State Telemedicine Policy Information
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California Telemedicine Policy
California Telemedicine Policy
With its first telemedicine parity laws passed in 1996, California has a long history in telemedicine reimbursement and was one of the first states to acknowledge the value of telemedicine.
Like many other U.S. states, California recognizes the importance of telemedicine in improving healthcare access for patients challenged by distance or mobility. California has been actively pursuing legislation to expand telemedicine access, from developing guidelines for using telehealth in schools to including Associate Marriage and Family Therapists as appropriate telehealth providers.
State Policy Overview
Additional State Telemedicine Info
California has a telemedicine parity law mandating private payer reimbursement for telemedicine.
Medi-Cal considers telemedicine to be the “use of medical information exchanged…using interactive telecommunication equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and physician or practitioner.” Medi-Cal reimburses for live video telemedicine (use the billing modifiers GT or 95), and store-and-forward services for dermatology, dentistry, and ophthalmology.
Type Of Telemedicine Covered
California’s Medicaid program covers live video telemedicine and store-and-forward services for teledermatology, teledentistry, and teleophthalmology.
Eligible Healthcare Providers
Medi-Cal does limit which healthcare providers can get reimbursed for telemedicine. Here’s who qualifies:
- Physician assistants
- Nurse practitioners
- Clinical nurse specialists
- Registered dietitians or nutrition professionals
- Nurse Midwives
- Certified registered nurse anesthetists
- Clinical psychologists
- Clinical social workers
- Speech-language pathologists
- OTs and PTs
Providers are prohibited from prescribing or dispensing dangerous drugs or dangerous devices on the Internet without an appropriate prior examination and medical indication.
Informed Patient Consent
Medi-Cal providers will need to get patient consent and document it in their medical record. California state regulations also say that the originating site provider (where the patient is) must get patient consent prior to care.
Restrictions On Locations
Medi-Cal has no limitations on where the patient or provider has to be during the telemedicine visit. That makes it easy for providers to offer quick, convenient virtual care.
California Medicaid reimburses telemedicine services according to the current physician fee schedule amount for that medical service. So reimbursement rates for a telemedicine service should be the same as the comparable in-person medical service.
Need a list of the eligible CA Medicaid codes for telemedicine? We’ve got you covered:
CPT E&M Codes
- 99201 – 99215 Office or another outpatient visit (new or established patient)
- 99231 – 99233 Initial hospital care or subsequent hospital care (new or established patient)
- 99241 – 99255 Consultations: Office or another outpatient, initial or follow-up inpatient, and confirmatory
CPT Psychiatric Codes
- 90791 Psychiatric diagnostic evaluation
- 90792 Psychiatric diagnostic evaluation with medical services
- 90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
- 90832 Psychotherapy, 30 minutes with a patient
- 90837 Psychotherapy, 60 minutes with a patient
- G0508 Telehealth consultation, critical care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth
- G0509 Telehealth consultation, critical care, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth
- Telehealth originating site facility fee: Q3014 (Once per day, same recipient & provider)
- Transmission costs for telehealth services via audio/video communication: T1014
- (Maximum of 90 minutes per day same recipient, same provider)
Plus, make sure you use the GT or 95 modifiers with your CPT code to indicate live video telemedicine. If you’re using a store-and-forward solution, use the GQ modifier.
Need more details? Check out the Medi-Cal Telehealth Handbook.
For More Information Visit These Sites:
- California Telehealth Resource Center
- Center for Connected Health Policy – California
- University of California Davis Center for Health and Technology
- The Medical Board of California: Practicing Medicine Through Telehealth Technology
- California Office of Health Information Integrity — eHealth (CalOHII)