West Virginia Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

West Virginia Medicaid reimburses for live video under some circumstances. Reimbursement is only made for real time communications, therefore there is no reimbursement for store-and-forward or remote patient monitoring.

Definitions
“Telehealth: The use of electronic information and telecommunications technologies to provide professional health care; is often used to connect practitioners and clinical experts in large hospitals or academic medical centers with patients in smaller hospitals or critical access hospitals which are typically located in more remote locations; and can assure that these remotely located patients enjoy the same access to potentially life-saving technologies and expertise that are available to patients in more populated parts of the country.”

Live Video
Policy
West Virginia Medicaid reimburses for a limited number of telehealth services that are provided to enrolled members by enrolled practitioners via a telecommunication system. WV Medicaid utilizes CMS guidance on Telehealth Services.

Eligible Services/Specialties
West Virginia Medicaid reimbursement of telehealth services is limited to certain CPT/HCPCS codes. See manual.

Eligible Providers
Click to view authorized distant site providers.

Eligible Sites
Click to view authorized originating sites.

Geographic Limits
WV Medicaid does not limit telehealth services to members in non-metropolitan statistical professional shortage areas as defined by CMS telehealth guidance.

Facility/Transmission Fee
An originating site can bill for an originating site fee, however facility fees are not covered.

Store-and-Forward
Policy
No reimbursement. WV Medicaid only reimburses for real time communications.

Eligible Services/Specialties
No reference found.

Geographic Limits
No reference found.

Transmission Fee
No reference found.

Remote Patient Monitoring
Policy
No reimbursement. WV Medicaid only reimburses for real time communications.

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
Provider must obtain patient’s (or legal guardian’s) written and verbal consent. The patient has the right to withdraw from telehealth services at any point for an alternative service.

Out of State Providers
No reference found.

Miscellaneous
Additional instructions regarding telehealth standards and billing available in the following manuals: Licensed Behavioral Health Center Services (Ch. 503); Behavioral Health Outpatient Services (Ch. 521). Limited to specific CPT codes.