The Medicaid agency recognizes most State plan
services when furnished using interactive video teleconferencing.
Payment is on a fee-for-service basis, which is
the same as reimbursement for covered services furnished
in the conventional, face-to-face manner. Reimbursement
is made at both the hub and spoke sites. Payment
for transmission costs are set at the lower of the
billed charge or the state's maximum allowable amount. Services specifically
excluded include medical equipment and supplies;
orthotics and prosthetics; personal care aide services;
pharmacy services; medical transportation services;
and mental health and substance abuse services and
home and community-based waiver services provided
by persons who do not meet practitioner standards
for coverage.
Sites and practitioners applying for Medicaid telehealth coverage and reimbursement should go to the Nebraska Health and Human Services website (www.hhs.state.ne.us/med/medindex.htm) for the latest information regarding application for Medicaid. This site provides explanations and links regarding Medicaid regulations, Medicaid enrollment, Medicaid billing instructions and frequently asked questions about telehealth. For Medicaid telehealth site enrollment questions, you can contact Chris Wright, M.D., at (402) 471-9136 or chris.wright@hhss.ne.gov. Your local telehealth site and/or your hub site may also be able to assist you in the process.
Reimbursement Information - Medicaid
The Balanced Budget Act of 1997 mandated Medicare reimbursement for telemedicine services that meet certain criteria, essentially viewing telemedicine technology as an extension of a practitioner's normal practice with the same requirements for licensure, malpractice and credentialing and the expectation that quality of service is comparable to in-person consultations. As such, telemedicine does not have separate CPT codes, but utilizes the GT modifier to denote the consult as a telemedicine visit for tracking and research purposes with reimbursement equal to that of in-person consultations. The GT modifier should be used for all Medicare, Medicaid and private insurance submissions.
While CMS continues to review services for inclusion, the following services are reimbursable under Medicare: consultation (CPT codes 99241-99275), office or other outpatient visits (99201-99215), individual psychotherapy (90804-90809), pharmalogic management (90862) and psychiatric diagnostic interview examinations (90801). As of January 1, 2006, end stage renal disease related services (HCPCS codes G0308, G0309, G0311, G0312, G0314, G0315, G0317 and G0318) have been added with certain guidelines regarding regular in-person examination of the access site.
Physicians, nurse practitioners, physician assistants, certified nurse anesthetists, nurse midwives, clinical nurse specialist, clinical psychologists, clinical social workers, registered dieticians and nutrition professionals are considered the only eligible providers. Eligible originating sites (patient sites) include: hospitals (inpatient or outpatient), critical access hospitals, the offices of physicians or practitioners, rural health clinics and federally qualified health centers.
Reimbursement Information - Private Insurance
There are an increasing number of private insurers in Nebraska that reimburse for telehealth. The Mid-Nebraska Telemedicine Network, which has seen over 10,000 consults to date, reports a very high reimbursement rate through Medicare, Medicaid and private insurers. If in doubt, it is wise to have the patient consult his or her insurance company prior to initiating a telemedicine appointment.
It is important to note that payment is only allowed for real-time consultations. Store and forward consultations (whereby the patient's visit is videotaped and forwarded to the provider) are only reimbursed in Hawaii and Alaska.
