California Telehealth Laws & Reimbursement Policies

Callifornia Telehealth Laws

Medicaid Telehealth Reimbursement

Summary

Medi-Cal reimburses for select services via live video. Medi-Cal will also reimburse store-and-forward for certain CPT/HCPCS codes. Specific CPT/HCPCS codes are outlined in the Medi-Cal manual. As of January 2019, Medi-Cal is also reimbursing for codes G0071, G2010 and G2012.

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Definitions

Telehealth [according to the Telehealth Advancement Act of 2011] “is the mode of delivering health care services and public health utilizing information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at the distant site.”

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Live Video

Policy
Medi-Cal will reimbursement for services provided via live video. Services must be billed with modifiers GT or 95.

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Eligible Services/Specialties
Specific eligible CPT/HCPCS codes are provided in Medi-Cal and Denti-Cal manuals.

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Eligible Providers
Allied dental professionals are not permitted to bill for teledentistry.

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Eligible Sites
Geographic Limits
The type of setting where services are provided is not limited.

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Facility/Transmission Fee
Medi-Cal will reimburse the originating site a facility fees, and originating and distant site for live video transmission costs.

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Store-and-Forward

Policy
Medi-Cal will reimburse for store-and-forward services for certain specialties.

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Eligible Services/Specialties
Eligible specialties include tele-dermatology, tele-ophthalmology and teledentistry.

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Geographic Limits
Transmission Fee
The originating site is eligible for a facility fee. A transmission fee is only reimbursed for live video, and therefore store-and-forward is not eligible.

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Remote Patient Monitoring

Policy
Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

Medi-Cal does not reimburse for telephone calls, electronic mail messages or facsimile transmissions.

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Consent

Provider must obtain oral consent from the patient and document it in the patient record.

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Out of State Providers

Miscellaneous

Medi-Cal covers telehealth to the extent services are allowable and reimbursed according to the department’s telehealth manual in the California Children’s Services Program (CCS), Genetically Handicapped Person’s Program (GHPP) and Child Health and Disability Prevention Program (CHDP).

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Private Payer Laws

Definitions

“Telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store-and-forward transfers.”

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Requirements

Private payers cannot require that in-person contact occur before payment is made for covered telehealth services, subject to contract terms and conditions. Health plans cannot limit the settings where services are provided. Settings are still subject to contract terms and conditions.

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Parity

Private payers cannot require that in-person contact occur before covering a telehealth delivered service, but it is subject to the terms and conditions of the contract.

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Professional Regulation/Health & Safety

Definitions

“Telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store–and-forward transfers.”

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Consent

The originating site provider must obtain and document verbal or written patient consent prior to service delivery.

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Online Prescribing

Providers are prohibited from prescribing or dispensing dangerous drugs or dangerous devices on the Internet without an appropriate prior examination and medical indication.

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Cross State Licensing

Miscellaneous

Click for a list of professional regulations with telehealth-specific standards.

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Source: Center for Connected Health Policy
https://www.cchpca.org

 

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