Illinois Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

IL Medicaid reimburses for live video telemedicine and telepsychiatry services for specific providers.

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Definitions

“Telemedicine” is the use of a telecommunication system to provide medical services for the purpose of evaluation and treatment when the patient is at one medical provider location and the rendering provider is at another location.

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Live Video

Policy
The Department of Healthcare and Family Services must reimburse psychiatrists, federally qualified health centers, clinical psychologists, clinical social workers, advances practice registered nurses certified in psychiatric and mental health nursing and mental health professionals and clinicians to provide behavioral health services to recipients via telehealth.

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Eligible Services/Specialties
Appropriate CPT codes must be billed with the GT modifier for telemedicine and telepsychiatry services. See Practitioner Services Handbook Appendices A-10 for telehealth billing examples.

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Eligible Providers
For telemedicine services, the distant site provider must be a physician, physician assistant, podiatrist, or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.

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Eligible Sites
Click for a list of eligible sites.

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Geographic Limits
Facility/Transmission Fee
Click for a list of sites eligible for a facility or transmission fee.

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Store-and-Forward

Policy
Although store-and-forward is included within the definitions of telehealth in IL Medicaid manuals and administrative code (see descriptions below), there are no details provided on store-and-forward reimbursement and other areas of policy indicate that the GT (live video) modifier is required for telehealth services.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
IL Medicaid will cover home uterine monitoring with prior approval and when patient meets specific criteria. Payment is only for the items and not for the service.

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Conditions
Click for a list of eligible conditions and requirements.

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Provider Limitations
Other Restrictions

Email/Phone/Fax

No reimbursement for telephone.
No reimbursement for FAX.
No reimbursement for text or email.

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Consent

Out of State Providers

For medical services, the provider rendering the service at the distant site can be a physician, physician assistant, podiatrist or advanced practice nurse, who is licensed by the State of Illinois or by the state where the patient is located.

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Miscellaneous

Specific documentation requirements apply for telehealth services. See administrative code for details.

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Private Payer Laws

Definitions

“Telehealth services” means the delivery of covered health care services by way of an interactive telecommunication system.

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Requirements

Click for a list of requirements.

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Parity

Payers are not required to cover telehealth services, they are only required to meet certain requirements if they choose to do so (see above).

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Professional Regulation/Health & Safety

Definitions

"Telehealth" means the evaluation, diagnosis, or interpretation of electronically transmitted patient-specific data between a remote location and a licensed health care professional that generates interaction or treatment recommendations. "Telehealth" includes telemedicine and the delivery of health care services provided by way of an interactive telecommunications system, as defined in subsection (a) of Section 356z.22 of the Illinois Insurance Code.

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Consent

Online Prescribing

Cross State Licensing

Member of the following: Interstate Medical Licensure Compact, Psychology Interjurisdictional Compact.

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Miscellaneous

Health professionals authorized by statute to engage in the practice of telehealth to the extent of his or her scope of practice include physicians, physician assistants, optometrists, advanced practice nurses, clinical psychologists licensed in IL, dentists, occupational therapists, pharmacists, physical therapists, clinical social workers, speech-language pathologists, audiologists, hearing instrument dispensers, and mental health professionals and clinicians authorized by Illinois law to provide mental health services.

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

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