Kentucky Guide to Reimbursement for Telemedicine PDF Print E-mail

July, 2013 KY Medicaid Update from ATA

 Kentucky issued final rules expanding the coverage of telehealth-provided services for Medicaid beneficiaries. Although providers are still limited to using only interactive video-conferencing to qualify for reimbursement, Medicaid beneficiaries will have access to a broader list of providers and telehealth-provided services including:

  • A physical health evaluation or management consultation provided by a physician, advanced practice registered nurse (APRN), optometrist or chiropractor
  • Mental health evaluation or management service, individual or group psychotherapy, and medication management provided by a psychiatrist, a physician, APRN, psychologist, licensed professional clinical counselor, licensed clinical social worker, licensed marriage and family therapist
  • Individual medical nutrition therapy consultation services provided by a licensed dietitian or certified nutritionist
  • Individual diabetes self-management training consultation provided by a physician, APRN, physician assistant, registered nurse, or licensed dietitian; and ordered by a physician, APRN or physician assistant
  • Occupational therapy evaluation or treatment provided by an occupational therapist who is employed by a physician, home health agency, or nursing facility
  • Physical therapy evaluation or treatment provided by a physical therapist who is employed by a physician, home health agency, hospital outpatient department or nursing facility
  • Speech therapy evaluation or treatment provided by a speech-language pathologist who is employed by a physician, home health agency, hospital outpatient department or nursing facility
  • Neurobehavioral status exam provided by a psychiatrist, physician, or psychologist
  • End-stage renal disease monitoring, assessment, or counseling consultations provided by a physician or APRN employed by a hospital’s outpatient department

Click here for the final rules published in July, 2013.

 

KAR 3:170. Telehealth consultation coverage and reimbursement as of 2009

Kentucky reimburses for telemedicine. 

 

Section 3. Coverage of Telehealth Provided by a Community Mental Health Center.

      (1) The department shall reimburse for the following telehealth consultation provided via a community mental health center in accordance with the following provisions:

      (a) A psychiatric diagnosis or evaluation interview with a CPT code of 90801 through 90802 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychologist with a license in accordance with KRS 319.010(5);

      4. A licensed marriage and family therapist;

      5. A licensed professional clinical counselor;

      6. A psychiatric medical resident;

      7. A psychiatric registered nurse;

      8. A licensed clinical social worker; or

      9. An advanced registered nurse practitioner;

      (b) Outpatient individual psychotherapy with a CPT code of 90804 through 90809 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychologist with a license in accordance with KRS 319.010(5);

      4. A licensed marriage and family therapist;

      5. A licensed professional clinical counselor;

      6. A psychiatric medical resident;

      7. A psychiatric registered nurse;

      8. A licensed clinical social worker; or

      9. An advanced registered nurse practitioner;

      (c) Outpatient individual interactive psychotherapy with a CPT code of 90810 through 90815 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychologist with a license in accordance with KRS 319.010(5);

      4. A licensed marriage and family therapist;

      5. A licensed professional clinical counselor;

      6. A psychiatric medical resident;

      7. A psychiatric registered nurse;

      8. A licensed clinical social worker; or

      9. An advanced registered nurse practitioner;

      (d) Inpatient individual psychotherapy with a CPT code of 90816 through 90822 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychologist with a license in accordance with KRS 319.010(5);

      4. A licensed marriage and family therapist;

      5. A licensed professional clinical counselor;

      6. A psychiatric medical resident;

      7. A psychiatric registered nurse;

      8. A licensed clinical social worker; or

      9. An advanced registered nurse practitioner;

      (e) Inpatient individual interactive psychotherapy with a CPT code of 90823 through 90829 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychologist with a license in accordance with KRS 319.010(5);

      4. A licensed marriage and family therapist;

      5. A licensed professional clinical counselor;

      6. A psychiatric medical resident;

      7. A psychiatric registered nurse;

      8. A licensed clinical social worker; or

      9. An advanced registered nurse practitioner;

      (f) Other psychotherapy with a CPT code of 90845 through 90846 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychologist with a license in accordance with KRS 319.010(5);

      4. A licensed marriage and family therapist;

      5. A licensed professional clinical counselor;

      6. A psychiatric medical resident;

      7. A psychiatric registered nurse;

      8. A licensed clinical social worker; or

      9. An advanced registered nurse practitioner;

      (g) Family therapy with a CPT code of 90847 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychologist with a license in accordance with KRS 319.010(5);

      4. A licensed marriage and family therapist;

      5. A licensed professional clinical counselor;

      6. A psychiatric medical resident;

      7. A psychiatric registered nurse;

      8. A licensed clinical social worker; or

      9. An advanced registered nurse practitioner;

      (h) Family or group psychotherapy with a CPT code of 90849 through 90857 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychologist with a license in accordance with KRS 319.010(5);

      4. A licensed marriage and family therapist;

      5. A licensed professional clinical counselor;

      6. A psychiatric medical resident;

      7. A psychiatric registered nurse;

      8. A licensed clinical social worker; or

      9. An advanced registered nurse practitioner;

      (i) Psychiatric medication management with a CPT code of 90862 if provided by:

      1. A psychiatrist;

      2. A physician;

      3. A psychiatric medical resident; or

      4. An ARNP;

      (j) Interpretation of data to family or others with a CPT code of 90887 if provided by:

      1. A psychiatrist;

      2. A physician; or

      3. An ARNP; or

      (k) A neurobehavioral status exam with a CPT code of 96116 if provided by:

      1. A psychiatrist; or

      2. A psychologist with a license in accordance with KRS 319.010(5).

      (2) The department shall not reimburse for a telehealth consultation if the consultation:

      (a) Is not medically necessary; or

      (b) Requires a face-to-face contact with a recipient in accordance with 42 C.F.R. 447.371.

      (3) A telehealth consultation shall require:

      (a) The use of two (2) way interactive video;

      (b) A referral by a health care provider;

      (c) A referral by a recipient’s KenPAC PCCM if the comparable nontelehealth service requires a KenPAC PCCM referral; and

      (d) A referral by a recipient’s lock-in provider if the recipient is locked-in pursuant to 42 C.F.R. 431.54 and 907 KAR 1:677.

 

Section 4. Reimbursement. (1) The department shall reimburse a telehealth provider for a telehealth consultation:

      (a) Except for a telehealth consultation provided by an ARNP or CMHC, an amount equal to the amount paid for a comparable in-person service in accordance with 907 KAR 3:010;

      (b) If a CMHC, in accordance with 907 KAR 1:045; or

      (c) If provided by an ARNP, an amount equal to the amount paid for a comparable in person service in accordance with 907 KAR 1:104.

      (2) A telehealth provider shall bill for a telehealth consultation using the appropriate evaluation and management CPT or HCPCS codeas specified in Section 2 or 3 of this administrative regulation along with the corresponding two (2) letter "GT" modifier.

      (3) The department shall not require the presence of a health care provider requesting a telehealth consultation at the time of the telehealth consultation unless it is requested by a telehealth provider at the hub site.

      (4) The department shall not reimburse for transmission costs.

 

      Section 5. Confidentiality and Data Integrity. (1) A telehealth consultation shall be performed on a secure telecommunications line or utilize a method of encryption adequate to protect the confidentiality and integrity of the telehealth consultation information.

      (2) Both a hub site and a spoke site shall use authentication and identification to ensure the confidentiality of a telehealth consultation.

      (3) A provider of a telehealth consultation shall implement confidentiality protocols that include:

      (a) Identifying personnel who have access to a telehealth transmission;

      (b) Usage of unique passwords or identifiers for each employee or person with access to a telehealth transmission; and

      (c) Preventing unauthorized access to a telehealth transmission.

      (4) A provider’s protocols and guidelines shall be available for inspection by the department upon request.

 

      Section 6. Informed Consent. (1) Before providing a telehealth consultation to a recipient, a health care provider shall document written informed consent from the recipient and shall ensure that the following written information is provided to the recipient in a format and manner that the recipient is able to understand:

      (a) The recipient shall have the option to refuse the telehealth consultation at any time without affecting the right to future care or treatment and without risking the loss or withdrawal of a Medicaid benefit to which the recipient is entitled;

      (b) The recipient shall be informed of alternatives to the telehealth consultation that are available to the recipient;

      (c) The recipient shall have access to medical information resulting from the telehealth consultation as provided by law;

      (d) The dissemination, storage, or retention of an identifiable recipient image or other information from the telehealth consultation shall comply with 42 U.S.C. 1301 et seq., 45 C.F.R. Parts 160, 162, 164, KRS 205.566, 216.2927, and any other federal law or regulation or state law establishing individual health care data confidentiality provisions;

      (e) The recipient shall have the right to be informed of the parties who will be present at the spoke site and the hub site during the telehealth consultation and shall have the right to exclude anyone from either site; and

      (f) The recipient shall have the right to object to the video taping of a telehealth consultation.

      (2) A copy of the signed informed consent shall be retained in the recipient's medical record and provided to the recipient or the recipient's legally-authorized representative upon request.

      (3) The requirement to obtain informed consent before providing a telehealth consultation shall not apply to an emergency situation if the recipient is unable to provide informed consent and the recipient's legally-authorized representative is unavailable.

Kentucky Medicaid Telehealth Rules

For more information see the ATA Wiki page for Kentucky found here.

 

Last Updated on Monday, 14 August 2017 11:00