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Wisconsin Telehealth Laws & Reimbursement Policies

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

No reference found.

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Facility/Transmission Fee

Reimbursement for facility fee.

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Store-and-Forward

Policy

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

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Eligible Services/Specialties

No reference found.

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Geographic Limits

No reference found.

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Transmission Fee

No reference found.

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Remote Patient Monitoring

Policy

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

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Conditions

No reference found.

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Provider Limitations

No reference found.

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Other Restrictions

No reference found.

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Email/Phone/Fax

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

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Consent

Informed consent required.

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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

POS code 02 required.

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Private Payer Laws

Definitions

No reference found.

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Requirements

No reference found.

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Parity

No reference found.

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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

Informed consent required.

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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

WI medical license required.

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Miscellaneous

Professional Board Telehealth-Specific Regulations: Medical Examining Board

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