Last updated 11/15/2023
Definitions
Telehealth is the use of telecommunications and information technology to provide access to physical, mental, and behavioral health care across distance.
Digital Health consists of online digital evaluation and management (E/M) services which are patient-initiated services with health care professionals. These are not real-time services. Patients initiate services through HIPAA-compliant secure platforms which allow digital communication with the health care professional. Online digital evaluation and management services are for established patients only. These services do not include nonevaluative electronic communications of test results, scheduling of appointments, or other communication that does not include evaluation and management.
Synchronous Telehealth is two-way, real-time interactive communication between a patient and their health care provider using technology such as interactive video/television, audio/visual secure online digital portals, and videoconferencing. Synchronous telehealth involves two collaborating sites: an “originating site” and a “distant site.” The patient is located at the originating site and the health care professional is located at the distant site.
Telehealth is an umbrella term which includes digital health and synchronous two-way real-time interactive audio/visual services. It does not include store and forward services.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 170, (Oct 2023), (Accessed Nov. 2023).
Synchronous teledentistry (D9995) is delivery of patient care and education where there is live, twoway interaction between the patient and at least one dental, medical, or health caregiver at one physical location and an overseeing supervising or consulting dentist or dental provider at another location.
The communication is real-time and continuous between all participants who are working together as a group. Synchronous teledentistry must use both audio and visual means. The totality of the communication of the information exchanged between the providers or others and the member during the synchronous teledentistry service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via an in-person interaction.
SOURCE: North Dakota Human Services Teledentistry Policy (July 2023), (Accessed Nov. 2023)
Last updated 11/15/2023
Email, Phone & Fax
Audio-Only Telephone Services can be delivered by using older-style “flip” phones or a traditional “land-line” phones that only support audio-based communication. Only certain services are covered using audio-only telephone services (see linked list of covered services below).
Audio Only Telephone E/M Services
Services must be initiated by an established patient or guardian of the established patient.
Do not report this service if:
- It is decided that the patient will be seen within 24 hours or at the next available urgent visit appointment,
- There is an E/M service for the same or a similar problem within the previous seven days
- The patient is within a postoperative period and related to the surgical procedure.
Audio-only telephone services (CPT™ 99441-99443) are only available through December 31, 2024.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 171-172, (Oct. 2023), (Accessed Nov. 2023).
Home Health and Private Duty Nursing
Telephonic encounters are not covered by ND Medicaid.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 66, (Oct. 2023), (Accessed Nov. 2023).
Targeted Case Management
Telephone calls, in person and email contacts are allowable costs under transitional care management (TCM) for making collateral contacts.
SOURCE: North Dakota Department of Human Services: Targeted Case Management – Individuals with a serious mental illness or serious emotional disturbance. (Oct. 2023) P. 8, & Targeted Case Management Child Welfare, (Oct. 2023) p. 6 (Accessed Nov. 2023).
Teledentistry
Noncovered Services:
- Examinations via online/email/electronic communication
- Patient contact with dentist who provides the consultation using audio means only (no visual component)
- Virtual check-in
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023), & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 13 (Accessed Nov. 2023).
Pharmacy Manual
Medication Therapy Management (MTM) services are allowable with audio-only telephone. See manual for codes.
SOURCE: ND Medicaid Pharmacy Medical Billing Manual, Jul. 2023, (Accessed Nov. 2023).
Last updated 11/15/2023
Live Video
POLICY
All qualified telehealth services must:
- Meet the same standard of care as in-person care.
- Be medically appropriate and necessary with supporting documentation included in the patient’s clinical medical record.
- Be provided via secure and appropriate equipment to ensure confidentiality and quality in the delivery of the service. The service must be provided using a HIPAA-compliant platform.
- Use appropriate coding as noted in the following tables. Health care professionals must follow CPT®/HCPCS coding guidelines.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 171, (Oct. 2023), (Accessed Nov. 2023).
ELIGIBLE SERVICES/SPECIALTIES
All qualified telehealth services must:
- Meet the same standard of care as in-person care.
- Be medically appropriate and necessary with supporting documentation included in the patient’s clinical medical record.
- Be provided via secure and appropriate equipment to ensure confidentiality and quality in the delivery of the service. The service must be provided using a HIPAA-compliant platform.
- Use appropriate coding as noted in the following tables. Health care professionals must follow CPT®/HCPCS coding guidelines.
Digital Health Evaluation and Management Services
Cumulative online digital evaluation and management (E/M) services occurring within a seven-day period beginning with the health care professional’s review of the patient-generated inquiry. Included services not separately billable:
- For the same or a related problem within seven days of a previous E/M service,
- Related to a surgical procedure occurring within the postoperative period of a previously completed procedure,
- Any subsequent online communication that does not include a separately reported E/M service.
- E/M services related to the patient’s inquiry provided by qualified health care professionals in the same group practice.
Separate reimbursement may be allowed for:
- Online digital inquiries initiated for a new problem within seven days of a previous online digital E/M service.
Permanent documentation storage (electronic or hard copy) of the encounter is required.
See manual for coding instructions.
Noncovered Services:
- Store and forward
- Virtual check-in
- Interprofessional Services
- Digital Assessment and Management Services
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 171-173, (Oct. 2023), (Accessed Nov. 2023).
See excel document of Telehealth Covered Services in Telehealth Policies section on Manuals Webpage.
Indian Health Services
Coverage and payment of services provided through telehealth is on the same basis as those provided through face-to-face contact.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, p. 80, (Oct. 2023), (Accessed Nov. 2023).
Medicaid Services Rendered in Schools
Services rendered in schools may be delivered via telehealth. See the Telehealth chapter for additional information on services rendered via telehealth.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Schools, p. 107, (Oct. 2023), (Accessed Nov. 2023).
Home Health Services
Telemonitoring is a covered service. See remote patient monitoring section.
Teledentistry
Patient records must include the CDT© Code(s) that reflect the teledentistry encounter. The claim submission must include all applicable CDT© codes. ND Medicaid will reimburse CDT© code D9995 or D9996 once per date of service.
See Teledentistry policy for covered services and non-covered services.
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023), & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 12 (Accessed Nov. 2023).
Medication Assisted Treatment
The member must require at least one face-to-face or telehealth check‐in per month for prescribing or dispensing OBOT/OTP medication.
Telehealth must be provided in accordance with applicable federal and state laws and policies and follow the Controlled Substances Act (CSA) (28 USC Part 802) for prescribing and administration of controlled substances.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, MAT, p. 94-95, (Oct. 2023), (Accessed Nov. 2023).
Behavioral Health
Remote service delivery is allowable as specified within each service. Remote support/telehealth limits, codes, and modifiers are available at https://www.hhs.nd.gov/sites/www/files/documents/1915i/1915i%20Codes.Rates_.Limits.pdf
SOURCE: ND Div. of Medical Assistance, Behavioral Health Provider Manual, p. 23, (Oct 2023), (Accessed Nov. 2023).
Pharmacy Manual
Medication Therapy Management (MTM) services are allowable with synchronous telehealth visits. See manual for codes
SOURCE: ND Medicaid Pharmacy Medical Billing Manual, July 2023, (Accessed Jun. 2023).
ELIGIBLE PROVIDERS
Payment will be made only to the distant health care professional during the telehealth session. No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site.
Payment is made for services provided by licensed professionals enrolled with ND Medicaid within their licensed scope of practice only. All service limits set by ND Medicaid apply to telehealth services.
Telehealth services provided by an Indian Health Service (IHS) facility or a Tribal 638 Clinic functioning as the distant site, are reimbursed at the All-Inclusive Rate (AIR), regardless of whether the originating site is outside the “four walls” of the facility or clinic
Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing telehealth services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue codes listed in the FQHC and RHC portions of this manual along with the CPT® or HCPCS code for the service rendered appended with modifier GT or 95.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 172-173, (Oct. 2023), (Accessed Nov. 2023).
Indian Health Services
Coverage and payment of services provided through telehealth is on the same basis as those provided through face-to-face contact.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, p. 80, (Oct. 2023), (Accessed Nov. 2023).
ELIGIBLE SITES
POS 10 is allowed, which indicates telehealth provided in patient’s home.
No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site.
Payment will be made to the originating site as a facility fee only in the following places of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians, or other technology or personnel utilized in the performance of the telehealth service.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 172-173, (Oct. 2023), (Accessed Nov. 2023).
Health Services billed by schools can be delivered via telehealth; however, no originating site fee is allowed. See Telehealth chapter for additional information.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 83, (Oct. 2023), (Accessed Nov. 2023).
Teledentistry
Claim submissions must be billed using place of service (POS)/place of treatment codes:
- 02 Teledentistry provided in a location other than the patient’s home.
- 10 Telehealth provided in patient’s home.
Claims with any other place of service will be denied.
Place of Service code 02 or 10 is recorded in Box # 38 on the claim form or electronic equivalent.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) – Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
Revenue Code 521: Clinic visit by member to RHC/FQHC.
One dental encounter is allowed per day. The encounter must be a face to face encounter to qualify for payment. Asynchronous teledentistry performed as a stand-alone service does not qualify for an encounter payment. At least one covered service must be performed as a face to face service to qualify for the dental encounter payment.
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023) & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 12 (Accessed Nov. 2023).
Pharmacy Manual
The business where services are provided (site of service) must:
- Be located within the state of ND or the local trade area within 50 miles of the ND border (General Information for Providers outlines the requirements for out-of-state services)
- Have appropriate size and accommodations for services provided
- Be enclosed sufficiently to prevent:
- Encounter from being heard and/or seen by others
- Interference by distracting noise from other areas of the business
For services delivered via synchronous telehealth:
- Both the origination site (where the member is located) and the distant site (where the provider is located) must meet the geographic location, privacy, and space requirements outlined above
- Provider is responsible for supplying audio and video equipment permitting two-way, real-time interactive communication between the origination and distant sites.
SOURCE: ND Medicaid Pharmacy Medical Billing Manual, July 2023, p. 4, (Accessed Nov. 2023).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Payment will be made to the originating site as a facility fee only in the following places of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional payment for equipment, technicians, or other technology or personnel utilized in the performance of the telehealth service.
Payment will be made only to the distant health care professional during the telehealth session. No payment is allowed to a professional at the originating site if their sole purpose is the presentation of the patient to the professional at the distant site.
Health Services billed by schools can be delivered via telehealth; however, no originating site fee is allowed.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 83 & 172, (Oct. 2023), (Accessed Nov. 2023).
Teledentistry
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) – Revenue code 0780 should only be reported along with Q3014 when the FQHC is the originating site. When providing teledentistry services to patients located in their homes or another facility, FQHCs and RHCs should continue to bill the revenue code listed below along with the CDT© code for the service rendered appended with modifier GT or 95.
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023) & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 13 (Accessed Nov. 2023).
Last updated 11/15/2023
Store and Forward
POLICY
Digital Health consists of online digital evaluation and management (E/M) services which are patient-initiated services with health care professionals. These are not real-time services. Patients initiate services through HIPAA-compliant secure platforms which allow digital communication with the health care professional. Online digital evaluation and management services are for established patients only. These services do not include nonevaluative electronic communications of test results, scheduling of appointments, or other communication that does not include evaluation and management.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 170, (Oct. 2023), (Accessed Nov. 2023).
Noncovered Services:
- Store and forward
- Virtual check-in
- Interprofessional Services
- Digital Assessment and Management Services
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 173, (Oct. 2023), (Accessed Nov. 2023).
Teledentistry
Allowed Code: D9996 – teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review. Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.
Asynchronous (store-and-forward) teledentistry (D9996) is the transmission of recorded health information (i.e., radiographs, photographs, digital impressions) through a HIPAA-compliant electronic communications system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.
Noncovered Services:
- Examinations via online/email/electronic communication
- Patient contact with dentist who provides the consultation using audio means only (no visual component)
- Virtual check-in
SOURCE: North Dakota Department of Human Services: Teledentistry Policy. (July 2023) & North Dakota Department of Human Services, Provider Manual for Dental Services, July 2023, Pg. 13 (Accessed Nov. 2023).
Medical assistance coverage must include payment for the following services: …
- Asynchronous teledentistry to reduce barriers to dental care through outreach programs and to integrate oral health into general health care settings to identify and refer treatment needs.
SOURCE: ND Statute Sec. 50-24.1-45 (Accessed Nov. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Digital Health Evaluation and Management Services
Cumulative online digital evaluation and management (E/M) services occurring within a seven-day period beginning with the health care professional’s review of the patient-generated inquiry. Included services not separately billable:
- For the same or a related problem within seven days of a previous E/M service,
- Related to a surgical procedure occurring within the postoperative period of a previously completed procedure,
- Any subsequent online communication that does not include a separately reported E/M service.
- E/M services related to the patient’s inquiry provided by qualified health care professionals in the same group practice.
Separate reimbursement may be allowed for:
- Online digital inquiries initiated for a new problem within seven days of a previous online digital E/M service.
Permanent documentation storage (electronic or hard copy) of the encounter is required.
SOURCE: ND Div. of Medical Assistance, General Information Provider Manual, Telemedicine, p. 171, (Oct. 2023), (Accessed Nov. 2023).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found