Pennsylvania Telehealth State Laws & Reimbursement Policies
Medicaid Telehealth Reimbursement
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.
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.
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.
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.
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.
Out of State Providers
Professional Regulation/Health & Safety
Cross State Licensing
Pennsylvania issues extraterritorial licenses that allow practice in Pennsylvania to physicians residing or practicing with unrestricted licenses in an adjoining state, near the Pennsylvania boundary, and whose practice extends into Pennsylvania.
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