Washington Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 1 year ago by Telehealthist

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Washington Medicaid (Apple Health) reimburses for live video, store-and-forward, and remote patient monitoring under some circumstances.

Definitions
“Telemedicine is when a health care practitioner uses HIPAA-compliant interactive real-time audio and video telecommunications (including web-based applications) or store-and-forward technology to deliver covered services that are within his or her scope of practice to a client at a site other than the site where the provider is located.”

Live Video
Policy
Live video is covered for patients with fee-for-service coverage when it is medically necessary. The referring provider is responsible for determining and documenting medical necessity.

Eligible Services/Specialties
Click to view eligible services for Applied Behavior Analysis (ABA) for Clients Age 20 and Younger, Behavioral Health and Teledentistry.

Eligible Providers
RHCs are authorized to serve as an originating site for telemedicine services.

Eligible Sites
Click to view list of eligible originating sites.

Geographic Limits
An urban or rural distinction must not be placed on the originating site.

Facility/Transmission Fee
Facility fees are available for originating sites, except inpatient hospitals, skilled nursing facilities, homes or other locations determined appropriate by the individual receiving service, but not specified as an eligible originating site.

Store-and-Forward
Policy
Washington Medicaid reimburses for some store-and-forward services under certain circumstances.

Eligible Services/Specialties
WA Apple Health pays for store-and-forward for teledermatology. Teledermatology services via store-and-forward must be billed with GQ modifier and 02 POS Code from the distant site.

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Geographic Limits
No reference found.

Transmission Fee
The originating site for store-and-forward is not eligible to receive an originating site fee.

Remote Patient Monitoring
Policy
The Medicaid agency covers the delivery of home health services through telemedicine for clients with a high risk of sudden change in medical condition which could compromise health outcomes and prescription drug monitoring.

Conditions
Services are provided for clients who have been diagnosed with an unstable condition, and who may be at risk for hospitalization or a more costly level of care. Coverage is limited to one telemedicine interaction, per patient, per day, based on the ordering licensed practitioner’s care plan.

Provider Limitations
Must be provided by a Registered Nurse or Licensed Practical Nurse. The Medicaid agency does not require prior authorization for the delivery of home health services through telemedicine.

Other Restrictions
Click to view eligible services.

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

Consent
Written consent must be obtained for store-and-forward.

Out of State Providers
No reference found.

Miscellaneous
“Use place of service (POS) 02 to indicate that a billed service was furnished as a telemedicine service from a distant site. Distant site practitioners billing for telemedicine services under Critical Access Hospital (CAH) optional payment method must use the GT modifier. Add modifier 95 if the distant site is designated as a nonfacility.”

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