Virginia Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

Virginia Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under certain circumstances. Plans participating in the Medicare-Medicaid Demonstration Waiver are permitted to use store-and-forward and remote patient monitoring in rural and urban locations and to provide reimbursement for services.

Definitions
“Telemedicine is the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment.”

Live Video
Policy
Reimbursement is provided subject to coverage requirements.

Eligible Services/Specialties
See billing information for specific codes. Click to see list of eligible services.

Eligible Providers
Click to view list of eligible providers.

Eligible Sites
Click to view list of eligible originating sites.

Geographic Limits
Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services. Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.

Facility/Transmission Fee
Reimburses a facility fee.

Store-and-Forward
Policy
DMAS reimburses for diabetic retinopathy screening through telemedicine for Medicaid members with Type 1 or 2 diabetes. Radiology related procedures are also included under telemedicine coverage as well as certain codes for teledermatology.

Eligible Services/Specialties
Click to view services covered. Refer to the manual for a full list of CPT and HCPCS codes reimbursable by Virginia Medicaid.

Geographic Limits
Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services. Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.

Transmission Fee
Reimburses a facility fee.

Remote Patient Monitoring
Policy
VA Medicaid reimburses for Continuous Glucose Monitoring.

Conditions
Used for patients with one or more chronic conditions.

Provider Limitations
No reference found.

Other Restrictions
No reference found.

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

Consent
No reference found.

Out of State Providers
Newly enrolling out-of-state physicians who enter on their enrollment application a service address that is within 50 miles of the Virginia border may be enrolled as in-state providers.

Miscellaneous
Use of telemedicine must be noted in the service documentation of the patient record.