Coverage and Reimbursement for Telehealth
Medicaid Telehealth Regulations: 471 NAC 1-006
The regulations for coverage criteria and reimbursement of Medicaid telehealth services are in the Nebraska Administrative Code 471 NAC 1-006. These regulations can be accessed at www.dhhs.ne.gov/reg/t471.htm. Click on Chapter 1 and scroll down to Section 1-006. This 13-page telehealth section explains the specific requirements related to Medicaid telehealth. Each service covered as a Medicaid telehealth service must otherwise be covered as a face-to-face service, and all other Medicaid policies and regulations in addition to 471 NAC 1-006 apply to telehealth services.
Medicaid Telehealth Enrollment
Each telehealth site must meet the definition in regulations and must enroll independently prior to billing for services. Both sites on a telehealth transmission must be enrolled as a Medicaid telehealth site. Once a telehealth site is in operation, Medicaid enrollment is done by sending a copy of a letter that assure the requirements of 471 NAC 1-006.10C are meet. The letter must include a list of those practitioners (and their Medicaid provider numbers) who are credentialed and approved to use the enrolling telehealth site’s facilities. A telehealth site may enroll with Medicaid even if no practitioners use the site, but the site is open for Medicaid clients to see practitioners at a distant site. A telehealth consent form must be included with the letter of enrollment; Medicaid recommends that the Medicaid sample consent form be used; this sample form can be mailed or be faxed upon request. Draft letters prior to final submission are welcome.
Medicaid Telehealth Billing Instructions
General billing instructions for telehealth services have been included in the Medicaid Provider Handbooks recently issued and are found in the Appendix, under the claim form instructions. Except for dental claims, a GT modifier should be added to the CPT/HCPCS procedure codes to indicate that a telehealth service is being billed. Medicaid transmission fees are billed using code T1014; the units of service are the number of minutes of transmission. Medicaid does not cover the Medicare facility fee code Q3014; these costs are covered per 471 NAC 1-006 regulations and are not separately billable to Medicaid. Claims for Medicare/Medicaid dual eligible clients should be billed to Medicare first; Medicaid pays coinsurance and deductibles automatically. See Medicaid Telehealth Frequently Asked Questions 16 – 28 for billing and reimbursement information.
Medicaid Reimbursement for Telehealth Services
Telehealth services are paid at the same rate as a face-to-face service and include the total component for the service. Transmission fees are paid at $.08/minute.
For Medicaid telehealth site enrollment and questions, contact Flora Coan at 402-471-9380 or firstname.lastname@example.org.
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