This document summarizes telehealth reimbursement policies for Medicaid and private payers in Oklahoma. It discusses who pays for telehealth services and restrictions for Medicare, Medicaid, and private insurance. The document outlines authorized originating and distant sites, eligible providers, and specific CPT codes covered by Medicaid. Billing procedures are also described for distant and originating sites under Medicaid. Questions about telehealth reimbursement policies are directed to contacts at the Heartland Telehealth Resource Center.

1. Oklahoma Telemedicine Conference 2014: Telehealth Transition
October 16, 2014
Cynthia Scheideman-Miller, MHSA
Heartland Telehealth Resource Center
TELEMEDICINE REIMBURSEMENT:
MEDICAID AND PRIVATE PAYERS

2. Who we are
Heartland Telehealth Resource Center is an
independent and impartial resource center that
is here to assist in the development of
sustainable telehealth programs and networks.
Heartland is the regional TRC for Kansas,
Missouri and Oklahoma.
HTRC activity is supported by grant number G22RH20214 from the Office for the
Advancement of Telehealth, Office of Health Information Technology, Health Resources
and Services Admin, DHHS.

3. Who pays for Telehealth?
 Federal and state programs
 Medicare - with restrictions
 Medicaid/ CHIP (SoonerCare) – with restrictions
 Private Insurance Programs
 Contracted Services

4. Distant vs Originating
Distant Site:
Where the
provider is
Originating
Site:
Where the
patient is

5. Authorized originating site
Medicare Medicaid
Hospital
Office of a physician or practitioner
Critical Access Hospitals (CAH)
Rural Health Clinics (RHC)
Federally Qualified Health Centers (FQHC)
Hospital or CAH-based Renal Dialysis Centers (including
satellites)
School
Outpatient Behavioral Health Clinic
Community Health Center
Indian Health Service facility, a Tribal Health facility, or
an Urban Indian Clinic (I/T/U)

6. Authorized distant site
specialty Providers
Medicare Medicaid
Physician
Advanced Registered Nurse
Practitioners
Physician Assistants
Genetic Counselors
Licensed Behavioral Health
Professionals
Registered Dieticians
I/T/U’s with specialty service providers
as listed above
Nurse midwife
Clinical Psychologist
Nutrition Professional
Clinical Nurse Specialist
Clinical SocialWorker

7. Reimbursement Comparison
Medicare Medicaid Private Payer
Pays for telehealth
Requires a modifier
Patient must be at a rural site*
Providers specified
Primary Care Only for I/T/U
Only reimburses for specific CPT codes
Interactive telecommunication network preapproved
Telemedicine visits counted toward the applicable benefit limits for
these services
Store & Forward
Non-covered services: telephone conversation,
E-mail, FAX
Patient must be in Oklahoma at time of teleconsult
*Medicare defines “Rural “as a non-MSA county . Medicaid defines “rural “as a
county with a population of less than 50,000 people.

8. Medicaid Telehealth/ Codes
Telehealth Service CPT/HCPCS Codes
Assessment H0031
Office or other outpatient visits 99201-99215
Behavioral Health Service Plan
H0032
Development
Individual Medical Nutrition Therapy 97802-97803
Individual psychotherapy 90832-90834, 90837-90838; H0004
Pharmacologic management Appropriate E/M code
Psychiatric diagnostic interview
examination and testing
90791-90792;96101-96103;96118-
96120;
96110-96111;90887
www.okhca.org “Soonercare Reimbursement Checklist for Telemedicine”

9. Telehealth Billing: Medicaid/
Distant Site
 Clinical fee services: same as the current fee schedule amount for
services provided without telemedicine. Use appropriate HCPS code with
modifier.
 Telemedicine/telehealth Modifiers (distant site only):
 GT for interactive audio and video telecommunications system
 Does not apply to X-ray, ultrasound or electrocardiogram as they are not considered
telemedicine.

10. Dual Eligibles
 If a service is eligible under Medicare
 the Medicare payment rate applies and
Medicaid would cover some portion of the
coinsurance.
 If the service isn’t eligible under Medicare
 Confirm with OHCA it is covered
 Have the beneficiary sign an Advanced
Beneficiary Notice if a Medicaid copayment
is required
Source: Aaron Fischbach , Policy Coordinator, HRSA

11. Telehealth Billing: Medicaid/
Originating Site
 Originating Site Fee: Originating site must
be Rural. Only the originating site will bill
for a facility fee.
 HCPCS code "Q3014, ($24.24 in 2012)
 “telehealth originating site facility fee";
short description "telehealth facility fee.”
 The type of service for the telehealth originating
site facility fee is "9, other items & services”

12. Questions?
Cynthia Scheideman-Miller
Cynthia-scheidemnmiller@ouhsc.edu
Telemedicine/Medicaid specific questions:
Adolf Maren
(405)522-7300