Virginia

Last updated 08/12/2024

Consent Requirements

• A description of the telehealth service(s);
• That the use of telehealth services is voluntary and that the member may refuse the telehealth service(s) at any time without affecting the right to future care or treatment and without risking the loss or withdrawal of the member’s benefits;
• That dissemination, storage, or retention of an identifiable member image or other information from the telehealth service(s) shall comply with federal laws and regulations and Virginia state laws and regulations requiring individual health care data confidentiality;
• That the member has the right to be informed of the parties who will be present at the distant (Provider) site and the originating (member) site during any telemedicine service and has the right to exclude anyone from either site; and
• That the member has the right to object to the videotaping or other recording of a telehealth consultation.

If a Provider, whether at the originating site or distant site, maintains a consent agreement that specifically mentions use of telehealth as an acceptable modality for delivery of services including the information noted above, this shall meet DMAS’s required documentation of patient consent.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) (Accessed Aug. 2024).

Last updated 08/12/2024

Definitions

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services,  (5/13/24). (Accessed Aug. 2024).

Telemedicine is a means of providing covered services through the use of two-way, real time interactive electronic communication between the student and the qualified provider located at a site distant from the student. This electronic communication must include, at a minimum, the use of audio and video equipment.

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Local Education Agency, (Jan. 12, 2024). (Accessed Aug. 2024).

Last updated 08/12/2024

Email, Phone & Fax

Opioid Treatment Services

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.

See manual for other services that can be provided with telephone.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Covered Svcs and Limitations, (1/10/24). (Accessed Aug. 2024).

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 Aug. 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 Aug. 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  (5/15/24) (Accessed Aug. 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 Aug. 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 Aug. 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 Aug. 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 Aug. 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 Aug. 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 Aug. 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 Aug. 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 Aug. 2024).

Development Disabilities Waiver

After the initial visit, the services facilitator is responsible for continued monitoring of the individual’s plan for supports quarterly, and more often as needed – which may be conducted by telephone to prepare the quarterly report to the support coordinator.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual DD Waiver, (6/14/23) (Accessed Aug. 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 Aug. 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, 1/5/24, p. 4. (Accessed Aug. 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 Aug. 2024).

Last updated 08/12/2024

Live Video

POLICY

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include:

• A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services, as defined in § 38.2-3418.16, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.

SOURCE: VA Code Annotated Sec. 32.1-325, (Accessed Aug. 2024).

Services delivered via telehealth will be eligible for reimbursement when all of the following conditions are met:

• The Provider at the distant site deems that the service being provided is clinically appropriate to be delivered via telehealth;
• The service delivered via telehealth meets the procedural definition and components of the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, as defined by the American Medical Association (AMA), unless otherwise noted in Table 1 – Table 8 in this Supplement;
• The service provided via telehealth meets all state and federal laws regarding confidentiality of health care information and a patient’s right to his or her medical information;
• Services delivered via telehealth meet all applicable state laws, regulations and licensure requirements on the practice of telehealth; and
• DMAS deems the service eligible for delivery via telehealth.

In order to be reimbursed for services using telehealth that are provided to Managed Care Organization (MCO)-enrolled members, Providers must follow their respective contract with the MCO.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services,  (5/13/2024) (Accessed Aug. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

Attachment A lists covered services that may be reimbursed when provided via telehealth. Specifically:

• Table 1 – Table 3 list Telemedicine services
• Table 4 list Radiology-Related Procedures for Physician Billing Included under
• Telehealth Coverage (store and forward)
• Table 5 lists Remote Patient Monitoring services
• Table 6 lists Virtual Check-In services
• Table 7 and Table 8 lists audio-only telehealth services

Services delivered via telehealth will be eligible for reimbursement when all of the following conditions are met:

• The Provider at the distant site deems that the service being provided is clinically appropriate to be delivered via telehealth;
• The service delivered via telehealth meets the procedural definition and components of the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, as defined by the American Medical Association (AMA), unless otherwise noted in Table 1 – Table 8 in this Supplement;
• The service provided via telehealth meets all state and federal laws regarding confidentiality of health care information and a patient’s right to his or her medical information;
• Services delivered via telehealth meet all applicable state laws, regulations and licensure requirements on the practice of telehealth; and
• DMAS deems the service eligible for delivery via telehealth.

In order to be reimbursed for services using telehealth that are provided to Managed Care Organization (MCO)-enrolled members, Providers must follow their respective contract with the MCO. Additional information about the Medicaid MCO programs can be found at https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-caremanaged-care/

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.

Unless otherwise noted in Attachment A, limitations for services delivered via telehealth are the same as for those delivered in-person.

All coverage requirements for a particular covered service described in the DMAS Provider Manuals apply regardless of whether the service is delivered via telehealth or in-person.

Clinicians shall use their clinical judgment to determine the appropriateness of service delivery via telehealth considering the needs and presentation of each individual. See Attachment A for code lists.

Virtual Check-In

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.

• Services must be patient-initiated.
• Patients must be established with the provider practice.
• Must not be billed if services originated from a related service provided within the previous 7 days or lead to a service or procedure within the next 24 hours or at the soonest available appointment.

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 Aug. 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. Billing codes covered by this policy, when conditions of coverage are met, and for services with dates of service on and after April 18, 2022, include the following:

• 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
• G2251: Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of clinical discussion
• G2252: 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; 11-20 minutes of medical discussion

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 Aug. 2024).

School-Based Services

The following school-based services may be provided via telemedicine: PT, OT, speech and language, behavioral health, and medical evaluation services. DMAS does not require the presence of a paid staff person with the student at the time of the service; however, if a paid staff person is present in a supervisory capacity at the time of the service, the LEA may submit a claim for the “originating site fee.”

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Local Education Agency Provider Manual, Covered Svcs. and Limitations, (Jan. 12, 2024). (Accessed Aug. 2024).

Durable Medical Equipment (DME) and Supplies

The face-to-face encounter may occur through telehealth, which is defined as the real time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment (DMAS Medicaid Memo dated May 20, 2014). Telehealth shall not include by telephone or email.

Telehealth visits may be used for face-to-face nutritional assessments.

NOTE: Home health visits for the sole purpose of performing a nutritional assessment for individuals whose conditions are stable and chronic in nature will not be covered under the home health program. Telehealth visits should be considered for these cases and for those who are not able to travel due to complex health conditions.

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Durable Medical Equipment and Supplies Manual, Covered Svcs. and Limitations, (1/4/24), (Accessed Aug. 2024).

Home Health

Face-to-face encounters may occur through telemedicine, which is defined as the two-way, real time interactive electronic communication between the member and the Provider located at a site distant from the member. 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, 1/5/24, p. 4. (Accessed Aug. 2024).

Opioid Treatment Services

“Face-to-face” means encounters that occur in person or through telehealth.

Substance use case management shall include an active ISP which requires: …

• At least one face-to-face contact, separate from the two distinct activities per month minimum, with the member at least every 90 calendar days. The face-toface contacts may be met delivered via telehealth.

Outpatient services (ASAM Level 1) shall include the following service components as medically necessary and indicated in the member’s ISP: …

• Individual psychotherapy between the member and a CATP. Services provided face-to-face or by telemedicine shall qualify as reimbursable.

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 Services (ASAM Level 3.1) co-occurring enhanced programs shall offer the following:

• 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

See manual for other services that can be provided with telephone or telemedicine.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Covered Svcs and Limitations, (1/10/24). (Accessed Aug. 2024).

DMAS expects Preferred OBAT services to be primarily delivered in-person/on-site and utilize telemedicine as an option to increase access to services as needed. Preferred OBATs services must have regular access to in-person/on-site visits and services shall not be delivered solely or predominantly through telemedicine. The practitioners must be  credentialed by DMAS, the DMAS fee-for-service contractor or MCOs to perform Preferred OBAT services. Preferred OBAT providers do not require a separate DBHDS license.

DMAS recognizes that there may be situations that telemedicine is necessary to engage the member in treatment and recovery, especially if the member makes this request. Thus Preferred OBAT services may be provided via telemedicine based on the individualized needs of the member and reasons why the in-person interactions are not able to meet the member’s specific needs must be documented. The primary means of services delivery shall in-person for the Preferred OBAT model with the exception of telemedicine for specific member circumstances. These circumstances may include but are not limited to: member transportation issues, member childcare needs, member employment schedule, member co-morbidities, member distance to provider, etc.). Where these situations may impede member’s access to treatment, telemedicine may be utilized as clinically appropriate and to help to remove these barriers to treatment. Providers delivering services using telemedicine shall bill according to the requirements in the DMAS Telehealth Services Supplemental Manual.

The Board of Medicine requires the prescriber to see the member weekly during the induction phase for prescribing MOUD … These visits shall be in-person/onsite however may be delivered through telemedicine based on the individual needs of the member to ensure access during this critical phase. The member must have documented clinical stability before spacing out visits beyond weekly. This applies to all members regardless of SUD diagnosis.

Providers working in the Mobile OBAT setting shall provide services in-person as well as be permitted to utilize technology to provide telemedicine sessions with providers located at the Preferred OBAT’s primary location. Providers delivering services using telemedicine shall follow the requirements set forth in the DMAS Telehealth Services Supplemental Manual.

Preferred OBAT and OTPs must include the following activities, which must be documented in each member’s record:

• These visits shall be in-person/onsite however may be delivered through telemedicine based on the individual needs of the member to ensure access during this critical phase. The member must have documented clinical stability as defined earlier in this Supplement before spacing out visits beyond weekly. This applies to all members regardless of SUD diagnosis. The IPOC must be updated to reflect these changes.

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 Aug. 2024).

MAT for Opioid Use Disorder

Prescribing controlled substances for the treatment of addiction delivered via telemedicine must include a qualified provider and a telepresenter located at the originating site, as well as a qualified prescribing provider located at the remote site. Psychotherapy and SUD counseling may also be provided via telemedicine by a qualified provider who is a credentialed addiction treatment professional as defined in this memorandum and DMAS ARTS Provider Manual.  See manual for eligible MAT codes.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, [Memos/bulletins prior to 2020 need to be requested by email] (Accessed Aug. 2024).

Residential Treatment Services

DMAS reimburses for telemedicine services under limited circumstances. Telemedicine is the real-time or near real-time exchange of information for diagnosing and treating medical conditions. Telemedicine utilizes audio/video connections linking medical practitioners in one locality with medical practitioners in another locality. DMAS recognizes telemedicine as a means for delivering some covered Medicaid services. Please refer to the Virginia Medicaid Memo dated May 13, 2014: “Updates to Telemedicine Coverage”. Medicaid Memos are posted at: https://www.virginiamedicaid.dmas.virginia.gov under Provider Services. For managed care enrolled members, the member’s plan may cover additional telemedicine/telehealth services and have different requirements. Providers should direct specific telemedicine/telehealth coverage questions to the member’s MCO.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Residential Treatment Services, Covered Services and Limitations, 12/29/23 (Accessed Aug. 2024).

Department of Behavioral Health and Developmental Services

• A licensed psychiatrist or nurse practitioner shall be available to the program, either in person or via telemedicine, 24 hours per day, seven days per week;
• One PRS, and either one QMHP (QMHP-A or QMHP-C) or one CSAC or CSAC-supervisee. A licensed staff member shall be required to be available via telemedicine for the assessment;
• One CSAC-A, and either one QMHP (QMHP-A or QMHP-C) or one CSAC or CSAC-supervisee. A licensed staff member shall be required to be available via telemedicine for the assessment;
• Two QMHPs (QMHP-A, QMHP-C, or QMHP-T; however, the team shall not be two QMHP-Ts). A licensed staff member shall be required to be available via telemedicine for the assessment;
• Two CSACs. A licensed staff member shall be required to be available via telemedicine for the assessment; or
• One QMHP (QMHP-A or QMHP-C), and one CSAC or CSAC-supervisee. A licensed staff member shall be required to be available via telemedicine for the assessment.

Crisis stabilization units shall meet the following staffing requirements:

• A licensed psychiatrist or psychiatric nurse practitioner shall be available 24 hours per day, seven days per week either in person or via telemedicine

SOURCE: VA Admin Code Title 12, 35-105-1830, (Accessed Sept. 2024).

Comprehensive Crisis Services

“Telemedicine assisted assessment” means the in-person service delivery encounter by a QMHPA, QMHP-C, CSAC with synchronous audio and visual support from a remote LMHP, LMHPR, LMHP-RP or LMHP-S to: obtain information from the individual or collateral contacts, as appropriate, about the individual’s mental health status; provide assessment and early intervention; and, develop an immediate plan to maintain safety in order to prevent the need for a higher level of care. The assessment includes documented recent history of the severity, intensity, and duration of symptoms and surrounding psychosocial stressors.

Mobile Crisis Response – Covered service components of Mobile Crisis Response include:

• Assessment, including telemedicine assisted assessment

Providers conducting an assessment through telemedicine or a telemedicine assisted assessment must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement” including the use of the GT modifier for units billed for assessments completed through telemedicine or a telemedicine assisted assessment. Mobile Crisis Response services are not eligible for originating site fee reimbursement. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

23-Hour Crisis Stabilization Billing Requirements – Psychiatric evaluation may be provided through telemedicine. Providers must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement”, including the use of telemedicine modifiers. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

Residential Crisis Stabilization Billing Requirements – Psychiatric evaluations and individual, group and family therapy may be provided through telemedicine. Providers must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement” including the use telemedicine modifiers. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

SOURCE: VA Dept. of Medical Assistance Services. Medicaid Provider Manual, Mental Health Services, Ch. 12 Appendix G: Comprehensive Crisis Services, 8/21/23, (Accessed Aug. 2024).

Comprehensive Needs Assessment

For information on whether a service assessment is required in-person or is allowed through telemedicine, refer to the service specific sections located in Appendices to this manual. A provider cannot use a Comprehensive Needs Assessment conducted through telemedicine as a Comprehensive Needs Assessment for a service that requires an in-person assessment. If a provider has a valid Comprehensive Needs Assessment that was conducted through telemedicine and later wants to use the assessment as a Comprehensive Needs Assessment for another service that requires an in-person assessment, the assessment update completed to recommend the service must be conducted in-person.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Mental health Services, Ch. 4, (5/15/24) & Updates to the Mental Health Services Manual, Memo, May 15, 2024, (Accessed Aug. 2024).

Developmental Disabilities Waivers

For therapeutic consultation behavioral services, direct therapy consists of the behavioral consultant implementing strategies with the individual that can only be accomplished while being physically present in the same environment as the individual and cannot be accomplished via telehealth modalities.

IFCT services may be rendered via an in-person or telehealth model, based upon the structure of training provided. Any training provided via a telehealth model must include both an audio and visual component.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual DD Waivers, (11/1/22) (Accessed Aug. 2024).

PAP Supplement

Telehealth services will not be eligible for payment at this time. Any change will be announced in future editions of this supplement.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual PAP Supplement, (7/3/24) (Accessed Aug. 2024).

Teledentistry

Teledentistry codes for synchronous and asynchronous encounters are listed as covered.

SOURCE:  VA Dept. of Medical Assistant Svcs., DentaQuest, (6/2/23) (Accessed Aug. 2024).

Intensive Clinic Based Support

In addition to the required activities for all mental health services providers located in Chapter IV, the following required activities apply to MH-PHP: …

• Initial medication evaluation must be conducted by the Psychiatrist, Nurse Practitioner, or Physician Assistant with the individual via in-person or telemedicine evaluation within 48 hours of admission.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Mental Health Services, Intensive Clinic Based Support, (11/22/21) (Accessed Aug. 2024).

Telehealth for Various Services:

Coverage of services delivered by telehealth are described in the “Telehealth Services Supplement”.

MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

SOURCE: VA Dept of Medical Assistance, Psychiatric Services, Ch. 4, [language used in multiple manuals], (2/23/24), (Accessed Aug. 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.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Peer Services Supplement, (12/29/23) (Accessed Aug. 2024).

Intensive Community Based Support – Youth

Billing requirements state that: Coverage of services delivered by telehealth are described in the “Telehealth Services Supplement”. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Mental Health Services, Appendix D: Intensive Community Based Support – Youth, (5/15/24) (Accessed Aug. 2024).

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ELIGIBLE PROVIDERS

For purposes of this manual supplement, the term “Provider” refers to the billing provider – either a qualified, licensed practitioner of the healing arts or a facility – who is enrolled with DMAS.

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 Aug. 2024).

The Member is located at an approved originating site with the Medicaid enrolled telepresenter. The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, [Memos/bulletins prior to 2020 need to be requested by email] (Accessed Aug. 2024).

DMAS expects Preferred OBAT services to be primarily delivered in-person/on-site and utilize telemedicine as an option to increase access to services as needed. Preferred OBATs services must have regular access to in-person/on-site visits and services shall not be delivered solely or predominantly through telemedicine. The practitioners must be credentialed by DMAS, the DMAS fee-for-service contractor or MCOs to perform Preferred OBAT services. Preferred OBAT providers do not require a separate DBHDS license.

The Credentialed Addiction Treatment Professional must work with the prescriber in an interdisciplinary team setting. The Credentialed Addiction Treatment Professionals may utilize telehealth as an option to increase access to services as needed.

Preferred OBATs may utilize telehealth as needed as a resource for home inductions as well as maintenance prescriptions.

DMAS recognizes that there may be situations that telemedicine is necessary to engage the member in treatment and recovery, especially if the member makes this request. Thus Preferred OBAT services may be provided via telemedicine based on the individualized needs of the member and reasons why the in-person interactions are not able to meet the member’s specific needs must be documented. The primary means of services delivery shall in-person for the Preferred OBAT model with the exception of telemedicine for specific member circumstances. These circumstances may include but are not limited to: member transportation issues, member childcare needs, member employment schedule, member co-morbidities, member distance to provider, etc.). Where these situations may impede member’s access to treatment, telemedicine may be utilized as clinically appropriate and to help to remove these barriers to treatment. Providers delivering services using telemedicine shall bill according to the requirements in the DMAS Telehealth Services Supplemental Manual.

The Board of Medicine requires the prescriber to see the member weekly during the induction phase for prescribing MOUD … These visits shall be in-person/onsite however may be delivered through telemedicine based on the individual needs of the member to ensure access during this critical phase. The member must have documented clinical stability before spacing out visits beyond weekly. This applies to all members regardless of SUD diagnosis.

Providers working in the Mobile OBAT setting shall provide services in-person as well as be permitted to utilize technology to provide telemedicine sessions with providers located at the Preferred OBAT’s primary location. Providers delivering services using telemedicine shall follow the requirements set forth in the DMAS Telehealth Services Supplemental Manual.

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, (1/10/24), (Accessed Aug. 2024).

23-Hour Crisis Stabilization Billing Requirements – Psychiatric evaluation may be provided through telemedicine. Providers must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement”, including the use of telemedicine modifiers. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

Residential Crisis Stabilization Billing Requirements – Psychiatric evaluations and individual, group and family therapy may be provided through telemedicine. Providers must follow the requirements for the provision of telemedicine described in the “Telehealth Services Supplement” including the use telemedicine modifiers. MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

SOURCE: VA Dept. of Medical Assistance Services. Medicaid Provider Manual, Mental Health Services, Ch. 12 Appendix G: Comprehensive Crisis Services, 8/21/23, (Accessed Aug. 2024).

Residential Treatment Services – IACCT Appendix

The LMHP, LMHP-R, LMHP-RP or LMHP-S will assess the youth (expedited, if possible) through either a face-to-face or telemedicine contact. For youth who are currently in an inpatient setting where telemedicine is not available and distance is a barrier for the IACCT LMHP, LMHP-R, LMHP-RP or LMHP-S, a telephonic interview with the youth may be conducted while the IACCT LMHP, LMHP-R, LMHP-RP or LMHP-S conducts a face to face with the legal guardian.

SOURCE: VA Dept. of Medical Assistance Services. Medicaid Provider Manual, Residential Treatment Services – IACCT, 1/12/21, (Accessed Aug. 2024).

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ELIGIBLE SITES

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 Aug. 2024).

For the purposes of this subdivision, “originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services pursuant to Title XIX of the United States Social Security Act and any amendments thereto. The Board shall include in such plan: …

• A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services, as defined in § 38.2-3418.16, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
• A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services, as defined in § 38.2-3418.16, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided.

SOURCE: VA Code Annotated Sec. 32.1-325, (Accessed Aug. 2024).

Mobile OBAT

Preferred OBAT Providers of an opportunity to provide OBAT services through a new mode of delivery called “Mobile Preferred OBATs.” Note this is separate from the Drug Enforcement Administration (DEA) recent approval in July 2021, of adding a “mobile component” to OTPs certified by SAMSHA. DMAS is working with DBHDS and will follow with updated policies when this is implemented in Virginia.

The Mobile Preferred OBAT model shall allow Preferred OBAT providers to provide the same services in a Mobile Unit as in a traditional Preferred OBAT setting. As indicated by the Centers for Medicare and Medicaid Services (CMS), and accepted by the Medicaid MCOs and the DMAS fee-for-service contractor, a “Mobile Unit” is designated as place of service (POS) 15 and is defined as a facility or unit that moves from place to place equipped to provide preventive, screening, diagnostic, and/or treatment services: https://www.cms.gov/Medicare/Coding/place-of-servicecodes/Place_of_Service_Code_Set.

A Mobile Unit shall also be permitted to operate as an extension of an established Preferred OBAT’s primary location. This shall allow providers at a Preferred OBAT to also provide services in the community using the POS “015” for a Mobile Unit. Providers working in the Mobile OBAT setting shall provide services in-person as well as be permitted to utilize technology to provide telemedicine sessions with providers located at the Preferred OBAT’s primary location. Providers delivering services using telemedicine shall follow the requirements set forth in the DMAS Telehealth Services Supplemental Manual. Current Preferred OBAT Providers shall notify the MCOs and the DMAS fee-for-services contractor prior to providing services in a Mobile Unit.

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Addiction and Recovery Treatment Services Manual, Ch. 8 Preferred Office-Based Addiction Treatment Programs,(12/29/23), (Accessed Aug. 2024).

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GEOGRAPHIC LIMITS

No reference found.

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FACILITY/TRANSMISSION FEE

In the event it is medically necessary for a Provider to be present at the originating site at the time a synchronous telehealth service is delivered, said Provider may bill an originating site fee (via procedure code Q3014) when the following conditions are met:

• The Medicaid member is located at a provider office or other location where services can be received (this does not include the member’s residence);
• The member and distant site Provider are not located in the same location; and
• The Provider (or the Provider’s designee), is affiliated with the provider office or other location where the Medicaid member is located and attends the encounter with the member. The Provider or designee may be present to assist with initiation of the visit but the presence of the Provider or designee in the actual visit shall be determined by a balance of clinical need and member preference or desire for confidentiality.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) (Accessed Aug. 2024).

SOURCE: VA Local Education Manual, Billing Instructions, (Oct. 2021), (Accessed Aug. 2024).

Medication Assisted Treatment

The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, [Memos/bulletins prior to 2020 need to be requested by email] (Accessed Aug. 2024).

Medication Assisted Treatment (MAT) – Outpatient Settings – non OTP/OBAT Settings

The telehealth originating site facility fee is not authorized.

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Addiction and Recovery Treatment Services Manual, Ch. 8 Preferred Office-Based Addiction Treatment Programs, 12/29/23 (Accessed Aug. 2024).

Last updated 08/12/2024

Miscellaneous

See Telehealth Supplement for Documentation and Equipment/Technology Requirements.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) (Accessed Aug. 2024).

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include: …

• A provision, when in compliance with federal law and regulation and approved by the Centers for Medicare & Medicaid Services (CMS), for payment of medical assistance services delivered to Medicaid-eligible students when such services qualify for reimbursement by the Virginia Medicaid program and may be provided by school divisions, regardless of whether the student receiving care has an individualized education program or whether the health care service is included in a student’s individualized education program. Such services shall include those covered under the state plan for medical assistance services or by the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit as specified in § 1905(r) of the federal Social Security Act, and shall include a provision for payment of medical assistance for health care services provided through telemedicine services, as defined in § 38.2-3418.16. No health care provider who provides health care services through telemedicine shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services …
• A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services, as defined in § 38.2-3418.16, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.  ….For the purposes of this subdivision, a health care provider duly licensed by the Commonwealth who provides health care services exclusively through telemedicine services shall not be required to maintain a physical presence in the Commonwealth to be considered an eligible provider for enrollment as a Medicaid provider. For the purposes of this subdivision, a telemedicine services provider group with health care providers duly licensed by the Commonwealth shall not be required to have an in-state service address to be eligible to enroll as a Medicaid vendor or Medicaid provider group.
  • For the purposes of this subdivision, “originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located;
• A provision for payment of medical assistance for remote patient monitoring services provided via telemedicine, as defined in § 38.2-3418.16, for (i) high-risk pregnant persons; (ii) medically complex infants and children; (iii) transplant patients; (iv) patients who have undergone surgery, for up to three months following the date of such surgery; and (v) patients with a chronic or acute health condition who have had two or more hospitalizations or emergency department visits related to such health condition in the previous 12 months when there is evidence that the use of remote patient monitoring is likely to prevent readmission of such patient to a hospital or emergency department. For the purposes of this subdivision, “remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload
• A provision for payment of the originating site fee to emergency medical services agencies for facilitating synchronous telehealth visits with a distant site provider delivered to a Medicaid member. As used in this subdivision, “originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located

SOURCE: VA Code Annotated Sec. 32.1-325, (Accessed Aug. 2024).

The Department, in consultation with the Department of Behavioral Health and Developmental Services and the Department of Medical Assistance Services, shall develop, adopt, and distribute to each school board a model memorandum of understanding between a school board and a public or private community mental health services provider or a nationally recognized school-based telehealth provider that sets forth parameters for the provision of mental health services to public school students enrolled in the local school division by such provider, including the provision of mental health teletherapy for students, reflects effective practices, and addresses privacy considerations related to the exchange of information between the parties to the memorandum of understanding and relevant laws and regulations. The Department shall maintain and update as necessary the model memorandum of understanding to ensure that it remains current, useful, and relevant.

That each school board may adopt policies and procedures to increase the accessibility of school-based mental health services for students enrolled in each school division who may not have access to mental health services otherwise by providing or expanding school-based virtual mental health resources that are available to students, including through establishing or expanding a partnership with (i) a public or private community mental health services provider that offers school-based teletherapy to students or (ii) a nationally recognized school-based telehealth provider that provides mental health teletherapy to students.

SOURCE: VA Code Annotated Sec. 22.1-272.2, & HB 919 (2024 Session), (Accessed Aug. 2024).

Last updated 08/12/2024

Out of State Providers

Providers must maintain a practice at a physical location in the Commonwealth or be able to make appropriate referral of patients to a Provider located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.

Providers must meet state licensure, registration or certification requirements per their regulatory board with the Virginia Department of Health Professions to provide services to Virginia residents via telemedicine. Providers shall contact DMAS Provider Enrollment (888-829-5373) or the Medicaid MCOs for more information.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) (Accessed Aug. 2024).

The purpose of this bulletin is to notify all providers that, pursuant to Virginia Acts of Assembly 2023, Chapter 112 (HB 1602, SB 1418), 1) licensed health care providers who provide health care services exclusively through telemedicine are not required to maintain a physical presence in the Commonwealth to be considered an eligible provider for enrollment as a Medicaid provider and 2) telemedicine services provider groups with licensed health care providers are not required to have an in-state service address to be eligible to enroll as a Medicaid vendor or Medicaid provider group. Providers wishing to enroll can access DMAS’s online provider enrollment process through the Provider Enrollment link located on the DMAS Medicaid Enterprise System (MES) Provider Resources site at https://vamedicaid.dmas.virginia.gov/provider.

In-state telemedicine providers will continue to need to meet the Virginia Department of Health Profession’s (DHP’s) licensing requirement and out-of-state telemedicine providers need to continue to meet DHP’s licensing requirements in addition to their state licensing requirements to provide telemedicine services to Virginia Medicaid members.

SOURCE:  Medicaid Bulletin:  No requirement for exclusive telemedicine providers to maintain a physical presence in Virginia/in-state address. April 20, 2023, (Accessed Aug. 2024).

For the purposes of this subdivision, a health care provider duly licensed by the Commonwealth who provides health care services exclusively through telemedicine services shall not be required to maintain a physical presence in the Commonwealth to be considered an eligible provider for enrollment as a Medicaid provider.

For the purposes of this subdivision, a telemedicine services provider group with health care providers duly licensed by the Commonwealth shall not be required to have an in-state service address to be eligible to enroll as a Medicaid vendor or Medicaid provider group.

SOURCE: Code of Virginia Sec. 32.1-325 (Accessed Aug. 2024).

Last updated 08/27/2024

Overview

Virginia Medicaid reimburses for live video, store-and-forward, remote patient monitoring and certain audio-only codes under certain circumstances. Virtual Check-Ins are also reimbursed.

VA Medicaid recently moved the telehealth-specific content they had in their individual provider manuals into a ‘telehealth supplement’.  Manuals that formerly included telehealth content now direct providers towards the telehealth supplement.  Provider manuals that incorporate the supplement include:

• Addiction and Recovery Treatment Services (ARTS)
• Early Intervention Services
• Mental Health Services
• Physician/Practitioner
• Home Health
• Psychiatric Services
• Rehabilitation

See the Provider Manual home page to access all manuals.

Last updated 08/12/2024

Remote Patient Monitoring

POLICY

SOURCE: VA Code Annotated Sec. 32.1-325 (Accessed Aug. 2024).

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) (Accessed Aug. 2024).

VA Medicaid reimburses for Continuous Glucose Monitoring.

SOURCE: VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Home Health Manual, Covered Services and Limitations. (1/5/24). (Accessed Aug. 2024).

Personal Emergency Response System (PERS)

Personal emergency response system (PERS) service is an electronic device and monitoring service that enables certain individuals to secure help in an emergency. PERS service is limited to those individuals who live alone or are alone for significant parts of the day and who have no regular caregiver for extended periods of time and who would otherwise require supervision.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Developmental Disabilities Waiver (BI, FIS, CL), (11/1/22) (Accessed Aug. 2024).

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CONDITIONS

The member receiving the RPM service must fall into one of the following five populations, with duration of initial service authorization in parentheses as per below:

• High-risk pregnant persons (6 months);
• Medically complex infants and children under 21 years of age (6 months);
• Transplant patients (6 months);
• Patients who have undergone surgery (up to 3 months following the date of surgery);
• Patients with a chronic or acute health condition who have had two or more hospitalizations or emergency department visits related to such health condition in the previous 12 months when there is evidence that the use of remote patient monitoring is likely to prevent readmission to a hospital or emergency department (6 months)

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 Aug. 2024).

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include:

• A provision for payment of medical assistance for remote patient monitoring services provided via telemedicine, as defined in § 38.2-3418.16, for (i) high-risk pregnant persons; (ii) medically complex infants and children; (iii) transplant patients; (iv) patients who have undergone surgery, for up to three months following the date of such surgery; and (v) patients with a chronic or acute health condition who have had two or more hospitalizations or emergency department visits related to such health condition in the previous 12 months when there is evidence that the use of remote patient monitoring is likely to prevent readmission of such patient to a hospital or emergency department. For the purposes of this subdivision, “remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload …
• A provision for payment of medical assistance for remote ultrasound procedures and remote fetal non-stress tests. Such provision shall utilize established CPT codes for these procedures and shall apply when the patient is in a residence or other off-site location from the patient’s provider that provides the same standard of care. The provision shall provide for reimbursement only when a provider uses digital technology (i) to collect medical and other forms of health data from a patient and electronically transmit that information securely to a health care provider in a different location for interpretation and recommendation; (ii) that is compliant with the federal Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. § 1320d et seq.); and (iii) that is approved by the U.S. Food and Drug Administration. For fetal non-stress tests under CPT Code 59025, the provision shall provide for reimbursement only if such test (a) is conducted with a place of service modifier for at-home monitoring and (b) uses remote monitoring solutions that are approved by the U.S. Food and Drug Administration for on-label use to monitor fetal heart rate, maternal heart rate, and uterine activity.

SOURCE: VA Code Annotated Sec. 32.1-325 as amended by SB 250 (2024 Session), (Accessed Aug. 2024).

Coverage Continuous Glucose Monitoring is limited to members with:

• Type 1 diabetes
• Type 2 diabetes (when over 16 years old)
• Pregnant women who are injecting insulin with either Type 1 or 2.

Service authorization is required. Additional requirements apply.

SOURCE: VA Department of Medical Assistance Services. Medicaid Memo. Clarification of Existing Medicaid Coverage of Continuous Glucose Monitoring for Members in Medicaid/FAMIS/FAMIS MOMS Fee-for-Service Programs. (Nov. 2016) (Accessed Aug. 2024).

Personal Emergency Response System (PERS)

PERS service is available to individuals enrolled in the FIS, CL, and BI waivers. PERS service may be authorized when there is no one else in the home with the individual enrolled in the waiver who is competent or continuously available to call for help in an emergency. Physician-ordered medication monitoring units may be provided simultaneously with PERS service.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Developmental Disabilities Waiver (BI, FIS, CL), (11/1/22) (Accessed Aug. 2024).

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PROVIDER LIMITATIONS

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OTHER RESTRICTIONS

Devices used to satisfy conditions for CPT 99453 and 99454 must automatically digitally upload patient data (i.e., not self-recorded or reported by patients) and automatically transmit either daily recordings of the beneficiary’s physiologic data OR the device must record daily values and transmit an alert if the beneficiary’s values fall outside predetermined parameters for 16 days in a 30-day period. Devices used to satisfy conditions for CPT 98975, 98976 and 98977 must be used to monitor data for 16 days in a 30-day period. These codes cannot be used for monitoring of parameters for which more specific codes are available (i.e., CPT 93296, 93264, 94760).

An individual provider must not bill for more than one set of RPM services per patient at any given time.

Equipment utilized for Remote Patient Monitoring must meet the Food and Drug Administration (FDA) definition of a medical device as described in section 201(h) of the Federal, Food, Drug and Cosmetic Act.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Physician/Practitioner), (5/13/24) (Accessed Aug. 2024).

Personal Emergency Response System (PERS)

The monitoring agency’s equipment must include the following:

• A primary receiver and a back-up receiver, which must be independent and interchangeable;
• Back-up information retrieval system;
• A clock printer, which must print out the time and date of the emergency signal, the PERS individual’s identification code, and the emergency code that indicates whether the signal is active, passive, or a responder test;
• Back-up power supply;
• A separate telephone service;
• A toll-free number to be used by the PERS equipment in order to contact the primary or back-up response center; and
• A telephone line monitor, which must give visual and audible signals when the incoming telephone line is disconnected for more than 10 seconds.

See manual for additional requirements.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Developmental Disabilities Waiver (BI, FIS, CL), (11/1/22) (Accessed Aug. 2024).

Last updated 08/12/2024

Store and Forward

POLICY

Store-and-forward means the asynchronous transmission of a member’s medical information from an originating site to a health care Provider located at a distant site. A member’s medical information may include, but is not limited to, video clips, still images, x-rays, laboratory results, audio clips, and text. The information is reviewed at the Distant Site without the patient present with interpretation or results relayed by the distant site Provider via synchronous or asynchronous communications.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) (Accessed Aug. 2024).

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ELIGIBLE SERVICES/SPECIALTIES

Refer to the telehealth supplement and billing manual for a full list of CPT and HCPCS codes reimbursable by Virginia Medicaid, including those through store and forward.

Store and Forward – Distant site Providers must include the modifier GQ.

See tables for select codes that are authorized for store-and-forward.

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.

• Services must be patient-initiated.
• Patients must be established with the provider practice.
• Must not be billed if services originated from a related service provided within the previous 7 days or lead to a service or procedure within the next 24 hours or at the soonest available appointment.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals),  (5/13/24), (Accessed Aug. 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. Billing codes covered by this policy, when conditions of coverage are met, and for services with dates of service on and after April 18, 2022, include the following:

• 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
• G2250: Remote assessment 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 service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment

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 Aug. 2024).

Coverage of services delivered by telehealth are described in the manual supplement “Telehealth Services.”

MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telehealth.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Physician/Practitioner. Billing Instructions, (3/22/24) (Accessed Aug. 2024).

Teledentistry codes for synchronous and asynchronous encounters are listed as covered.

SOURCE:  VA Dept. of Medical Assistant Svcs., DentaQuest, (6/2/23) (Accessed Aug. 2024).

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GEOGRAPHIC LIMITS

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals), (5/13/24) (Accessed Aug. 2024).

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TRANSMISSION FEE

Originating site fee is only available for synchronous telehealth services.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services (5/13/24) (Accessed Aug. 2024).