Georgia Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward is not reimbursable as interactive telecommunications is a condition of payment; however, GA Medicaid will reimburse for the technical component of x-rays, ultrasounds, etc. as well as store-and-forward teledentistry. There is no reference to remote patient monitoring.

Definitions
Telemedicine is the use of medical information exchange from one site to another via electronic communications to improve patient’s health status. It is the use of two-way, real time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video communications equipment.

Live Video
Policy
Georgia Medicaid reimbursement for telehealth is specific to clinical services rendered via telehealth.

Eligible Services/Specialties
Click for a list of eligible services and specialties.

Eligible Providers
Click for a list of eligible distant site providers.

Eligible Sites
Click for a list of eligible originating sites.

Geographic Limits
No reference found.

Facility/Transmission Fee
Originating sites are paid an originating site facility fee. Hospitals are eligible to receive reimbursement for a facility fee for telehealth when operating as the originating site. There is no separate reimbursement for telehealth serves when performed during an inpatient stay, outpatient clinic or emergency room visit or outpatient surgery, as these are all-inclusive payments.

Store-and-Forward
Policy
GA Medicaid defines asynchronous or “store-and-forward” as the “transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous communication does not include telephone calls, images transmitted via fax machines and text messages without visualization of the patient (electronic mail).

Eligible Services/Specialties
Reimbursement can be made for technical component of store-and-forward applications such as an MRI, X-rays or ultrasounds. However no other reimbursement can be made.

Geographic Limits
No reference found.

Transmission Fee
The originating site fee (billed as D9996) associated with a real-time teledentistry exam is supposed to cover the asynchronous sending of information by a dental hygienist to a dentist for review.

Remote Patient Monitoring
Policy
No reference found.

Conditions
No reference found.

Provider Limitations
No reference found.

Other Restrictions
No reference found.

Email/Phone/Fax
No reimbursement for FAX.
No reimbursement for telephone.
No reimbursement for email.

Consent
Prior to an initial telehealth service, the practitioner who delivers the service to a GA Medicaid Member shall ensure that the telehealth member consent form is provided to the member and signed. See manual for specific requirements.

Out of State Providers
Out-of-state providers may be licensed under the Interstate Medical Licensure Compact. Providers should see the Georgia Composite Medical Board for additional information.

Miscellaneous
No reference found.