Medicaid Handbook Transmittal Letter (MHTL) No xx. John B. McCarthy, Director Medicaid coverage of services delivered through telemedicine

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1 Medicaid Handbook Transmittal Letter (MHTL) No xx : TO: FROM: SUBJECT: Eligible Providers of Medicaid Services Chief Executive Officers, Managed Care Plans (MCPs) John B. McCarthy, Director Medicaid coverage of services delivered through telemedicine Summary Rule , Telemedicine, is being created to establish policy relating to the coverage of Medicaid services delivered through telemedicine. Changes: Rule is being created to establish Medicaid coverage for evaluation and management and psychiatric services through the use of telemedicine. Telemedicine is the direct delivery of services to a Medicaid eligible patient via synchronous, interactive, real-time electronic communication that comprises both audio and video elements. Licensed practitioners such as MDs, DOs, and psychologists will be able to provide and receive reimbursement for providing eligible services through telemedicine, and practitioners' offices, clinics, and outpatient hospitals will be eligible to receive reimbursement as originating sites. Additional Provider Information Originating site providers who are eligible for reimbursement under this rule should use the Q3014 procedure code when submitting a claim for a telehealth originating site facility fee. If the originating site provider is billing the Department for an evaluation and management procedure code in lieu of the Q3014 code, then the provider should also include a U modifier with the appropriate procedure code. Distant site providers who are eligible for reimbursement as a result of rendering eligible services should use the appropriate procedure code and GT modifier when submitting a claim to the Department. Access to Rules and Related Material The main Ohio Department of Job and Family Services (ODJFS) web page includes links to valuable information about its services and programs; the address is The web page of the Ohio Department of Medicaid (ODM) may be accessed through the ODJFS main page or directly at

2 ODJFS maintains an "electronic manuals" web page of ODJFS and Medicaid rules, manuals, transmittal letters, forms, and handbooks. The web address for this "emanuals" web page is From the "emanuals" page, providers may view documents online by following these steps: (1) Select the 'Ohio Health Plans - Provider' collection. (2) Select the appropriate service provider type or handbook. (3) Select the desired document type. (4) Select the desired item from the 'Table of Contents' pull-down menu. Most current Medicaid maximum reimbursement amounts are listed in rule 5101: or in Appendix DD to that rule. Providers may view this information by following these steps: (1) Select the 'Ohio Health Plans - Provider' folder. (2) Select 'General Information for Medicaid Providers'. (3) Select 'General Information for Medicaid Providers (Rules)'. (4) Select '5101: Medicaid Reimbursement' from the 'Table of Contents' pulldown menu and then scroll down to the link to Appendix DD. The Legal/Policy Central Calendar site, is a quick reference for finding documents that have recently been published. This site also provides a link to a listing of ODJFS and Medicaid letters, The listing is categorized by letter number and subject, and a link is provided to each easy-print (PDF) document. To receive automatic electronic notification when new Medicaid transmittal letters are published, sign up for the ODJFS subscription service at Additional Information Questions pertaining to this letter should be addressed to: Ohio Department of Medicaid Bureau of Provider Services P.O. Box 1461 Columbus, OH Telephone (800)

3 Telemedicine. Unless stated otherwise in the Administrative Code, the following rule applies to services covered by the Medicaid program and delivered using telemedicine. (A) For purposes of this rule, the following definitions apply: (1) "Telemedicine" is the direct delivery of services to a patient via synchronous, interactive, real-time electronic communication that comprises both audio and video elements. The following activities are not telemedicine: (a) The delivery of service by electronic mail, telephone, or facsimile transmission; (b) Conversations between practitioners regarding the patient without the patient present either physically or via synchronous, interactive, real-time electronic communication; and (c) Audio-video communication related to the delivery of service in an intensive care unit. (2) "Distant site" is the physical location of the consulting practitioner at the time when a telemedical service is provided. (3) "Originating site" is the physical location of the patient at the time when a telemedical service is provided. The originating site may be one of five places: (a) The office of a medical doctor, doctor of osteopathic medicine, optometerist, or podiatrist; (b) A federally qualified health center, rural health center, or comprehensive primary care clinic; (c) An outpatient hospital; (d) An inpatient hospital; or (e) For services not included in the nursing facility per diem payment, a nursing facility. (B) Requirements and responsibilities. (1) The originating site is responsible for documenting the medical necessity of the telemedical service, for securing the informed consent of the patient, and for developing and maintaining progress notes. (2) The practitioner at the distant site must be a medical doctor, doctor of [ stylesheet: rule.xsl 2.14, authoring tool: i4i 2.0 ras3 Feb 10, :02, (dv: 0] print date: 02/10/ :08 PM

4 osteopathic medicine or licensed psychologist. (3) The distant site is responsible for maintaining documentation of the telemedical service delivered and for sending progress notes to the originating site for incorporation into the patient's records. (C) Coverage. (1) Payment may be made for the following telemedical services at the distant site: (a) Evaluation and management services characterized as "office or other outpatient services"; (b) Evaluation and management services characterized as either "office or other outpatient consultations" or "inpatient consultations"; or (c) Psychiatry services characterized as "psychiatric diagnostic procedures", "psychotherapy," "pharmacologic management," or "interactive complexity." (2) No payment is made for a telemedical service if the originating site is located less than five miles from the distant site. An exception to this restriction may be made if either of two criteria is met: (D) Claim payment. (a) The situation is a medical emergency; or (b) Travel to or from the medical service either is infeasible or poses an undue hardship for the patient. (1) The distant site provider may submit a professional claim for the telemedical service. No institutional (facility) claim may be submitted. All appropriate codes and modifiers must be reported. (2) An originating site provider that is neither an inpatient hospital nor a nursing facility may submit a claim for a telehealth originating fee. If such an originating site provider renders a separately identifiable evaluation and management service to the patient on the same date as the telemedical service, then the provider may instead submit a claim for the evaluation and management service with the appropriate originating site modifier. No originating site provider may receive both a telehealth originating fee and payment for an evaluation and management service provided to a patient on the same day. (3) The payment amount for a telemedical service, a telehealth originating fee, or an evaluation and management service is the lesser of the submitted charge or

5 the maximum amount shown in Appendix DD to rule of the Administrative Code for the date of service.

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