Wisconsin Telehealth Laws & Reimbursement Policies

Wisconsin Telehealth Laws

Medicaid Telehealth Reimbursement

Summary

Forward Medicaid allows reimbursement for live video under some circumstances. There is no reimbursement for store-and-forward or remote patient monitoring as services must be delivered at the same functional equivalency as face-to-face care.

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Definitions

Telehealth enables a provider who is located at a distant site to render the service remotely to a member located at an originating site using a combination of interactive video, audio, and externally acquired images through a networking environment.

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Live Video

Policy
ForwardHealth allows for certain covered services to be provided via telehealth.

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Eligible Services/Specialties
See Manual for covered telehealth CPT and HCPCS codes.

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Eligible Providers
Click to view list of eligible providers.

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Eligible Sites
Click to see list of eligible originating sites.

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Geographic Limits
Facility/Transmission Fee

Store-and-Forward

Policy
No reimbursement. Services must be functionally equivalent to face-to-face.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
No reimbursement. Services must be functionally equivalent to face-to-face.

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Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

No reimbursement for telephone. No reimbursement for written electronic communication (text, email).

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Consent

Out of State Providers

Out-of-state providers who do not have border status enrollment with WI Medicaid are required to obtain prior authorization (PA) before providing services. WI Medicaid is prohibited from paying providers located outside of the US and its territories.

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Miscellaneous

Private Payer Laws

Definitions

Requirements

Parity

Professional Regulation/Health & Safety

Definitions

Telemedicine means the practice of medicine when patient care, treatment or services are provided through the use of medical information exchanged from one site to another via electronic communications.

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Consent

Online Prescribing

When a physician uses a website to communicate with a patient located in this state, the physician may not provide treatment recommendations, including issuing a prescription unless certain requirements are met.

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Cross State Licensing

Miscellaneous

Professional Board Telehealth-Specific Regulations: Medical Examining Board

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

 
 

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