Medicaid Telehealth Reimbursement
Summary
Montana Medicaid reimburses for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring based on the definition for telemedicine.
Definitions
Telemedicine is the use of interactive audio-video equipment to link practitioners and patients located at different sites.
Live Video
Policy
MT Medicaid reimburses for medically necessary telemedicine services to eligible members. Providers must be enrolled as Montana Medicaid providers.
Eligible Services/Specialties
Healthy Montana Kids: Services provided by telemedicine are allowed for non-surgical medical services and behavioral health outpatient services.
Eligible Providers
Click for a list of eligible providers.
Eligible Sites
Telemedicine can be provided in a member’s residence; the distance provider is responsible for the confidentiality requirements.
Geographic Limits
The originating and distant providers may not be within the same facility or community or have the same tax ID number.
Facility/Transmission Fee
Click for a list of provider types that can bill an originating site fee.
Store-and-Forward
Policy
There is no reimbursement for store-and-forward based on the definition for telemedicine restricting the service to interactive audio-video.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
There is no reimbursement for remote patient monitoring based on the definition for telemedicine restricting the service to interactive audio-video.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
Click for a list of telemedicine reimbursement restrictions.
Consent
No reference found.
Out of State Providers
Providers must be licensed in the state of Montana.
Miscellaneous
Effective Jan. 1, 2017 the new place of service code is “02”.
Private Payer Laws
Definitions
Telemedicine means the use of interactive audio, video, or other telecommunications technology…
Requirements
Click for a list of private payer requirements.
Parity
Private payers are required to provide coverage for services delivered through telemedicine if the services are otherwise covered by the policy, certificate, contract, or agreement.
Professional Regulation/Health & Safety
Definitions
Telemedicine means the practice of medicine using interactive electronic communication, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening health care provider.
Consent
No reference found.
Online Prescribing
No reference found.
Cross State Licensing
Member of the following: Interstate Medical Licensure Compact, Nurse Licensure Compact, Physical Therapy Compact.
Miscellaneous
Click for a list of professional board telehealth-specific regulations.
Source: Center for Connected Health Policy
https://www.cchpca.org