Wisconsin Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

Wisconsin Medicaid (Forward Medicaid) allows reimbursement for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring as services must be delivered at the same functional equivalency as face-to-face care.

Definitions
Telehealth enables a provider who is located at a distant site to render the service remotely to a member located at an originating site using a combination of interactive video, audio, and externally acquired images through a networking environment.

Live Video
Policy
Forward Health allows for certain covered services to be provided via telehealth.

Eligible Services/Specialties
See Manual for covered telehealth CPT and HCPCS codes.

Eligible Providers
Click to view list of eligible providers.

Eligible Sites
Click to see list of eligible originating sites.

Geographic Limits
No reference found.

Facility/Transmission Fee
Reimbursement for facility fee using HCPCS procedure code Q3014. Modifier GT should not be included with procedure code Q3014.

Store-and-Forward
Policy
No reimbursement. Services must be functionally equivalent to face-to-face.

Eligible Services/Specialties
No reference found.

Geographic Limits
No reference found.

Transmission Fee
No reference found.

Remote Patient Monitoring
Policy
No reimbursement. Services must be functionally equivalent to face-to-face.

Conditions
No reference found.

Provider Limitations
No reference found.

Other Restrictions
No reference found.

Email/Phone/Fax
No reimbursement for telephone. No reimbursement for written electronic communication (text, email).

Consent
Informed consent required.

Out of State Providers
Out-of-state providers who do not have border status enrollment with WI Medicaid are required to obtain prior authorization (PA) before providing services. WI Medicaid is prohibited from paying providers located outside of the US and its territories.

Miscellaneous
POS code 02 required.