Oregon Reimbursement for Telehealth
Oregon Medicaid Live Video Policy
Oregon Medicaid will reimburse for live video when billed services comply with their billing requirements.
The referring provider is not required to be present with the client for the consult.
The referring provider may bill an evaluation and management code for the patient visit only if a separately identifiable visit is performed. The visit must meet all of the criteria of the code billed.
The evaluating practitioner at the distant site may bill for the evaluation, but not for the transmission.
The authority must provide coverage for behavioral health telemedicine services to the same extent that the service would be covered if they were provided in-person.
Oregon Private Payer Laws Parity
Oregon requires a health benefit plan to provide coverage of a health service that is provided using synchronous two-way interactive video conferencing if:
- The plan provides coverage of the health service when provided in-person by a health professional;
- The health service is medically necessary;
- The health service is determined to be safely and effectively provided using synchronous two-way interactive video conferencing according to generally accepted health care practices and standards; and
- The application and technology used to provide the health service meet all standards required by state and federal laws governing the privacy and security of protected health information.
Plans may not distinguish between originating sites that are rural and urban in providing coverage.
Coverage is subject to the terms and conditions of the health benefit plan and the reimbursement specified in the contract between the plan and the health professional.
Center for Connected Health Policy
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