Modalities Allowed

Live Video

CY 2024 Physician Fee Schedule notes that section 4113 of Division FF, Title IV, Subtitle A of the Consolidated Appropriations Act, 2023 (CAA, 2023) (Pub. L. 117-328, December 29, 2022) extends the telehealth policies enacted in the Consolidated Appropriations Act, 2022 (CAA, 2022) (Pub. L. 117-103, March 15, 2022) through December 31, 2024, if the PHE ends prior to that date, as discussed in section II.D.c. of this final rule. These provisions included:

…

• Temporarily allowing a more expansive list of eligible providers in Medicare to provide services via telehealth such as physical and occupational therapists and federally qualified health centers (FQHCs) and rural health clinics (RHCs)

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Jul. 2025).

Temporary Policy – Ends Sept. 30, 2025

During the emergency period described in section 1320b–5(g)(1)(B) of this title and, in the case that such emergency period ends before December 31, 2024, during the period beginning on the first day after the end of such emergency period and ending on September 30, 2025—

• the Secretary shall pay for telehealth services that are furnished via a telecommunications system by a Federally qualified health center or a rural health clinic to an eligible telehealth individual enrolled under this part notwithstanding that the Federally qualified health center or rural clinic providing the telehealth service is not at the same location as the beneficiary;
• the amount of payment to a Federally qualified health center or rural health clinic that serves as a distant site for such a telehealth service shall be determined under subparagraph (B); and
• for purposes of this subsection—
  • the term “distant site” includes a Federally qualified health center or rural health clinic that furnishes a telehealth service to an eligible telehealth individual; and
  • the term “telehealth services” includes a rural health clinic service or Federally qualified health center service that is furnished using telehealth to the extent that payment codes corresponding to services identified by the Secretary under clause (i) or (ii) of paragraph (4)(F) are listed on the corresponding claim for such rural health clinic service or Federally qualified health center service.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Jul. 2025).

Mental Health Visit – Delayed to Oct. 1, 2025

A mental health visit is a medically-necessary face-to-face encounter between an RHC or FQHC patient and an RHC or FQHC practitioner during which time one or more RHC or FQHC mental health services are rendered. Effective January 1, 2022, a mental health visit is a face-to-face encounter or an encounter furnished using interactive, real-time, audio and video telecommunications technology or audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

Beginning January 1, 2026, there must be an in-person mental health service furnished within 6 months prior to the furnishing of the mental health service furnished via telecommunications and that an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reasons for this decision in the patient’s medical record.

RHCs and FQHCs are instructed to append modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) in instances where the mental health visit was furnished using audio-video communication technology and to append modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System) in cases where the service was furnished using audio-only communication.

Mental health services that qualify as stand-alone billable visits in an FQHC are listed on the FQHC center website, http://www.cms.gov/Center/Provider-Type/FederallyQualified-Health-Centers-FQHC- Center.html. Services furnished must be within the practitioner’s state scope of practice.

Medicare-covered mental health services furnished incident to an RHC or FQHC visit are included in the payment for a medically necessary mental health visit when an RHC
or
FQHC practitioner furnishes a mental health visit. Group mental health services do not meet the criteria for a one-one-one, face-to-face encounter in an FQHC or RHC.

Note: Beginning January 1, 2024, group therapy with physicians or psychologists or other mental health professionals to the extent authorized under State law may be covered and paid under the IOP benefit (see section 250 of this chapter).

A mental health service should be reported using a valid HCPCS code for the service furnished, a mental health revenue code, and for FQHCs, an appropriate FQHC mental health payment code. For detailed information on reporting mental health services and claims processing, see Pub. 100-04, Medicare Claims Processing Manual, chapter 9, http://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/downloads/clm104c09.pdf

Medication management, or a psychotherapy “add on” service, is not a separately billable service in an RHC or FQHC and is included in the payment of an RHC or
FQHC medical visit. For example, when a medically-necessary medical visit with an RHC or FQHC practitioner is furnished, and on the same day medication management or a psychotherapy add on service is also furnished by the same or a different RHC or FQHC practitioner, only one payment is made for the qualifying medical services reported with a medical revenue code. For FQHCs, an FQHC mental health payment code is not required for reporting medication management or a psychotherapy add on service furnished on the same day as a medical service.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, 4/21/25, pg. 42-43 (Accessed Jul. 2025).

Prior to March 27, 2020, RHCs and FQHCs were not authorized to serve as a distant site for telehealth consultations, which is the location of the practitioner at the time the telehealth service is furnished, and they could not bill or include the cost of a visit on the cost report. This included telehealth services that are furnished by an RHC or FQHC practitioner who is employed by or under contract with the RHC or FQHC, or a non-RHC or FQHC practitioner furnishing services through a direct or indirect contract. For more information on Medicare telehealth services, see Pub. 100-02, Medicare Benefit Policy Manual, chapter 15, and Pub. 100-04, Medicare Claims Processing Manual, chapter 12.

On March 27, 2020, Congress signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Section 3704 of the CARES Act authorized RHCs and FQHCs to provide distant site telehealth services to Medicare patients during the COVID-19 PHE. Section 4113 of the Consolidated Appropriations Act, 2023, extended this authority through December 31, 2024.

RHCs and FQHCs can continue to provide on a temporary basis, for non-behavioral health visits furnished via telecommunication technology under the methodology that has been in place for these services during and after the COVID-19 PHE through December 31, 2024. Specifically, RHCs and FQHCs can continue to bill for RHC and FQHC services furnished using telecommunication technology by reporting HCPCS code G2025 on the claim, including services furnished using audio-only communications technology through December 31, 2025. For payment for non-behavioral health visits furnished via telecommunication technology in CY 2025, the payment amount is based on the average amount for all PFS telehealth services on the telehealth list, weighted by volume for those services reported under the PFS.

Any health care practitioner working within their scope of practice can provide distant site telehealth services. Practitioners can provide distant site telehealth services – approved by Medicare as a distant site telehealth service under the physician fee schedule (PFS) – from any location in the United States (see 42 CFR 411.9(a)(1)), including their home, during the time that they’re employed by or under contract with the RHC or FQHC.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, 4/21/25, pg. 46-47, (Accessed Jul. 2025).

RHCs and FQHCs can continue to provide on a temporary basis, for non-behavioral health visits furnished via telecommunication technology under the methodology that has been in place for these services during and after the COVID-19 PHE through December 31, 2024. Specifically, RHCs and FQHCs can continue to bill for RHC and FQHC services furnished using telecommunication technology by reporting HCPCS code G2025 on the claim, including services furnished using audio-only communications technology through December 31, 2025. For payment for non-behavioral health visits furnished via telecommunication technology in CY 2025, the payment amount is based on the average amount for all PFS telehealth services on the telehealth list, weighted by volume for those services reported under the PFS

SOURCE: CMS Manual System, Transmittal 13133, March 20, 2025, (Accessed Jul. 2025).

CMS will continue to allow on a temporary basis payment to FQHCs and RHCs for non-behavioral health visits that use telecommunications technology. This temporary policy would allow other non-mental health services to be provided via telehealth by FQHCs and RHCs through 2025 by continuing to use the code G2025 to bill. CMS notes that this will help ensure continuation of services if the current telehealth waivers do expire on December 31, 2024. It should be noted that in calculating the amount to be reimbursed for G2025, CMS will be basing it on the average amount for all PFS telehealth services on the telehealth list, weighted by the volume for those services reported under the PFS.

SOURCE: Center for Medicare and Medicaid Services, CY 2025 Physician Fee Schedule, Final Rule, CMS 1807-F and 4201-F5, (Accessed Jul. 2025).

We’ll continue to pay Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for:

• Non-behavioral and non-mental telehealth services through September 30, 2025, using the national average payment rates for comparable services under the Physician Fee Schedule (PFS) through December 31, 2025
• Behavioral and mental health telehealth services under the RHC all-inclusive rate (AIR) and FQHC Prospective Payment System (PPS), respectively

We’ll delay the in-person visit requirements for behavioral and mental health visits that RHCs and FQHCs provide via telecommunications technology until January 1, 2026

SOURCE: Centers for Medicare and Medicaid Services (CMS), Telehealth Services MLN Fact Sheet, Apr. 2025, (Accessed Jul. 2025).

RHCs and FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. You may use audio-only technology in situations when your patient can’t access or doesn’t consent to use audio-video technology. You can report and get paid in the same way as in-person visits.

• Audio-video visits: Use modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System).
• Audio-only visits: Use new service-level modifier FQ or 93.

These in-person visit requirements apply only to a patient getting mental health visits via telecommunications at home:

• There must be an in-person mental health visit 6 months before the telecommunications visit
• In general, there must be an in-person mental health visit at least every 12 months while the patient is getting services from you via telecommunications to diagnose, evaluate, or treat mental health disorders

NOTE: Section 4113 of the Consolidated Appropriations Act (CAA), 2023, delayed the in-person visit requirements under Medicare for mental health visits that RHCs and FQHCs provide via telecommunications technology. For RHCs and FQHCs, we won’t require in-person visits until January 1, 2025.

CMS will allow for limited exceptions to the requirement for an in-person visit every 12 months based on patient circumstances in which the risks and burdens of an in-person visit may outweigh the benefit. These include, but aren’t limited to, when:

• An in-person visit is likely to cause disruption in service delivery or has the potential to worsen the patient’s condition
• The patient getting services is in partial or full remission and only needs maintenance level care
• The clinician’s professional judgment says that the patient is clinically stable and that an in-person visit has the risk of worsening the patient’s condition, creating undue hardship on self or family
• The patient is at risk of withdrawing from care that’s been effective in managing the illness

With proper documentation, the in-person visit requirement isn’t applicable for that 12-month period. You must document the circumstance in the patient’s medical record.

SOURCE: Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health Centers, MLN Matters SE22001, (May 23, 2023), (Accessed Jul. 2025).

Through September 30, 2025:

• Medicare patients can get non-behavioral and non-mental telehealth services in their home
• You can deliver non-behavioral and non-mental telehealth services using audio-only communication platforms

You may continue to bill for telehealth services using HCPCS code G2025. We’ll base the payment amount on the average amount for all Medicare telehealth services paid under the PFS, weighted by volume through December 31, 2025.

You may use 2-way, interactive, audio-only technology for any telehealth visits if the distant site provider is technically capable of using an audio-video telehealth system, but the patient isn’t capable of, or doesn’t consent to, using video technology. You don’t need any additional documentation except to append the FQ modifier on the claim.

We pay for mental health visits using telehealth in the same way as face-to-face services. The changes also allow you to use audio-only telehealth in cases where patients can’t, or don’t consent to, using audio-video telehealth. You can report and get paid in the same way as in-person visits.

SOURCE: Centers for Medicaid and Medicare Services, Medicare Learning Network Booklet 6397, Federally Qualified Health Centers, Apr. 2025, & MLN Booklet 6398, Rural Health Clinics, Apr. 2025, (Accessed Jul. 2025).

We may cover these behavioral health and wellness services:

• Depression screening through telehealth
• Digital mental health treatment (DMHT) devices provided “incident to” professional behavioral health services used along with ongoing treatment under a behavioral health treatment plan or therapy plan of care.
  • The billing practitioner must prescribe or order the DMHT device that’s been cleared under section 510(k) of the Food, Drug, and Cosmetics Act
  • The patient can use the DMHT device at home or in an outpatient setting, if that’s how FDA classified the device for use under 21 CFR 882.5801
• Telehealth, defined as 2-way, interactive, audio-video technology, to diagnose, evaluate, or treat certain mental health or SUDs if the patient is in their home. Practitioners must be able to provide 2-way, real-time, audio-video technology services but may use audio-only technology given an individual patient’s technological limitations, abilities, or preferences. We cover telehealth for behavioral and mental health on a permanent basis.

Starting October 1, 2025, in-person visit requirements will apply for mental health services provided by telehealth. This includes a required in-person visit within the 6 months before the initial telehealth treatment, as well as the required subsequent in-person visits at least every 12 months.

Telehealth also applies to mental health services provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). For RHCs and FQHCs, we don’t require the in-person visit for mental health services provided through telehealth to patients in their homes until January 1, 2026.

The regulations at 42 CFR 410.78(b)(3)(xiv) describe 2 exceptions to the in-person requirements that take effect on October 1, 2025:

1. Patients who already get telehealth behavioral health services and have circumstances where in-person care may not be appropriate
2. Groups with limited availability for in-person behavioral health visits have the flexibility to arrange for practitioners to provide in-person and telehealth visits with different practitioners, based on availability.

SOURCE: Centers for Medicare and Medicaid Services, Medicare Learning Network Booklet 1986542, Medicare & Mental Health Coverage, Apr. 2025, (Accessed Jul. 2025).

Supervision

CMS will continue to allow use of video to meet direct supervision requirements in specific cases:

…

• Continue to allow the current flexibility for federally qualified health centers (FQHCs) and Rural Health Clinics (RHCs) to use live video to meet the “immediately available” requirement for direct supervision to December 31, 2025.

SOURCE: Center for Medicare and Medicaid Services, CY 2025 Physician Fee Schedule, Final Rule, CMS 1807-F and 4201-F5, (Accessed Jul. 2025).

* The US Health and Human Services Administration maintains a website that summarizes information for Billing Medicare as a safety-net provider.

See: Federal Medicare Live Video

Store and Forward

General Care Management Services (which includes store-and-forward elements)  include: Chronic Care Management (CCM), Principal Care Management (PCM), Chronic Pain Management (CPM), General Behavioral Health Integration (BHI) services, Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Community Health Integration (CHI), Principal Illness Navigation (PIN), PIN Peer-Support (PIN-PS) and Advanced Primary Care
Management.  See manual for details.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, 4/21/25, pg. 56-69, (Accessed Jul. 2025).

Also see Virtual Communications section below.

See: Federal Medicare Store-and-forward

Remote Patient Monitoring

Services such as RPM are not separately billable because they are already included in the RHC AIR or FQHC PPS payment.

SOURCE: CY 2020 Final Physician Fee Schedule. CMS, p. 432, (Accessed Jul. 2025).

FQHCs can also be reimbursed for chronic care management, which can include elements of RPM.

SOURCE:  Centers for Medicare and Medicaid Services, Care Management in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), Frequently Asked Questions, Dec. 2019, (Accessed Jul. 2025).

General Care Management Services include: Chronic Care Management (CCM), Principal Care Management (PCM), Chronic Pain Management (CPM), General Behavioral Health Integration (BHI) services, Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Community Health Integration (CHI), Principal Illness Navigation (PIN), PIN Peer-Support (PIN-PS) and Advanced Primary Care
Management.  See manual for details.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, 4/21/25, pg. 56-69, (Accessed Jul. 2025).

CMS will include the CPT codes related to RPM and RTM in the general care management code HCPCS G0511 which will provide FQHCs/RHCs payment for RTM and RPM services. CMS noted that these services are similar to the nonface-to-face requirements for general care management services and reflect the additional resources needed to provide such services by an FQHC/RHC.

SOURCE: Center for Medicare and Medicaid Services, CY 2024 Physician Fee Schedule, Final Rule, CMS 1784-F, (Accessed Jul. 2025).

FQHCs/RHCs provide:

• Certain care coordination services like transitional care management (TCM), chronic care management (CCM), advanced primary care management (APCM), general behavioral health integration (BHI), principal care management (PCM), chronic pain management (CPM), psychiatric collaborative care model (CoCM) services, remote physiologic monitoring (RPM), remote therapeutic monitoring (RTM), community health integration (CHI), principal illness navigation (PIN), and PIN-Peer Support (PIN-PS).

SOURCE: Centers for Medicaid and Medicare Services, Medicare Learning Network Booklet 6397, Federally Qualified Health Centers, Apr. 2025, & MLN Booklet 6398, Rural Health Clinics, Mar. 2024, (Accessed Jul. 2025).

See: Federal Medicare Remote Patient Monitoring

Audio-Only

Temporary Policy – Ends Sept. 30, 2025

During the emergency period described in section 1320b–5(g)(1)(B) of this title and, in the case that such emergency period ends before December 31, 2024, during the period beginning on the first day after the end of such emergency period and ending on September 30, 2025—

• the Secretary shall pay for telehealth services that are furnished via a telecommunications system by a Federally qualified health center or a rural health clinic to an eligible telehealth individual enrolled under this part notwithstanding that the Federally qualified health center or rural clinic providing the telehealth service is not at the same location as the beneficiary;
• the amount of payment to a Federally qualified health center or rural health clinic that serves as a distant site for such a telehealth service shall be determined under subparagraph (B); and
• for purposes of this subsection—
  • the term “distant site” includes a Federally qualified health center or rural health clinic that furnishes a telehealth service to an eligible telehealth individual; and
  • the term “telehealth services” includes a rural health clinic service or Federally qualified health center service that is furnished using telehealth to the extent that payment codes corresponding to services identified by the Secretary under clause (i) or (ii) of paragraph (4)(F) are listed on the corresponding claim for such rural health clinic service or Federally qualified health center service.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Jul. 2025).

Mental Health Visit – Delayed to Oct. 1, 2025

A mental health visit is a medically-necessary face-to-face encounter between an RHC or FQHC patient and an RHC or FQHC practitioner during which time one or more RHC or FQHC mental health services are rendered. Effective January 1, 2022, a mental health visit is a face-to-face encounter or an encounter furnished using interactive, real-time, audio and video telecommunications technology or audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

Beginning January 1, 2026, there must be an in-person mental health service furnished within 6 months prior to the furnishing of the mental health service furnished via telecommunications and that an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reasons for this decision in the patient’s medical record.

RHCs and FQHCs are instructed to append modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) in instances where the mental health visit was furnished using audio-video communication technology and to append modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System) in cases where the service was furnished using audioonly communication.

Mental health services that qualify as stand-alone billable visits in an FQHC are listed on the FQHC center website, http://www.cms.gov/Center/Provider-Type/FederallyQualified-Health-Centers-FQHC- Center.html. Services furnished must be within the practitioner’s state scope of practice.

Medicare-covered mental health services furnished incident to an RHC or FQHC visit are included in the payment for a medically necessary mental health visit when an RHC or FQHC practitioner furnishes a mental health visit. Group mental health services do not meet the criteria for a one-one-one, face-to-face encounter in an FQHC or RHC.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, 4/21/25, pg. 42-43, (Accessed Jul. 2025).

We may cover these behavioral health and wellness services:

• Depression screening through telehealth
• Digital mental health treatment (DMHT) devices provided “incident to” professional behavioral health services used along with ongoing treatment under a behavioral health treatment plan or therapy plan of care.
  • The billing practitioner must prescribe or order the DMHT device that’s been cleared under section 510(k) of the Food, Drug, and Cosmetics Act
  • The patient can use the DMHT device at home or in an outpatient setting, if that’s how FDA classified the device for use under 21 CFR 882.5801
• Telehealth, defined as 2-way, interactive, audio-video technology, to diagnose, evaluate, or treat certain mental health or SUDs if the patient is in their home. Practitioners must be able to provide 2-way, real-time, audio-video technology services but may use audio-only technology given an individual patient’s technological limitations, abilities, or preferences. We cover telehealth for behavioral and mental health on a permanent basis.

Starting October 1, 2025, in-person visit requirements will apply for mental health services provided by telehealth. This includes a required in-person visit within the 6 months before the initial telehealth treatment, as well as the required subsequent in-person visits at least every 12 months.

Telehealth also applies to mental health services provided by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). For RHCs and FQHCs, we don’t require the in-person visit for mental health services provided through telehealth to patients in their homes until January 1, 2026.

The regulations at 42 CFR 410.78(b)(3)(xiv) describe 2 exceptions to the in-person requirements that take effect on October 1, 2025:

1. Patients who already get telehealth behavioral health services and have circumstances where in-person care may not be appropriate
2. Groups with limited availability for in-person behavioral health visits have the flexibility to arrange for practitioners to provide in-person and telehealth visits with different practitioners, based on availability.

The telehealth policies described above also apply to Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).

SOURCE: Centers for Medicare and Medicaid Services, Medicare Learning Network Booklet 1986542, Medicare & Mental Health Coverage, Apr. 2025, (Accessed Jul. 2025).

RHCs and FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. Use audio-only technology in situations when the patient can’t access or doesn’t consent to use audio-video technology. They can report and get paid in the same way as in-person visits.

Audio-only visits: Use new service-level modifier FQ or 93.

SOURCE: Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health Centers, MLN Matters SE22001, (May 23, 2023), (Accessed Jul. 2025).

Through September 30, 2025:

• Medicare patients can get non-behavioral and non-mental telehealth services in their home
• You can deliver non-behavioral and non-mental telehealth services using audio-only communication platforms

You may use 2-way, interactive, audio-only technology for any telehealth visits if the distant site provider is technically capable of using an audio-video telehealth system, but the patient isn’t capable of, or doesn’t consent to, using video technology. You don’t need any additional documentation except to append the FQ modifier on the claim.

We pay for mental health visits using telehealth in the same way as face-to-face services. The changes also allow you to use audio-only telehealth in cases where patients can’t, or don’t consent to, using audio-video telehealth. You can report and get paid in the same way as in-person visits.

Revenue code 0900, use FQ or 93 for audio only moidifiers.

SOURCE: Centers for Medicaid and Medicare Services, Medicare Learning Network Booklet 6397, Federally Qualified Health Centers, Jan. 2024, & MLN Booklet 6398, Rural Health Clinics, Mar. 2024, (Accessed Apr. 2025).

Mental health visit includes audio-only interaction in cases where beneficiaries are not capable of, or do not consent to, the use of devices that permit a two-way, audio/video interaction for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

RHCs and FQHCs can report and be paid for furnishing those visits in the same way they currently do when these services are furnished in-person. RHCs and FQHCs will be paid for mental health visits furnished via telecommunications technology at the same rate they are paid for in-person mental health visits (that is, the AIR or FQHC PPS).

There must be an in-person mental health service furnished within 6 months prior to the furnishing of the telecommunications service and that in general, there must be an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders.  This applies only to patients receiving services at home.  If the patient and practitioner consider the risks and burdens of an in-person service and agree that, on balance, these outweigh the benefits, and the practitioner documents the basis for that decision in the patient’s medical record, then the in-person visit requirement is not applicable for that 12-month period.

In person requirement delayed under Medicare until on or after January 1, 2025.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215 & delay in implementation in HR 2617 (2022 Session).  (Accessed Jul. 2025).

Virtual Communications

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes communication technology-based services (may include audio-only/telephone) to an RHC or FQHC patient. RHCs and FQHCs receive payment for communication technology-based services or remote evaluation services when an RHC or FQHC practitioner provides at least 5 minutes of communications-based technology or remote evaluation services to a patient who has been seen in the RHC or FQHC within the previous year.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, & Virtual Communication Services RHCs and FQHCs FAQs, December 2018, (Accessed Jul. 2025).

General Care Management Services include: Chronic Care Management (CCM), Principal Care Management (PCM), Chronic Pain Management (CPM), General Behavioral Health Integration (BHI) services, Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Community Health Integration (CHI), Principal Illness Navigation (PIN), PIN Peer-Support (PIN-PS) and Advanced Primary Care
Management.  See manual for details.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, 4/21/25, pg. 56-69, (Accessed Jul. 2025).

FQHCs provide:

• Virtual communication services like communication-based technology and remote evaluation services.

You can also provide virtual communication services, which you bill differently than telehealth.

Virtual communication services are services where a practitioner meets with a patient for at least 5 minutes to decide if the patient needs a visit. The 2 ways to provide virtual communication services are:

• Through communication-based technology
• With remote evaluation services

We pay for virtual communication services when an FQHC practitioner meets certain requirements, including the:

• Practitioner provides at least 5 minutes of billable FQHC virtual communications, either through communication-based technology or remote evaluation services
• Patient had at least 1 face-to-face billable visit within the previous year
• Virtual visit isn’t related to services provided within the last 7 days
• Virtual visit doesn’t lead to an in-person FQHC service within the next 24 hours or at the next appointment

When the virtual communication HCPCS code G0071 is on an FQHC claim alone or with other payable services, we require FQHCs to submit HCPCS code G2012 (communication technologybased services) or HCPCS code G2010 (remote evaluation services).

When an FQHC practitioner provides virtual communication services, they don’t need to meet face-to-face, so the coinsurance doesn’t apply.

See Virtual Communication Services FAQs for more information.

We require patient consent for all services, including non-face-to-face services. You may get patient consent at the same time you initially provide the services. We don’t require direct supervision to get consent. In general, auxiliary personnel under general supervision of the FQHC practitioner can get patient consent for these services.

SOURCE: Centers for Medicaid and Medicare Services, Medicare Learning Network Booklet 6397, Federally Qualified Health Centers, Apr. 2025, & MLN Booklet 6398, Rural Health Clinics, Apr. 2025, (Accessed Jul. 2025).

RHCs and FQHCs are not eligible for reimbursement of interprofessional consultation services, as only practitioners that can bill Medicare independently for evaluation and management services are eligible.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Jul. 2025).

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes these services to an RHC or FQHC patient. RHCs and FQHCs receive payment for communication technology-based services or remote evaluation services when an RHC or FQHC practitioner provides at least 5 minutes of communications-based technology or remote evaluation services to a patient who has been seen in the RHC or FQHC within the previous year.

RHCs and FQHCs may only bill for these services when the medical discussion or remote evaluation is for a condition not related to an RHC or FQHC service provided within the previous 7 days, and does not lead to an RHC or FQHC service within the next 24 hours or at the soonest available appointment, since in those situations, Medicare already pays for the services as part of the RHC or FQHC per-visit payment.

RHCs and FQHCs can bill G0511, G0512, and G0071 alone or with other payable services on an RHC or FQHC claim.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, (Accessed Jul. 2025)

What are “virtual communication services” for RHCs and FQHCs?

In the 2019 Physician Fee Schedule (PFS) Final Rule, CMS finalized a policy that, effective January 1, 2019, RHCs and FQHCs can receive payment for virtual communication services when at least 5 minutes of communication technology-based or remote evaluation services are furnished by an RHC or FQHC practitioner to a patient who has had an RHC or FQHC billable visit within the previous year, and both of the following requirements are met:

• The medical discussion or remote evaluation is for a condition not related to an RHC or FQHC service provided within the previous 7 days, and
• The medical discussion or remote evaluation does not lead to an RHC or FQHC visit within the next 24 hours or at the soonest available appointment.

See FAQ for more details.

SOURCE:  Virtual Communication Services RHCs and FQHCs FAQs, December 2018, (Accessed Jul. 2025).

See: Federal Medicare Email, Phone & Fax

Live Video

FQHC manual instructs providers to reference Physician manual. Physician manual outlines reimbursement for live video telemedicine.  See:  AL Medicaid Live Video

Store and Forward

Asynchronous is included in definition of telemedicine and telehealth but no further mention of it is made in telemedicine policy.

There is no reference found for store-and-forward for FQHCs.  See: AL Medicaid Store-and-Forward.

Remote Patient Monitoring

There is no reference found for RPM in Medicaid for FQHCs specifically.  See: AL Medicaid Remote Patient Monitoring

Audio-Only

Audio-only is reimbursed in AL Medicaid, per the AL Telemedicine policy with modifier FQ, however no explicit mention is made to whether or not FQHCs specifically can be reimbursed for the modality. See: AL Medicaid Email, Phone and Fax

Live Video

Submitting a claim for a telemedicine service is identical to the way a claim would be submitted for a face-to-face visit. Depending on the method of telemedicine used and the role of the provider in the consultation determines whether a modifier should be added to the procedure code. The role of the provider falls into three categories:

• Referring Provider: Evaluates a patient, determines the need for a consultation, and arranges services of a consulting provider for the purpose of diagnosis and treatment.
• Presenting Provider: Introduces a patient to the consulting provider during an interactive telemedicine session (may assist in the telemedicine consultation).
• Consulting Provider: Evaluates the patient and/or medical data/images using telemedicine mode of delivery upon recommendation of the referring provider.

NOTE: Manual is under review.

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Section II: Professional Claims Management [listed under FQHC tab], Feb. 6, 2020, pg. 20, (Accessed Jun. 2025).

The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including: …

• services provided by a rural health clinic or a federally qualified health center

SOURCE: AK Statute Sec. 47.07.069, (Accessed Jun. 2025).

Will my facility be able to continue to provide telemedicine (video-audio synchronous) and telephonic (audio-only) behavioral health services as a Tribal FQHC?

Refer to the most current guidance document on telehealth: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Updates/20230919_Telehealth_FAQs.pdf.

Telehealth Services. Will my facility be able to provide telemedicine (video-audio synchronous), telephonic (audio-only), and store and forward telehealth services and be reimbursed for those services as a Tribal FQHC?

Yes, telehealth services regulations were effective 9/1/2023. Refer to the most current guidance on telehealth services: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Sites/Telehealth.html

Can a Tribal FQHC provide services off-site after February 11, 2025?

Yes, please refer to telehealth regulations that were effective 9/1/2023 https://aws.state.ak.us/OnlinePublicNotices/Notices/Attachment.aspx?id=142671

SOURCE: AK Medicaid, FAQs on Tribal FQHCs, 2/12/24, (Accessed Jun. 2025).

Store and Forward

A consulting provider may send data he/she has received during a store-and-forward telemedicine consultation to another consulting provider (with equal or greater scope of practice as determined by his/her occupational license or level of expertise within their field of specialty).

SOURCE: AK Dept. of Health and Social Svcs. Billing for Telemedicine Services. Section II: Professional Claims Management [listed under FQHC tab], Feb. 6, 2020, pg. 20, (Accessed Jun. 2025).

The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including: …

• services provided by a rural health clinic or a federally qualified health center.

• services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio;

SOURCE: AK Statute Sec. 47.07.069, (Accessed Jun. 2025).

Patient Initiated Evaluation and Management Services

Patient initiated evaluation and management services (telephone or online digital) are covered when performed by advanced practice registered nurses (APRNs), audiologists, Community Health Aides (CHAs), direct entry midwives (DEMs), optometrists, physicians, physician assistants, and podiatrists. Federally Qualified Health Centers (FQHCs) and Rural Health Clinic (RHCs) are reimbursed at the facilities encounter rate for services provided by a rendering provider listed here.

See fee schedule for codes.

Patient Initiated Assessment and Management Services

Patient initiated assessment and management services are covered when performed by behavioral health aides (BHAs) under the direction of a physician, psychologists, and school districts enrolled as a school-based service provider. Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may be reimbursed at the facilities encounter rate for services provided by licensed clinical social workers (LCSWs), marital and family therapists, professional counselors, and psychologists.

See fee schedule for codes.

SOURCE: Alaska Medicaid, Telehealth Services: Temporary Fee Schedule, Effective 4/30/25, (Accessed Jun. 2025).

What provider types are authorized to bill for patient initiated online digital services?

CPT Codes 98970-98972: Covered for behavioral health aides under the direction of a physician, psychologists, and school districts enrolled as a school-based services provider. Federally Qualified Health Centers and Rural Health Centers may be reimbursed at their encounter rate for services provided by licensed clinical social workers, marital and family therapists, professional counselors, and psychologists.

CPT Codes 99421-99423: Covered for advanced practice registered nurses, audiologists, Community Health Aides, direct entry midwives, optometrists, physicians, physician assistants, and podiatrists. Federally Qualified Health Centers and Rural Health Clinic may be reimbursed at the facility’s encounter rate for services provided by a rendering providers listed here.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Jun. 2025).

Telehealth Services. Will my facility be able to provide telemedicine (video-audio synchronous), telephonic (audio-only), and store and forward telehealth services and be reimbursed for those services as a Tribal FQHC?

Yes, telehealth services regulations were effective 9/1/2023. Refer to the most current guidance on telehealth services: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Sites/Telehealth.html

SOURCE: AK Medicaid, FAQs on Tribal FQHCs, 2/12/24, (Accessed Jun. 2025).

Remote Patient Monitoring

No reference found.

Audio-Only

The department shall pay for all services covered by the medical assistance program provided through telehealth if the department pays for those services when provided in person, including: …

• services provided by a rural health clinic or a federally qualified health center.

• services provided through audio, visual, or data communications, alone or in any combination, or through communications over the Internet or by telephone, including a telephone that is not part of a dedicated audio conference system, electronic mail, text message, or two-way radio;

SOURCE: AK Statute Sec. 47.07.069, (Accessed Jun. 2025).

Patient Initiated Evaluation and Management Services

Patient initiated evaluation and management services (telephone or online digital) are covered when performed by advanced practice registered nurses (APRNs), audiologists, Community Health Aides (CHAs), direct entry midwives (DEMs), optometrists, physicians, physician assistants, and podiatrists. Federally Qualified Health Centers (FQHCs) and Rural Health Clinic (RHCs) are reimbursed at the facilities encounter rate for services provided by a rendering provider listed here.

See fee schedule for codes.

Patient Initiated Assessment and Management Services

Patient initiated assessment and management services are covered when performed by behavioral health aides (BHAs) under the direction of a physician, psychologists, and school districts enrolled as a school-based service provider. Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) may be reimbursed at the facilities encounter rate for services provided by licensed clinical social workers (LCSWs), marital and family therapists, professional counselors, and psychologists.

See fee schedule for codes.

SOURCE: Alaska Medicaid, Telehealth Services: Temporary Fee Schedule, Effective 4/30/25, (Accessed Jun. 2025).

What provider types are authorized to bill for patient-initiated telephone services?

CPT Codes 98966-98968: Covered for behavioral health aides under the direction of a physician, psychologists, and school districts enrolled as a school-based services provider. Federally Qualified Health Centers and Rural Health Centers may be reimbursed at their encounter rate for services provided by licensed clinical social workers, marital and family therapists, professional counselors, and psychologists.

CPT Codes 99441-99443: Covered for advanced practice registered nurses, audiologists, Community Health Aides, direct entry midwives, optometrists, physicians, physician assistants, and podiatrists. Federally Qualified Health Centers and Rural Health Clinic may be reimbursed at the facility’s encounter rate for services provided by a rendering providers listed here.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023), (Accessed Jun. 2025).

Will my facility be able to continue to provide telemedicine (video-audio synchronous) and telephonic (audio-only) behavioral health services as a Tribal FQHC?

Refer to the most current guidance document on telehealth: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Updates/20230919_Telehealth_FAQs.pdf.

Telehealth Services. Will my facility be able to provide telemedicine (video-audio synchronous), telephonic (audio-only), and store and forward telehealth services and be reimbursed for those services as a Tribal FQHC?

Yes, telehealth services regulations were effective 9/1/2023. Refer to the most current guidance on telehealth services: https://extranetsp.dhss.alaska.gov/hcs/medicaidalaska/Provider/Sites/Telehealth.html

SOURCE: AK Medicaid, FAQs on Tribal FQHCs, 2/12/24, (Accessed Jun. 2025).

Audio-Only

Manual specifies that telehealth and telemedicine may qualify as an FQHC/RHC visit if it meets the requirements of the Telehealth and Telemedicine AMPM Manual 320-I.  Reimbursement is provided for audio-only coverage for certain codes in manual section 320-I.  See: AZ Medicaid Email, Phone and Fax.  However, because it is not face-to-face and doesn’t meet the definition of a FQHC visit, it is unclear whether or not this is reimbursable.

Live Video

To comply with CMS mandate, telehealth visits are to be paid the same as a face-to-face encounter visit for FQHC providers. The following procedure codes have had the rates updated to match their encounter rate: G2025

SOURCE: AR Department of Human Services, FQHC Provider Rate for G2025, Sept. 15, 2023, (Accessed May 2025).

FQHC Manual refers providers to Telemedicine policy manual for encounters.  AR Medicaid covers live video telemedicine in some circumstances.

See:  AR Medicaid Live Video

Store and Forward

FQHC Manual refers providers to Telemedicine policy manual for encounters.  No information regarding store-and-forward reimbursement is found in the telemedicine policy section beyond a definition.

See: AR Medicaid Store-and-Forward.

Remote Patient Monitoring  

FQHC Manual refers providers to Telemedicine policy manual for encounters.  No information regarding remote patient monitoring reimbursement is found in the telemedicine policy section beyond a definition.

See: AR Medicaid Remote Patient Monitoring

Audio-Only

FQHC Manual refers providers to Telemedicine policy manual for encounters.  Audio-only is allowed only in certain circumstances in telemedicine policy section.  No direct reference to whether or not an FQHC can use the modality is provided.

See: AR Medicaid Email, Phone and Fax

Live Video

Synchronous interaction means a real-time audio-visual, two-way interaction between a new or established patient and an FQHC or RHC billable provider at a distant site.

Medi-Cal benefits or services being provided are clinically appropriate and meet the procedural and billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter.

An FQHC patient who receives telehealth services shall otherwise be eligible to receive in-person services from the FQHC pursuant to the federal Health Resources Services Administration requirements.

A patient may be “established” via synchronous interaction if all of the conditions of the “New Patient” requirements in this manual section are met.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Manual. Mar. 2024. Pg. 16. (Accessed May 2025).

A visit shall also include an encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, certified nurse-midwife, clinical psychologist, licensed clinical social worker, visiting nurse, comprehensive perinatal services program practitioner, dental hygienist, dental hygienist in alternative practice, or marriage and family therapist using video synchronous interaction, when services delivered through that interaction meet the applicable standard of care.

SOURCE: WIC 14132.100. (Accessed May 2025).

In regard to patient choice of telehealth modality and right to in-person services requirements, FQHC/RHC providers are directed to refer to the policies found in more detail in the Telehealth Manual.

SOURCE: CA Dept. of Health Care Services, Part 2 Manual, Medi-Cal Rural Health Clinics and Federally Qualified Health Centers (Mar. 2024), p. 15.  (Accessed May 2025).

See: CA Medicaid Live Video

Store and Forward

Asynchronous store and forward means the transmission of a patient’s medical information from an originating site to the billable provider at a distant site.

Medi-Cal benefits or services being provided are clinically appropriate and meet the procedural and billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter.

A patient may be “established” on an asynchronous store and forward service, if all of the conditions of the “New Patient” requirements in this manual section are met.

Only one visit or store and forward service may be billed at the PPS rate when there is a service payment contract with a non-FQHC/RHC, contractor, or another FQHC or RHC. Conversely, the non-FQHC/RHC or contractor may request fee-for-service reimbursement for a visit or store and forward service directly from the appropriate managed care plan or the Medi-Cal Fiscal Intermediary if no service payment contract exists with the FQHC or RHC.

An e-consult, e-visit, or remote patient monitoring is not a reimbursable telehealth service for FQHCs or RHCs.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Manual. Mar. 2024 Pg. 15-17. (Accessed May 2025).

A visit shall also include an encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, certified nurse-midwife, clinical psychologist, licensed clinical social worker, visiting nurse, comprehensive perinatal services program practitioner, dental hygienist, dental hygienist in alternative practice, or marriage and family therapist using an asynchronous store and forward modality, when services delivered through that modality meet the applicable standard of care.

SOURCE: WIC 14132.100. (Accessed May 2025).

See: CA Medicaid Store and Forward

Remote Patient Monitoring

An e-consult, e-visit, or remote patient monitoring is not a reimbursable telehealth service for FQHCs or RHCs.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Mar. 2024. Pg. 15. (Accessed May 2025).

See: CA Medicaid RPM

Audio-Only

An audio-only synchronous interaction is eligible for reimbursement if provided by a billable provider and FQHC or RHC patient.

Medi-Cal benefits or services being provided are clinically appropriate and meet the procedural and billing requirements that would have applied if the applicable services were delivered via a face-to-face encounter.

A patient may not be “established” using an audio-only synchronous interaction unless the visit is related to a “sensitive service”, as defined in the California Civil Code, section 56.05, subdivision (n), or if the patient requests “audio only” or does not have access to video.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Mar. 2024. Pg. 16. (Accessed May 2025).

A visit shall also include an encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, certified nurse-midwife, clinical psychologist, licensed clinical social worker, visiting nurse, comprehensive perinatal services program practitioner, dental hygienist, dental hygienist in alternative practice, or marriage and family therapist using audio-only synchronous interaction, when services delivered through that modality meet the applicable standard of care.

SOURCE: WIC 14132.100. (Accessed May 2025).

In regard to patient choice of telehealth modality and right to in-person services requirements, FQHC/RHC providers are directed to refer to the policies found in more detail in the Telehealth Manual.

SOURCE: CA Dept. of Health Care Services, Part 2 Manual, Medi-Cal Rural Health Clinics and Federally Qualified Health Centers (Mar. 2024), p. 15. (Accessed May 2025).

See: CA Medicaid Email, Phone, & Fax

Live Video

Telemedicine may be provided through interactive audio, interactive video, or interactive data communication, including but not limited to telephone, relay calls, interactive audiovisual modalities, and live chat, as long as the technologies are compliant with the federal “Health Insurance Portability and Accountability Act of 1996”, Pub.L. 104-191, as amended. The health-care or mental health-care services are subject to reimbursement policies developed pursuant to the medical assistance program. A telemedicine service meets the definition of a face-to-face encounter for a rural health clinic, Indian health service, or federally qualified health center.

See: CO Medicaid Live Video

Health First Colorado allows telemedicine visits to qualify as billable encounters for Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs), and Indian Health Services (IHS). Services allowed under telemedicine may be provided via telephone, live chat, or interactive audiovisual modality for these provider types.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/25, (Accessed Jun. 2025).

Store and Forward

The member typically must be present during any Telemedicine visit, limiting ability to use store-and-forward modalities.

See: CO Medicaid Store-and-Forward

Health First Colorado only allows reimbursement for a visit, which is a face-to-face encounter between a Health First Colorado member and a provider listed at 10 CCR 2505-10 sections 8.700.6 and 8.700.1. A direct visualization by a physician without the member present is not billable as an encounter.  For the technical component of an imaging service, when free standing FQHCs own the equipment, the costs are accounted for in the Prospective Payment System (PPS) rate and the technical component is not billable. When free standing FQHCs order imaging from another provider, the technical component services are billed by the rendering provider. For hospital based FQHCs, the costs of imaging and labs are removed from the cost report when determining the encounter rate. Since the costs are removed from the cost report, the technical component of imaging may be billed separately to Health First Colorado by the hospital.

SOURCE: CO Dep. of Health Care Policy and Financing, FQHC/RHC Services, Last revised 4/15/25, (Accessed Jun. 2025).

eConsult dialogues between Treating Practitioners and Consulting Practitioners do not meet the definition of an FQHC or RHC visit as defined in CCR 8.700. Costs associated with performing eConsults through an FQHC/RHC are considered allowable costs for the cost report and will be included in the calculation of the reimbursement rate for a patient visit at an FQHC/RHC.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 5/25, (Accessed Jun. 2025).

eConsult visits between primary care providers and specialty providers do not meet the definition of an FQHC or RHC visit as defined in 10 C.C.R. 2505-10 8.700. Costs associated with services provided through eConsult visits through an FQHC/RHC are considered allowable costs for the cost report and will be included in the calculation of the reimbursement rate for a patient visit at an FQHC/RHC.

SOURCE:  CO Department of Health Care Policy and Financing, FQHC/RHC Billing Manual (4/25). (Accessed Jun. 2025).

Remote Patient Monitoring

Health First Colorado only allows RPM coverage in limited circumstances.

See: CO Medicaid RPM

For FQHCs/RHCs, a direct visualization by a physician without the member present is not billable as an encounter. For the technical component of an imaging service, when free standing FQHCs own the equipment, the costs are accounted for in the Prospective Payment System (PPS) rate and the technical component is not billable. When free standing FQHCs order imaging from another provider, the technical component services are billed by the rendering provider.

SOURCE: CO Dep. of Health Care Policy and Financing, FQHC/RHC Services, Last revised 4/15/25, (Accessed Jun. 2025).

Audio-Only

Any health benefits provided through interactive audio (including but not limited to telephone and relay calls), interactive video (including but not limited to interactive audiovisual modalities), or interactive data communication (including but not limited to live chat and excluding text messaging, electronic mail, and facsimile transmission) must meet the same standard of care as in-person care in accordance with Section 8.095.

SOURCE: Colorado Adopted Rule 8.700.1. (Accessed Jun. 2025).

Health First Colorado allows telemedicine visits to qualify as billable encounters for Federally Qualified Health Centers (FQHCs), Rural Health Clinic (RHCs), and Indian Health Services (IHS). Services allowed under telemedicine may be provided via telephone, live chat, or interactive audiovisual modality for these provider types.

SOURCE: CO Department of Health Care Policy and Financing. “Telemedicine Billing Manual” 5/25. (Accessed Jun. 2025).

See: CO Medicaid Email, Phone and Fax

Live Video

CT Medicaid covers specified synchronized telemedicine, which is defined as an audio and video telecommunication system with real-time communication between the patient and practitioner.

See: CT Medicaid Live Video

Store and Forward

CT Medicaid doesn’t have explicit coverage of store-and-forward services, though it recently began covering e-consult services. However, separate reimbursement from the encounter received for e-consults is not permitted for FQHCs. E-consults that are performed in the FQHC setting are reimbursed as part of the overall encounter for the date of service. Case management or follow-up services to an econsult performed by FQHCs will be considered part of the initial visit and no additional payments will be made to the FQHCs for this follow-up care rendered on the same date of service.

See: CT Medicaid Store-and-forward

Remote Patient Monitoring

CT Medicaid doesn’t cover RPM.

See: CT Medicaid RPM

Audio-Only

No explicit reimbursement of telephone for FQHCs.

See: CT Medicaid Email, Phone, & Fax

Live Video

Generally, DE Medicaid reimburses for live video telemedicine services.

See: DE Medicaid Live Video.

Store and Forward

DE Medicaid recently began covering certain store-and-forward services, however, FQHCs are not explicitly referenced.

See: DE Medicaid Store-and-Forward.

Remote Patient Monitoring

DE Medicaid recently began covering certain RPM services, however, FQHCs are not explicitly referenced.

See: DE Medicaid RPM.

Audio-Only

Telephone Services – services by means of a telephone call between a physician and a patient (including those in which the physician provides advice or instructions to or on behalf of the patient) are covered services that are included in the payment made to the FQHC and should not be billed as an encounter.

SOURCE: DE FQHC Policy Manual, 7/1/23, p. 6. (Accessed May 2025).

Live Video

FQHCs are allowed to use live video telehealth.

See: DC Medicaid Live Video

Store and Forward

DC Medicaid does not cover store-and-forward.

See: DC Medicaid Store-and-Forward

Remote Patient Monitoring

DC Medicaid does not cover RPM.

See: DC Medicaid RPM

Audio-Only

DC Medicaid recently began covering audio-only, but there is no explicit mention for FQHCs.

See: DC Medicaid Email, Phone, & Fax

Live Video

No explicit reference to telehealth for FQHCs/RHCs.

Generally, FL Medicaid reimburses for real time, two-way, interactive telemedicine.

See: FL Medicaid Live Video

Store and Forward

A Medicaid notice indicates store-and-forward is covered, however no explicit reference is made for FQHCs.

See: FL Medicaid Store-and-Forward.

Remote Patient Monitoring

A Medicaid notice indicates remote patient monitoring is covered, however no explicit reference is made for FQHCs.

See: FL Medicaid RPM

Audio-Only

No reimbursement for telephone, chart review, e-mail or fax.

See: FL Medicaid Email, Phone, & Fax

Live Video

FQHCs may serve as distant site providers and bill the cost of the visit. They are referred to the GA Medicaid Telehealth Manual.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance p. 17. (Apr. 1, 2025), Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 27. (Apr. 1, 2025). (Accessed Jun 2025).

Store and Forward

There is no reference found for store-and-forward explicitly for FQHCs although store and forward is allowed under general GA Medicaid policy for teledentistry.

SOURCE:  Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 17 (Apr. 1, 2025). (Accessed Jun. 2025).

Remote Patient Monitoring

No reference found.

Audio-Only

No reimbursement for telephone, fax or email.

SOURCE: Georgia Department of Community Health, Division of Medicaid, Telehealth Guidance, p. 9-10 (Apr. 1, 2025). (Accessed Jun 2025).

Except for services that meet the criteria for a TCM visit, telephone or electronic communication between a physician and a patient, or between a physician and someone on behalf of a patient, are considered physicians’ services and are included in an otherwise billable visit. They do not constitute a separately billable visit.

SOURCE: Georgia Department of Community Health, Division of Medicaid, Federally Qualified Health Center Services and Rural Health Clinic Services, p. 21. (Apr. 1, 2025) (Accessed Jun 2025).

Live Video

FQHCs may provide services via telehealth. Hawaii Medicaid refers FQHCs to the telehealth memo (MedQUEST Memo QI-2139/FFS 21-15) for the program regarding eligible codes.

SOURCE: HI Medicaid Provider Manual (FQHC) (March 2016), p. 8-9. (Accessed Jun. 2025).

Until December 31, 2024, FQHC behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories.

• If the FQHC behavioral health provider does not have the capacity to provide in-person services, they must inform the patient that: the patient has the right to receive in-person services if they prefer; they (the provider) are incapable of providing in-person services; and they (the provider) must inform the patient that their QI MCO can assist with finding a provider who can provide in-person services.
• If prescribing controlled substances, the provider must be located in the State of Hawai’i.

FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap-around non-billable services, and this may mean delivering care to the patient’s location as one way to ensure services are received. Wrap-around non-billable services may or may not occur on the same day as services provided through telehealth modality and the eligible FQHC provider delivering services through the telehealth modality must provide clear instructions to the patient on how and when the wrap-around non-billable services will be provided. Wrap-around non-billable services must be documented in the patient’s medical record.

See Memo QI-2338/FFS 23-22/CCS-2311 for codes.

SOURCE: HI Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Jun. 2025).

Dentistry

Clinics that qualify for FQHC Prospective Payment System (PPS) reimbursement may submit telehealth claims using PPS reimbursement, as long as both the patient and dentist were each physically located at separate eligible FQHC/RHC sites during the encounter and the diagnosis. (Form 5b service sites registered with Med-QUEST as a Medicaid location and issued a HRSA Notice of Award identifying the specific service location address). Refer to Provider Memo QI-2338/ FFS 23-22. The first lines of these claims should be D9999 or D0140.

Claims for patients that were located at “public health settings” not federally registered as a FQHC or RHC service site are not eligible for PPS reimbursement.

SOURCE: HI Med-QUEST Medicaid Provider Manual Dental Benefits (May 2025), p. 40.  (Accessed Jun. 2025).

Store and Forward

Telemedicine-based retinal imaging and interpretation is not a covered service for PPS reimbursement. It should be billed with the code and modifier 92014 SE and billed on the CMS 1500 form or electronically in CMS 1500 format. A face-to-face encounter with a member by an ophthalmologist or optometrist is eligible for PPS reimbursement, regardless of whether retinal imaging or interpretation is a component of the services provided.

SOURCE: HI Medicaid Provider Manual (FQHC) (March 2016), p. 4. (Accessed Jun. 2025).

Remote Patient Monitoring

No reference for FQHCs found.

Audio-Only

In the latest Med-QUEST memo, FQHCs are mentioned in the Audio-Only policy section:

FQHCs must ensure the provision of relevant wrap-around non-billable services. Efforts shall be made to ensure that patients receive relevant wrap-around non-billable services, and this may mean delivering care to the patient’s location as one way to ensure services are received. Wrap-around non-billable services may or may not occur on the same day as services provided through telehealth modality and the eligible FQHC provider delivering services through the telehealth modality must provide clear instructions to the patient on how and when the wrap-around non-billable services will be provided. Wrap-around non-billable services must be documented in the patient’s medical record.

See Memo QI-2338/FFS 23-22/CCS-2311 for codes.

SOURCE: HI Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311.  (Accessed Jun. 2025).

Live Video

Virtual care services provided as an encounter by a facility are reimbursable if the services are delivered in accordance with the Virtual Care Services section of the General Information and Requirements for Providers, Idaho Medicaid Provider Handbook.

SOURCE: ID Medicaid Provider Handbook: IHS, FQHC, and RHC Services (Apr. 17, 2025 )., p. 33.  (Accessed Jun 2025).

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 will now accept places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers should use these places of service on claims for virtual care going forward. 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.

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: General Information and Requirements for Providers (May 9, 2025),9.13.3 p. 145.  MedicAide May 2023.  (Accessed Jun 2025).

Store and Forward

Idaho Medicaid does not reimburse for Store and Forward. See ID Medicaid Store and Forward. No specific mention of FQHCs.

Remote Patient Monitoring

Idaho Medicaid reimburses for RPM.  See ID Medicaid RPM. No specific mention of FQHCs.

Audio-Only

Idaho Medicaid will now accept places of service 02 (Telehealth provided other than in patient’s home) and 10 (Telehealth provided in patient’s home). Providers should use these places of service on claims from virtual care going forward. 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.

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: General Information and Requirements for Providers (May 9 2025), 9.13.3 p. 145.  MedicAide May 2023.  (Accessed Jun 2025).

Live Video

The Department of Healthcare and Family Services shall reimburse psychiatrists, federally qualified health centers as defined in Section 1905(l)(2)(B) of the federal Social Security Act, clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing, and mental health professionals and clinicians authorized by Illinois law to provide behavioral health services to recipients via telehealth.  The Department shall reimburse epilepsy specialists, as defined by the Department by rule, who are authorized by Illinois law to provide epilepsy treatment services to persons with epilepsy or related disorders via telehealth. The Department, by rule, shall establish: (i) criteria for such services to be reimbursed, including appropriate facilities and equipment to be used at both sites and requirements for a physician or other licensed health care professional to be present at the site where the patient is located; however, the Department shall not require that a physician or other licensed health care professional be physically present in the same room as the patient for the entire time during which the patient is receiving telehealth services; and (ii) a method to reimburse providers for mental health services provided by telehealth.

SOURCE: 305 ILCS 5/5-5.25. (Accessed Jun 2025).

An encounter clinic serving as the distant site shall be reimbursed as follows:

• If the originating site is another encounter clinic, the distant site encounter clinic shall receive no reimbursement from the Department.  The originating site encounter clinic is responsible for reimbursement to the distant site encounter clinic; and
• If the originating site is not an encounter clinic, the distant site encounter clinic shall be reimbursed for its medical encounter.  The originating site provider will receive a facility fee.

See Encounter Clinic Services Appendices supplement for telehealth billing examples for encounter clinics.

SOURCE: IL Admin. Code Title 89, 140.403; IL Dept. of Healthcare and Family Svcs., Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010; Handbook for Encounter Clinic Services. Ch. 200, pg. 17.  Aug. 2016 & IL All Providers Handbook Supplement (Sept. 2020), pg. 43-45. Encounter Clinic Services – Appendices. (Accessed Jun 2025).

Store and Forward

No explicit reference to FQHCs.

Remote Patient Monitoring

No explicit reference to FQHCs.

Audio-Only

Modifier 93 is a new modifier used to identify services that are provided via telephone or other real-time interactive audio-only telecommunication systems. It does not replace modifier GT, which should continue to be used to identify telehealth interactions using both audio and video telecommunications systems. When using modifier 93, the communication during the audio-only service must be of an amount or nature that meets the same key components and/or requirements of a face-to-face interaction. Modifier 93 is effective with dates of service beginning July 1, 2022.

SOURCE: IL Dept. of Healthcare and Family Services, Provider Notice 03/21/2022, Delay in Implementation of Modifier 93 and Place of Service 10 Implementation July 1, 2022. (Accessed Jun 2025).

Exception made during public health emergency:

Notwithstanding the restriction on services provided via phone in Section 140.6(m) and this Section, brief communication technology-based service, e.g. virtual check-in that uses audio-only real-time telephone interactions or synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission. Virtual check-ins must be rendered by a physician, advanced practice registered nurse, physician assistant, or other qualified health-care professional who can report evaluation and management (E/M) services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. The Department will reimburse for this service at the rate established on the Department’s fee schedule. Federally Qualified Health Centers, Rural Health Clinics, and Encounter Rate Clinics may also receive reimbursement for this service at the rate established on the Department’s fee schedule.

SOURCE: IL Admin. Code Title 89, 140.403(e)(1)(A) (Accessed Jun 2025).

Live Video

Special billing considerations apply for federally qualified health center (FQHC) and rural health clinic (RHC) providers. FQHC and RHC providers may bill for telehealth services if the service rendered is considered a valid FQHC or RHC encounter (as defined in the Federally Qualified Health Centers and Rural Health Clinics module) and a covered telehealth service (as defined by the Telehealth and Virtual Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers). Subject to the following criteria, reimbursement is available to FQHCs and RHCS when they are serving as either the distant site or the originating site for telehealth services. See manual for additional details.

Updated Code Set as of July 1, 2025

SOURCE: Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Oct. 30, 2024), p. 6.  (Accessed Jul 2025).

Effective July 28, 2025, the Indiana Health Coverage Programs (IHCP) will include the Current Procedural Terminology (CPT®1) codes and Current Dental Terminology (CDT®2) code in Table 1 as valid encounter codes for federally qualified health center (FQHC) and rural health clinic (RHC) claims. This update applies retroactively to claims with dates of service (DOS) on or after Jan. 1, 2025.

SOURCE: IHCP Bulletin IHCP Updates FQHC and RHC Encounter Codes BT 202593 (June 26, 2025).  (Accessed Jul. 2025).

FQHCs may provide services via live video if it is a valid encounter and covered service.  IN Medicaid reimburses a specific code list if service is provided via telehealth.  See Bulletin for code list.

SOURCE: IHCP Bulletin 202239 (May 19, 2022), p. 3. Indiana Health Coverage Programs, Federally Qualified Health Centers and Rural Health Clinics, p 6, (May 7, 2024). (Accessed Jul 2025).

The Indiana Health Coverage Programs (IHCP) published IHCP Banner Page BR202152 introducing the addition of place of service (POS) code 10. The Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) is clarifying that the IHCP will allow the use of POS code 10 for federally qualified healthcare centers (FQHCs) and rural health clinics (RHCs) for dates of service (DOS) on or after July 21, 2022. Any FQHC or RHC claims with DOS before July 21, 2022, will deny if the POS 10 is present on the claim. Please correct these claims using the appropriate POS 02 and resubmit. The definitions for the telehealth POS codes changed on Jan. 1, 2022:

• POS 02 – Telehealth provided other than in patient’s home
• POS 10 – Telehealth provided in patient’s home

As posted in IHCP Bulletin BT202239, the following modifiers are used on telehealth claims:

• Modifier 95 – Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system
• Modifier 93 – Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system

SOURCE: IHCP Allows New POS Code for FQHCs and RHCs July 21 BT 202253 (July 14, 2022).  (Accessed Jul 2025).

Store and Forward

Store and Forward is not reimbursed by IN Medicaid.

Remote Patient Monitoring

FQHCs are not explicitly mentioned as being eligible to provide remote patient monitoring services.

Audio-Only

FQHCs may provide some services via audio-only, see CPT code list for specific services allowed.

SOURCE: IHCP Bulletin 202239 (May 19, 2022), p. 3. (Accessed Jul 2025).

See: IA Medicaid Email, Phone and Fax

Live Video

Telemedicine – Note: Refer to Section 2720 of the General Benefits Fee-for-Service Provider Manual for complete details regarding Telemedicine.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, FQHC/RHC, 8-14 (4/25), (Accessed Jun 2025).

See: KS Medicaid Live Video

Store and Forward

The member must be present at the originating site, excluding store-and-forward modality.

See: KS Medicaid Store and Forward

Remote Patient Monitoring

Not mentioned in FQHC manual, although reimbursed in other KS Medicaid programs.

See: KS Medicaid Remote Patient Monitoring

Audio-Only

Not mentioned in FQHC manual, although reimbursed in other KS Medicaid programs.

See: KS Medicaid Email, Phone and Fax

Live Video

The department must reimburse an eligible telehealth care provider for a telehealth service in an amount that is at least 100 percent of the amount for a comparable in-person service. A managed care plan may establish a different rate for telehealth reimbursement via contract.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Jun. 2025).

A request for reimbursement shall not be denied solely because:

• An in-person consultation between a Medicaid-participating practitioner and a patient did not occur; or
• A Medicaid-participating provider employed by a rural health clinic, federally qualified health center, or federally qualified health center look-alike was not physically located on the premises of the clinic or health center when the telehealth service or telehealth consultation was provided.

SOURCE: KY Revised Statute Sec. 205.559. (Accessed Jun. 2025).

See: KY Medicaid Live Video

Store and Forward

KY Medicaid reimburses for store-and-forward, however it’s not explicitly stated whether or not FQHCs qualify for reimbursement.

See: KY Medicaid Store and Forward

Remote Patient Monitoring

Providers who may provide remote patient monitoring services include:

• A federally qualified health center

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Jun. 2025).

See: KY Medicaid Remote Patient Monitoring

Audio-Only

The definition for telehealth or digital health includes audio-only encounters, and Medicaid has added reimbursement for telephonic services but does not explicitly state FQHCs are eligible.  

See: KY Medicaid Audio-Only

Live Video

If a covered service is provided via an interactive audio and video telecommunications system (telemedicine), providers must refer to Chapter 5 of the Professional Services Provider Manual on www.lamedicaid.com for specific billing instructions.

SOURCE: LA Dept. of Health, Federally Qualified Health Centers Provider Manual, Chapter 22, Sec. 22.4, pg. 33, (As issued on 6/30/22) (Accessed Jun. 2025).

LA Medicaid reimburses for service codes that are appropriate for telemedicine/telehealth via live video, including for FQHCs.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Jun. 2025).

See: LA Medicaid Live Video

Store and Forward

Store-and-forward is not included in definition of telemedicine for LA Medicaid.  See: LA Medicaid Store and Forward

Remote Patient Monitoring

LA Medicaid provides reimbursement for ‘telecare’ which includes remote monitoring activities in the Community Choice Waiver program. However, there is no reference to whether or not FQHCs could be reimbursed for RPM.  See: LA Medicaid Remote Patient Monitoring

Audio-Only

Rural health clinics (RHC) and federally qualified health clinics (FQHC) are required to indicate the appropriate place of service, either 02 (other than home) or 10 (home), based on the beneficiary’s location at the time of and append modifier 95 for the billing of telemedicine/telehealth services. Services delivered via an audio/video system and via an audio-only system are to be coded the same way.

SOURCE: LA Dept. of Health, Informational Bulletin 20-1. (May 20, 2022). (Accessed Jun. 2025).

See: LA Medicaid Email, Phone and Fax

Live Video

FQHCs are paid both as a provider site and originating site fee, if approved.

See: ME Medicaid Live Video

Store and Forward

Although ME Medicaid reimburses for two types of store-and-forward, FQHCs are not explicitly mentioned leaving it unclear if they would be eligible for such services.

See: ME Medicaid Store-and-Forward

Remote Patient Monitoring

Although ME Medicaid reimburses for telemonitoring in some situations, FQHCs are not explicitly mentioned leaving it unclear if they would be eligible for such services.

See: ME Medicaid Remote Patient Monitoring

Audio-Only

Although ME Medicaid reimburses for telephonic services in some situations, FQHCs are not explicitly mentioned leaving it unclear if they would be eligible for such services. 

See: ME Medicaid Email, Phone and Fax

Live Video

MD Medicaid covers live video services provided by eligible providers.

See: MD Medicaid Live Video

Store and Forward

There is no explicit reference found for store-and-forward for FQHCs.

See: MD Medicaid Store-and-Forward.

Remote Patient Monitoring

MD Medicaid reimburses RPM for certain chronic conditions and FQHCs are eligible to prescribe RPM. Preauthorization requirements apply.

SOURCE: Remote Patient Monitoring. MD Department of Health. MD Medical Assistance Program PT 14-18. RPM. Jan. 10, 2018. (Accessed May 2025).

See: MD Medicaid RPM.

Audio-Only

No explicit reference found for FQHCs related to audio-only.

See: MD Medicaid Email, Phone & Fax.

Live Video

Community Health Centers, Community Mental Health Centers, and Outpatient Substance Use Disorder providers (provider types 20, 26 and 28) may deliver the following covered services via telehealth:

• All services specified in 101 CMR 306.00 et seq.; and
• The outpatient services specified in the following categories:
• Opioid Treatment Services: Counseling;
• Ambulatory Services: Outpatient Counseling; Clinical Case Management; and
• Services for Pregnant/Postpartum Clients: Outpatient Services

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Apr. 2025).

MassHealth lists specific codes that may be used by community health centers for services delivered through telehealth. See Transmittal Letter for details.

SOURCE: MassHealth, Community Health Center Manual, Service Codes and Descriptions, 11/21/24, (Access Apr. 2025).

According to statute, there is no restrictions on distant sites, and live video is covered.

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

Billing and Payment Rates for Services

Providers billing under an 837I/UB-04 form must include the modifier GT when submitting claims for services delivered via telehealth. Providers billing under an 837P/1500 form must include the place of service (POS) code 02 or 10 when submitting claims for services delivered via telehealth.

Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telehealth;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GQ to indicate services rendered via asynchronous telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications; and/or
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology.

Rates of payment for services delivered via telehealth will be the same as the rates of payment for services delivered via traditional (i.e., in-person) methods as set forth in the applicable regulations.

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2025).

See: MA Medicaid Live Video.

Store and Forward

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

Billing and Payment Rates for Services

Providers billing under an 837I/UB-04 form must include the modifier GT when submitting claims for services delivered via telehealth. Providers billing under an 837P/1500 form must include the place of service (POS) code 02 or 10 when submitting claims for services delivered via telehealth.

Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telehealth;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GQ to indicate services rendered via asynchronous telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications; and/or
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology.

Rates of payment for services delivered via telehealth will be the same as the rates of payment for services delivered via traditional (i.e., in-person) methods as set forth in the applicable regulations.

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2025.

According to teledentistry and the GQ modifier are covered for store-and-forward. However, CCHP has not found an explicit reference to whether or not FQHCs/CHCs are eligible for reimbursement for store-and-forward.

See:  MA Medicaid Store and Forward.

Remote Patient Monitoring

Although MassHealth reimburses some select RTM codes, there is no explicit indications to whether or not FQHCs are eligible to be reimbursed those codes.

See: MA Medicaid Remote Patient Monitoring.

Audio-Only

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GT to indicate services rendered via interactive audio and video telecommunications systems;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;
• modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or
• modifier GQ to indicate services rendered via asynchronous telehealth.

Modifier GT is required on the institutional claim, for the distant-site provider, when there is an accompanying professional claim containing POS 02 or 10.

Effective August 31, 2023, modifier V3, which was previously used to indicate services rendered via audio-only telehealth, will no longer be available. Providers must use modifier 93 in its place.

Billing and Payment Rates for Services

Providers billing under an 837I/UB-04 form must include the modifier GT when submitting claims for services delivered via telehealth. Providers billing under an 837P/1500 form must include the place of service (POS) code 02 or 10 when submitting claims for services delivered via telehealth.

Additionally, for any such professional claim, providers must include:

• modifier 95 to indicate counseling and therapy services rendered via audio-video telehealth;
• modifier 93 to indicate services rendered via audio-only telehealth;
• modifier GQ to indicate services rendered via asynchronous telehealth;
• modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications; and/or
• modifier FR to indicate a supervising practitioner was present through a real-time two-way, audio and video communication technology.

Rates of payment for services delivered via telehealth will be the same as the rates of payment for services delivered via traditional (i.e., in-person) methods as set forth in the applicable regulations.

Providers may not bill MassHealth a facility claim for originating sites.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2025).

While telephonic delivery of children’s behavioral health initiative services is allowed in some situations, and MA statute indicates reimbursement for audio-only telephone, CCHP has not found an explicit indication that FQHCs/CHCs can be reimbursed for the audio-only modality.

See:  MA Medicaid Email, Phone and Fax.

Live Video

All current Medicaid policy for telemedicine services, including definitions, requirements and parameters of telemedicine apply to FQHCs and RHCs. FQHCs and RHCs are responsible for ensuring compliance with all telemedicine policy.

Distant site services provided by qualified Medicaid enrolled providers may be covered when the qualified provider is employed by the clinic or working under the terms of a contractual agreement with the clinic. FQHCs and RHCs must maintain all practitioner contracts and provide them to MDHHS upon request.

During the Medicaid provider enrollment process, contracted providers must associate to the FQHC or RHC billing NPI. Refer to the Billing & Reimbursement for Institutional Providers chapter of this Manual for further information.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2211-2212, Apr. 1, 2025, (Accessed Apr. 2025).

The provision of bulletin MSA 20-34 which allows providers to work from home, is also allowable per bulletin MSA 20-09, which defines the parameters for the distant site to include “the provider’s office, or any established site considered appropriate by the provider, so long as the privacy of the beneficiary and security of the information shared during the telemedicine visit are maintained”.

Clinics are also permitted to submit for reimbursement telemedicine services (using simultaneous audio/visual technologies) per bulletin MSA 20-09 if all other provisions of telemedicine policy are maintained. Simultaneous audio/visual telemedicine services, as indicated by CPT/HCPCS codes listed on the telemedicine fee schedule and considered qualifying visits, will also be considered face-to-face and will trigger the PPS/AIR if the service billed is listed as a qualifying visit.

For services submitted on the Institutional invoice, the appropriate National Uniform Billing Committee (NUBC) revenue code, along with the appropriate telemedicine Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) procedure code and modifier 95 or Modifier 93, must be used.

Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC)/Tribal Health Center (THC)/ Tribal Federally Qualified Health Centers (Tribal FQHC) Considerations – PT, OT and ST, when provided in accordance with this policy using both audio/visual modalities, will be considered face-to-face and will trigger the PPS AIR if the service billed is listed as a qualifying visit.

For FQHCs, RHCs, THCs and Tribal FQHCs, the appropriate CPT/HCPCS code, PPS/AIR payment code (if the service generates a Qualifying Visit), and modifier 95 – synchronous telemedicine must be used. Refer to www.michigan.gov/medicaidproviders >> Provider Specific Information for additional information.

SOURCE:  MI Dept. of Health and Human Services. Bulletin 23-10, Telemedicine Policy Post-COVID PHE, Mar. 2, 2023, (Accessed Apr. 2025).

An FQHC, can be either an originating or distant site for telemedicine services.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 801, Apr. 1, 2025, (Accessed Apr. 2025).

Claims for telemedicine services must be submitted using the ASC X 12N 837 5010 form using the appropriate telemedicine HCPCS or CPT code. All telemedicine claims must include the corresponding modifier 95- “Synchronous Telemedicine Service rendered via a real-time interactive audio and video telecommunications system” or 93 – “Synchronous Telemedicine Service rendered via telephone or other real-time interactive audio-only telecommunications system” and the appropriate revenue code.

During the Medicaid provider enrollment process, contracted providers must associate to the FQHC or RHC billing NPI. Refer to the Billing & Reimbursement for Institutional Providers chapter of this Manual for further information.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2211 & 2212, Apr. 1, 2025, (Accessed Apr. 2025).

See: MI Medicaid Live Video.

Store and Forward

Asynchronous telemedicine services are allowed in specific situations, however, CCHP has not found an explicit reference stating whether or not FQHCs can be reimbursed in Medicaid manuals.

See: MI Medicaid Store and Forward.

Remote Patient Monitoring

According to the MI Medicaid provider manual, RPM is covered with restrictions, however there is no indication from Medicaid if FQHCs can bill for this.

See: MI Medicaid Remote Patient Monitoring.

Audio-Only

For services submitted on the Institutional invoice, the appropriate National Uniform Billing Committee (NUBC) revenue code, along with the appropriate telemedicine Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) procedure code and modifier 95 or Modifier 93, must be used.

Clinics will be permitted to submit for reimbursement allowable audio-only service codes, as indicated above, if appropriate for the interaction with the beneficiary. Medicaid clinic billing and reimbursement requirements apply. The provider must be employed by or contracted with the FQHC, RHC, or THC and the procedure code billed must appear on the clinic qualifying visit list located on the MDHHS website.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2206 & 2212, Apr. 1, 2025, (Accessed Apr. 2025).

MDHHS will allow FQHCs and RHCs to be reimbursed for identified audio-only services (those represented on the audio-only database and that are identified as qualifying visits) to generate the PPS.

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2212, Apr. 1, 2025, (Accessed Apr. 2025).

See: MI Medicaid Email, Phone and Fax.

Live Video

Telehealth visits provided through audio and visual communication or accessible video-based platforms may be used to satisfy the face-to-face requirement for reimbursement under the payment methods that apply to a federally qualified health center, rural health clinic, Indian health service, 638 tribal clinic, and certified community behavioral health clinic, if the service would have otherwise qualified for payment if performed in person.

SOURCE: MN Statute Sec. 256B.0625, Subd. 3b(d). (Accessed Feb. 2024).

See: MN Medicaid Live Video

Store and Forward

 MN allows some services through store-and-forward. The definition of telehealth includes store-and-forward. No explicit reference is made regarding whether or not FQHCs would be eligible for store-and-forward reimbursement.

See: MN Medicaid Store and Forward

Remote Patient Monitoring

While there is a section for telemonitoring, there is no reference to whether or not a FQHC would be eligible for remote monitoring reimbursement.

See: MN Medicaid Remote Patient Monitoring

Audio-Only

Effective July 1, 2025, audio-only communication will end as part of a face-to-face encounter payment methodology.

SOURCE: MN Dept of Human Services, Federally Qualified Health Center and Rural Health Clinic, Mar. 18, 2024, (Accessed Jun. 2025).

See: MN Medicaid Audio-Only

Live Video

The Division of Medicaid reimburses for telehealth services which meet the requirements of Miss. Admin. Code Part 225 as follows:

• An encounter for face-to-face telehealth services provided by the FQHC acting as a distant site provider.
• A fee per completed transmission for telehealth services provided by the RHC acting as an originating site provider. The FQHC may not bill for an encounter visit unless a separately identifiable service is performed. The originating site facility fee will be paid at the existing fee-for-service rate in effect as of January 1, 2021.
• Reimburses a FQHC for both the distant and originating provider site when such services are appropriately provided by the FQHC.

SOURCE: MS Admin. Code Title 23, Part 211, Rule. 1.5. (Accessed Apr. 2025).

According to Administrative Code, there are no restrictions on originating and distant sites, and live video is covered.

See:  MS Medicaid Live Video.

Store and Forward

According to Administrative Code, store-and-forward is included in the definition of telemedicine, however there is no indication that the Medicaid program is currently reimbursing for any services beyond teleradiology as well as no indication FQHCs can be reimbursed for store-and-forward. Additionally, FQHC manual indicates encounters must be race-to-face which would exclude store-and-forward.

See:  MS Medicaid Store and Forward.

Remote Patient Monitoring

According to Administrative Code, remote patient monitoring is included in the definition of telemedicine, and reimbursed in some circumstances. However, CCHP has not found an explicit reference that FQHCs can bill for this.

See: MS Medicaid Remote Patient Monitoring.

Audio-Only

According to Administrative Code and statute, audio-only telehealth is reimbursed during states of emergencies under some circumstances. However, CCHP has not found an explicit reference that FQHCs can bill for this.

See:  MS Medicaid Email, Phone and Fax.

Live Video

According to statute, there is no restrictions on distant sites, and live video is covered.

See:  MO Medicaid Live Video.

Store and Forward

While store and forward is reimbursed, CCHP has not found an explicit reference to whether FQHCs are qualified for reimbursement in Medicaid manuals.

See:  MO Medicaid Store and Forward.

Remote Patient Monitoring

CCHP has not found an explicit reference in Medicaid manuals.

See: MO Medicaid Remote Patient Monitoring.

Audio-Only

While audio-only is reimbursed in some circumstances, CCHP has not found an explicit reference to whether or not FQHCs are reimbursed in Medicaid manuals.

See:  MO Medicaid Email, Phone and Fax.

Live Video

MT Medicaid reimburses for medically necessary services by means of telehealth (live video) under certain circumstances.  There is no reference found that explicitly references whether or not FQHCs can deliver services via telehealth and be reimbursed.

See: MT Medicaid Live Video

Store-and-Forward

There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.  However, there is no explicit reference to FQHCs being able to use store-and-forward technology specifically.

See: MT Medicaid Store-and-forward

Remote Patient Monitoring

No reference found.

See: MT Medicaid Remote Patient Monitoring

Audio-Only

There are no specific requirements for technologies used to deliver services via telemedicine/telehealth and can be provided using secure portal messaging, secure instant messaging, telephone conversations, and audio-visual conversations.  However, there is no explicit reference to FQHCs being able to use telephone/audio-only specifically.

See: MT Medicaid Audio-Only

Live Video

IHS and Tribal 638 facilities can bill the encounter rate for telehealth services as long as these services meet the definition of an encounter. The facility must stay in accordance with the four walls rule to bill for telehealth. Federally qualified health centers and rural health centers may bill the encounter rate for core services that are allowed via telehealth. Learn more about the list of allowable telehealth codes on our website.

SOURCE: NE Medicaid Program, Bulletin 23-08:  Guidance on Telehealth, Mar. 23, 2023, (Accessed Apr. 2025).

See:  NE Medicaid Live Video.

Store and Forward

According to statute, there is no restriction on distant sites, and all modes of telehealth including store-and-forward, is supposed to covered. However, CCHP has not found an explicit reference.

See:  NE Medicaid Store and Forward.

Remote Patient Monitoring

According to statute, RPM is covered with restrictions, however there is no indication from Medicaid they are implementing this, and there is no clarification if FQHCs can bill for this.

See: NE Medicaid Remote Patient Monitoring.

Audio-Only

Audio-only is reimbursed for some codes, however there is nothing explicit that states FQHCs can be reimbursed for those services.

See: NE Medicaid Email, Phone and Fax.

Live Video

A licensed professional operating within the scope of their practice under state law may provide services via telehealth. Providers must follow guidelines set forth in MSM Chapter 3400 (Telehealth Services). ….

• Distant Site: FQHCs providing services for a recipient from a distant site may bill the appropriate encounter rate with Place of Service (POS) Code 02. Use of the POS code certifies the service meets telehealth requirements.
• Originating Site: The FQHC may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee (Q3014), and the distant encounter site may bill the encounter code.

SOURCE: NV Medicaid FQHC Billing Guidelines. 4/14/25. (Accessed Jul. 2025).

Facilities that are eligible for encounter reimbursement (e.g. Indian Health (IH) programs, Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs)) may bill for an encounter in lieu of an originating site facility fee, if the distant site is for ancillary services (i.e. consult with specialist). If the originating site and distant site are two different encounter sites, the originating site may only bill the telehealth facility fee, and the distant encounter site may bill the encounter code.

See: NV Medicaid Live Video

Store and Forward

No reference specifically in FQHC manual chapter.  However, Chapter refers providers to telehealth Services Chapter 3400.  In that chapter, store-and-forward is allowed in some circumstances.

See: NV Medicaid Store and Forward

Remote Patient Monitoring

No reference found.

See: NV Medicaid Remote Patient Monitoring

Audio-Only

No reference specifically in FQHC manual chapter.  However, Chapter refers providers to telehealth Services Chapter 3400.  In that chapter, audio-only is allowed for certain behavioral health services.  

See: NV Medicaid Audio-Only

Live Video

According to statute, there is no restrictions on distant sites, and live video is covered.  However, no explicit reference to FQHCs was found.

See: NH Medicaid Live Video.

Store and Forward

According to statute, there is no restriction on distant sites, and all modes of telehealth including store-and-forward, are supposed to be covered. However, CCHP has not found an explicit reference to whether or not FQHCs can be reimbursed for store and forward.

See: NH Medicaid Store and Forward.

Remote Patient Monitoring

According to statute, RPM is covered with restrictions, however there is no clarification if FQHCs can bill for RPM.

See: NH Medicaid Remote Patient Monitoring.

Audio-Only

According to statute, there is no restriction on distant sites, and all modes of telehealth including audio-only, are supposed to be covered. However, CCHP has not found an explicit reference to whether or not FQHCs can be reimbursed for audio-only.

See: NH Medicaid Email, Phone and Fax.

Live Video

According to the NJ statute, Medicaid is prohibited from placing restrictions on the location or setting of the distant site.  A 2018 newsletter (Vol. 28, No. 17) that was sent to FQHCs (among other providers) indicates reimbursement is provided for live video telehealth. This follows a 2013 Medicaid Newsletter indicating that only psychiatrists and psychiatric advanced practice nurses are eligible for telehealth reimbursement, while an independent clinic (which includes FQHCs) may be an eligible originating site (although NJ does not reimburse an originating site facility fee).

Additionally, newsletters released in 2020 that apply to FQHCs indicate reimbursement is provided for pediatric and adolescent well care and teledentistry as a response to the COVID emergency.  No expiration date for these policies is provided.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013, Volume 30, No. 8, Apr 2020, Volume 30, No. 12 & Volume 28, No. 17, Sept. 2018. (Accessed May 2025).

Teledentistry (D9995) can only be billed in conjunction with CDT code D0140 – limited oral evaluation – problem focused. For Federally Qualified Health Centers – the encounter code (D0120 with modifier 22), along with D9995 and D0140, must be billed for the same date with all services submitted on the same claim.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter Vol. 33, No. 13, Aug. 2023, p. 3. (Accessed May 2025).

See: NJ Medicaid Live Video.

Store and Forward

NJ statute defines store-and-forward, however NJ Medicaid only lists reimbursement for real-time two way audio in combination with asynchronous store-and-forward technology, if the provider has determined that they are able to meet the standard of care of face-to-face service. There is no explicit reference to whether or not this applies to FQHCs specifically.

See: NJ Medicaid Store and Forward.

Remote Patient Monitoring

According to statute, NJ Medicaid is required to cover RPM, however CCHP has not found an indication from NJ Medicaid that they have implemented this.  Additionally, there is no explicit clarification regarding whether or not FQHCs would be eligible for RPM reimbursement.

See: NJ Medicaid Remote Patient Monitoring.

Audio-Only 

Statute states, in no case shall the State Medicaid and NJ Family Care Programs restrict the ability of a provider to use any electronic or technical platform to provide services using telemedicine or telehealth, including but not limited to interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:

• Allows the provider to meet the same standard of care as would be provided if the services were provided in person’
• Is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164.

 However, there is no explicit clarification to whether or not FQHCs can be reimbursed for the audio-only modality.

See: NJ Medicaid Email, Phone and Fax.

Live Video

The location of a MAP eligible recipient at the time the service is being furnished via an interactive telemedicine communications system. The origination-site can be any of the following medically warranted sites where services are furnished to a MAP eligible recipient.

• A federally qualified health center (as defined in section 1861 (aa)(4) of the Act).

SOURCE: NM Administrative Code 8.310.2.12 (M)(a). (Accessed Jun. 2025).

See: NM Medicaid Live Video

Store and Forward

MAD will reimburse for services delivered through store-and forward.  To be eligible for payment under store-and-forward, the service must be provided through the transference of digital images, sounds, or previously recorded video from one location to another; to allow a consulting provider to obtain information, analyze it, and report back to the referring physician providing the telemedicine consultation.  Store-and-forward telemedicine includes encounters that do not occur in real time (asynchronous) and are consultations that do not require a face-to-face live encounter between patient and telemedicine provider.

The Administrative Code does not explicitly state reimbursement for FQHCs.

SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Jun. 2025).

See:  NM Medicaid Store-and-Forward

Remote Patient Monitoring

No Reference Found

See:  NM Medicaid Remote Patient Monitoring

Audio-Only

No explicit reference to FQHCs being reimbursed for audio-only services although NM Medicaid will reimburse certain providers for limited professional services delivered by telephone without video. 

See:  NM Medicaid Email, Phone and Fax

Live Video

NY Medicaid reimburses for live video telemedicine services.

See: NY Medicaid Live Video

Store and Forward

Generally, reimbursement will be made to the consulting distant-site practitioner when billed with an appropriate procedure code. The consulting distant-site practitioner must provide the requesting originating-site practitioner with a written report of the consultation in order for payment to be made. The consulting practitioner should bill the CPT code for the professional service appended with the telehealth GQ modifier.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 11. (Accessed Mar. 2024).

Remote Patient Monitoring

FQHCs that have opted out of APGs are unable to bill for RPM services at this time.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 12. (Accessed Mar. 2024).

Audio-Only

Audio-only rate codes used during the COVID-19 PHE will be retired. FQHCs can bill the Prospective Payment System (PPS) rate code “4012” or “4013”, depending on on-site presence as outlined in “VII. Billing Rules for Telehealth Services”, “M. FFS Billing for Telehealth by Site and Location” on page 14 of this issue. Wrap payments are available for any telehealth services, including telephonic services reimbursed by an MMC Plan, under qualifying PPS and off-site rate codes.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 11. (Accessed Mar. 2024).

See: NY Medicaid Email, Phone, & Fax

Live Video

Core Services

Core visit services delivered via telehealth are billed under the FQHC and RHC provider number using the HCPCS code T1015 (clinic visit/encounter, all-inclusive), T1015-HI (for behavioral health services), or T1015-SC (subsequent sick visit) and appended with the GT modifier. Eligible providers include all core service providers as defined in Section 3.2.1 of this policy, which includes physicians, physician assistants, nurse practitioners, nurse midwives, clinical psychologists, clinical social workers, licensed psychological associates, licensed clinical mental health counselors, licensed marriage and family therapists, advance practice nurse specialists, clinical nurse specialists, and licensed clinical addiction specialists.

Hybrid Telehealth with Supporting Home Visit

In addition, FQHC and RHC core service providers may conduct telehealth visits with a supporting home visit by a delegated staff member (“hybrid model”) with new or established patients and bill using HCPCS code T1015 (or T1015-HI, T1015-SC), for a range of scenarios including (but not limited to) chronic disease management and perinatal visits.

See manual for additional guidance.

Telehealth claims, except for hybrid telehealth with supporting home visits, should be filed with the provider’s usual place of service code(s).

Hybrid telehealth with supporting home visits should be filed with Place of Service (POS) 12 (home).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, Aug. 15, 2023. (Accessed Jun. 2025).

List of eligible Virtual Communication Services provided on page 14 of Attachment A of the Telehealth, Virtual Communications and Remote Patient Monitoring manual.  FQHCs, FQHC Lookalikes and RHCs are only allowed to bill for Online Digital Evaluation and Management Codes (not Telephonic Evaluation and Management and Virtual Communication Codes OR Interprofessional Assessment and Management Codes).

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, Feb. 15, 2025. (Accessed Jun. 2025).

Dietary Evaluation

Dietary evaluation and counseling is provided in hospital outpatient clinics; public agencies such as health departments, federally qualified health centers, and rural health clinics; private agencies; physician or medical diagnostic clinics; and physician offices.

Telehealth claims should be filed with the provider’s usual place of service code(s).

Lactation Consultation Services

Services must be provided in hospital outpatient clinics; public agencies such as health departments, federally qualified health centers, and rural health clinics; private agencies; physician or medical diagnostic clinics; and physician offices.

Telehealth claims should be filed with the provider’s usual place of service code(s).

For infant weight element for diagnostic lactation assessment, the weight cannot be conducted via telephone and audio/video.

SOURCE:  NC Div. of Medical Assistance, Clinical Coverage Policies Dietary Evaluation and Counseling and Medical Lactation Services Amended Aug. 15, 2023, pg.  18, (Accessed Jun. 2025).

See: NC Medicaid Live Video

Store and Forward

As outlined in Section 5.7 and Attachment A, select services may be provided via telehealth, virtual patient communications, and remote patient monitoring. Services delivered via telehealth, virtual patient communications, and remote patient monitoring must follow the requirements and guidance set forth in Clinical Coverage Policy 1-H: Telehealth, Virtual Patient Communications, and Remote Patient Monitoring.

FQHCs and RHCs may also deliver a select set of services via telehealth, virtual patient communications, and remote patient monitoring that are not defined as a core visit service in Section 5.3 of Clinical Coverage Policy 1D-4: Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics. FQHCs and RHCs would be reimbursed on a fee-for-service basis for delivering non-core visit services via telehealth, virtual patient communications, or remote patient monitoring. See Attachment A, Section C.1 of this policy for further guidance for billing virtual patient communications and remote patient monitoring codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, Feb. 15, 2025. (Accessed Jun. 2025).

 See: NC Medicaid Store and Forward

Remote Patient Monitoring

As outlined in Section 5.7 and Attachment A, select services may be provided via telehealth, virtual patient communications, and remote patient monitoring. Services delivered via telehealth, virtual patient communications, and remote patient monitoring must follow the requirements and guidance set forth in Clinical Coverage Policy 1-H: Telehealth, Virtual Patient Communications, and Remote Patient Monitoring.

FQHCs and RHCs may also deliver a select set of services via telehealth, virtual patient communications, and remote patient monitoring that are not defined as a core visit service in Section 5.3 of Clinical Coverage Policy 1D-4: Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics. FQHCs and RHCs would be reimbursed on a fee-for-service basis for delivering non-core visit services via telehealth, virtual patient communications, or remote patient monitoring. See Attachment A, Section C.1 of this policy for further guidance for billing virtual patient communications and remote patient monitoring codes.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, Feb. 15, 2025. (Accessed Jun. 2025).

See: NC Medicaid Remote Patient Monitoring

Audio-Only

FQHCs and RHCs may conduct telephonic evaluation and management services using HCPCS code G0071. Eligible providers include physicians, nurse practitioners, psychiatric nurse practitioners, physician assistants, and certified nurse midwives.

Note: Virtual patient communications and remote patient monitoring services are always considered non-core visit services; please refer to Section 5.7 for more information on reimbursement for non-core visit services

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics, p. 18, Aug. 15, 2023. (Accessed Jun. 2024).

Lactation Consultation Services

Services must be provided in hospital outpatient clinics; public agencies such as health departments, federally qualified health centers, and rural health clinics; private agencies; physician or medical diagnostic clinics; and physician offices.

Telehealth claims should be filed with the provider’s usual place of service code(s).

For infant weight element for diagnostic lactation assessment, the weight cannot be conducted via telephone and audio/video.

SOURCE:  NC Div. of Medical Assistance, Clinical Coverage Policies Dietary Evaluation and Counseling and Medical Lactation Services Amended Aug. 15, 2023, pg.  18, (Accessed Jun. 2025).

See: NC Medicaid Audio-Only

Live Video

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.

Refer to the FQHC and RHC portions of this manual for the revenue codes to bill for the various services.

SOURCE: ND Medicaid, Telehealth, May 2025, (Accessed Jun. 2025).

FQHCs and RHCs – Dentistry

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 512: Dental Clinic.

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 Human Services Dental Manual, Teledentistry, pg. 12(Jul. 2024), (Accessed Jun. 2025).

See: ND Medicaid Live Video

Store and Forward

Store-and-forward is reimbursed through digital health evaluation and management services but unclear if FQHCs can bill this service specifically.

FQHCs and RHCs – Dentistry

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 Human Services Dental Manual, Teledentistry, pg. 12(Jul. 2024), (Accessed Jun. 2025).

See: ND Medicaid Store and Forward

Remote Patient Monitoring

Telemonitoring is a covered service under home health services for ND Medicaid but no reference was found to whether or not FQHCs can be reimbursed for remote patient monitoring.

See: ND Medicaid Remote Patient Monitoring

Audio-Only

Audio-only is covered in specific circumstances, but no direct reference to FQHCs, so unclear if FQHCs would be reimbursed.

See: ND Medicaid Audio-Only

Live Video

Managed Care Entities

See manual for chart with modifiers depending if a professional services or FQHC/RHC.

Federally Qualified Health Center and Rural Health Clinics

For a covered telehealth service that is also an FQHC or RHC service, the face-to-face requirement is waived.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  7/15/2022 (Updated Jan. 2025), p. 9, (Accessed Jun. 2025).

Dental/Teledentistry

Dentists may provide a limited problem-focused oral exam (CDT D0140) or periodic oral evaluation (D0120) through telehealth under this rule.

• When billing for the procedure on a professional claim, providers should use the GT modifier to indicate the service was provided through telehealth. There is no need to report D9995.
• When billing for the procedure on a dental claim, providers should include procedure code D9995 to indicate the service was provided through telehealth.
• Dental services furnished through telehealth at FQHCs are covered under 5160-1-18 and are paid as covered FQHC dental services. See manual for billing details.

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  7/15/2022 (Updated Jan. 2025), p. 9-10.  (Accessed Jun. 2025).

See: OH Medicaid Live Video.

 Store and Forward

FQHCs are required to report modifier ‘GT’ (which indicates telehealth services occurring via real-time interactive audio-video), according to the OH Medicaid Telehealth manual, indicating they are not eligible for store-and-forward reimbursement.

See: OH Medicaid Store and Forward.

Remote Patient Monitoring

Remote patient monitoring will be paid through FFS as a covered non-FQHC/RHC service under the clinic provider type 50 (using ODM’s payment schedules).

SOURCE: The Ohio Department of Medicaid.  Telehealth Billing Guide.  7/15/2022 (Updated Jan. 2025), p. 9.  (Accessed Jun. 2025).

See: OH Medicaid Remote Patient Monitoring.

Audio-Only

While the OH Medicaid Telehealth billing guide billing guide indicates telephone calls fall within the telehealth definition,  CCHP has not found an explicit reference to whether or not FQHCs can be reimbursed for services delivered via telephone.

See: OH Medicaid Email, Phone and Fax.

Live Video

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to 42 Code of Federal Regulations (CFR) § 440.90. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Jun. 2025).

See: OK Medicaid Live Video.

 Store and Forward

According to OK Admin Code, health care delivered by telehealth such as store-and-forward must be compensable by OHCA in order to be reimbursed.  There is no explicit reference to whether or not FQHCs can be reimbursed for store-and-forward.

See: OK Medicaid Store and Forward.

Remote Patient Monitoring 

According to OK Admin Code, health care delivered by telehealth such as remote patient monitoring must be compensable by OHCA in order to be reimbursed.  Reimbursement is provided for continuous glucose monitoring in some circumstances.  There is no explicit reference to whether or not FQHCs can be reimbursed for remote patient monitoring.

See: OK Medicaid Remote Patient Monitoring.

 Audio-Only 

An RHC and an FQHC shall be reimbursed for services delivered via audio-only telecommunications at the fee-for-service rate per the fee-for-service fee schedule.

SOURCE: OK Admin. Rule 317:30-3-27.1. (Accessed Jun. 2025).

See: OK Medicaid Email, Phone and Fax.

Live Video

OR Medicaid covers health services delivered using telemedicine, however no explicit reference to whether or not FQHCs can be reimbursed was found.

See: OR Medicaid Live Video.

Store and Forward

OR Medicaid covers asynchronous transmissions in some circumstances however no explicit reference to whether or not FQHCs can be reimbursed was found.

See: OR Medicaid Store and Forward.

Remote Patient Monitoring

OR Medicaid covers remote patient monitoring in some circumstances however no explicit reference to whether or not FQHCs can be reimbursed was found.

See: OR Medicaid Remote Patient Monitoring.

Audio-Only 

Telephone encounters qualify as a valid encounter for services provided in accordance with OAR 410-130-0595, Maternity Case Management (MCM) and 410-130-0190, Tobacco Cessation (see also OAR 410-120-1200). Except as set forth below, providers may not make telephone contacts at the exclusion of face-to-face visits. Telephone encounters must include all the same components of the service as if provided face-to-face.

See:  OR Medicaid Email, Phone and Fax.

Live Video

Telemedicine encounters must be provided according to the same standard of care as if delivered in-person. FQHCs/RHCs providing physical health services are to refer to MA Bulletin 99-23-08, titled “Updates to Guidelines for the Delivery of Physical Health Services via Telehealth,” or the current MA Bulletin or Department guidance, for more information. (https://www.dhs.pa.gov/docs/Publications/Documents/FORMS%20AND%20PUBS%20OMAP/MAB2023080201.pdf).

Telehealth encounters must be provided according to the same standard of care as if delivered in-person. FQHCs/RHCs providing behavioral health services licensed by OMHSAS are to refer to OMHSAS Bulletin OMHSAS-22-02, titled “Revised Guidelines for the Delivery of Behavioral Health Services Through Telehealth,” or the current OMHSAS Bulletin or Department guidance, for more information (https://www.dhs.pa.gov/docs/Documents/OMHSAS/Bulletin%20OMHSAS-22-02%20­%20Revised%20Guidelines%20for%20Delivery%20of%20BH%20Services%20Through%20Telehealth%207.1.22.pdf)

Some dental services can be provided using teledentistry. FQHCs/RHCs are to refer to MA Bulletin 08-22-13, titled “Teledentistry Guidelines and Dental Fee Schedule Updates,” or the current MA Bulletin, for more information (https://www.dhs.pa.gov/docs/Publications/Documents/FORMS%20AND%20PUBS%20OMAP/MAB2022061301.pdf

SOURCE:  PA Department of Human Services, Medical Assistance Bulletin, Updates to The PROMISe™ Provider Handbook 837 Professional/CMS-1500 Claim Form, Appendix E – FQHC/RHC Handbook, March 1, 2024, Number 08-24-04 (Accessed Apr. 2025).

Teledentistry may be used by dentists, FQHCs, and RHCs to provide dental services to MA beneficiaries. The provider must be licensed in Pennsylvania and enrolled in the MA Program.

FQHCs and RHCs are to continue billing procedure code T1015 with the U9 modifier to indicate dental visits/encounters rendered via teledentistry to patients. FQHCs and RHCs should no longer use the GT modifier, as previously directed in Provider Quick Tip # 237, “Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health  Clinics”(https://www.dhs.pa.gov/providers/QuickTips/Documents/PROMISeQuickTip237.pdf), and must begin using POS 02 as of May 2, 2022.

Teledentistry visits must be provided according to the same standard of care as if delivered in-person.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin, Teledentistry Guidelines and Dental Fee Schedule Updates (May 2, 2022). (Accessed Apr. 2025).

See: PA Medicaid Live Video.

Store and Forward

 Telehealth, for purposes of MA Program payment, does not include asynchronous or store and forward technology or facsimile machines, electronic mail systems or remote patient monitoring devices. However, these technologies may be utilized as a part of the provision of a MA-covered service.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-23-08, p. 2-3, Aug. 2, 2023, (Accessed Apr. 2024).

There is no explicit reference to whether or not FQHCs  can be reimbursed for Store and Forward.

See:  PA Medicaid Store and Forward.

Remote Patient Monitoring

 Telehealth, for purposes of MA Program payment, does not include asynchronous or store and forward technology or facsimile machines, electronic mail systems or remote patient monitoring devices. However, these technologies may be utilized as a part of the provision of a MA-covered service.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-23-08, p. 2-3, Aug. 2, 2023, (Accessed Apr. 2024).

There is no explicit reference to whether or not FQHCs can be reimbursed for remote patient monitoring.

See: PA Medicaid Remote Patient Monitoring.

Audio-Only

PA Medicaid allows audio-only telecommunication technology to be used when the beneficiary does not have video capability or for an urgent medical situation.

SOURCE: PA Department of Human Services, Medical Assistance Bulletin 99-23-08, p. 2, Aug. 2, 2023, (Accessed Apr. 2024).

There is no explicit reference to whether or not FQHCs can be reimbursed for audio-only delivery.

See:  PA Medicaid Email, Phone and Fax.

Live Video

No reference found.

Store and Forward

No reference found.

Remote Patient Monitoring

No reference found.

Audio-Only

No reference found.

Live Video

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed May 2025).

See:  RI Medicaid Live Video

Store and Forward

No explicit reference has been found to RI Medicaid reimbursing for store-and-forward.

See: RI Medicaid Store-and-Forward.

Remote Patient Monitoring

No explicit reference has been found to RI Medicaid reimbursing for remote patient monitoring. 

See:  RI Medicaid Remote Patient Monitoring

Audio-Only

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed May 2025).

See: RI Medicaid Email, Phone and Fax

Live Video

The Centers for Medicare and Medicaid Services (CMS) defines telehealth as the use of electronic information and telecommunications technologies to extend care when a provider and a patient are not in the same place at the same time.

Services rendered via telehealth may be rendered synchronously or asynchronously using a telecommunication system (audio/video) that permits interactive communications between a provider and a patient. The telecommunication system must be Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant. SCDHHS only reimburses services conducted synchronously with both audio and video components unless otherwise specified.

Services rendered via telehealth are not an addition to Medicaid-covered services but a mode of delivery of certain covered services. Quality of health care must be maintained regardless of the mode of delivery

Telehealth generally involves two-way, interactive technology that permits communication between the practitioner and patient who are not at the same location at the time the service is delivered.

FQHCs can provide certain services via telehealth to extend care when a patient is in a different location.

Office visits that are conducted via telehealth are counted towards the applicable benefit limits for these services.

Healthy Connections Medicaid allows the service to be delivered via telehealth when the service meets the following criteria:

• The beneficiary must be present and participating in the telehealth visit, unless otherwise specified in the procedure code description.
• The referring provider must provide pertinent medical information and/or records to the consulting provider via a secure transmission.
• Interactive audio and video telecommunication must be used, permitting encrypted communication between the distant site physician or practitioner and the Medicaid beneficiary.
• The telecommunication service must be secure and adequate to protect the confidentiality and integrity of the telehealth information transmitted.
• The telehealth equipment and transmission speed and image resolution must be technically sufficient to support the service billed. Any staff involved in the telehealth visit must be trained in the use of the telehealth equipment and competent in its operation.
• A trained healthcare professional at the referring site (patient site presenter) is required to present the beneficiary to the provider at the consulting site and remain available as clinically appropriate (this condition is waived when the referring site is the patient home).
• If the beneficiary is a minor (under 18 years old), a parent and/or guardian must present the minor for telehealth service unless otherwise exempted by State or Federal law. The parent and/or guardian need not attend the telehealth session unless attendance is therapeutically appropriate.
• The beneficiary retains the right to withdraw from the telehealth visit at any time.
• All telehealth activities must comply with the requirements of HIPAA: Standards for Privacy of individually identifiable health information and all other applicable State and Federal Laws and regulations.
• The beneficiary has access to all transmitted medical information, except for live interactive video, as there is often no stored data in such encounters.
• The provider at the distant site must obtain prior approval for service when services require prior approval, based on service type or diagnosis.
• The medical care is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the beneficiary’s need.
• The medical care can be safely furnished.
• No equally effective, more conservative or less costly treatment is available statewide.

SOURCE: SC Health and Human Svcs. Dept. FQHC Provider Manual, p. 21-23 (Apr. 2025). (Accessed Jun. 2025).

See: SC Medicaid Live Video

Store and Forward

G2010 (Remote image submitted by a patient) is listed as reimbursed for FQHCs for established patients.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Jun. 2025).

Generally, however, SC doesn’t appear to cover store-and-forward services.

See: SC Medicaid Store-and-forward

Remote Patient Monitoring

No RPM coverage for FQHCs.

See: SC Medicaid RPM

Audio-Only

Services rendered through an FQHC or RHC for certain audio-only CPT codes will be reimbursed.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Jun. 2025).

See: SC Medicaid Email, Phone, & Fax

Live Video

FQHC/RHCs are eligible to serve as an originating site for telemedicine services and may also provide distant site telemedicine services.

A distant site is the physical location of the practitioner providing the service via telemedicine. Please refer to the Telemedicine manual for additional information.

Reimbursement for the telemedicine facility fee is limited to the amount listed on the Physician Services fee schedule.

SOURCE: SD Medicaid Billing and Policy Manual, FQHC and RHC Services, Jun. 2024, pg. 7 (Accessed Apr. 2025).

 See:  SD Medicaid Live Video.

Store and Forward

CCHP has not found an explicit reference in Medicaid manuals.

See:  SD Medicaid Store and Forward.

Remote Patient Monitoring

Reimbursement for the telemedicine facility fee is limited to the amount listed on the Physician Services fee schedule.

A claim for a telemedicine originating site fee should be billed under the FQHC/RHC’s NPI. As indicated above, payment is limited to the fee schedule amount.

SOURCE: SD Medicaid Billing and Policy Manual: FQHC and RHC Services, p. 8 & 10 (Jun. 2024). (Accessed Apr. 2025).

See: SD Medicaid Remote Patient Monitoring.

Audio-Only

For FQHCs/RHCs and IHS/Tribal 638 Providers, SUD agency services may also be provided via audio-only if the provider is an accredited and enrolled agency. Audio-only behavioral health services are reimbursed at the encounter rate.

FQHC/RHC and IHS/Tribal 638 providers may bill for audio-only evaluation and management services using codes 98966, 98967, and 98968 and be reimbursed at the fee schedule rate. These services must be submitted using the FQHC/RHCs non-PPS billing NPI. For more information regarding billing with a non-PPS NPI please refer to the FQHC/RHC Service Manual.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine (Feb. 2025), (Accessed Apr. 2025).

See:  SD Medicaid Email, Phone and Fax.

Live Video

According to statute, a health insurance entity (includes Medicaid) shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located. Any provisions not stipulated in the telehealth services section of the insurance code shall be governed by the terms and conditions of the health insurance contract. However, no explicit reference to FQHCs was found.

See:  TN Medicaid Live Video.

Store and Forward

TN statute defines store-and-forward telemedicine services, but does not require coverage store-and-forward specifically.  There is also no explicit reference to whether or not FQHCs can be reimbursed for the modality.

See:  TN Medicaid Store and Forward.

Remote Patient Monitoring

According to statute, A health insurance entity may consider any remote patient monitoring service a covered medical service if the same service is covered by Medicare. The appropriate parties may negotiate the rate for these services in the manner in which is deemed appropriate by the parties. There is no clarification if FQHCs can bill for this.

See: TN Medicaid Remote Patient Monitoring.

Audio-Only

According to statute, neither telehealth nor provider-based telemedicine includes audio-only conversation with the exception of HIPAA audio-only conversation for the provision of behavioral health and or healthcare services when other means are unavailable.  A school-based manual indicates reimbursement for audio-only services, however there is no clarification if FQHCs can bill for this.

See:  TN Medicaid Email, Phone and Fax.

Live Video

A medical visit is a face-to-face, telemedicine, or telehealth encounter between an FQHC patient and a physician, physician assistant, nurse practitioner, certified nurse midwife, or visiting nurse. An “other” health visit includes, but is not limited to, a face-to-face, telemedicine, or telehealth encounter between an FQHC patient and a qualified clinical psychologist, clinical social worker, other health professional for mental health services, a dentist, a dental hygienist, an optometrist, or a Texas Health Steps Medical Screen.

SOURCE:  Texas Admin Code Title 1, Sec. 355.8261, (Accessed Apr. 2025).

Telemedicine

FQHCs may be reimbursed the distant-site provider fee for telemedicine services at the Prospective Payment System (PPS) rate or Alternative Prospective Payment System (APPS) rate.

FQHC practitioners may be employees of the FQHC or contracted with the FQHC.

Telehealth

FQHCs may be reimbursed the distant-site provider fee for telehealth services at the Prospective Payment System (PPS) rate or Alternative Prospective Payment System (APPS) rate.

FQHC practitioners may be employees of the FQHC or contracted with the FQHC.

SOURCE:  TX Medicaid Telecommunication Services Handbook, (Apr. 2025), p. 10, 13, (Accessed Apr. 2025).

See:  TX Medicaid Live Video.

Store and Forward

TX Administrative Code includes definitions of “Telemedicine Medical Service,” “Telehealth Services” and “Telemedicine” which encompasses store-and-forward, stating that it includes “clinical data transmission using computer imaging by way of still-image capture and store-and-forward.” While the definition of telemedicine includes store-and-forward and the Medicaid manual indicates FQHCs are eligible for reimbursement, there isn’t an explicit mention of FQHCs being reimbursed for store-and-forward specifically.

See:  TX Medicaid Store and Forward.

Remote Patient Monitoring

Home telemonitoring services, also known as remote patient monitoring, is a benefit of Texas Medicaid. Home telemonitoring is a health service that requires scheduled remote monitoring of data related to a client’s health, and transmission of the data from the client’s home to a licensed home health agency, hospital, FQHC, or RHC. Data and information collected remotely will be transmitted from the client’s home to the home health agency, hospital, FQHC, or RHC. The data transmission must comply with standards set by HIPAA.

Home telemonitoring providers must establish a plan of care (POC) with outcome measures based on the physician or requesting provider’s order for each client, and the POC and outcome measures must be reviewed by the client’s physician.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 14-16 (Apr. 2025). (Accessed Apr. 2025).

The RN, NP, CNS, or PA in a licensed home health agency, hospital, FQHC, or RHC is responsible for reporting data to the physician or requesting provider. Telemonitoring providers must be available 24 hours a day, 7 days a week. Although transmissions are generally at scheduled times, they can occur any time of the day or any day of the week, according to the client’s plan of care.

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 14-15 (Apr. 2025). (Accessed Apr. 2025).

Facility Services: The provision and maintenance of home telemonitoring equipment is the responsibility of the home health agency, hospital, FQHC, or RHC. Procedure code S9110 with modifier U1 is reimbursed one time to a home health agency or hospital for the initial setup and installation in the client’s home. A claim for a subsequent set up and installation will not be reimbursed unless there is a documented new episode of care. There will not be reimbursement for the addition of monitoring parameters during the current episode of care. Monthly home telemonitoring services (procedure code S9110 with the appropriate modifier) are a benefit when services are provided by a home health agency or hospital. Home health agency and hospital providers must submit revenue code 780 with procedure code S9110 and one of the appropriate modifiers listed in the table within this section.

Use one of the modifiers [listed in the manual] with monthly home telemonitoring services procedure code S9110 to indicate the number of days per month data is transmitted from the client’s home to the home telemonitoring provider.

Providers are not required to submit modifiers U2, U3, U4, U7, U8, or U9 for telemonitoring on the prior authorization request, but are required to submit the appropriate modifier on the claim for reimbursement based on the number of days as outlined in the table.

Documentation supporting medical necessity for home telemonitoring services must be maintained in the client’s medical record by the entity providing the service (home health agency, hospital, FQHC, or RHC) and is subject to retrospective review. All paid home telemonitoring services not supported by documentation of medical necessity are subject to recoupment.

FQHCs/RHCs:  FQHC and RHC providers may be reimbursed outside the encounter rate for the provision of home telemonitoring services if the services follow all requirements as outlined in this section and in the following subsections 3.7.1, “Prior Authorization of Telemonitoring Services,” and 3.8.1, “Documentation Requirements.”

Procedure code G0511 may be reimbursed to an FQHC or RHC for the provision of home telemonitoring services.

Initial equipment set up, patient education on use of equipment, monthly collection and transmission of physiologic data, and physician or requesting provider services must be billed by one provider
under procedure code G0511.

Procedure code G0511 is reimbursed once per month, per client. The place of service code reported on the claim must reflect the physical location of the client. At least 16 days of data collection per month are required for reimbursement.

See manual for more on prior authorization requirements.

Home telemonitoring providers, the home health agency, hospital, FQHC, or RHC must maintain all documentation in the client’s medical record (see manual for more details).

SOURCE: TX Medicaid Telecommunication Services Handbook, p. 14-15 (Apr. 2025). (Accessed Apr. 2025).

See: TX Medicaid Remote Patient Monitoring.

Audio-Only

FQHCs and RHCs that provide telemedicine and telehealth services using synchronous audiovisual and synchronous telephone (audio-only) technology may be reimbursed.  See manual for codes.

Behavioral health services delivered using synchronous telephone (audio-only) technologies must be billed using the FQ modifier. Non-behavioral health services delivered using synchronous telephone (audio-only) technologies must be billed using the 93 modifier.

HTW Plus: Procedure code H0001 is authorized for delivery by synchronous telephone (audio-only) technology only during certain public health emergencies or natural disasters; to the extent allowed by federal law (assessments for withdrawal management services are excluded); and the ‘existing clinical relationship’ requirement is waived.

SOURCE: TX Medicaid Healthy Texas Women Program Handbook, (Apr. 2025), pg. 12-13, 16 (Accessed Apr. 2025).

See:  TX Medicaid Email, Phone and Fax.

Audio-Only

FQHC Manual refers providers to refer to Section 1: General Information manual for Telemedicine instructions.  General Information manual allows for interprofessional telephone/internet assessments and management services. No reference found on whether or not that service applies to FQHCs.

See: UT Medicaid Email, Phone and Fax

Live Video

Health insurance plans (includes Medicaid) must provide coverage for health care services and dental services delivered through telemedicine by a health care provider at a distant site to a patient at an originating site to the same extent that the plan would cover the services if they were provided through in-person consultation.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k (Accessed Jul. 2025).

Covered services must be clinically appropriate for delivery through telemedicine and be medically necessary.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Jul. 2025).

No explicit reference to whether or not FQHC’s are eligible telehealth providers.

See: VT Medicaid Live Video

Store and Forward

While some reimbursement is allowed for store-and-forward in VT Medicaid, including HCPCS G2010, it is unclear whether or not FQHCs can bill for these services.

See: VT Medicaid Store and Forward

Remote Patient Monitoring  

While reimbursement for some remote patient monitoring is provided in VT Medicaid, it is not explicitly specified whether or not FQHCs can bill for these services.

See: VT Medicaid Remote Patient Monitoring

Audio-Only

VT Medicaid allows audio-only reimbursement when clinically appropriate and medically necessary, however no explicit reference is made to whether or not FQHCs can bill for these services.

See: VT Medicaid Audio-Only

Live Video

No reference found.

Store and Forward

No reference found.

Remote Patient Monitoring

No reference found.

Audio-Only

No reference found.

Live Video

Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider or originating site and bill under the encounter rate. The encounter rate methodology for FQHCs and RHCs is described in 12VAC30-80-25; the encounter rate for IHCs (including Tribal clinics) is the All Inclusive Rate set by Indian Health Services.

SOURCE:  VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (5/13/24) (Accessed Apr. 2025).

Policies described in the Telehealth Supplement are applicable to all Providers (including FQHCs) who are able to bill for services listed in Attachment A.

SOURCE: VA Medicaid Telehealth Questions and Answers (Aug. 2021). (Accessed Apr. 2025).

See  VA Medicaid Live Video.

Store and Forward

Certain codes are eligible for reimbursement delivered by store and forward in VA Medicaid.  There is nothing explicit however that indicates FQHCs are eligible for these codes.

See:  VA Medicaid Store and Forward.

Remote Patient Monitoring

Certain RPM services are eligible for reimbursement in VA Medicaid. There is nothing explicit however that indicates FQHCs are eligible for these codes.

See: VA Medicaid Remote Patient Monitoring.

Audio-Only

Certain audio-only codes are eligible for reimbursement in VA Medicaid.  There is nothing explicit however that indicates FQHCs are eligible for those codes.

See:  VA Medicaid Email, Phone and Fax.

Live Video

Encounter: A face-to-face or telemedicine (including audio-only telemedicine) visit between an encounter eligible client and an FQHC provider who exercises independent judgment when providing services that qualify for encounter rate reimbursement.

SOURCE: WA HCA Medicaid Billing Guide, Federally Qualified Health Centers, p. 8 (Apr. 2025). (Accessed May 2025).

See: WA Medicaid Live Video

Store and Forward

No explicit reference for FQHCs found.

See: WA Medicaid Store-and-Forward

Remote Patient Monitoring

CPT® code 99453 is encounter-eligible when performed by a Federally Qualified Health Center (FQHC) encounter-qualified provider. Other RPM procedure codes are not FQHC-encounter eligible.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 84 (Apr. 2025). (Accessed May 2025).

See: WA Medicaid RPM

Audio-Only

“Encounter” – A face-to-face or telemedicine (including audio-only telemedicine) visit between an encounter-eligible client and an FQHC provider who exercises independent judgment when providing services that qualify for encounter rate reimbursement.

SOURCE: WA Admin Code 182-548-1100; Federally Qualified Health Centers, p. 8 (Apr. 2025). (Accessed May 2025).

Effective August 1, 2022, HCA pays for audio-only telemedicine services for specific procedure codes when provided and billed as directed in HCA provider billing guides. HCA published the list of audio-only codes on HCA’s Provider billing guides and fee schedules webpage. FQHCs may receive the encounter rate when billing as an audio-only code if the service being billed is encounter eligible and meets the billing requirements as outlined in the Encounters section of the FQHC guide.

SOURCE: WA HCA Medicaid Billing Guide, Federally Qualified Health Centers, p. 64 (Apr. 2025). (Accessed May 2025).

See: WA Medicaid Email, Phone, & Fax

Live Video

WV Medicaid reimburses live video telehealth services. The member must be able to see and interact with the off-site provider at the time services (“real-time not delayed”) are provided through Telehealth. Services provided through videophone or webcam are not covered.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 9. (July 1, 2019). (Accessed May 2025).

See: WV Medicaid Live Video

Store and Forward

WV Medicaid does not explicitly cover store-and-forward for FQHCs.

See: WV Medicaid Store-and-Forward

Remote Patient Monitoring

WV Medicaid does not explicitly cover RPM for FQHCs.

See: WV Medicaid RPM

Audio-Only

Telehealth is not a telephone conversation, email, or faxed transmission between a healthcare provider and a member, or a consultation between two healthcare providers.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 9. (July 1, 2019). (Accessed May 2025).

See: WV Email, Phone & Fax

Live Video

FQHCs may serve as originating and distant site providers for telehealth services.

SOURCE: WI ForwardHealth Handbook, Originating and Distant Sites, Topic #22739, (Accessed Apr. 2025).

See:  WI Medicaid Live Video.

Store and Forward

According to ForwardHealth Telehealth handbook, Services must be functionally equivalent to face-to-face visits.  There is no indication that store-and-forward is reimbursed.

See: WI Medicaid Store and Forward.

Remote Patient Monitoring

According to statute, RPM is covered with restrictions, however there is no indication if FQHCs can bill for this.

See: WI Medicaid Remote Patient Monitoring.

 Audio-Only

Community Health Centers may use the FQ (audio-only) modifier.

SOURCE: WI ForwardHealth Online Handbook, Topic #21997.  (Accessed Apr. 2025).

See: WI Medicaid Email, Phone and Fax.

Live Video

Each site will be able to bill for their own services as long as they are an enrolled Medicaid Provider (this includes out-of-state Medicaid Providers). Providers shall not bill for both the spoke and hub site; unless the Provider is at one location and the Member is at a different location even though the pay to Provider is the same. Examples include Community Mental Health Centers and Substance Abuse Treatment Centers. A single pay to Provider can bill both the originating site (spoke site) and the distant site Provider (hub site) when applicable.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 157 (Apr. 1, 2025),& Institutional Provider Manual pg. 133.  (Apr. 1, 2025). (Accessed May 2025).

See:  WY Medicaid Live Video

Store and Forward

WY Medicaid’s definition of telehealth excludes store-and-forward.

See:  WY Medicaid Store-and-Forward

Remote Patient Monitoring

No reference found.

See:  WY Medicaid Remote Patient Monitoring

Audio-Only

WY Medicaid’s definition of telehealth excludes audio-only telephone conversations.

See: WY Medicaid Email, Phone and Fax