Medicaid Telehealth Reimbursement
Georgia Medicaid reimburses for live video under some circumstances. Store-and-forward is not reimbursable as interactive telecommunications is a condition of payment; however, GA Medicaid will reimburse for the technical component of x-rays, ultrasounds, etc. as well as store-and-forward teledentistry. There is no reference to remote patient monitoring.
Telemedicine is the use of medical information exchange from one site to another via electronic communications to improve patient’s health status. It is the use of two-way, real time interactive communication equipment to exchange the patient information from one site to another via an electronic communication system. This includes audio and video communications equipment.
Georgia Medicaid will not reimburse for store-and-forward because an interactive telecommunication system is a condition of payment. The exception is that Georgia Medicaid allows for reimbursement of teledentistry.
The originating site fee (billed as D9996) associated with a real time teledentistry exam is supposed to cover the asynchronous sending of information by a dental hygienist to a dentist for review.
Out of State Providers
Private Payer Laws
“Telemedicine means the practice, by a duly licensed physician or other health care provider acting within the scope of such provider’s practice, of health care delivery, diagnosis, consultation, treatment, or transfer of medical data by means of audio, video, or data communications which are used during a medical visit with a patient or which are used to transfer medical data obtained during a medical visit with a patient. Standard telephone, facsimile transmissions, unsecured e-mail, or a combination thereof do not constitute telemedicine services.”
Services must be appropriately provided through telemedicine and in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. It Is also subject to all the terms and conditions of the applicable health benefit plan.
Professional Regulation/Health & Safety
“Telehealth” is the use of electronic communications to provide and deliver a host of health related information and health care services including, but not limited to physical therapy related information and services, over large and small distances. Telehealth encompasses a variety of health care and health promotion activities including, but not limited to, education, advice, reminders, interventions, and monitoring of interventions.
Physicians are prohibited from prescribing controlled substances or dangerous drugs based solely on an electronic consult, unless the physician is on-call or covering for another provider and prescribing up to a 72-hour supply of medications for a patient of the other provider.