Pennsylvania Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

The Pennsylvania Medical Assistance Program provides reimbursement for live-video under some circumstances. There is no reimbursement available for store-and-forward or remote patient monitoring.

Definitions
Telemedicine is the use of real-time interactive telecommunications technology that includes, at a minimum, audio and video equipment as a mode of delivering consultation services.

Live Video
Policy
For FQHCs and RHCs: Telepsychiatry Services – Only applicable to Behavioral Health Managed Care delivery system claims and not fee-for-service delivery. Service is in real-time, interactive audio-video transmission and do not include phone, email or facsimile transmission. Consultation between two healthcare practitioners do not count as a qualifying service.

Eligible Services/Specialties
See listing for reimbursable procedure codes when the service is provided via interactive telecommunication technology.

Eligible Providers
Pennsylvania Medicaid will provide reimbursement for live video to all Medicaid enrolled physician specialists.

Eligible Sites
A patient is allowed to access a telemedicine consultation at any enrolled office of the referring provider or any other participating physicians, certified registered nurse practitioner, or certified nurse midwife.

Geographic Limits
Services should be rendered face-to-face whenever practical and appropriate. Providers may consider if the recipient must travel more than 60 minutes in a rural area or 30 minutes in an urban area.

Facility/Transmission Fee
Originating site may bill for facility fee.

Store-and-Forward
Policy
Pennsylvania Medicaid will not reimburse for store-and-forward because a telemedicine consultation must consist of a two-way, real time interactive communication between the patient and the physician at the distant site.

Eligible Services/Specialties
No reference found.

Geographic Limits
No reference found.

Transmission Fee
No reference found.

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 reference found. No reimbursement for email. No reimbursement for telephone. No reimbursement for FAX.

Consent
Informed consent is required from individuals participating in any services utilizing telepsych.

Out of State Providers
When services are provided from a location in another state, the psychiatrist/licensed psychologist must be licensed in Pennsylvania.

Miscellaneous
No reference found.