Aug 2024).

School-Based Services

All TennCare medically necessary, covered services provided on school grounds shall be billed with the place of service code (03), defined by CMS as any facility whose primary purpose is education. School-based services rendered via telehealth shall be billed with place of service code (02), indicating telehealth was provided other than the student’s home or place of service code (10) indicating telehealth was provided in the student’s home. Additionally, the appropriate modifier should be used to indicate whether the telehealth service was delivered via a televisual visit (append using the GT modifier) or delivered via audio-only (append using the 93 modifier or FQ modifier as appropriate).

See manual for additional information.

SOURCE:  TennCare Biling Manual: Tennessee School Districts (July 2023), p. 11.  (Accessed Aug. 2024).

Mental Health and Substance Abuse

Behavioral health crisis services can be activated by telephone contact or at a walk-in center. A tollfree number is available 24/7, 365 days a year and answered by trained crisis specialists. A triage screening determines the acuity of the crisis and determines the appropriate intervention needed to alleviate and/or stabilize the crisis. The triage screening can be completed via telephone assessment or, in the case of a walk-in service, via a face-to-face assessment (or telehealth).

Crisis Services Intervention – An intervention may be completed via telephone or face to face (which includes telehealth). Interventions include an assessment to determine the need(s) of the individual including but are not limited to active, supportive listening and the need for referrals to additional services and/or treatment. The intervention is intended to identify and provide resources specific to the needs of the caller. A face-to-face assessment shall always be conducted if there is a substantial likelihood of serious harm. All appropriate resources should be utilized in an effort to stabilize the individual and prevent escalation of the crisis. The intervention is intended to assess the need(s) of the individual for possible face to face contact with crisis services or a referral to the appropriate resource(s) in order to support and/or stabilize the individual and prevent escalation of the crisis.

A telephone intervention or consultation occurs between crisis staff and the individual and/or the family/health care providers, as appropriate. Title 33 requires physicians and psychologists to consult with a crisis service provider before initiating a certificate of need. Telephone triage personnel must be available to provide the required consultation which includes a review of the clinical information and provision of recommended alternatives as clinically appropriate.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services, Office of Crisis Services and Suicide Prevention, Minimal Standards of Care (Apr. 2024).  (Accessed Sept. 2024).

Telemedicine medical services and telehealth services are authorized service delivery methods for Texas Medicaid covered services as provided in this section. All telemedicine medical services and telehealth services are subject to the specifications, conditions, limitations, and requirements established by the Texas Health and Human Services Commission (HHSC) or its designee.

• A client must not be required to receive a covered service as a telemedicine medical service or telehealth service except in the event of an active declaration of state of disaster and at the direction of HHSC.
• In the event of a declaration of state of disaster, HHSC may issue direction to providers regarding the use of telemedicine medical services and telehealth services, including the use of an audio-only platform, to provide covered services to clients who reside in the area subject to the declaration of state of disaster.
• HHSC considers the following criteria when determining whether a covered service may be delivered as telemedicine medical service or telehealth service, including via an audio-only platform:
  • Clinical effectiveness;
  • Cost effectiveness;
  • Health and safety;
  • Patient choice and access to care; and
  • Other criteria specific to the service.

Conditions for reimbursement applicable to behavioral health services provided through an audio-only platform are described in this section.

• The provider must be enrolled in Texas Medicaid.
• The provider must obtain informed consent from the client, client’s parent, or the client’s legally authorized representative prior to rendering a behavioral health service via an audio-only platform; except when doing so is not feasible or could result in death or injury to the client. Verbal consent is permissible and must be documented in the client’s medical record.
• The covered services must be provided in compliance with the standards established by the respective licensing or certifying board of the professional providing the audio-only telemedicine medical service or audio-only telehealth service.
• Behavioral health services provided via audio-only platform must be designated for reimbursement by HHSC. Behavioral health services provided via an audio-only platform designated for reimbursement are those that are clinically effective and cost-effective, as determined by HHSC and in accordance with §354.1432(3) of this subchapter (relating to Telemedicine and Telehealth Benefits and Limitations). Behavioral health services that HHSC has determined are clinically effective and cost-effective when provided via an audio-only platform can be found in the Texas Medicaid Provider Procedures Manual (TMPPM).

SOURCE: TX Admin Code Title 1, Sec. 354.1435, (Accessed Dec. 2024).

• Synchronous audio-only technology between the distant site provider and the client in another location

A Texas Medicaid Managed Care organization (MCO) is not required to provide reimbursement for telemedicine services [or telehealth service] that are provided through the following methods:

• A text-only email message
• A facsimile transmission

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 6, 9, 12-13 (Dec. 2024). (Accessed Dec. 2024).

Conditions for reimbursement applicable to telemedicine and telehealth provided using a synchronous audiovisual technology platform, or using store and forward technology in conjunction with synchronous audio-only are those that meet the following conditions:

• Must be designated for reimbursement by HHSC.
• Must be clinically effective and cost-effective, as determined and published in the benefit language by HHSC.
• May not be denied solely because an in-person medical service between a provider and client did not occur.
• May not be limited by requiring the provider to use a particular synchronous audiovisual technology platform to receive reimbursement for the service.

Other conditions for reimbursement applicable to services may vary by service type. Providers may refer to the appropriate TMPPM handbook for additional information on synchronous audiovisual technology platform coverage conditions.

Note: : Telemedicine and telehealth services that HHSC has determined are clinically effective and cost-effective when provided via a synchronous audiovisual technology platform or using store and forward technology in conjunction with synchronous audio-only technology can be found in the appropriate TMPPM handbooks.

Conditions for reimbursement applicable to behavioral health services provided using a synchronous audio-only technology platform are those that meet the following conditions:

• Must be designated for reimbursement by HHSC.
• Provider must obtain informed consent from the client, client’s parent, or the client’s legally authorized representative prior to rendering a behavioral health service through a synchronous audio-only technology platform; except when doing so is not feasible or could result in death or injury to the client. Verbal consent is permissible and must be documented in the client’s medical record.
• Must be clinically effective and cost-effective, as determined and published in the benefit language by HHSC.
• May not be denied solely because an in-person medical service between a provider and client did not occur.
• May not be limited by requiring the provider to use a particular synchronous audio-only technology platform to receive reimbursement for the service.
• Other conditions for reimbursement applicable to behavioral health services may vary by service type. Providers may refer to the appropriate TMPPM handbook for additional information on audio-only coverage conditions.

Conditions for reimbursement applicable to non-behavioral health services provided using a synchronous audio-only technology platform:

• Must be designated for reimbursement by HHSC.
• Clinically effective and cost-effective, as determined and published by HHSC.
• May not be denied solely because an in-person medical service between a provider and client did not occur.
• May not be limited by requiring the provider to use a particular synchronous audio-only technology platform to receive reimbursement for the service.

Note: Behavioral or non-behavioral health services that HHSC has determined are clinically effective and cost-effective when provided via a synchronous audio-only technology platform can be found in the appropriate TMPPM handbooks.

Telemedicine and telehealth services are reimbursed in accordance with 1 TAC §355.

In the event of a Declaration of State of Disaster, HHSC will issue direction to providers regarding the use of telemedicine or telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law.

Declaration of State of Disaster is when to an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Texas Government Code §418.014.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 6-7 (Dec. 2024). (Accessed Dec. 2024).

Procedure codes that are reimbursed to distant site providers when billed with the 93 modifier (audio-only services) are included in the individual TMPPM handbooks. Procedure codes that indicate telephone or audio-only delivery in their description do not need to be billed with the 93 modifier.

Behavioral health procedure codes that are reimbursed to distant site providers when billed with the FQ modifier (audio-only services) are included in the individual TMPPM handbooks. Procedure codes that indicate telephone or audio-only delivery in their description do not need to be billed with the FQ modifier.

See manual for codes MCOs must reimburse when delivered via telemedicine services.

Texas Medicaid MCOs may optionally provide reimbursement for telemedicine services that are provided through asynchronous audio-only technology, such as voice mail technology. Distant site providers should contact each MCO to determine whether an MCO provides reimbursement for a specified modality.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 8-9, Dec. 2024 (Accessed Dec. 2024).

Telemedicine medical services used for the treatment of chronic pain with scheduled drugs via audio-only is prohibited, unless a patient:

• Is an established chronic pain patient of the physician or health professional issuing the prescription;
• Is receiving a prescription that is identical to a prescription issued at the previous visit; and
• Has been seen by the prescribing physician or health professional defined under Section 111.001(1) of Texas Occupations Code, in the last 90 days either in-person or via telemedicine using audiovisual communication.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 10 (Dec. 2024). (Accessed Dec. 2024).

Case Management for Children and Pregnant Women

Case Management for Children and Pregnant Women services are limited to one contact per day per person. Additional provider contacts on the same day are denied as part of another service rendered on the same day. Prior authorization is not required for case management services.

Procedure code G9012, with required modifiers, may be reimbursed for Case Management for Children and Pregnant Women (CPW) services. Modifiers are used to identify which service component is provided.

CPW services may be provided using synchronous audiovisual technologies if clinically appropriate and safe, as determined by the provider, and agreed to by the client receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit.

The Telecommunication Services Handbook (Vol. 2, Provider Handbooks) for information on policy restrictions for services delivered by synchronous telephone (audio-only) technologies. Services delivered using audio-only technologies must be billed using the 93 modifier.

During a Declaration of State Disaster, HHSC may issue direction to providers regarding the use of a telemedicine or telehealth service to include the use of synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law. A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

A follow-up visit may be completed in-person or through the use of synchronous audiovisual technology, or synchronous telephone (audio-only) technology. Follow-up visits completed using synchronous audiovisual technology or synchronous telephone (audio-only) technology should only be provided if agreed to by the client, parent, or legal guardian.

Intellectual and Developmental Disabilities Service Coordination

Supportive Encounter (Type B):  A face-to-face, telephone, or telemedicine contact with a person or with a collateral on the person’s behalf to provide service coordination.

Outpatient Mental Health Services

The following MHR services may be provided by synchronous telephone (audio-only) technology to persons with whom the billing provider has an existing clinical relationship and if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services or LAR. In addition, except for crisis intervention services, approval to deliver the services by synchronous telephone (audio-only) technology must be documented in the plan of care of the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers of MHR services must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. MHR services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

• Medication training and support
• Skills training and development
• Psychosocial rehabilitation services
• Crisis intervention services
  • Synchronous telephone (audio-only) technology may only be used for crisis intervention services as a back-up mode of delivery only, meaning if the person who is in crisis, not the billing provider, is unwilling or has limited technological capabilities that prevent them from using a synchronous audiovisual platform at the time the crisis intervention services are delivered. Also, the existing clinical relationship requirement is waived.
  • Documented approval of the use of synchronous telephone (audio-only) technology in the plan of care is not required prior to the delivery of crisis intervention services. However, providers must document the justification for using synchronous telephone (audio-only) technology to deliver crisis intervention services in the medical record.

An existing clinical relationship occurs when a person has received at least one in-person or synchronous audiovisual MHR, MHTCM, or peer specialist service from the same billing provider within the six months prior to the initial service delivered by synchronous telephone (audio-only) technology. The six-month requirement for at least one in-person or synchronous MHR, MHTCM, or peer specialist audiovisual service by the same billing provider prior to the initial synchronous telephone (audio-only) service may not be waived.

Note:  “Same billing provider” refers to providers that are within the same entity, as identified by the entity’s NPI number or numbers, if the entity has multiple locations (i.e., the same LMHA/LBHA or same non-LMHA/private provider).

Note:  The required in-person or synchronous audiovisual-delivered MHTCM, MHR, or peer specialist service may be delivered by another authorized professional or paraprofessional of the same LMHA/LBHA or the same non-LMHA as the professional or paraprofessional who delivers the service by synchronous telephone (audio-only) technology.

The billing provider is required to conduct at least one in-person or synchronous audiovisual MHR, MHTCM, or peer specialist service every rolling 12 months from the date of the initial service delivered by synchronous telephone (audio-only) technology unless the person receiving services and the billing provider agree that an in-person or synchronous audiovisual service is clinically contraindicated, or the risks or burdens of an in-person or synchronous audiovisual service outweigh the benefits. The decision to waive the 12-month requirement applies to that particular rolling 12-month period and the basis for the decision must be documented in the person’s medical record. Examples of when a synchronous telephone (audio-only) service may be more clinically appropriate or beneficial than an in-person or synchronous audiovisual service include, but are not limited to, the following:

• The person receiving services is located at a qualifying originating site in an eligible geographic area, e.g., a practitioner office in a rural Health Professional Shortage Area.
• An in-person or synchronous audiovisual service is likely to cause disruption in service delivery or has the potential to worsen the person’s condition(s).

Note: The required in-person or synchronous audiovisual-delivered MHTCM, MHR, or peer specialist service may be delivered by another authorized professional or paraprofessional of the same LMHA/LBHA or the same non-LMHA as the professional or paraprofessional who delivers the service by synchronous telephone (audio-only) technology.

Peer Specialist Services

Peer specialist services may be provided by synchronous telephone (audio-only) technology to persons with whom the billing provider has an existing clinical relationship and if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services. In addition, approval to deliver the services by synchronous telephone (audio-only) technology must be documented in the person-centered recovery plan of the person receiving services.

Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers of peer specialist services must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. Peer specialist services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

An existing clinical relationship occurs when a person has received at least one in-person or synchronous audiovisual peer specialist, MHTCM, or MHR service from the same billing provider within the six months prior to the initial service delivered by synchronous telephone (audio-only) technology. The six-month requirement for at least one in-person or synchronous audiovisual peer specialist, MHTCM, or MHR service from the same billing provider prior to the initial synchronous telephone (audio-only) service may not be waived.

Note: “Same billing provider” refers to providers that are within the same entity or organization, as identified by the entity’s or organization’s NPI number or numbers, if the entity or organization has multiple locations (i.e., the same LMHA/LBHA, comprehensive provider agency of mental health targeted case management or rehabilitative services, clinic/group practice, FQHC, rural health clinic, or chemical dependency treatment facility, or opioid treatment provider) presuming all other applicable state and federal laws and regulations are followed.

Note: The required in-person or synchronous audiovisual delivered peer specialist, MHTCM, or MHR service may be delivered by another authorized professional or paraprofessional of the same billing provider as the professional or paraprofessional who delivers the service by synchronous telephone (audio-only) technology.

The billing provider is required to conduct at least one in-person or synchronous audiovisual peer specialist, MHTCM, or MHR service every rolling 12 months from the date of the initial service delivered by synchronous telephone (audio-only) technology unless the person receiving services and the billing provider agree that an in-person or synchronous audiovisual service is clinically contraindicated, or the risks or burdens of an in-person or synchronous audiovisual service outweigh the benefits.  The decision to waive the 12-month requirement applies to that particular rolling 12-month period and the basis for the decision must be documented in the person’s medical record. Examples of when a synchronous telephone (audio-only) service may be more clinically appropriate or beneficial than an in-person or synchronous audiovisual service include, but are not limited to, the following:

• The person receiving services is located at a qualifying originating site in an eligible geographic area, e.g., a practitioner office in a rural Health Professional Shortage Area.
• An in-person or synchronous audiovisual service is likely to cause disruption in service delivery or has the potential to worsen the person’s condition.

Note:  The required in-person or synchronous audiovisual delivered peer specialist, MHTCM, or MHR service may be delivered by another authorized professional or paraprofessional of the same billing provider as the professional or paraprofessional who delivers the service by synchronous telephone (audio-only) technology.

Screening, Brief Intervention, and Referral to Treatment (SBIRT)

SBIRT services may be provided by synchronous telephone (audio-only) technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. SBIRT services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.  See manual for additional information.

Medication Assisted Treatment Services

The following SUD services may be provided by synchronous telephone (audio-only) technology to persons with whom the billing provider has an existing clinical relationship and if clinically appropriate and safe, as determined by the billing provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers of SUD services must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. SUD services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ.

• Comprehensive assessment (procedure code H0001) – Only during certain public health emergencies or natural disasters; to the extent allowed by federal law (assessments for withdrawal management services are excluded); and the existing clinical relationship requirement is waived.
• Individual and group counseling (procedure codes H0004 and H0005)

An existing clinical relationship occurs when a person has received at least one in-person or synchronous audiovisual SUD service (comprehensive assessment, individual or group counseling, MAT, outpatient or residential withdrawal management, or residential treatment services) from the same provider within the six months prior to the initial service delivered by synchronous telephone (audio-only) technology. The six-month requirement for at least one in-person or synchronous audiovisual service by the same billing provider prior to the initial synchronous telephone (audio-only) service may not be waived.

Note: “Same billing provider” refers to providers within the same entity or organization, as identified by the entity’s or organization’s NPI number or numbers, if the entity or organization has multiple locations (i.e., CDTF, OTP or clinic, or group practice).

Note: The required in-person or synchronous audiovisual-delivered SUD service (comprehensive assessment, individual or group counseling, MAT, outpatient or residential withdrawal management, or residential treatment services) may be delivered by another authorized professional or paraprofessional of the same billing provider as the professional or paraprofessional who delivers the service by synchronous telephone (audio-only) technology, presuming all other applicable state and federal laws and regulations are followed.

The billing provider is required to conduct at least 1 in-person or synchronous audiovisual SUD service (comprehensive assessment, individual or group counseling, MAT, outpatient or residential withdrawal management, or residential treatment services) every rolling 12 months from the date of the initial service delivered by synchronous telephone (audio-only) technology unless the person receiving services and the billing provider agree that an in-person or synchronous audiovisual service is clinically contraindicated, or the risks or burdens of an in-person or synchronous audiovisual service outweigh the benefits. The decision to waive the 12-month requirement applies to that particular rolling 12-month period and the basis for the decision must be documented in the person’s medical record. Examples of when a synchronous telephone (audio-only) service may be more clinically appropriate or beneficial than an in-person or synchronous audiovisual service include, but are not limited to, the following:

• The person receiving services is located at a qualifying originating site in an eligible geographic area, e.g., a practitioner office in a rural Health Professional Shortage Area.
• An in-person or synchronous audiovisual service is likely to cause disruption in service delivery or has the potential to worsen the person’s condition(s).

Note: The required in-person or synchronous audiovisual-delivered SUD service (comprehensive assessment, individual or group counseling, MAT, outpatient or residential withdrawal management, or residential treatment services) may be delivered by another authorized professional, or paraprofessional, of the same billing provider as the professional, or paraprofessional, who delivers the service by synchronous telephone (audio-only) technology, presuming all other applicable state and federal laws and regulations are followed.

SOURCE: TX Medicaid Behavioral Health and Case Management Services Handbook, (Dec. 2024). (Accessed Dec. 2024).

A cardiac rehabilitation program in which the cardiac monitoring is done using telephonically transmitted electrocardiograms (ECGs) to a remote site is not a benefit of Texas Medicaid.

SOURCE: TX Medicaid Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, (Aug. 2024), pg. 66 (Accessed Aug. 2024).

For the diagnosis, evaluation and treatment of a mental health or substance use condition, as well as non-behavioral health conditions, the following office and other outpatient services may be provided by synchronous telephone (audio-only) technology if clinically appropriate and safe, as determined by the provider, and agreed to by the client receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology for telemedicine and telehealth services. Therefore, providers must document in the client’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. Established patient services for mental health or substance use conditions provided by synchronous telephone (audio-only) technology must be billed using modifier FQ. Established patient services for non-behavioral health conditions provided by synchronous telephone (audio-only) technology must be billed using modifier 93.

Procedure code 99211 may be delivered by synchronous telephone (audio-only) technology during certain public health emergencies only.

See manual for more details on procedure codes.

SOURCE: TX Medicaid Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, (Dec. 2024), pg. 179 (Accessed Dec. 2024).

CSHCN – Physicians

Non-face-to-face specialist or subspecialist telephone consultations (procedure code 99499 with modifier U9) are a benefit for a specialist or subspecialist when the clinician providing the medical home contacts the specialist for advice or a referral and the consultation is at least 15 minutes in duration.

Telephone consultations are defined by the CSHCN Services Program as the process where the specialist or subspecialist receives a telephone call from the clinician providing the medical home. During the telephone call, the specialist or subspecialist assesses and manages the client’s condition by providing advice or referral to a more appropriate provider.

Specifically, non-face-to-face clinician supervision of the development or revision of a client’s care plan (care plan oversight services) may include the following activities.

These services do not have to be contiguous:

• Review of charts, reports, treatment plans, or lab or study results, except for the initial interpretation or review of lab or study results ordered during or associated with a face-to-face encounter
• Telephone calls with other clinicians (not employed in the same practice), including specialists or subspecialists involved in the care of the client
• Telephone or face-to-face discussions with a pharmacist about pharmacological therapies (not just ordering a prescription)
• Medical decision making
• Activities to coordinate services (if the coordination activities require the skill of a clinician)
• Documentation of the services provided, including writing a note in the client chart describing services provided, decision making performed, and amount of time spent performing the countable services, including time spent by the physician working on the care plan after the nurse has conveyed pertinent information from agencies or facilities to the physician, including the start and stop times

See manual or activities not covered as non-face-to-face oversight/supervision of the development or revision of the client’s care plan.

Non-face-to-face specialist or subspecialist telephone consultations may be billed with procedure code 99499 and modifier U9.

A specialist or subspecialist telephone consultation is limited to two every 6 months by the same provider.

The specialist or subspecialist must maintain documentation of the telephone consultation using the CSHCN Services Program Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services Form or similar clinical record documentation. These records are subject to retrospective review.

Non-face-to-face specialist or subspecialist telephone consultations do not require authorization.

Preventive care medical checkups are not a benefit of a telemedicine or telehealth service.

SOURCE: TX Medicaid CSHCN Services Program Manual – Physician, (Nov. 2024), (Accessed Dec. 2024).

To the extent permitted by state and federal law and to the extent it is cost-effective and clinically effective, as determined by the commission, the executive commissioner by rule shall develop and implement a system that ensures behavioral health services may be provided using an audio-only platform consistent with Section 111.008, Occupations Code, to a Medicaid recipient, a child health plan program enrollee, or another individual receiving those services under another public benefits program administered by the commission or a health and human services agency.

If the executive commissioner determines that providing services other than behavioral health services is appropriate using an audio-only platform under a public benefits program administered by the commission or a health and human services agency, in accordance with applicable federal and state law, the executive commissioner may by rule authorize the provision of those services under the applicable program using the audio-only platform. In determining whether the use of an audio-only platform in a program is appropriate under this subsection, the executive commissioner shall consider whether using the platform would be cost-effective and clinically effective.

SOURCE: TX Government Code Title 4, Subtitle I, Chapter 531, Subchapter A, Sec. 531.02161. [Repealed eff. Apr. 1, 2025], (Accessed Dec. 2024).

Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telehealth services.

Providers must defer to the needs of the client receiving services, allowing the mode of service delivery to be accessible, person- and family-centered, and primarily driven by the client in service’s choice and not provider convenience.

Services delivered by synchronous audiovisual technology will require participation of a parent or caregiver to assist with the treatment.

Therapy assistants may deliver services and receive supervision using synchronous audiovisual technology in accordance with each discipline’s rules. Providers should refer to state practice rules and national guidelines regarding supervision requirements for each discipline.

See manual for applicable codes.

Telehealth Exclusions

See manual for procedure codes that are in-person only and will not be reimbursed if provided through telehealth delivery.

Any PT, OT, ST, and SST services delivered through synchronous telephone (audio-only) technology is not a benefit.

During a Declaration of State of Disaster, HHSC may issue direction to providers regarding the use of a telehealth service to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law. A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

See Children’s Services Handbook for a list of procedure codes that are in-person only and will not be reimbursed if provided through telehealth delivery.

Targeted Case Management (TCM)

TCM services (procedure code T1017) may also be delivered using a synchronous telephone (audioonly) platform. TCM services delivered using a synchronous telephone (audio-only) platform are subject to the restrictions outlined in the Telecommunication Services Handbook (Vol. 2, Provider Handbooks).

Health and Behavior Assessment and Intervention

HBAI services may be provided by synchronous telephone (audio-only) technology if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interaction, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. HBAI services provided by synchronous telephone (audio-only) technology must be billed using modifier FQ. See manual for eligible services and additional requirements.

Medical Nutrition Counseling Services (CCP)

Certain telehealth services may be provided for medical nutrition therapy and nutrition counseling services clients if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interactions, such as an in-person visit, as well as the use of synchronous audiovisual technology over synchronous telephone (audio-only) technology of telehealth services. Therefore, providers must document in the person’s medical record the reason(s) that services were delivered by synchronous telephone (audio-only) technology.  See chart in manual for services are authorized for telehealth delivery using synchronous audiovisual and synchronous telephone (audio-only) technologies.

The procedure codes in the table above may be delivered by synchronous telephone (audio-only) technology only during certain PHE or natural disasters.

Medical nutrition counseling services (procedure code S9470) are authorized for telehealth delivery using synchronous audiovisual and synchronous telephone (audio-only) technologies, when noted.

Medical nutrition counseling services (procedure code S9470) may be delivered by synchronous telephone (audio-only) technology only during certain PHE or natural disasters. Services provided by synchronous audio-visual technology must be billed using modifier 95. Services delivered using audio-only technologies must be billed using modifier 93. Documentation requirements for a telehealth service are the same as for an in-person visit and must accurately reflect the services rendered. Documentation must identify the means of delivery when provided.

During a Declaration of State of Disaster, the Texas Health and Human Services Commission (HHSC) may issue direction to providers regarding the use of telehealth services to include the use of a synchronous telephone (audio-only) platform to provide covered services outside of the allowances described herein to the extent permitted by Texas law. A Declaration of State of Disaster is when an executive order or proclamation is issued by the governor declaring a state of disaster in accordance with Section 418.014 of the Texas Government Code.

SOURCE: TX Medicaid Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook pg. 10, (Dec. 2024). (Accessed Dec. 2024).

Healthy Texas Women (HTW) Program/HTW Plus

Certain telemedicine and telehealth services may be provided for HTW clients if clinically appropriate and safe, as determined by the provider, and agreed to by the person receiving services. Whenever possible, HHSC encourages face-to-face interactions, such as an in-person visit, as well as the use of synchronous audio-visual technology over synchronous telephone (audio-only) technology of telemedicine and telehealth services. Therefore, providers must document in the person’s medical record the reason(s) for why services were delivered by synchronous telephone (audio-only) technology. See manual for codes.

See manual for synchronous telephone (audio-only) technology services that are eligible only during certain PHE or natural disasters.

Established client services for behavioral health or substance use conditions provided by synchronous telephone (audio-only) technology must be billed using modifier FQ. Established patient services for non-behavioral health conditions provided by synchronous telephone (audio-only) technology must be billed using modifier 93.  See manual for codes.

Behavioral health services delivered using synchronous telephone (audio-only) technologies must be billed using the FQ modifier. Non-behavioral health services delivered using synchronous telephone (audio-only) technologies must be billed using the 93 modifier.

HTW Plus: Procedure code H0001 is authorized for delivery by synchronous telephone (audio-only) technology only during certain public health emergencies or natural disasters; to the extent allowed by federal law (assessments for withdrawal management services are excluded); and the ‘existing clinical relationship’ requirement is waived.

FQHCs and RHCs may be reimbursed for telemedicine and telehealth in the following manner:

• The distant site provider fee is reimbursable as a prospective payment system (PPS), alternative prospective payment system (APPS), or AIR (All Inclusive Rate) PPS.
• The facility fee (procedure code Q3014) is an add-on procedure code that should not be included in any cost reporting that is used to calculate a FQHC PPS, APPS, or the RHC AIR (All Inclusive Rate) PPS per visit encounter rate.

The Medicaid program shall reimburse for audio-only telehealth services as specified by division rule.

SOURCE: UT Code 26B-3-123 (Accessed Nov. 2024).

Telehealth services seek to improve an individual’s health by permitting two-way communication between members and their providers and may be performed for a variety of medically necessary services. This communication often requires the use of interactive telecommunications equipment that can include both audio and video components but may also be conducted via audio-only.  Audio-only telehealth is not allowed if it is solely for the sake of provider convenience. The utilization of telehealth services is dependent upon the member and their situation. As such, providers must determine the clinical appropriateness and medical necessity of the services being delivered through clinical-based decision making. Some examples of when telehealth may be appropriate are:

• Diagnostic review and discussion of results
• Evaluation and management services
• Management of chronic conditions
• Medication management
• Mental health, behavioral health, and substance use disorder services
• Telepsychiatric consultation
• Teledentistry
• Treatment counselling
• Wellness checks

Telecommunication technologies that support synchronous care include:

• Live video two-way, face-to-face interaction between the member and the provider using audiovisual communication, including E-visits through an online patient portal.
• Audio only visits by means of telephone or other forms of communication without video.

As outlined by the Centers for Medicare and Medicaid Services (CMS), audio-only synchronous care or care that does not clinically require visual inspection, is covered for a limited number of services. Medicaid limits these services to:

• Behavioral health, including substance use disorders (SUD)
• Diabetic self-management
• Speech and hearing
• Nutritional counselling
• Tobacco cessation
• Education for chronic kidney disease
• Advanced care planning

Providers are responsible for determining the applicable CPT and HCPCS codes associated with each of the above-listed services and ensure the codes are covered. Reporting requirements for services provided via telehealth are the same as those provided for services performed in-person.

Telepsychiatry

When psychiatrists consult with a physician regarding a member’s possible need for telepsychiatry, they must report the following CPT codes to receive payment for services:

• 99446 Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
• 99447 11-20 minutes of medical consultative discussion and review
• 99448 21-30 minutes of medical consultative discussion and review
• 99449 31 minutes or more of medical consultative discussion and review

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (July 2024). (Accessed Nov. 2024).

The agency may bill Medicaid for targeted case management services if the following criteria are met: …

• The time spent in the activity involves a face-to-face encounter, telephone or written communication with the child, family, caretaker, service provider, or other individual with a direct involvement in providing or assuring the child obtains the necessary services documented in the targeted case management service plan.

SOURCE: Utah Medicaid Provider Manual: Targeted Case Management, Early Childhood Ages 0-4, p. 8 (Jul. 2023).  (Accessed Nov. 2024).

Case Management Monitoring includes at a minimum, the case management agency must make at least one monthly contact directly with the participant either by telephone or in person.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services, New Choices Waiver (Jul. 2021).  (Accessed Jun. 2024).

The agency may report the covered services and activities specified in Chapter 2-1, B. only if: …

• the time spent in the service or activity involves a face-to-face encounter, telephone or written communication with the client, family, caretaker, service provider, or other individual with a direct involvement in providing or assuring the client obtains the necessary services documented in the targeted case management service plan;

For each date of service, documentation must include: …

• setting in which the service was rendered (when via telehealth, the provider setting and notation that the service was provided via telehealth);

SOURCE: Utah Medicaid Provider Manual: Targeted Case Management for Individuals with Serious Mental Illnesses (Sept. 2024).  (Accessed Nov. 2024).

Effective January 1, 2024, members may receive face-to-face and telephonic Medication Therapy Management (MTM) services provided by a Medicaid enrolled pharmacist in an outpatient setting.

Pharmacists shall be licensed in the state of Utah and enrolled as a provider with Utah Medicaid to provide these services. Additional information on how to become a Medicaid provider can be found here: https://medicaid.utah.gov/become-medicaid-provider/.

MTM services are covered for Medicaid enrolled adult and pediatric eligible members. Medicaid members may receive one initial MTM service and three follow-up services per calendar year. Medicaid members must be taking at least three medications to treat or prevent at least one chronic disease. Medicaid members cannot be eligible for Medicare Part D to receive these services.

Specific coverage and reimbursement information by procedure code is found in the Coverage and Reimbursement Code Lookup. For a full description of the MTM program, please see the Utah Medicaid Pharmacy website.

See bulletin for codes.

SOURCE:  Utah Medicaid Provider Manual: Pharmacy Services, (Sept. 2024), & Utah Medicaid Bulletin, January 2024, (Accessed Nov. 2024).

“Audio-Only” means real-time health care delivery by a provider who is located at a distant site to a beneficiary at an originating site for purposes of evaluation, diagnosis, consultation, or treatment, using audio-only telecommunications technology.

Audio-Only: To be covered, services shall be:

• Clinically appropriate for delivery through audio-only, and
• Medically necessary.

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.7), Telehealth, (Accessed Nov. 2024).

Effective 1/1/24, Telehealth coding for place of service and modifier guidance given during the Public Health Emergency (PHE) period no longer applies. Vermont Medicaid updated the following changes to telehealth coding: Place of Service code 10 – Telehealth Provided in Patient’s Home and Place of Service code 02 – Telehealth Provided Other than in Patient’s Home. Current Procedural Terminology (CPT) Code Modifier 93 for Telemedicine services delivered via audio-only telecommunications should be billed for clinically appropriate services delivered via telephone. Modifier 93 replaces the use of modifier V3. A list of allowable audio-only service codes can be found on the DVHA website. VT Medicaid follows Medicare place of service guidelines, CPT, and Healthcare Common Procedure Coding System (HCPCS) modifiers as indicated in the VT Medicaid General Billing and Forms Manual.

SOURCE: Department of VT Health Access, Banner Notice, Feb. 9, 2024, Telehealth Guidance (Accessed Nov. 2024).

Audio-Only Telephone

Subject to the limitations of the license under which the individual is practicing and, for Medicaid patients, to the extent permitted by the Centers for Medicare and Medicaid Services, a health care provider may deliver health care services to a patient using audio-only telephone if the patient elects to receive the services in this manner and it is clinically appropriate to do so. A health care provider shall comply with any training requirements imposed by the provider’s licensing board on the appropriate use of audio-only telephone in health care delivery.

A health care provider delivering health care services using audio-only telephone shall include or document in the patient’s medical record:

• The patient’s informed consent for receiving services using audio-only telephone in accordance with subsection (c) of this section; and
• The reason or reasons that the provider determined that it was clinically appropriate to deliver health care services to the patient by audio-only telephone.

A health care provider shall not require a patient to receive health care services by audio-only telephone if the patient does not wish to receive services in this manner.

A health care provider shall deliver care that is timely and complies with contractual requirements and shall not delay care unnecessarily if a patient elects to receive services through an in-person visit or telemedicine instead of by audio-only telephone.

Neither a health care provider nor a patient shall create or cause to be created a recording of a provider’s telephone consultation with a patient.

Audio-only telephone services shall not be used in the following circumstances:

• For the second certification of an emergency examination determining whether an individual is a person in need of treatment pursuant to section 7508 of this title; or
• For a psychiatrist’s examination to determine whether an individual is in need of inpatient hospitalization pursuant to 13 V.S.A. § 4815(g)(3).

SOURCE: VT Statute 18 VSA Sec. 9362, (Accessed Nov. 2024).

See list of covered audio-only telehealth service codes.

SOURCE:  Department of VT Health Access, VT Medicaid Audio Only Telehealth Services 10.1.23, (Accessed Nov. 2024).

Is audio-only (telephone) a covered service under Vermont Medicaid?

Yes – Vermont Medicaid will provide reimbursement at the same rate for medically necessary, clinically appropriate services delivered by telephone. Reimbursement will be at the same rate as currently established for Medicaid-covered services provided through telemedicine/face-to-face as long as the claim is submitted to Vermont Medicaid with a 93 modifier (to indicate “service delivered via telephone, i.e., audio-only”). The V3 modifier used during the Public Health Emergency is no longer accepted as of January 1, 2024.

SOURCE: Department of Vermont Health Access. Agency of Human Services. Telehealth: Methods for healthcare service delivery using telecommunications technologies. (Accessed Nov. 2024).

Effective immediately, Vermont Medicaid has added Naturopathic Physicians to the list of providers allowed to bill Current Procedural Terminology (CPT) codes 99441, 99442, and 99443. Refer to the Fee Schedule for coverage criteria https://vtmedicaid.com/#/feeSchedule. A list of audio-only covered codes can be found on the Department of Vermont Health Access website: https://dvha.vermont.gov/providers/telehealth.

SOURCE: Department of VT Health Access, Banner Notice, May 31, 2024, Telephone Evaluation and Management Services by Naturopathic Physicians, (Accessed Nov. 2024).

Effective 7/1/2023, Vermont Medicaid added Healthcare Common Procedure Coding System (HCPCS) code H2019 Therapeutic Behavioral Services, per 15 minutes to the list of Audio-Only covered codes. Refer to the Fee Schedule for coverage criteria https://vtmedicaid.com/#/feeSchedule. Current Procedural Terminology (CPT) Code Modifier 93 should be billed for clinically appropriate services delivered via telephone. A list of audio-only covered codes can be found on the Department of Vermont Health Access website: https://dvha.vermont.gov/providers/telehealth.

SOURCE: Department of VT Health Access, Banner Notice, April 5, 2024, H2019 Audio-Only List Addition, (Accessed Nov. 2024).

See the Miscellaneous section of the Professional Regulation category for additional requirements.

No reference found.

Telehealth encompasses telemedicine as well as a broader umbrella of services that includes the use of such technologies as telephones, interactive and secure medical tablets, remote patient monitoring devices, and store-and-forward devices. Telehealth includes services delivered in the dental health setting (i.e., teledentistry), and telehealth policies for dentistry are covered in the dental manuals.

Telemedicine: This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine does not include an audio-only telephone.

Audio only: The use of real-time telephonic communication that does not include use of video.

Attachment A lists covered services that may be reimbursed when provided via telehealth. Specifically: …

• Table 7 and Table 8 lists audio-only telehealth services

Telemedicine and Audio-Only Telehealth

• Services delivered via telemedicine or audio-only telehealth must be provided with the same standard of care as services provided in person.
• Telemedicine or audio-only telehealth must not be used when in-person services are medically and/or clinically necessary. The distant Provider is responsible for determining that the service meets all requirements and standards of care. Certain types of services that would not be expected to be appropriately delivered via telemedicine include, but are not limited to, those that: are performed in an operating room or while the patient is under anesthesia; require direct visualization or instrumentation of bodily structures; involve sampling of tissue or insertion/removal of medical devices; and/or otherwise require the in-person presence of the patient for any reason.
• If, after initiating a telemedicine or audio-only telehealth visit, the telemedicine or audio-only telehealth modality is found to be medically and/or clinically inappropriate, or otherwise can no longer meet the requirements stipulated in the “Reimbursable Telehealth Services” section, the Provider shall provide or arrange, in a timely manner, an alternative to meet the needs of the member. In this circumstance, the Provider shall be reimbursed only for services successfully delivered.

Distant site Providers must include:

• the modifier GT on claims for services delivered via telemedicine
• the modifier 93 on claims for services delivered via audio-only telehealth.

CPT codes for activities that are not considered to be essentially in-person services per the CPT Manual do not require telehealth modifiers. Examples include codes used exclusively for audio-only delivery of services (see Table 7 in this supplement below).

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) & Updates to Telehealth Services Supplement Memo, May 13, 2024, (Accessed Dec. 2024).

Opioid Treatment Services

Intensive outpatient service providers shall meet the ASAM Level 2.1 service components. The following service components shall be assessed and monitored weekly and shall be provided in accordance to the ASAM Criteria, as directed by the member’s ISP and based on the member’s treatment needs identified in the multidimensional assessment. The provider must demonstrate the following service components in the member’s ISP as medically necessary, through provision of services or through referral: …

• Requests for a psychiatric or a medical consultation shall be available within 24 hours of the requested consult by telephone and preferably within 72 hours of the requested consult in person or via telemedicine. Referrals to external resources are allowed in this setting;

Partial hospitalization (ASAM Level 2.5) service components shall include the following provided at least once weekly or as directed by the ISP and based on the member’s treatment needs identified in the multidimensional assessment: …

• Psychiatric and medical formal agreements to provide medical consult within 8 hours of the requested consult by telephone, or within 48 hours in person or via telemedicine. Referrals to external resources are allowed in this setting;

In addition to the above, Partial Hospitalization Services (ASAM Level 2.5) co-occurring enhanced programs shall offer the following: …

• Psychiatric services as appropriate to meet the member’s mental health condition. Services may be available by telephone and on site, or closely coordinated off site, or via telemedicine.
• Clinical leadership and oversight and, at a minimum, capacity to consult with an addiction psychiatrist via telephone, telemedicine, or in person.

In addition to the Level 3.1 service components listed in this section, Clinically Managed Low Intensity Residential:

• Programs for members who have both unstable substance use and psychiatric disorders including appropriate psychiatric services, medication evaluation and laboratory services. Such services are provided either on-site, via telemedicine, or closely coordinated with an off-site provider, as appropriate to the severity and urgency of the member’s mental health condition

Clinically managed population-specific high intensity residential services (ASAM Level 3.3) as defined in 12VAC30-130-5120 and 12VAC35-105-1590 to 1620, must have all the following service components through service provision or through referral:

• Access to consulting physician or physician extender and emergency services 24 hours a day and seven days a week via telephone and in person.

Clinically managed high-intensity residential services (adult) and clinically managed medium-intensity residential services (adolescent) (ASAM Level 3.5) as defined in 12VAC30-130-5130 and 12VAC35-105-1530 to 1570, are residential treatment services which shall include through service provision or through referral:

• Telephone or in-person consultation with a physician or physician-extender who shall be available to perform required physician services. Emergency services shall be available 24 hours per day and seven days per week.

Clinically managed high-intensity residential services (adult) and clinically managed medium-intensity residential services (adolescent) (ASAM Level 3.5) co-occurring enhanced programs shall include the services listed in this section in addition to psychiatric services (psychiatric evaluation and/or therapy individual, group, family), medication evaluation, and laboratory services which shall be available by telephone within eight hours of requested service and on-site or via telemedicine, or closely coordinated with an off-site provider within 24 hours of requested service, as appropriate to the severity and urgency of the member’s mental and physical condition. Level 3.5 cooccurring enhanced programs offer planned clinical activities designed to stabilize the member’s mental health problems and psychiatric symptoms, and to maintain such stabilization. Planned clinical activities shall be required and shall be designed to stabilize and maintain the member’s mental health problems and psychiatric symptoms.

A psychiatric assessment of the member shall occur within four hours of admission by telephone and within 24 hours following admission in person or via telemedicine, or sooner, as appropriate to the member’s behavioral health condition, and thereafter as medically necessary. A behavioral health-focused assessment at the time of admission shall be performed by a registered nurse or licensed mental health clinician. A licensed registered nurse or licensed practical nurse supervised by a registered nurse shall be responsible for monitoring the member’s progress and administering or monitoring the member’s self-administration of medications.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Opioid Treatment Services/Medication Assisted Treatment, (8/28/24), (Accessed Dec. 2024).

Additions to the Telehealth Supplement include defining virtual check-in services, identifying covered codes, specifying reimbursement requirements, and outlining fee-for-service (FFS) billing details.  See Update for list of codes.

As noted in the Telehealth Supplement (Attachment A), all FFS claims for audio only codes should be billed directly to DMAS, including those delivered in the context of mental health and substance use disorder services. Chapter V of the Physician/Practitioner Manual provides detailed billing instructions for submitting claims to DMAS.

SOURCE: VA Department of Medical Assistance Services, Coverage of Virtual Check-In and Audio Only Services/Updates to Telehealth Services Supplement, April 1, 2022. (Accessed Dec. 2024).

Care Management

Care Management includes care coordination, but is primarily conducted telephonically and is typically performed by a benefits administrator or managed care company. This is in order to include network and claims data and trend analysis for enhanced care planning for individual cases.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Mental health Services, Ch. 4, p. 6  (11/15/24) (Accessed Dec. 2024).

Peer Services

Face-to-face services may be provided through telemedicine. Coverage of services delivered by telemedicine are described in the “Telehealth Services Supplement”. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

Telephone time is supplemental rather than replacement of face-to-face contact and is limited to 25% or less of total time per recipient per calendar year. Justification for services rendered with the member via telephone shall be documented. Any telephone time rendered over the 25% limit will be subject to retraction.

Contact shall be made with the member receiving Peer Support Services or Family Support Partners a minimum of twice each month. At least one of these contacts must be face-to-face and the second may be either face-to-face or telephone contact, subject to the 25% limitation described above, depending on the member’s support needs and documented preferences.

In the absence of the required monthly face-to-face contact and if at least two unsuccessful attempts to make face-to-face contact have been tried and documented, the provider may bill for a maximum of two telephone contacts in that specified month, not to exceed two units. After two consecutive months of unsuccessful attempts to make face-to-face contact, discharge shall occur.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Peer Services Supplement, (12/29/23) (Accessed Dec. 2024).

BIS Case Management

Case Management Agency Requirements – The provider agency also must: …

• Guarantee that individuals have access to emergency assistance either directly or on-call 24 hours per day, seven days per week and holidays. This may be done via telephone and face-to face contact and/or coordination with other providers and DBHDS administered crisis services.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual BIS Case management Supplement, (1/4/24) (Accessed Dec. 2024).

Intensive Community Based Services

Crisis intervention must be available 24 hours per day, seven days per week, including holidays, via telephone and face-to face contact.

After hours crisis intervention provided by a qualified ACT team member through audio only telehealth may be included in the 15-minute minimum required to bill the per diem if the provider determines that the crisis can be safely managed through telephonic services as specified in the ISP.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual MHS Appendix E – Intensive Community Based Support, (7/1/22) (Accessed Dec. 2024).

Community Mental Health Rehabilitative Services

Family meetings and contacts, either in person or by telephone, occurs at least once per week to discuss treatment needs and progress. Contacts with parents/guardian include at a minimum the youth’s progress, any diagnostic changes, any ISP changes, and discharge planning. The parent/guardian should be involved in any significant incidents during the school day and be informed of any changes associated with the ISP. Family meetings are not considered to be the same as family therapy.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual MHS Appendix H – Community Mental Health Rehabilitative Services, (6/14/23) (Accessed Dec. 2024).

Psychiatric Services

The following are non-covered services: …

• Telephone consultations

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Psychiatric Services, (2/23/24) (Accessed Dec. 2024).

Opioid Treatment Services

In addition, OTP providers must meet the following criteria:

• A physician or physician extender, as defined in 12VAC30-130-5020, must be available during medication dispensing and clinical operating hours, in-person or by telephone

Peer Recovery Specialists may deliver services in-person or through telehealth or audio-only.

Face-to-face Substance Use Care Coordination is encouraged and should be documented. If for some reason the member is unable to meet face-to-face and other forms of communication are conducted, such as telehealth or telephonic mode of delivery, this too must be documented. If the member continues to be unavailable for face-to-face Substance Use Care Coordination, the member should then be re-evaluated to see if the service is appropriate for the member currently within their treatment process.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Opioid Treatment Services/Medication Assisted Treatment, (12/29/23), (Accessed Dec. 2024).

DMAS intends to update the Telehealth Services Supplement to continue allowing delivery of certain outpatient psychiatric and ARTS services via audio-only telehealth that are at present allowed under the authority of the federal COVID-19 Public Health Emergency (PHE). The federal COVID-19 PHE is set to expire on May 11, 2023 and the planned changes will allow continued audio-only telehealth delivery for specific CPT codes (see bulletin).

Providers must continue to follow the conditions for telehealth reimbursement outlined in the Reimbursable Telehealth Services section of the Telehealth Services Supplement when providing audio-only telehealth services. Documentation for services delivered via audio-only telehealth are the same as for a comparable in-person service. Providers should continue to bill for audio-only telehealth as they normally would if the service was provided in-person until otherwise notified. Additional reimbursement and billing guidelines for audio-only telehealth services will be included in a forthcoming update to the Telehealth Services Supplement.

DMAS will continue to evaluate whether there are additional CPT/HCPCS codes that should be authorized for audio-only telehealth coverage after the end of the Federal PHE.  Future audio-only telehealth policy changes will be included in updates to the Telehealth Services Supplement.

SOURCE:  Medicaid Bulletin:  Telehealth Updates to Outpatient Psychiatric and Addiction Recovery and Treatment Services (ARTS) Services. April 20, 2023, (Accessed Dec. 2024).

Nursing Services

Initial Assessment Visit: During this visit, the RN Supervisor must conduct and document all of the following activities:

• Introduction of the aide to be assigned to the individual, if services start the same day. Each regularly assigned aide must be introduced to the individual by the RN Supervisor, or other staff (this may be done by telephone) and oriented to the individual’s Plan of Care on or prior to the aide’s start of care for that individual

A RN/LPN Supervisor must be available to the aides by telephone at all times that an aide is providing services to an individual.

The SF must be available by telephone to individuals receiving CD services during normal business hours, have voice mail capability, and return phone calls within one business day.

Personal Emergency Response System (PERS) is an electronic device that shall be capable of being activated by a remote wireless device and enables individuals to secure help in an emergency. PERS electronically monitors individual’s safety in the home and provides access to emergency crisis intervention for medical or environmental emergencies through the provision of a two-way voice communication system that dials a 24-hour response or monitoring center upon activation via the individual’s home telephone line or other two way voice communication system. When appropriate, PERS may also include medication monitoring devices.

See manual for additional details.

SOURCE: VA Dept. of Medical Assistance Medicaid Provider Manual, CCC Plus Waiver, Ch. 4, (12/29/23), (Accessed Dec. 2024).

Development Disabilities Waiver

Telemedicine does not include an audio-only telephone. Telemedicine is the only form of
telehealth allowable for select DD waiver services.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual DD Waiver, (10/10/24) (Accessed Dec. 2024).

Personal Care Services

The SF must be available by telephone to individuals receiving CD services during normal business hours, have voice mail capability, and return phone calls within 1 business day. The SF is not responsible for supervision of personal care assistants and has no authority in hiring/firing assistants. The EOR is solely responsible for attendant supervision.

Each regularly assigned assistant must be introduced to the individual by the RN Supervisor, or other staff (this may be done by telephone) and oriented to the individual’s Person Centered Plan of Care prior to the assistant’s start of care for that individual. The RN/LPN Supervisor must closely monitor every situation when a new assistant is assigned to an individual so that any difficulties or questions are dealt with promptly.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, EPSDT Supplements, Personal Care Services, (8/21/19) (Accessed Dec. 2024).

Home Health

This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine shall not include encounters by telephone or email.

SOURCE: VA Dept. of Medical Assistant Svcs.  Home Health, Covered Services and Limitations, 8/28/24, p. 4. (Accessed Dec. 2024).

BabyCare

Upon referral or indication that a member may benefit from case management, the case manager must initiate contact to the member or member’s caregiver to schedule a face-to-face meeting. A telephone call or collateral contact must be made, at a minimum, within 15 calendar days from the date the referral was received. A collateral contact is defined as contact with the member, primary care provider and/or the member’s significant others to promote implementation of services. The provider should maintain privacy requirements as set forth by Health Insurance Portability and Accountability Act (HIPAA).

SOURCE: VA Dept. of Medical Assistant Svcs.  BabyCare, Covered Services and Limitations, 5/2/17, p. 16. (Accessed Dec. 2024).

HCA will pay for audio-only services for specific billing codes when provided and billed as directed in HCA provider billing guides. Refer to HCA’s Provider billing guides and fee schedules webpage (scroll down to Telehealth under Billing guides and fee schedules) for a complete list of audio-only telemedicine procedure codes.

For services that are partially audio/visual and partially audio-only, a service is considered audio-only if 50% or more of the service was provided via audio-only telemedicine.

Audio-only telemedicine requires an established relationship between the health care practitioner and the client. An established relationship is defined as a relationship between a health care practitioner and an Apple Health (Medicaid) client in which both the following are true:

• The health care practitioner providing audio-only telemedicine has access to sufficient health care records to ensure safe, effective, and appropriate care services.
• The client meets either of the following:
  • Has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the health care practitioner providing audio-only telemedicine or with a health care practitioner employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under Chapter 48.44 or 48.46 RCW as the health care practitioner providing audio-only telemedicine.
  • Was referred to the health care practitioner providing audio-only telemedicine by another health care practitioner who has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the client and has provided relevant medical information to the health care practitioner providing audio-only telemedicine.

Providers must obtain consent before rendering audio-only services and document the consent in the client record.

SOURCE: Medicaid Provider Guide, Telemedicine Policy and Billing, p. 21 (Jun. 2024). (Accessed Jun. 2024).

The authority shall adopt rules regarding medicaid fee-for-service reimbursement for services delivered through audio-only telemedicine.  The rules must establish a manner of reimbursement for audio-only telemedicine that is consistent with RCW 74.09.325. The rules shall require rural health clinics to be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between a patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.  It does not include:

• The use of facsimile or email; or
• The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

SOURCE: RCW 74.09.327 (Accessed Jun. 2024).

Managed Care & Behavioral Health Administrative Services Organizations

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.  It does not include:

• The use of facsimile or email; or
• The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

Upon initiation or renewal of a contract with the Washington state health care authority to administer a Medicaid managed care plan, a managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine or store and forward technology if … Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

“Established relationship” means the provider providing audio-only telemedicine has access to sufficient health records to ensure safe, effective, and appropriate care services and:

• The covered person has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 44 or 48.46 RCW as the provider providing audio-only telemedicine; or
• The covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine;

If a provider intends to bill a patient, a behavioral health administrative services organization, or a managed care organization for an audio-only telemedicine service, the provider must obtain patient consent for the billing in advance of the service being delivered. The authority may submit information on any potential violations of this subsection to the appropriate disciplining authority, as defined in RCW 18.130.020.

SOURCE: Revised Code of Washington 74.09.325 as amended by SB 5821 (2024 Legislative Session) & 71.24.335. (Accessed Jun. 2024).

Managed Care

A rural health clinic shall be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.

SOURCE: Revised Code of Washington 74.09.325. (Accessed Jun. 2024).

School-Based Health Services

The SBHS program reimburses for some services when provided through audio-only telemedicine (i.e., telephone service delivery).

To indicate that the service was provided through audio-only telemedicine (i.e., telephone service delivery with no visual component), school districts must submit claims for telemedicine services using either place of service (POS) 02 or POS 10 and must add modifier 93 to the claim to indicate services were provided through audio-only telemedicine. When billing for audio-only telemedicine through the SBHS program, the school district always submits a claim on behalf of both the originating and distant site.

A phone call between a provider and a parent when the student is not present is not billable. If the student is present and the provider is speaking with the parent while the parent assists the child with performing the activities as part of the service delivery, this is billable.

HCA does not cover the following services provided through telemedicine:

• Email and facsimile transmissions
• Installation or maintenance of any telecommunication devices or systems
• Purchase, rental, or repair of telemedicine equipment

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, SBHS Billing, p. 35-40 (Oct. 2023). (Accessed Jun. 2024).

Obstetrical Services

HCA allows obstetrical services to be provided via audio-only. Audio-only visits for pregnant clients must:

• Be utilized only when clinically appropriate for the individual client, based on current clinical guidance and standards of care from ACOG and AAFP.
• Not be used when client circumstances call for an in-person assessment or procedure.
• Be informed by client preference. Clients must have input on and choice regarding how services are delivered.
• Have documentation that complies with HCA’s telemedicine policies. Must include start and stop time of audio-only interaction.

Medical abortion services provided via audio-only telemedicine are not eligible for the HCPCS code S0199 bundled payment.

See manual for audio-only billing instructions relative to global OB care and unbundled obstetrical care.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 237, 241 (Apr. 2024). (Accessed Jun. 2024).

Maternity Support Services and Infant Case Management

When billing for MSS- and ICM-covered services provided via telephone (audioonly) or telemedicine, use the appropriate MSS or ICM procedure code and place of service (POS) code. When billing for MSS or ICM services provided via audio-only telemedicine, you must include modifier 93 (synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) on the claim. Modifier 93 indicates that the services were provided using an audio-only system. Claims for services provided via telemedicine do not require an additional modifier to indicate services were provided via HIPAA-compliant, real-time video and audio technology

SOURCE: WA State Health Care Authority. Medicaid Provider Guide. Maternity Support Services and Infant Case Management Billing, p. 46-47 (Oct. 2023). (Accessed Jun. 2024).

Physical Therapy, Occupational Therapy, and Speech Therapy Services

Audio-only telemedicine may require participation of a caregiver to assist with the treatment. Providers are responsible for making this determination and ensuring appropriate assistance or supervision, or both. Audio-only telemedicine for the evaluation of speech is:

• Allowed for patients who have already had a face-to-face (in-person), initial evaluation with the provider.
• Permitted for less than 50% of the visits per year.
• Not allowed for outpatient physical or occupational therapy

SOURCE: WA State Health Care Authority, Neurodevelopmental Centers Billing Guide, p. 16 (Oct. 2023). (Accessed Jun. 2024).

Comprehensive assessment and care planning for persons living with cognitive impairment

Face-to-face visits via an in-person or audio-visual encounter are allowed, but HCA does not allow telephonic and email encounters.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 80 (Apr. 2024). (Accessed Jun. 2024).

Telephone Services

HCA pays for telephone services when used by a physician to report and bill for episodes of care initiated by an established patient (i.e., someone who has received a face-to-face service from you or another physician of the same specialty in your group in the past three years) or by the patient’s guardian.  See manual for codes and additional requirements.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 61 (Apr. 2024). (Accessed Jun. 2024).

Texting/Emailing/Virtual Check-Ins

Teledentistry

The agency does not cover email or facsimile transmissions as teledentistry services.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental-Related Services, p. 75. (Apr. 2024). (Accessed Jun. 2024).

Home Health and Hospice

“Audio-only telemedicine” means the delivery of health care services through the use of HIPAA-compliant audio-only technology (including web-based applications), permitting real-time communication between the patient and the agency provider for the purpose of consultation, education, diagnosis, or treatment, as appropriate per scope of practice. “Audio-only telemedicine” also includes supervision of home health aide services to evaluate compliance with the plan of care and patient satisfaction with care. “Audio-only telemedicine” does not include the use of facsimile, electronic mail, or text messages.

“Established relationship” means the patient has had, within the past two years, at least one in-person appointment with the agency provider providing audio-only telemedicine or with a provider employed at the same agency as the provider providing audio-only telemedicine; or the patient was referred to the agency provider providing audio-only telemedicine by another provider who has had, within the past two years, at least one in-person appointment with the patient and has provided relevant medical information to the provider providing audio-only telemedicine.

SOURCE: WAC 246-335-510 & WAC 246-335-610. (Accessed Jun. 2024).

FACILITY FEE

HCA does not pay an originating site facility fee for audio-only services.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Telemedicine Policy and Billing, p. 17 (Jun. 2024); WA State Health Care Authority, Medicaid Provider Guide, SBHS Billing, p. 39 (Oct 2023). (Accessed Jun. 2024).

A hospital that is an originating site or distant site for audio-only telemedicine may not charge a facility fee.

SOURCE: RCW 70.41.530. (Accessed Jun. 2024).

Ongoing Telehealth Medicaid Flexibilities until December 31, 2024:

As noted in a 2023 WV Medicaid Provider Newsletter, with the end of the federal Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) have extended telehealth flexibilities until December 31, 2024. West Virginia Medicaid and the WVCHIP will also continue to follow CMS in allowing Telehealth flexibilities until this date. For more information on WV Medicaid COVID Telehealth Policies, see the Medicaid memos located on the WV Medicaid COVID-19 Telehealth Website, which also reference temporary audio-only allowances. In addition, in August 2023 WV Medicaid added an appendix to its Practitioners Services Medicaid Policy Manual Telehealth Section with available codes specific to the PHE Medicaid Telehealth Services Flexibilities – see Policy 519.17 Appendix B.

Permanent Policy

No reimbursement for FAX.

No reimbursement for email.

The Jan. 1, 2022 update to the WV Medicaid Provider Manual on Telehealth Services removed the reference to telephones under Non-Covered Services.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. p. 4, 6 (Effective Jan. 1, 2022). (Accessed Nov. 2024).

FQHCs/RHCs, Behavioral Health Outpatient Services & Licensed Behavioral Health Centers

No reimbursement for telephone.

No reimbursement for FAX.

No reimbursement for email.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 9. (July 1, 2019). WV Dept. of Health and Human Svcs, Behavioral Health Outpatient Services Chapter 521, p. 9 (Jan. 15, 2018). WV Dept. of Health and Human Svcs, Licensed Behavioral Health Centers, Chapter 503, p. 9 (July 15, 2018). (Accessed Nov. 2024).

Substance Use Disorder

Reimbursement is not available for a telephone conversation, electronic mail message (e-mail), or facsimile transmission (fax) between a provider and a member except for targeted case management services.

SOURCE: WV Dept. Health and Human Svcs., Substance Use Disorder, Chapter 504, p. 10 (Jan. 1, 2023). (Accessed Nov. 2024).

Children with Serious Emotional Disorder Waiver

Reimbursement is not available for a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a provider and a member except for wraparound facilitation services.

In extenuating circumstances, plan of care members may participate by teleconferencing (i.e., telephone).

SOURCE: WV Dept. of Health and Human Svcs, Children with Serious Emotional Disorder Waiver, Chapter 502, p. 14, 33 (July 1, 2021). (Accessed Nov. 2024).

A virtual check-in is a brief patient-initiated asynchronous or synchronous communication and technology-based service intended to be used to decide whether an office visit or other service is needed. The encounter may involve synchronous discussion over a phone or exchange of information through video or image. A provider may respond to the member’s concern by phone, audio-visual communications, or a secure patient portal. Covered services include both the remote evaluation of a recorded video or image submitted by a member and the interpretation and follow-up by the provider.

An e-visit is a communication between a member and their provider through an online HIPAA-compliant patient portal. These patient-initiated asynchronous services involve a member having non-face-to-face communications cumulatively over a span of seven days with a provider with whom they have an established relationship. Providers who can bill E&M services may utilize online digital E&M codes while other providers may be eligible to bill online assessment and management codes.

Allowable procedure codes for virtual check-in and e-visit services can be found in the Manual section.

These services do not require prior authorization and are patient-initiated by established patients of the provider’s practice.

Virtual check-in and e-visit telehealth services are not covered or billable if they:

• Take place during an in-person visit.
• Take place within seven days after an in-person visit furnished by the same provider.
• Trigger an in-person visit within 24 hours or the soonest available appointment.
• Do not have sufficient information from the remote evaluation of an image or video (store and forward) for the provider to complete the service.

Only the relevant in-person procedure code that was rendered would be reimbursed if any of the above conditions apply.

Telephone Evaluation and Management Services:  See handbook for list of reimbursable for telephone E&M service codes.

SOURCE: Virtual Check-In, E-Visit and Telephone Evaluation and Management Services, Topic #22742. (Accessed Dec. 2024).

Can I receive services by phone (audio-only)?

Some services can be delivered over the phone with the same quality and effectiveness as an in-person service. These services can be provided by phone (audio-only). Your provider will let you know which type of technology is right for your appointment.

SOURCE: Wisconsin Department of Health Services, Medicaid Telehealth Expansion: Frequently Asked Questions, May 11, 2023, (Accessed Dec. 2024).

Modifiers

Providers should include all applicable modifiers to identify the delivery method for telehealth services. Claims for synchronous telehealth services should be indicated by one or more
of the following applicable modifiers:

• 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system)
• FQ (A telehealth service was furnished using audio-only communication technology) Use this modifier when the patient is unable to use audio and video communications. (This modifier is for behavioral health services
  only.)

Note: The FQ and FR modifiers are for behavioral health services only.

Providers are required to include any additional provider, benefit, or service specific modifiers that may apply to a service code when delivered through telehealth. For example, when a service is provided by a physical therapist (PT), the codes would need to include the corresponding therapy modifier GP (Services delivered under an outpatient physical therapy plan of care) to signify the telehealth service is furnished as therapy services furnished under a PT plan of care.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, (Accessed Dec. 2024).

Claims for services delivered via telehealth must include all modifiers required by the existing benefit coverage policy in order to reimburse the claim correctly. Telehealth delivery of the service is shown on the claim by indicating POS code 02 or 10 and including either the GQ, GT, FQ, or 93 modifier in addition to any other required benefit-specific modifiers.

County-administered programs, school-based services, and any other programs that utilize cost reporting must include required modifiers, such as renderer credentials and group versus individual services, as well as correct details for cost reporting to ensure correct reimbursement.

Note: The GT, FQ or 93 modifiers may not be listed on the fee schedule, but it is still required on all claim submissions that use POS code 02 or 10 to indicate the telehealth service was performed synchronously. The GQ modifier is required to indicate the telehealth service was performed asynchronously.

Audio Only Guidelines

When possible, telehealth services should include both an audio and visual component. In circumstances where audio-visual telehealth is not possible due to member preference or technology limitations, telehealth may include real-time interactive audio-only communication if the provider feels the service is functionally equivalent to the in-person service and there are no face-to-face or in-person restrictions listed in the procedural definition of the service.

Documentation should include that the service was provided via interactive synchronous audio-only telehealth.

Modifier 93 should be used for any service performed via audio-only telehealth. The GT modifier should only be used to indicate services that were performed using audio-visual technology.

SOURCE: ForwardHealth Telehealth Policy Topic #510, (Accessed Dec. 2024).

The Department may promulgate rules specifying any telehealth service that is provided solely by audio-only telephone, facsimile machine or electronic mail as reimbursable under Medical Assistance.

SOURCE: WI Statute Sec. 49.45 (61). (Accessed Dec. 2024).

Behavioral Health Services

Behavioral health services should be indicated by the following modifiers.

• FQ*:  A telehealth service was furnished using audio-only communication technology
• FR*: A supervising practitioner was present through a real-time two-way, audio/video communication technology
• GQ: Via asynchronous telecommunications system
• GT: Via interactive audio and video telecommunication systems

*Use for behavioral health services only.

SOURCE: WI ForwardHealth Online Handbook. Topic #22737 Behavioral Health Telehealth Services, (Accessed Dec. 2024).

Interprofessional Consultations (E-Consults)

An interprofessional consultation or e-consult is an assessment and management service in which a member’s treating provider requests the opinion and/or treatment advice of a provider with specific expertise (the consultant) to assist the treating provider in the diagnosis and/or management of the member’s condition without requiring the member to have face-to-face contact with the consultant. Both the treating and consulting providers may be reimbursed for the e-consult as described below.

Consulting providers must be physicians enrolled in Wisconsin Medicaid as an eligible rendering provider. Consulting providers may bill CPT procedure codes 99446–99449 and 99451 under the following limitations:

• Services are not covered if the consultation leads to a transfer of care or other face-to-face service within the next 14 days or next available date of the consultant. Additionally, if the sole purpose of the consultation is to arrange a transfer of care or other face-to-face service, these procedure codes should not be submitted.
• Consulting services are covered once in a seven-day period.

Treating providers may be a physician, nurse practitioner, physician assistant, or podiatrist enrolled in Wisconsin Medicaid as an eligible rendering provider. Treating providers may bill CPT procedure code 99452 as a covered service once in a 14-day period.

Both the consulting and treating providers must be enrolled in Wisconsin Medicaid to receive reimbursement for the e-consult and the consultation must be medically necessary.

Providers are expected to follow CPT guidelines including that the CPT procedure codes should not be submitted if the consulting provider saw the member in a face-to-face encounter within the previous 14 days.

SOURCE: WI ForwardHealth Online Handbook. Topic #22738, Interprofessional Consultations (E-Consults), (Accessed Dec. 2024).

Crisis Intervention, Birth to 3 Telehealth Services, School Based Services, and Community Health Centers may use the FQ (audio-only) modifier.

SOURCE: WI ForwardHealth Online Handbook, Topic #6777, Topic #22617, Topic #1447, & Topic #21997.  (Accessed Aug. 2024).

• The consultation is a professional service furnished to a recipient by a certified provider at the request of the treating provider.
• The consultation constitutes an evaluation and management service in which the certified provider treating a recipient requests the opinion or treatment advice of a consulting provider with specific expertise to assist the treating provider in the evaluation or management of the recipient’s problem without requiring the recipient to have face–to–face contact with the consulting provider.
• The consulting provider provides a written report that becomes a part of the recipient’s permanent medical record.

SOURCE: Department of Health Services Administrative Rules Sec. 107.06(4)(cm), (Accessed Dec. 2024).

Except as provided in par. (b), outpatient psychotherapy services shall be covered services when provided by a provider certified under s. DHS 105.22, and when the following conditions are met: …  Psychotherapy is performed only in any of the following: …

• Via telehealth when the provider is in a location that ensures privacy and confidentiality of recipient information and communications.

The provider who performs psychotherapy shall engage in contact with the recipient in person, via real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth for at least 5/6 of the time for which reimbursement is claimed under MA.

AODA treatment services are performed only in the office of the provider, a hospital or hospital outpatient clinic, an outpatient facility, a nursing home or a school or by telehealth when functionally equivalent to services provided in person.

The provider who performs AODA treatment services shall engage in contact with the recipient in person, via real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth for at least 5/6 of the time for which reimbursement is claimed.

SOURCE: Department of Health Services Administrative Rules Sec. 107.13(2)(a)(4), (5), (3)(a)(5) & (6), (Accessed Dec. 2024).

Supervision – Ancillary Care Providers

For telehealth services, the supervising physician is not required to be onsite, but they must be able to interact with the member using real-time audio or audiovisual communication, if needed. For supervision of ancillary providers, remote supervision is allowed in circumstances where the physician feels the member is not at risk of an adverse event that would require hands-on intervention from the physician.

SOURCE: WI ForwardHealth Online Handbook. Topic #22757, Supervision, (Accessed Dec. 2024).

Interpretive Services

Claims for interpretive services must include HCPCS procedure code T1013 and the appropriate modifier(s):

• U1 (Spoken language)
• U3 (Sign Language)
• GT (Via interactive audio and video telecommunication systems)
• 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system)

SOURCE: WI ForwardHealth Online Handbook. Topic #22917, Interpretive Services, (Accessed Dec. 2024).

Intensive Outpatient Program (IOP) – Behavioral Health

Providers should use informational behavioral health modifiers when they render telehealth services:

• FQ: A telehealth service was furnished using audio-only communication technology
• FR: A supervising practitioner was present through a real time two way audio/video communication technology
• GQ: Via asynchronous telecommunications system
• GT: Via interactive audio and video telecommunication system

SOURCE: WI ForwardHealth Update:  New Intensive Outpatient Program Benefit, No. 2024-38, Oct. 2024, (Accessed Dec. 2024).

Telehealth does not include a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a healthcare practitioner and a member, or a consultation between two health care practitioners asynchronous “store and forward” technology.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, pg. 137 (Oct. 1, 2024), & Institutional Provider Manual pg. 136.  (Oct. 1, 2024). (Accessed Oct. 2024).

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. 

SOURCE: WY Division of Health Insurance, School Based Services Manual, pg. 16, (Oct. 1, 2024). (Accessed Oct. 2024).