Pennsylvania Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

The Pennsylvania Medical Assistance Program provides reimbursement for live-video under some circumstances. There is no reimbursement available for store-and-forward or remote patient monitoring.

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Definitions

Telemedicine is the use of real-time interactive telecommunications technology that includes, at a minimum, audio and video equipment as a mode of delivering consultation services.

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Live Video

Policy
For FQHCs and RHCs: Telepsychiatry Services – Only applicable to Behavioral Health Managed Care delivery system claims and not fee-for-service delivery. Service is in real-time, interactive audio-video transmission and do not include phone, email or facsimile transmission. Consultation between two healthcare practitioners do not count as a qualifying service.

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Eligible Services/Specialties
See listing for reimbursable procedure codes when the service is provided via interactive telecommunication technology.

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Eligible Providers
Pennsylvania Medicaid will provide reimbursement for live video to all Medicaid enrolled physician specialists.

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Eligible Sites
A patient is allowed to access a telemedicine consultation at any enrolled office of the referring provider or any other participating physicians, certified registered nurse practitioner, or certified nurse midwife.

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Geographic Limits
Services should be rendered face-to-face whenever practical and appropriate. Providers may consider if the recipient must travel more than 60 minutes in a rural area or 30 minutes in an urban area.

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Facility/Transmission Fee
Originating site may bill for facility fee.

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Store-and-Forward

Policy
Pennsylvania Medicaid will not reimburse for store-and-forward because a telemedicine consultation must consist of a two-way, real time interactive communication between the patient and the physician at the distant site.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

No reference found. No reimbursement for email. No reimbursement for telephone. No reimbursement for FAX.

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Consent

Informed consent is required from individuals participating in any services utilizing telepsych.

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Out of State Providers

When services are provided from a location in another state, the psychiatrist/licensed psychologist must be licensed in Pennsylvania.

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Miscellaneous

Private Payer Laws

Definitions

Requirements

Parity

Professional Regulation/Health & Safety

Definitions

Consent

Online Prescribing

Cross State Licensing

Pennsylvania issues extraterritorial licenses that allow practice in Pennsylvania to physicians residing or practicing with unrestricted licenses in an adjoining state, near the Pennsylvania boundary, and whose practice extends into Pennsylvania.

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Miscellaneous

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

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