At eVisit, we get a lot of interest from healthcare providers who want to offer better care access to their Medicaid patients. And why not? Telemedicine can be a great way to make sure even your Medicaid patients who live far away or have trouble getting into the office get all the care they need.
The good news is that in most states, Medicaid does cover telemedicine services in some form. But like with Medicare, there are some basic guidelines and restrictions you’ll need to follow, depending on what state you’re in.
Here are the top questions about how telemedicine works with Medicaid – answered!
Which state Medicaid programs cover telemedicine?
Currently, all state Medicaid programs, except for Massachusetts, Iowa, and Rhode Island have some coverage for telemedicine services. Check your state Medicaid program site, program information, or your state policy page at the National Telehealth Policy Center for details.
What types of telemedicine are covered?
The most commonly covered form of telemedicine is live video telemedicine (think videochat). Chances are, if your state Medicaid program has telemedicine coverage, this is the type of telemedicine they’ll reimburse for. Some states additionally cover store-and-forward telemedicine, and remote patient monitoring, or even just phone consultations – but often place restrictions on this coverage (like only covering store-and-forward for certain specialties). Currently, 9 state Medicaid programs pay for store-and-forward telemedicine in some form and 16 programs cover remote patient monitoring.
Which health services does my state Medicaid program cover?
The health services you can deliver via telemedicine ranges widely from state to state. The best way to look up which health services and CPT/HCPCS codes are covered is to check your Medicaid manual or contact a representative.
How do I bill telemedicine services?
While billing guidelines for telemedicine vary from state to state, we’ve found that many state Medicaid programs follow the example of Medicare. So, you would bill the appropriate CPT/HCPCS code (once you verify it’s covered via telemedicine) and then add on the GT modifier to indicate the service was done via telemedicine. Again, this is the general trend, but make sure you verify billing guidelines with your Medicaid department before submitting a claim.
How much will I get paid?
In general, Medicaid programs seem to be reimbursing for telemedicine services at the same rate as in-person services. So, if you’re billing a standard 99213 E/M code with the GT modifier, it’s likely your Medicaid will just reimburse at your standard rate for 99213.
I keep seeing these terms in my Medicaid manual: hub site, spoke site, originating site, distant site. What does these mean and why are they important to telemedicine?
All of these terms describe the location of the patient or provider at the time of the telemedicine service. Spoke site or originating site usually describe the location of the patient at the time of the telemedicine visit. The hub or distant site describe the location of the healthcare provider who’s consulting or providing treatment to the patient.
It’s important to pay attention to how your Medicaid program defines these terms and what restrictions they place on them. For example, does your program say that only hospitals or provider offices qualify as eligible spoke or originating sites? That means a patient needs to be located at one of those sites to do a telemedicine visit, and cannot do the visit from their home.
Right now, 24 states and DC don’t have any specific requirements for the patient location and 25 states specifically recognize the patient’s home as an eligible originating or spoke site. And more states are moving in that direction to expand to eliminate restrictions on where the patient has to be at the time of the visit.
Which of my Medicaid patients can do telemedicine?
In most states (82%), as long as the provider and patient are meeting all the other guidelines (doing the visit from an eligible originating site, delivering a covered health service, etc), any Medicaid beneficiary should be eligible for telemedicine. A few states, however, do make telemedicine coverage dependent on where a patient lives. For instance, Idaho requires Medicaid patients to be located in a rural area. Other states may require the patient to live at least X miles away from the provider in order to qualify for telemedicine coverage.
Which providers can practice telemedicine?
While Medicaid will reimburse physicians for telemedicine care in most states, many programs restrict what other healthcare providers are eligible to do telemedicine. Currently, 15 states and DC don’t have any stated restrictions on the type of healthcare provider (check to see if your state is one of the lucky ones!). The rest of the states specifically list out eligible providers. And in 4 states, Medicaid limits telemedicine coverage to physicians only.
Are the Medicaid guidelines for telemedicine likely to change any time soon?
Telemedicine policy is changing rapidly, so there’s a good chance your state’s Medicaid coverage for telemedicine could Bchange soon. The best way to stay-up-to-date is to keep in touch with your Medicaid rep, have the latest Medicaid manuals on file, and bookmark the resources we’ve provided in this article!
Where can I find more information about Medicaid and telemedicine?
Here are some of the resources we use at eVisit to stay-up-to-date on Medicaid telemedicine policy:
- American Telemedicine Association (ATA)’s State Policy Center
- The National Telehealth Policy Center’s State Policy Map
- State Medicaid Websites