Coverage and Reimbursement for Telehealth
Medicaid Telehealth Regulations: 471 NAC 1-006
The regulations for coverage criteria and reimbursement of Medicaid telehealth services
are in the Nebraska Administrative Code 471 NAC 1-006. These regulations can be accessed
at www.dhhs.ne.gov/reg/t471.htm. Click on Chapter 1 and scroll
down to Section 1-006. This 13-page telehealth section explains the specific requirements
related to Medicaid telehealth. Each service covered as a Medicaid telehealth service must
otherwise be covered as a face-to-face service, and all other Medicaid policies and
regulations in addition to 471 NAC 1-006 apply to telehealth services.
Medicaid Telehealth Enrollment
Each telehealth site must meet the definition in regulations and must enroll
independently prior to billing for services. Both sites on a telehealth transmission must
be enrolled as a Medicaid telehealth site. Once a telehealth site is in operation,
Medicaid enrollment is done by sending two copies of a letter that assure the requirements
of 471 NAC 1-006.10C are meet. The letter must include a list of those practitioners (and
their Medicaid provider numbers) who are credentialed and approved to use the enrolling
telehealth site’s facilities. A telehealth site may enroll with Medicaid even if no
practitioners use the site, but the site is open for Medicaid clients to see practitioners
at a distant site. A telehealth consent form must be included with the letter of
enrollment; Medicaid recommends that the Medicaid sample consent form be used; this sample
form can be mailed or be faxed upon request. Draft letters prior to final submission are
welcome.
Medicaid Telehealth Billing Instructions
General billing instructions for telehealth services have been included in the Medicaid
Provider Handbooks recently issued and are found in the Appendix, under the claim form
instructions. Except for dental claims, a GT modifier should be added to the CPT/HCPCS
procedure codes to indicate that a telehealth service is being billed. Medicaid
transmission fees are billed using code T1014; the units of service are the number of
minutes of transmission. Medicaid does not cover the Medicare facility fee code Q3014;
these costs are covered per 471 NAC 1-006 regulations and are not separately billable to
Medicaid. Claims for Medicare/Medicaid dual eligible clients should be billed to Medicare
first; Medicaid pays coinsurance and deductibles automatically. See Medicaid Telehealth
Frequently Asked Questions 16 – 28 for billing and reimbursement information.
Medicaid Reimbursement for Telehealth Services
Telehealth services are paid at the same rate as a face-to-face service and include the
total component for the service. Transmission fees are paid at $.08/minute. See Practitioner Fee Schedules
For Medicaid telehealth site enrollment and questions, please contact Chris Wright, MD,
at (402) 471-9136 or chris.wright@dhhs.ne.gov;
for telehealth questions, contact Sandi Kahlandt, Unit Manager, at (402) 471-9366 or sandi.kahlandt@dhhs.ne.gov.
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