Medicaid Telehealth Reimbursement
Summary
Nevada Medicaid and the Nevada Check Up (NCU) program reimburses for live video and store-and-forward services under specific conditions. There is no reimbursement for remote patient monitoring.
Definitions
“Telehealth is the use of a telecommunications system to substitute for an in-person encounter for professional consultations, office visits, office psychiatry services, and a limited number of other medical services.”
Live Video
Policy
Nevada Medicaid and Nevada Check Up program will reimburse for live video, as long as services have parity with face-to-face services and health care professionals follow Medicaid’s policies for specific services they are providing, as well as practice standards established by licensing agencies.
Eligible Services/Specialties
Click for a list of eligible services and specialties.
Eligible Providers
Telehealth may be used by any Nevada Medicaid and Nevada Check Up provider working within their scope of practice.
Eligible Sites
Click for a list of eligible sites.
Geographic Limits
A Medicaid Managed Care Organization may not refuse to provide coverage of telehealth services because of the distant or originating site.
Facility/Transmission Fee
Originating site is qualified to receive a facility fee if they are an enrolled Medicaid provider. If a patient is receiving telehealth services at a site not enrolled in Medicaid, the originating site is not eligible to receive a facility fee.
Store-and-Forward
Policy
Reimbursement is available for services delivered via asynchronous telehealth. Photographs must be specific to the patient’s condition and adequate for rendering or confirming a diagnosis or a treatment plan.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
Store-and-forward services are not eligible for originating site facility fees.
Remote Patient Monitoring
Policy
No reference found.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reimbursement for email.
No reimbursement for telephone, except psychiatric treatment in crisis intervention.
No reimbursement for FAX.
Consent
No reference found.
Out of State Providers
No reference found.
Miscellaneous
No reference found.
Private Payer Laws
Definitions
“Telehealth” means the delivery of services from a provider of health care to a patient at a different location through the use of information and audio-visual communication technology, not including standard telephone, facsimile or electronic mail.
Requirements
Click for a list of private payer requirements.
Parity
Every health plan policy issued must include coverage for services provided through telehealth to the same extent as through provided in-person or by other means.
Professional Regulation/Health & Safety
Definitions
Telehealth means the delivery of services from a provider of health care to a patient at a different location through the use of information and audio-visual communication technology, not including standard telephone, facsimile or electronic mail.
Consent
No reference found.
Online Prescribing
A provider of health care who is located at a distant site and uses telehealth to direct or manage the care or render a diagnosis of a patient who is located in Nevada or write a treatment order or prescription for such a patient must comply with all state and federal laws that would apply if the provider was located within the state including holding a valid license or certificate to practice in Nevada.
Cross State Licensing
A practitioner must hold a valid Nevada License or certificate to practice his or her profession, including a special purpose license before providing services via telehealth unless he or she is a provider of health care services who is providing services within the scope of his or her employment by or pursuant to a contract entered into with an urban Indian organization.
Miscellaneous
The Board of Medicine is required to adopt regulations regarding a physician assistant’s use of equipment that transfers information concerning the medical condition of a patient electronically, telephonically or by fiber optics, including, without limitation, through telehealth, from within or outside Nevada or the United States.
Source: Center for Connected Health Policy
https://www.cchpca.org