Pennsylvania Reimbursement for Telehealth

Pennsylvania Medicaid programs do reimburse for Live Video sessions with providers under most circumstances and the originating site (patient site) can bill Medicaid for the facility fee.  This is an added fee that will be paid to the patient site to cover costs of technology and equipment.  Compared to other states, there are more exclusions and specifics regarding what can and can't be done using Live video sessions.  For example, patients should be in an approriate originating site such as an enrolled office of a physician or nurse practitioner.  For more details, please visit the Center for Connected Health policy website at https://www.cchpca.org

For FQHCs & RHCs
Telepsychiatry Services are covered – Only applicable to Behavioral Health Managed Care delivery system claims and not fee-for-service delivery. Service is in real-time, interactive audio-video transmission and do not include phone, email or facsimile transmission.  Consultation between two healthcare practitioners do not count as a qualifying service.  Service providers are limited to psychologists and psychiatrists. Service providers are required to have a service description approved by the Office of Mental Health and Substance Abuse Services and deliverable through the managed care option.

Center for Connected Health Policy
https://www.cchpca.org

Since many organizations can bill for the added facility fee to pay for equpment and technology, this extra revenue can be used to quickly pay for our services and then the rest is added income for your organization.  This is a great opportunity to reach more people and increase your revenue.  Please contact us below for information about how to get started or how to grow your Telehealth operations.

There are currently no parity laws mandating insurance companies reimburse for Telehealth sessions although many are seeing the advantages and choosing to do so.  Please contact the payers directly to see what they would cover.