Last updated 12/15/2023
Consent Requirements
Any written information must be provided to the participant before the virtual care appointment in a form and manner which the participant can understand using reasonable accommodations when necessary. The participant must be informed and consent to the delivery models, provider qualifications, treatment methods, or limitations and virtual care technologies. The rendering provider at the distant site must also disclose to the participant their identity, current location, telephone number and Idaho license number. If the participant (or legal guardian) indicates at any point that he wants to stop using the technology, the service should cease immediately and an alternative (in-person) appointment should be scheduled. The partial, interrupted service is not reimbursable.
The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and those services were delivered via virtual care. The documentation must be of the same quality as is originated during an in-person visit. These documentation requirements are specific to delivery via virtual care and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Aug 2, 2023, Section 9.12, 9.12.2, 9.12.3 p. 131-132; ID MedicAide May 2023. (Accessed Dec. 2023).
Last updated 12/15/2023
Email, Phone & Fax
Virtual care or telehealth means providing medically necessary health care services without actual physical contact, through the use of electronic means. Under Idaho Medicaid this means the participant and the provider are interacting in real-time or “live” from two physically different locations, by video or telephone.
Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers:
- FQ – A telehealth service was furnished using real-time audio-only communication technology.
- GT – A telehealth service was furnished using real-time audio-visual communication technology.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Aug 2, 2023, Sections 9.12 7 9.12.3 p. 131-132, Idaho MedicAide May 2023. (Accessed Dec. 2023).
Certain CPT/HCPCS codes are covered. See bulletin for specific codes.
SOURCE: Idaho MedicAide August 2023, p. 9, Idaho MedicAide October 2023, p. 9. (Accessed Dec. 2023).
Last updated 12/15/2023
Live Video
POLICY
Services delivered through virtual care will be considered for reimbursement when rendered within the provider’s scope of practice and billed according to all applicable administrative rules, policy, federal and state regulations. Any covered service may be delivered via virtual care when:
- The service can be safely and effectively delivered via virtual care and the medium utilized;
- The service fully meets the code definition when provided via virtual care;
- The service is billed with the FQ or GT modifier; and
- All other existing coverage criteria are met.
Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Aug. 2, 2023, Section 9.12 & 9.12.1 p. 131-132. Idaho MedicAide May 2023. (Accessed Dec. 2023).
Services delivered via virtual care as defined in Title 54, Chapter 57, Idaho Code, must be identified as such in accordance with billing requirements published in the Idaho Medicaid Provider Handbook. Virtual care services billed without being identified as such are not covered. Virtual care services may be reimbursed within limitations defined by the Department in the Idaho Medicaid Provider Handbook. Fee-for-service reimbursement is not available for asynchronous services except remote monitoring.
SOURCE: ID Administrative Code 16.03.09 Sec. 210 (09), Pg. 25 (Accessed Dec. 2023).
For Home Health, the face-to-face encounter that initiates treatment may occur virtually.
SOURCE: ID Administrative Code 16.03.09 Sec. 723 (02)(b), Pg. 101, ID Medicaid Provider Handbook: Home Health and Hospice Services, 1.2.4.1, p. 6. (Mar. 2, 2021). (Accessed Dec. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Any covered service may be delivered via virtual care when:
- The service can be safely and effectively delivered via virtual care and the medium utilized;
- The service fully meets the code definition when provided via virtual care;
- The service is billed with the FQ or GT modifier; and
- All other existing coverage criteria are met.
Reporting of test results only is not covered as a telehealth service.
Only one eligible provider may be reimbursed per service per participant per date of service. No reimbursement is available for the use of equipment at the originating or remote sites. Reimbursement is also not available for services that are interrupted and/or terminated early due to equipment difficulties. Claims for services delivered via virtual care will be reimbursed at the same rate as face-to-face services.
Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers:
- FQ – A telehealth service was furnished using real-time audio-only communication technology.
- GT – A telehealth service was furnished using real-time audio-visual communication technology.
Additionally, providers can also use the following modifier in conjunction with one of the above:
- FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. May 26, 2023, Sections 9.12 & 9.12.3 p. 131-132, Idaho MedicAide May 2023. (Accessed Dec. 2023).
Physician/Non-Physician Practitioner Services:
Services in the National Diabetes Prevention Program are eligible for telehealth.
Physicians and non-physician practitioners are eligible to receive reimbursement for telehealth services.
Physicians and psychiatric nurse practitioners may provide psychotherapy (CPT® 90839 and 90840) to participants in crisis via telehealth. The medical record of the participant must support a crisis service was provided for the full duration billed and demonstrate that an urgent assessment of the participant’s mental state was necessary, and/or their health or safety was at risk. The participant must be in the room for the duration of the visit or a majority of the service, which is focused on the individual. 90839 is a stand-alone code not to be reported with psychotherapy or psychiatric diagnostic evaluation codes, the interactive complexity code, or any other psychiatry section code.
SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (Aug 8, 2023), p. 51, 77, 79. (Accessed Dec. 2023).
Children with Developmental Disabilities
Children’s DD Telehealth services are reimbursable if provided and billed in accordance with the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook.
SOURCE: ID Medicaid Provider Handbook Agency Professional (Feb. 22, 2023), p. 28. (Accessed Dec. 2023).
Therapy Services (Occupational, Physical Therapists & Speech Language Pathologists)
Covered telehealth services are real-time communication through interactive technology that enables a provider and a patient at two locations separated by distance to interact simultaneously through two-way video and audio transmission. Evaluations and reevaluations must be provided in-person and not by telehealth. The therapist must certify that the services can safely and effectively be done with telehealth and the physician or nonphysician practitioner order must specifically allow the services to be provided by telehealth. Therapists must adhere to all requirements of their licensing board for telehealth services. Specific service codes found in manual.
SOURCE: ID Medicaid Provider Handbook, Therapy Services Aug. 8, 2023 pg 37 , (Accessed Dec. 2023).
Psychiatric Crisis
Physicians and psychiatric nurse practitioners may provide psychotherapy (CPT® 90839 and 90840) to participants in crisis via telehealth. The medical record of the participant must support a crisis service was provided for the full duration billed and demonstrate that an urgent assessment of the participant’s mental state was necessary, and/or their health or safety was at risk. The participant must be in the room for the duration of the visit or a majority of the service, which is focused on the individual. 90839 is a stand-alone code not to be reported with psychotherapy or psychiatric diagnostic evaluation codes, the interactive complexity code, or any other psychiatry section code.
SOURCE: ID Medicaid Provider Handbook: Physician and Non-Physician Practitioner (Aug 8, 2023), p. 79. (Accessed Dec. 2023).
Laboratory Services
To be reimbursable, drug tests must be ordered by a licensed or certified healthcare professional who has performed a face-to-face evaluation of the participant (this may include telehealth if the requirements of the telehealth policy are met).
SOURCE: ID Medicaid Provider Handbook: Laboratory Services (Aug 8, 2023), p. 22. (Accessed Dec. 2023).
Eye and Vision Services
Vision therapy is not covered for group therapy, telehealth or with home computer programs.
SOURCE: ID Medicaid Provider Handbook: Eye and Vision Services (Aug. 2, 2023), p. 54. (Accessed Dec. 2023).
ELIGIBLE PROVIDERS
Only one eligible provider may be reimbursed for the same service per participant per date of service.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Aug 2, 2023, Sections 9.12.3 p. 132, Idaho MedicAide May 2023. (Accessed Dec. 2023).
Idaho Medicaid therapy services, see manual for specific codes.
SOURCE: ID Medicaid Provider Handbook, Therapy Services Aug 8, 2023 pg 37 (Accessed Dec. 2023).
Physicians and psychiatric nurse practitioners may provide psychotherapy to participants in crisis via telehealth, using CPT 90839 and 90840.
Physicians and non-physician practitioners are eligible to receive reimbursement for telehealth services.
SOURCE: ID Medicaid Provider Handbook, Physician and Non-Physician Practitioner. Sec. 4.34.3, Pg. 73, (4.38) 77. Aug 8, 2023, (Accessed Dec. 2023).
FQHCs, RHCs & IHS
Telehealth services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Idaho Medicaid Telehealth Policy and applicable handbooks.
FQHC, RHC or IHS providers should not report the GT or FQ modifier with encounter code T1015 but should include it with each applicable supporting codes.
SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services, Nov. 18, 2022, p. 30. Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Aug 2,, 2023, Sections 9.12.3 p. 132, Idaho MedicAide May 2023. (Accessed Dec. 2023).
ELIGIBLE SITES
Idaho Medicaid uses places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers must use these places of service on claims for virtual care. Claims for virtual care must include one of the following modifiers:
- FQ – A telehealth service was furnished using real-time audio-only communication technology.
- GT – A telehealth service was furnished using real-time audio-visual communication technology.
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Aug 2, 2023, Sections 9.12.3 p. 132, Idaho MedicAide May 2023. (Accessed Dec. 2023).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Therapy Services
Therapy services covered via virtual care are listed in the table below. Reimbursement is according to the numerical fee schedule. There is no additional fee for either the originating or the distant site.
SOURCE: ID Medicaid Provider Handbook, Therapy Services Aug 8, 2023 pg 37 (Accessed Dec. 2023).
Last updated 12/15/2023
Miscellaneous
Technical Requirements:
Video must be provided in real-time with full motion video and audio that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication. Transmission of voices must be clear and audible.
Documentation Requirements
The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and that services were delivered via virtual care. The documentation must be of the same quality as is originated during an in-person visit. These documentation requirements are specific to delivery via virtual care and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).
SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Aug2, 2023 9.12.1 & 1.12.2, p. 131, ID MedicAide May 2023. (Accessed Dec. 2023).
