Arkansas

Medicaid recognizes physician consultations when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine services.

The state uses specific codes to identify telemedicine services. The state contact is Will Taylor (501) 682-8362.

California

Medicaid recognizes physician consultations (medical & mental health) when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for telemedicine services.

The state uses consultative CPT codes with the modifier "TM" to identify telemedicine services. The state contact is Dr. Michael Farber (916) 657-0548.

Georgia

Medicaid recognizes physician consultations when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for telemedicine services.

The state uses specific local codes to identify the consultation furnished at the hub site. No special codes or modifier is used at the spoke site. The state contact is Sherley Benson (404) 657-7213.

Illinois

The Medicaid agency recognizes physician consultations when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for telemedicine services.

The state uses specific codes to identify telemedicine services. The state contact is R. Calluza or Maryann Daily (217) 782-2570.

Iowa

Medicaid recognizes physician consultations when furnished using interactive video teleconferencing.

Payment is based on the state's fee-for-service rates for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for telemedicine services.

Specific local codes are used for the add-on payment and CPT codes with the modifier "TM" is used to identify the consultations. The State contact is Marty Swartz (515) 281-5147.

Kansas

Medicaid recognizes home health care and mental health services already covered by the state plan when furnished using teleconferencing. Home health is limited to certain services.

Payment is on a fee-for-service basis for the mental health services, which is the same as the reimbursement for covered services furnished in the conventional manner. Compensation for home health care via telemedicine is made at a reduced rate. Reimbursement is made for only the service furnished at the hub site.

Local codes have been established to specifically identify home health services furnished using visual communication equipment. No special modifiers are used for mental health services. The state contact is Ms. Fran Seymour-Hunter (785) 296-3386.

Louisiana

The Medicaid agency recognizes physician consultations when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional face-to-face manner. Reimbursement is made at both ends (hub and spoke site) for the telemedicine services. Physician Assistants are allowed to perform the service using telemedicine if they are authorized by a primary physician, which is the only one that is authorized to bill.

The State uses consultative CPT codes. The state contact is Ms. Kandice McDaniels (504) 342-3891, E-mail: Kmcdanie@dhhmail.dhh.state.la.us.

Minnesota

The Medicaid agency recognizes physician consultations (medical and mental health) when furnished using interactive video or store-and-forward technology. Interactive video consultations may be billed when there is no physician present in the emergency room, if the nursing staff requests a consultation from a physician in a hub site. Coverage is limited to three consultations per beneficiary per calendar week.

Payment is on a fee-for-service basis, suing the same payment rate as for covered services furnished in a conventional, face-to-face manner. Payment is made at both the hub and spoke sites. No payment is made for transmission fees.

Minnesota uses consultation CPT codes with the modifier "CT" for interactive video services and the modifier "WT" for consultations provided through store-and-forward technology. Emergency room CPT codes are used with a "GT" modifier for interactive video consultations done between emergency rooms. The state contact is Christine Reisdorf (651) 296-8822.

Montana

The Medicaid Agency recognizes any medical or psychiatric service already covered by the state plan when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine service.

No special codes have been developed. Providers use codes from the existing CPT. The state contact is Dave Thorsen (406) 444-3634.

Nebraska

The Medicaid agency recognizes most state plan services when furnished using interactive video teleconferencing. In general, services are covered so long as a comparable service is not available to a client within a 30-mile radius of his or her home. Services specifically excluded include medical equipment and supplies; orthotics and prosthetics; personal care aide services; pharmacy services; medical transportation services; and mental health and substance abuse services and home and community-based waiver services provided by persons who do not meet practitioner standards for coverage.

Payment is on a fee-for-service basis, which is the same as reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both the hub and spoke sites. Payment for transmission costs are set at the lower of the billed charge or the state's maximum allowable amount.

Billing and coding requirements will vary depending on who bills for the service and which claim form is used. The state contact is Dr. Chris Wright (402) 471-9136.

North Carolina

The Medicaid agency recognizes initial, follow-up or confirming consultations in hospitals and outpatient facilities when furnished using real-time interactive video teleconferencing. The patient must be present during the teleconsultation.

Payment is on a fee-for-service basis. The consulting practitioner at the hub site receives 75 percent of the fee schedule amount for the consultation code. The referring practitioner at the spoke site receives 25 percent of the applicable fee.

Teleconsultations are billed with modifiers to identify which portion of the teleconsult visit is billed; i.e., the consulting practitioner at the hub site uses a GT modifier and the referring practitioner at the spoke site uses a YS modifier.  The state contact is Janet Tudor (919)857-4049.

North Dakota

Medicaid recognizes specialty physician consultations when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine services.

Current CPT codes for consultative services are used with a "TM" modifier to specifically identify covered services which are furnished by using audio visual communication equipment. The state contact is David Zetner (701)328-3194.

Oklahoma

Medicaid recognizes physician consultations when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional face-to-face manner. Reimbursement is made at both ends (hub and spoke site) for the telemedicine services.

The state uses consultative CPT codes. The state contact is Ms. Nelda Paden (405) 530-3398, E-mail: Padenn@ohca.state.ok.us.

South Dakota

Medicaid recognizes physician consultations when furnished using (interactive & non-interactive) video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine services.

The state uses consultative CPT codes with a "TM" modifier to identify telemedicine services. The state contact is Linda Waldman (605) 773-3495.

Texas

The Medicaid agency recognizes physician consultations (teleconsultations) when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional face-to-face manner. Reimbursement is made at both ends (hub and spoke site) for the telemedicine services. Other health care providers, such as advanced nurse practitioners and certified nurse midwives are allowed to bill, as are "Rural Health Clinics and Federally Qualified Health Centers."

The state uses consultative CPT codes with the modifier "TM" to identify telemedicine services. The state contact is Nora Cox Taylor (512) 424-6669, E-mail: nora.taylor@hhsc.state.tx.us.

Utah

The Medicaid agency recognizes the following services when furnished using interactive video teleconferencing: mental health consultations provided by psychiatrists, psychologists, social workers, psychiatric registered nurses and certified marriage or family therapists; diabetes self management training provided by qualified registered nurses or dieticians and; services provided to children with special health care needs by physician specialists, dieticians and pediatricians when those children reside in rural areas.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both the hub and spoke sites for diabetes self management training services and services provided to children with special health care needs. Reimbursement is made only to the consulting professional for mental health services. Payment is made for transmission fees.

The state uses CPT codes with GT and TR modifiers to identify telehealth services. The state contact is Mr. Blake Anderson (801) 538-9925.

Virginia

The Medicaid Agency recognizes, as a pilot project, medical and mental health services already covered by the state plan when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for only medical services.

The state uses specific local codes to identify telemedicine services. The state contact is Jeff Nelson (804)371-8857.

West Virginia

Medicaid recognizes physician consultations when furnished using interactive video teleconferencing.

Payment is on a fee-for-service basis, which is the same as the reimbursement for covered services furnished in the conventional, face-to-face manner. Reimbursement is made at both ends (hub and spoke sites) for the telemedicine services.

The state uses consultative CPT codes with the modifier "TV" to identify telemedicine services. The state contact is Laure L. Harbert (304) 926-1718.

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