California Reimbursement for Telehealth PDF Print E-mail

California is one of the best states for insurance reimbursement for telehealth. 

For more information on setting up Telehealth services in California, please contact us.  We provide HIPAA-compliant video conferencing software as well as set-up and technical support for a low monthly fee.

California Medicaid Telehealth Rules - Download 

California Medicaid reimburses for telehealth + a separate facility fee Q3014. 

Read about the new California law expanding Medicaid coverage for Telemedicine here.

Modifiers Claims for reimbursement should be submitted with the appropriate CPT code or HCPCS code for the professional services provided and one of the following Telemedicine modifiers:

GT for interactive audio and video telecommunications system (live interactive)

 

Originating Site Fee

 

The originating site is eligible to receive a facility fee for providing services via telehealth. For 2011, the site facility fee is 80% of the lesser of the actual charge or $24.10. Sites are instructed to use HCPCS code Q3014 when submitting facility fee claims. Sites fee are limited to once per day, same recipient, same provider.

Medi-Cal Eligible Telemedicine Services

Live Interactive Service

CPT and HCPCS Codes

Psychiatric Diagnosis, Interview, Examination

90801 – 90802

Individual Psychotherapy, outpatient and inpatient, with and without evaluation and management component

90804 – 90819

90821 – 90824

90826 – 90829

Group Psychotherapy

90853

Individual Medical Psychotherapy by a physician

Z0300

Office or Other Outpatient Visit – New or established patient

99201 – 99215

Initial Hospital Care or Subsequent Hospital Care – new or established patient

99221 – 99233

Consultations – office or other outpatient, initial or follow-up inpatient, and confirmatory

99241 – 99275

 

See the 2011 California Law AB 415 expanding the use of Telemedicine here.

AB 415 will:

  • Update the definition of telehealth to reflect the broader range of services in use today, and apply the definition to all licensed health professionals;
  • Change the need for an additional written patient consent specifically for telehealth services to a verbal consent;
  • Remove the Medi-Cal rule requiring documentation of a barrier to an in-person visit before a beneficiary can receive telehealth services;
  • Remove a twice-extended sunset date in Medi-Cal on store and forward services reimbursement for teledermatology and teleopthalmalogy;
  • Eliminate restrictions on reimbursement of services provided via email or telephone;
  • Eliminate restrictions on the physical location, such as doctors’ offices or hospitals, where telehealth services may be provided;
  • Allow California hospitals to use new federal rules to more easily establish medical credentials of telehealth providers

For more information, visit the California Telehealth Resource Center here

Last Updated on Wednesday, 09 August 2017 12:27