In a recent newsletter, the post-pandemic virtual care policy was published and covers most current regulations. Idaho Medicaid uses virtual care and telehealth interchangeable and defines this as “providing medically necessary health care services without actual physical contact, through the use of electronic means.” Patient and provider need to be interacting in real-time or “live” from two physically different locations, by video or telephone. Idaho Medicaid requires that whomever is providing virtual care must be within provider’s scope of practice and billed as per Medicaid regulations and accurate NPI.
Below is a list of requirements for billing these services:
• The service can be safely and effectively delivered via virtual care
• The service fully meets the code definition when providing virtual care
• Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care
• The service is billed with the FQ or GT modifier
FQ – A telehealth service was furnished using real-time audio-only communication technology
GT – A telehealth service was furnished using real-time audio-visual communication technology
• FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology.
• Federally qualified health centers (FQHC’s), rural health centers (RHC’s), and Indian health clinics (IHC’s) providers should not report the GT or FQ modifier with encounter code T1015, but should include it with each applicable supporting code
• Informed consent must be obtained and documented in the chart. If the participant (or legal guardian) indicates at any point that they want to stop using the technology, the service should cease immediately, and an alternative (in-person) appointment should be scheduled
• Any written information must be provided to the participant before the virtual care appointment in a form and manner which the participant can understand using reasonable accommodations when necessary
• The rendering provider at the distant site must also disclose to the participant their identity, current location (must be within the United States), telephone number and Idaho license number
• Medicaid policy does not follow Medicare restrictions for virtual care unless the participant has Medicare primary. Otherwise, all Medicaid providers, including FQHC’s, RHC’s, and IHC’s may bill for virtual care services according to these guidelines
• Reporting of test results only is not covered as a telehealth service
• Services provided via asynchronous communication are not reimbursable under Idaho Medicaid. However, remote monitoring services are covered.
Link to May 2023 Newsletter: https://www.idmedicaid.com/General%20Information/General%20Information%20and%20Requirements%20for%20Providers.pdf