Utah

At A Glance

1 / 4

MEDICAID REIMBURSEMENT

Live Video: Yes
Store-and-Forward: Yes*
Remote Patient Monitoring: Yes
Audio Only: Yes

PRIVATE PAYER LAW

Law Exists: Yes
Payment Parity: Yes (telepsychiatric provider-to-provider consultations only)

PROFESSIONAL REQUIREMENTS

Licensure Compacts: APRN, ASLP-IC, CC, EMS, IMLC, NLC, OT, PA, PSY, PTC
Consent Requirements: Yes

STATE RESOURCES

Medicaid Program: Utah Medicaid
Administrator: Utah Department of Health and Human Services
Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center

Private Payer

Last updated 11/29/2023

Definition

“Telemedicine services” means telehealth services including:

clinical care;
health education;
health administration;
home health;
facilitation of self-managed care and caregiver support; or
remote patient monitoring occurring incidentally to general supervision; and

provided by a provider to a patient through a method of communication that:

uses asynchronous store and forward transfer or synchronous interaction; and
meets industry security and privacy standards, including compliance with the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health Act.

SOURCE: UT Code Sec. 26B-4-704 (Accessed Nov. 2023).

“Telemedicine services” means the same as that term is defined in Section 26B-4-704.

“Telepsychiatric consultation” means a consultation between a physician and a board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in the state, that utilizes:

the health records of the patient, provided from the patient or the referring physician;
a written, evidence-based patient questionnaire; and
telehealth services that meet industry security and privacy standards, including compliance with the:
- Health Insurance Portability and Accountability Act; and
- Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.

SOURCE: Utah Code 31A-22-649 & 649.5 (Accessed Nov. 2023).

Last updated 11/29/2023

Parity

SERVICE PARITY

A health benefit plan shall provide coverage for:

telemedicine services that are covered by Medicare; and
treatment of a mental health condition through telemedicine services if:
- the health benefit plan provides coverage for the treatment of the mental health condition through in-person services; and
- the health benefit plan determines treatment of the mental health condition through telemedicine services meets the appropriate standard of care; and

reimburse a network provider that provides the telemedicine services at a negotiated commercially reasonable rate.

SOURCE: UT Code, 31A-22-649.5. (Accessed Nov. 2023).

Telepsychiatric Consultations

A health benefit plan that offers coverage for mental health services shall:

Provide coverage for telepsychiatric consultation during or after an initial visit between the patient and a referring in-network physician;
Provide coverage for a telepsychiatric consultation from an out-of-network board certified psychiatrist if the telepsychiatric consultant is not made available to a physician within seven business days after the initial request is made by an in-network provider of telepsychiatric consultations; and
Reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

Telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in the state, that utilizes:

The health records of the patient, provided from the patient or the referring physician;
A written, evidence-based patient questionnaire; and
Telehealth services that meet industry security and privacy standards, including compliance with the:
- Health Insurance Portability and Accountability Act; and
- Health Information Technology for Economic and Clinical Health Act

SOURCE: UT Code, 31A-22-649. (Accessed Nov. 2023).

PAYMENT PARITY

A health benefit plan shall reimburse a network provider that provides the telemedicine services at a negotiated commercially reasonable rate.

SOURCE: UT Code, 31A-22-649.5 (2(b)) (Accessed Nov. 2023).

Telepsychiatric Consultations (provider to provider)

A health benefit plan that offers coverage for mental health services shall reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

SOURCE: UT Code, 31A-22-649, (Accessed Nov. 2023).

No explicit payment parity for services with the exception of telepsychiatric consultations.

Last updated 11/29/2023

Requirements

All health insurance plans must disclose whether the insurer provides coverage for telehealth services in accordance with section 26B-3-123 and terms associated with that coverage.

SOURCE: UT Code 31A-22-613.5(2)(f). (Accessed Nov. 2023).

A health benefit plan offered in the individual market, the small group market, or the large group market shall provide coverage for:

telemedicine services that are covered by Medicare; and
treatment of a mental health condition through telemedicine services if:
- the health benefit plan provides coverage for the treatment of the mental health condition through in-person services; and
- the health benefit plan determines treatment of the mental health condition through telemedicine services meets the appropriate standard of care; and

reimburse a network provider that provides the telemedicine services described in Subsection (2)(a) at a negotiated commercially reasonable rate.

A health benefit plan may not impose originating site restrictions, geographic restrictions, or distance-based restrictions.

A network provider that provides the telemedicine services described above may utilize any synchronous audiovisual technology for the telemedicine services that is compliant with HIPAA.

SOURCE: UT Code, 31A-22-649.5. (Accessed Nov. 2023).

Telepsychiatric Consultations

A health benefit plan that offers coverage for mental health services shall:

Provide coverage for telepsychiatric consultation during or after an initial visit between the patient and a referring in-network physician;
Provide coverage for a telepsychiatric consultation from an out-of-network board certified psychiatrist if the consultant is not made available to a physician within seven business days after the initial request is made by an in-network provider; and
Reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

A single telepsychiatric consultation includes all contacts, services, discussion, and information review required to complete an individual request from a referring physician for a patient.

An insurer can also meet the requirement to cover telepsychiatric consultation for a patient by:

providing coverage for behavioral health treatment; and
ensuring that the patient receives an appointment for the behavioral health treatment in person or using telehealth services on a date that is within seven business days after the initial request is made by the in-network referring physician (see statute for details).

An insurer may receive a temporary waiver from the department from the requirements in this section if the insurer demonstrates to the department that the insurer is unable to provide the benefits described in this section due to logistical reasons.

An insurer that receives a waiver from the department under Subsection (6)(a) is subject to the requirements of this section beginning July 1, 2019.

This section does not limit an insurer from engaging in activities that ensure payment integrity or facilitate review and investigation of improper practices by health care providers.

SOURCE: UT Code, 31A-22-649. (Accessed Nov. 2023).

Medicaid

Last updated 11/29/2023

Definitions

“Telehealth services” means the transmission of health-related services or information through the use of electronic communication or information technology.

“Telemedicine services” means telehealth services including:

clinical care;
health education;
health administration;
home health;
facilitation of self-managed care and caregiver support; or
remote patient monitoring occurring incidentally to general supervision; and

provided by a provider to a patient through a method of communication that:

uses asynchronous store and forward transfer or synchronous interaction; and
meets industry security and privacy standards, including compliance with the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health Act.

SOURCE: UT Code Sec. 26B-4-704, (Accessed Nov. 2023).

“Telehealth services” means the transmission of health-related services or information through the use of electronic communication or information technology.

“Teledentistry” means the use of information technology and telecommunications for dental care, consultation, and education.

“Telepsychiatric consultation” means a consultation between a licensed provider and a board-certified psychiatrist that utilizes:

the health records of the member, provided from the member or the referring provider; and
a written, evidence-based member questionnaire.

SOURCE: UT Admin. Code R414-42-2. (Accessed Nov. 2023).

Telehealth – is the use of electronic information and telecommunications technologies that support distant healthcare to provide ease of access to health assessments, diagnostics, intervention, consultations, supervision, and education.

Telemedicine – see Telehealth.

Teledentistry is the use of information technology and telecommunications for dental care, consultation, and education.

Telepsychiatric Consultation is a consultation between a physician and a board-certified psychiatrist that utilizes:

the health records of the patient, provided from the patient or the referring physician
a written, evidence-based patient questionnaire

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov. 2023).

“Early childhood psychotherapeutic telehealth consultation” means a consultation regarding a child’s mental health care during the child’s early childhood between a child care provider or a mental health therapist and a child mental health therapist that is focused on psychotherapeutic and psychosocial interventions and is completed through the use of electronic or telephonic communication.

SOURCE: UT Code 26B1-328, (Accessed Nov. 2023).

Last updated 11/29/2023

Email, Phone & Fax

The Medicaid program shall reimburse for audio-only telehealth services as specified by division rule.

SOURCE: UT Code 26B-3-123 (Accessed Nov. 2023).

Telehealth services seek to improve an individual’s health by permitting two-way communication between members and their providers and may be performed for a variety of medically necessary services. This communication often requires the use of interactive telecommunications equipment that can include both audio and video components but may also be conducted via audio-only. Audio-only telehealth is not allowed if it is solely for the sake of provider convenience. The utilization of telehealth services is dependent upon the member and their situation. As such, providers must determine the clinical appropriateness and medical necessity of the services being delivered through clinical-based decision making. Some examples of when telehealth may be appropriate are:

Diagnostic review and discussion of results
Evaluation and management services
Management of chronic conditions
Medication management
Mental health, behavioral health, and substance use disorder services
Telepsychiatric consultation
Teledentistry
Treatment counselling
Wellness checks

Telecommunication technologies that support synchronous care include:

Live video two-way, face-to-face interaction between the member and the provider using audiovisual communication, including E-visits through an online patient portal.
Audio only visits by means of telephone or other forms of communication without video.

As outlined by the Centers for Medicare and Medicaid Services (CMS), audio-only synchronous care or care that does not clinically require visual inspection, is covered for a limited number of services. Medicaid limits these services to:

Behavioral health, including substance use disorders (SUD)
Diabetic self-management
Speech and hearing
Nutritional counselling
Tobacco cessation
Education for chronic kidney disease
Advanced care planning

Providers are responsible for determining the applicable CPT and HCPCS codes associated with each of the above-listed services and ensure the codes are covered. Reporting requirements for services provided via telehealth are the same as those provided for services performed in-person.

Telepsychiatry

Psychiatrists can report:

Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Dec. 2022). (Accessed Jun. 2023).

Telephone contact can be billed in the Targeted Case Management for Early Childhood program.

SOURCE: Utah Medicaid Provider Manual: Targeted Case Management, Early Childhood Ages 0-4, p. 8 (Jul. 2023). (Accessed Nov. 2023).

Case Management Monitoring includes at least one monthly contact directly with the participant either by telephone or in person.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services, New Choices Waiver (Jul. 2021). (Accessed Nov. 2023).

The agency may report the covered services and activities specified in Chapter 2-1, B. only if: …

the time spent in the service or activity involves a face-to-face encounter, telephone or written communication with the client, family, caretaker, service provider, or other individual with a direct involvement in providing or assuring the client obtains the necessary services documented in the targeted case management service plan;

For each date of service, documentation must include: …

setting in which the service was rendered (when via telehealth, the provider setting and notation that the service was provided via telehealth);

SOURCE: Utah Medicaid Provider Manual: Targeted Case Management for Individuals with Serious Mental Illnesses (Jul. 2022). (Accessed Nov. 2023).

Last updated 11/29/2023

Live Video

POLICY

Communication by telemedicine is considered face-to-face contact between a health care provider and a patient under the state’s medical assistance program if:

the communication by telemedicine meets the requirements of administrative rules adopted in accordance with Subsection (3); and
the health care services are eligible for reimbursement under the state’s medical assistance program.

This Subsection (1) applies to any managed care organization that contracts with the state’s medical assistance program.

The reimbursement rate for telemedicine services approved under this section:

shall be subject to reimbursement policies set by the state plan; and
may be based on:
- a monthly reimbursement rate;
- a daily reimbursement rate; or
- an encounter rate.

The department shall adopt administrative rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, which establish:

the particular telemedicine services that are considered face-to-face encounters for reimbursement purposes under the state’s medical assistance program; and
the reimbursement methodology for the telemedicine services designated under Subsection (3)(a).

SOURCE: UT Code Annotated Sec. 26B-3-122. (Accessed Nov. 2023).

Telecommunication technologies that support synchronous care include:

Live video two-way, face-to-face interaction between the member and the provider using audiovisual communication, including E-visits through an online patient portal.
Audio only visits by means of telephone or other forms of communication without video.

Telehealth encounters must comply with HIPAA privacy and security measures and the Health Information Technology for Economic and Clinical Health Act, Pub. L. No.111-5, 123 Stat. 226, 467, as amended to ensure that all member communications and records, including recordings of telehealth encounters, are secure and remain confidential. The provider is responsible for ensuring the encounter is HIPAA compliant. Security measures for transmission may include password protection, encryption, and other reliable authentication techniques. Compliance with the Utah Health Information Network (UHIN) Standards for Telehealth must be maintained. These standards provide a uniform standard of billing for claims and encounters delivered via telehealth.

Services not otherwise covered by Utah Medicaid are not covered when delivered via telehealth.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov. 2023).

Telehealth services are an additional method of delivering health care to patients. Refer to Section I: General Information, Chapter 8-4.2, Telehealth.

SOURCE: Utah Medicaid Provider Manual: Physician Services (Nov. 2023). (Accessed Nov. 2023).

A licensed provider may deliver services via synchronous telehealth, as clinically appropriate. Services include consultation services, evaluation and management services, teledentistry services, mental health services, substance use disorder services, and telepsychiatric consultations.

Telehealth services must comply with privacy and security measures set forth under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act, Pub. L. No. 111-5, 123 Stat. 226, 467, to ensure that all patient communications and records, including recordings of telehealth encounters, are secure and remain confidential. The provider is responsible to ensure the encounter is HIPAA compliant. Security measures for transmission may include password protection, encryption, and other reliable authentication techniques.

A provider must comply with the Utah Health Information Network (UHIN) standards for telehealth. These standards provide a uniform standard of billing for claims and encounters delivered via telehealth.

The Department pays the lesser of the amount billed or the rate on the fee schedule. A provider may not charge the Department a fee that exceeds the provider’s usual and customary charges for the provider’s private pay patients.

SOURCE: UT Admin. Code R414-42-3, -4, -5 (Accessed Nov. 2023).

ELIGIBLE SPECIALTIES/SERVICES

“Telemedicine services” means telehealth services including:

clinical care;
health education;
health administration;
home health;
facilitation of self-managed care and caregiver support; or
remote patient monitoring occurring incidentally to general supervision; and

provided by a provider to a patient through a method of communication that:

uses asynchronous store and forward transfer or synchronous interaction; and
meets industry security and privacy standards, including compliance with the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health Act.

SOURCE: UT Code Sec. 26B-4-704, (Accessed Nov. 2023).

The utilization of telehealth services is dependent upon the member and their situation. As such, providers must determine the clinical appropriateness and medical necessity of the services being delivered through clinical-based decision making. Some examples of when telehealth may be appropriate are:

Diagnostic review and discussion of results
Evaluation and management services
Management of chronic conditions
Medication management
Mental health, behavioral health, and substance use disorder services
Telepsychiatric consultation
Teledentistry
Treatment counselling
Wellness checks

When psychiatrists consult with a physician regarding a member’s possible need for telepsychiatry, they must report the following CPT codes to receive payment for services:

99446 Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
99447 11-20 minutes of medical consultative discussion and review
99448 21-30 minutes of medical consultative discussion and review
99449 31 minutes or more of medical consultative discussion and review

The treating physician, consulting with the psychiatrist, reports CPT code 99358- Prolonged evaluation and management service before and/or after direct patient care

Teledentistry services are covered for eligible members statewide.

Providers must report one of the following CPT codes to receive reimbursement for services:

D0140 –Limited oral evaluation – problem focused; An evaluation limited to a specific oral health problem or complaint. This may require interpretation of information acquired through additional diagnostic procedures. Report additional diagnostic procedures separately. Definitive procedures may be required on the same date as the evaluation. Typically, patients receiving this type of evaluation present with a specific problem and/or dental emergencies, trauma, acute infections, etc.
D0170 – Re-evaluation – limited, problem focused (established patient; not post-operative visit); Assessing the status of a previously existing condition. For example: – a traumatic injury where no treatment was rendered but patient needs follow-up monitoring; – evaluation for undiagnosed continuing pain; – soft tissue lesion requiring follow-up evaluation.
D0171 – Re-evaluation – post-operative office visit.

The dentist, to receive reimbursement, must reports CPT code D9995- teledentistry – synchronous; real-time encounter; Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service to denote that services were rendered via teledentistry. Rates for approved teledentistry are the same as rates for in-person dental services.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov. 2023).

The Medicaid program shall reimburse for telemedicine services at the same rate that the Medicaid program reimburses for other health care services.

The Medicaid program shall reimburse for audio-only telehealth services as specified by division rule.

The Medicaid program shall reimburse for telepsychiatric consultations at a rate set by the Medicaid program.

SOURCE: UT Code 26B-3-123 (Accessed Nov. 2023).

Rehabilitative Mental Health and Substance Use Disorder

Services may be provided via telemedicine when clinically appropriate.

For dates of service prior to April 1, 2022, when services are provided by telemedicine, providers must specify place of service ‘02’ in the place of service field on the claim. For dates of service on or after April 1, 2022, providers must specify the place of service as follows:

’02’ (Telehealth Provided Other than in Patient’s Home)
’10’ (Telehealth Provided in Patient’s Home)

The scope of rehabilitative behavioral health services includes the following:

Psychiatric Diagnostic Evaluation
Mental Health Assessment by a Non-Mental Health Therapist
Psychological Testing
Psychotherapy with Patient
Family psychotherapy with Patient Present and Family Psychotherapy without Patient Present
Group Psychotherapy and Multiple Family Group Psychotherapy
Psychotherapy for Crisis
Psychotherapy with Evaluation and Management (E/M) Services
Evaluation and Management (E/M) Services (Pharmacologic Management)
Therapeutic Behavioral Services
Psychosocial Rehabilitative Services
Peer Support Services
SUD Services in Licensed SUD Residential Treatment Programs
Assertive Community Treatment (ACT) and Assertive Community Outreach Treatment (ACOT)
Mobile Crisis Outreach Teams (MCOT)
Clinically Managed Residential Withdrawal Management
Mental Health Services in Licensed Mental Health Residential Treatment Programs
Behavioral Health Receiving Centers

SOURCE: Utah Medicaid Provider Manual: Rehabilitative Mental Health and Substance Use Disorder Services. (May 2023) (Accessed Nov. 2023).

Autism Spectrum Disorder

When clinically appropriate, supervision of an assistant behavior analyst or behavior technician may occur via remote access technology.

Parent training services via remote technology are covered when it is clinically appropriate, per Utah Administrative Rule R414-42.

Documentation must substantiate the clinical appropriateness of telehealth services.

The provider may deliver services or supervise only one member or one group session at a time. Medicaid coverage requires synchronous delivery of services. This is comprised of real-time videoconferencing that occurs via two-way video and audio interactions.

The following services not covered when performed via telehealth:

Adaptive behavior treatment administered by a technician
Group adaptive behavior treatment administered by a technician
Group adaptive behavior treatment with protocol modification administered by a QHP

SOURCE: Utah Medicaid Provider Manual: Autism Spectrum Disorder (July 2023). (Accessed Nov. 2023).

Supervision and parent training may be performed by a behavior therapist via telehealth regardless of geographic location. These services are reported with CPT codes 97151, 97155, 97156, and 97157. Remote access technology may not be used for other ABA services.

SOURCE: UT Medicaid Information Bulletin, Jan. 2023, (accessed Nov. 2023).

Utah Medicaid has allowed home health and hospice interventions to be delivered by telehealth when home visits have been restricted by quarantine or self-isolation or not allowed due to restrictions on facility/community access.

Continuing – The following changes will remain:

Telehealth visits for home health and hospice services provided to members living in facilities will remain permitted when the facility is closed due to infection control measures.
Home Health and Hospice agencies that are CLIA certified can perform COVID-19 testing in patients’ homes and receive reimbursement for these services.

Utah Medicaid has allowed flexibility for Applied Behavior Analysis (ABA) services during the PHE. Please refer to the Autism Spectrum Disorder Services provider manual for additional information.

Continuing – The following changes related to ABA will remain at the end of the PHE. Including:

Telehealth services without geographic restriction for supervision and parent training by a psychologist or behavioral analyst
Telehealth services for CPT code 97151 and 97153 in limited circumstances; such as, issues with access to care
Use of additional autism diagnostic tools
Telehealth services for ABA therapy may only be delivered to one patient at a time

SOURCE: UT Department of Health and Human Services, COVID-19 and the Public Health Emergency, (April 2023), (Accessed Nov. 2023).

School Based Skills Development Services

Utah Medicaid covers medically necessary, non-experimental, and cost-effective services provided via telehealth. Telehealth is a twoway, real-time interactive communication to facilitate contact directly between a student and a provider. This electronic communication uses interactive telecommunications equipment that includes, at a minimum, audio and video equipment that complies with HIPAA and UHIN privacy and security standards for telehealth.

Covered telehealth services include but are not limited to the following:

Consultation services
Evaluation and management services
Mental health services

Reporting requirements for provided telehealth services are the same as those provided when the student is present (in person).

SOURCE: Utah Medicaid Provider Manual: School Based Skills Development Services (Nov. 2023). (Accessed Nov. 2023).

ELIGIBLE PROVIDERS

Distant site (hub site) – is where the provider delivering the service is located at the time the service is provided via telecommunications system

Distant providers:

CMS 1500 Professional Claims- Provider must indicate that the service(s) was provided via telehealth by indicating Place of Service (POS) 02 – Telehealth Provided Other than in Patient’s Home, or POS 10 – Telehealth Provided in Patient’s Home on the CMS 1500 claim form with the service’s usual billing codes.
UB-04 Institutional Claims- Providers must indicate that the service(s) was provided via telehealth by appending the GT modifier to the UB-04 institutional claim form with the service’s usual billing codes.
- GT – Via interactive audio and video telecommunication systems
Services provided via telehealth have the same service thresholds, authorization requirements, and reimbursement rates as services delivered face-to-face.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov. 2023).

ELIGIBLE SITES

There are no geographic restrictions surrounding the use of telehealth services. Medicaid covers telehealth services when performed via synchronous care. Telecommunication technologies that support synchronous care include:

Live video two-way, face-to-face interaction between the member and the provider using audiovisual communication, including E-visits through an online patient portal.
Audio only visits by means of telephone or other forms of communication without video.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov. 2023).

Rehabilitative Mental Health and Substance Use Disorder

’02’ (Telehealth Provided Other than in Patient’s Home)
’10’ (Telehealth Provided in Patient’s Home)

SOURCE: Utah Medicaid Provider Manual: Rehabilitative Mental Health and Substance Use Disorder Services. (May 2023) (Accessed Jun. 2023).

Autism Spectrum Disorder

When reporting services delivered via remote access technology, the CMS 1500 claim form must include “Place of Service 02” to identify the service as delivered via telehealth.

SOURCE: Utah Medicaid Provider Manual: Autism Spectrum Disorder (July 2023). (Accessed Nov. 2023).

School Based Skills Development Services

There are no geographic restrictions for telehealth services.

SOURCE: Utah Medicaid Provider Manual: School Based Skills Development Services (Nov. 2023). (Accessed Nov. 2023).

GEOGRAPHIC LIMITS

Live video two-way, face-to-face interaction between the member and the provider using audiovisual communication, including E-visits through an online patient portal.
Audio only visits by means of telephone or other forms of communication without video.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov. 2023).

School Based Skills Development Services

There are no geographic restrictions for telehealth services.

SOURCE: Utah Medicaid Provider Manual: School Based Skills Development Services (Nov. 2023). (Accessed Nov. 2023).

FACILITY/TRANSMISSION FEE

The provider, if the member is in a facility i.e. the originating site, receives no additional reimbursement for the use of telehealth services.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023), (Accessed Nov. 2023).

The originating site receives no reimbursement for the use of telehealth services.

SOURCE: Utah Admin Code, R414-42-4.(3). (Accessed Nov. 2023).

School Based Skills Development Services

Providers at the originating site receive no additional reimbursement for the use of telehealth services.

SOURCE: Utah Medicaid Provider Manual: School Based Skills Development Services (Nov. 2023). (Accessed Nov. 2023).

Last updated 11/29/2023

Miscellaneous

Home and Community Based New Choices Waiver Services

A non face-to-face medication reminder system using telecommunication device is covered.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services, New Choices Waiver, p. 63 (Jul. 2021). (Accessed Nov. 2023).

Provider Requirements

A provider offering telehealth services shall

at all times:
- act within the scope of the provider’s license under Title 58, Occupations and Professions, in accordance with the provisions of this section and all other applicable laws and rules; and
- be held to the same standards of practice as those applicable in traditional health care settings;
If the provider does not already have a provider-patient relationship with the patient, establish a provider-patient relationship during the patient encounter in a manner consistent with the standards of practice, determined by the Division of Professional Licensing in rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, including providing the provider’s licensure and credentials to the patient;
Before providing treatment or prescribing a prescription drug, establish a diagnosis and identify underlying conditions and contraindications to a recommended treatment after:
- obtaining from the patient or another provider the patient’s relevant clinical history; and
- documenting the patient’s relevant clinical history and current symptoms;
be available to a patient who receives telehealth services from the provider for subsequent care related to the initial telemedicine services, in accordance with community standards of practice;
be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated;
in accordance with any applicable state and federal laws, rules, and regulations, generate, maintain, and make available to each patient receiving telehealth services the patient’s medical records; and
if the patient has a designated health care provider who is not the telemedicine provider:
- consult with the patient regarding whether to provide the patient’s designated health care provider a medical record or other report containing an explanation of the treatment provided to the patient and the telemedicine provider’s evaluation, analysis, or diagnosis of the patient’s condition;
- collect from the patient the contact information of the patient’s designated health care provider; and
- within two weeks after the day on which the telemedicine provider provides services to the patient, and to the extent allowed under HIPAA as that term is defined in Section 26B-3-126, provide the medical record or report to the patient’s designated health care provider, unless the patient indicates that the patient does not want the telemedicine provider to send the medical record or report to the patient’s designated health care provider.

The last bullet does not apply to prescriptions for eyeglasses or contacts.

A provider offering telemedicine services may not diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of the following:

an online questionnaire;
an email message; or
a patient-generated medical history.

A provider may not offer telehealth services if:

the provider is not in compliance with applicable laws, rules, and regulations regarding the provider’s licensed practice; or
the provider’s license under Title 58, Occupations and Professions, is not active and in good standing.

The Division of Professional Licensing created in Section 58-1-103 is authorized to enforce the provisions of this section as it relates to providers licensed under Title 58, Occupations and Professions.

The department is authorized to enforce the provisions of:

this section as it relates to providers licensed under this title; and
this section as it relates to providers licensed under Chapter 2, Part 1, Human Services Programs and Facilities.

SOURCE: UT Code Sec. 26B-4-704 (Accessed Nov. 2023).

Office of Substance Use and Mental Health is required to award grants to a health facility that implements a program that provides a primary care provider access to a telehealth psychiatric consultation when the primary care provider is evaluating a patient for or providing a patient mental health treatment. See statute for details.

SOURCE UT Code 26B-1-328, (Accessed Nov. 2023).

Tenant Housing Services

For each date of service, documentation must include: … Setting in which the service was rendered (when via telehealth, the provider setting and
notation that the service was provided via telehealth).

SOURCE: Utah Medicaid Provider Manual: Housing Related Services and Supports (Aug. 2022). (Accessed Nov. 2023).

Durable Medical Equipment

In addition, documentation must indicate:

the evaluating physician
the date of the face-to-face
if the evaluation was conducted via telehealth

SOURCE: Utah Medicaid Provider Manual: Medical Supplies and Durable Medical Equipment, (Sept. 2022). (Accessed Nov. 2023).

Targeted Case Management for Individuals with Serious Mental Illness

For each date of service, documentation must include: … setting in which the service was rendered (when via telehealth, the provider setting and notation that
the service was provided via telehealth).

SOURCE: Utah Medicaid Provider Manual: Targeted Case Management for Individuals with Serious Mental Illness, (Jul. 2022). (Accessed Nov. 2023).

Last updated 11/29/2023

Out of State Providers

A non-resident provider may report telehealth services given to an in-state Medicaid member when the following conditions are met:

The provider meets the licensing requirements of the Department of Professional Licensing (DOPL) as outlined in Utah Annotated Code 58-1-302.1
The provider is enrolled as a Utah Medicaid provider as explained in Chapter 3 Provider Participation and Requirements
Follow the policies outlined in Chapter 8-4.2 Telehealth.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov. 2023).

Last updated 11/29/2023

Overview

Utah Medicaid recently updated their telehealth provider manual section to allow reimbursement for services that are clinically appropriate for telehealth, providing examples of such services. They also allow reimbursement for audio-only services under some conditions. They state that there is no reimbursement for store-and-forward or remote patient monitoring, though there is reimbursement for interprofessional telephone/internet assessments and management and home telemetry.

Last updated 11/29/2023

Remote Patient Monitoring

POLICY

“Telemedicine services” means telehealth services including:

clinical care;
health education;
health administration;
home health;
facilitation of self-managed care and caregiver support; or
remote patient monitoring occurring incidentally to general supervision; and

provided by a provider to a patient through a method of communication that:

uses asynchronous store and forward transfer or synchronous interaction; and
meets industry security and privacy standards, including compliance with the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health Act.

SOURCE: UT Code Sec. 26B-4-704, (Accessed Nov. 2023).

Home telemetry is covered for outpatient, long-term cardiac (Holter) monitoring codes 93224, 93225, 93226, and 93227 will require prior authorization if more than 3 units of any code are reported in one year. Prior authorization will use the following criteria:

A cardiologist must order outpatient, long-term cardiac (Holter) monitoring
Member must have had a stroke or TIA with no identifiable cause
Member should have already had 24-hour monitoring done previously (either with outpatient, long-term cardiac monitoring, or as inpatient with telemetry)
Member should not be currently taking anti-coagulated or Warfarin for any other reason
Member should not have a known contraindication for Warfarin
Outpatient long-term cardiac monitoring may only be authorized for the 30-day test
Data from the test must be reviewed and interpreted by a cardiologist

SOURCE: Utah Medicaid Provider Manual: Physician Manual, (Nov. 2023). (Accessed Nov. 2023).

Medicaid does not cover telehealth services when performed by means of asynchronous communication. Examples of asynchronous communication include: …

Remote patient monitoring (RPM)
- - Blood pressure monitors
  - Pacemakers
  - Glucose meters
  - Oximeters
  - Wireless scales
  - Heart rate monitors

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov. 2023).

CONDITIONS

Only for patients with a long-term cardiac health issue.

SOURCE: Utah Medicaid Provider Manual: Physician Manual, (Nov. 2023). (Accessed Nov. 2023).

PROVIDER LIMITATIONS

Test must be ordered by a cardiologist and reviewed and interpreted by a cardiologist.

SOURCE: Utah Medicaid Provider Manual: Physician Manual, (Nov. 2023). (Accessed Nov. 2023).

OTHER RESTRICTIONS

No Reference Found

Last updated 11/29/2023

Store and Forward

POLICY

“Telemedicine services” means telehealth services including:

clinical care;
health education;
health administration;
home health;
facilitation of self-managed care and caregiver support; or
remote patient monitoring occurring incidentally to general supervision; and

provided by a provider to a patient through a method of communication that:

uses asynchronous store and forward transfer or synchronous interaction; and
meets industry security and privacy standards, including compliance with the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health Act.

SOURCE: UT Code Sec. 26B-4-704, (Accessed Nov. 2023).

Medicaid does not cover telehealth services when performed by means of asynchronous communication.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Nov. 2023). (Accessed Nov 2023).

ELIGIBLE SERVICES/SPECIALTIES

Medicaid does not cover telehealth services when performed by means of asynchronous communication. Examples of asynchronous communication include:

Email communication
Text messaging
Other forms of messaging with follow-up instructions or confirmations
Mobile Health (mHealth)
- Fitness tracker
- Phone applications that record a patient’s exercise
- Automatic reminders such as when to take medicine.
- Storing information or educational materials such as discharge instructions
Remote patient monitoring (RPM)
- Blood pressure monitors
- Pacemakers
- Glucose meters
- Oximeters
- Wireless scales
- Heart rate monitors
Store-and-forward imaging
Transmission of lab or other diagnostic/screening results

Telepsychiatry

Psychiatrists can report:

Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review

SOURCE: Utah Medicaid Provider Manual: Section I: General Information (Dec. 2022). (Accessed Jun. 2023).

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 11/29/2023

Cross State Licensing

An out-of-state physician may practice without a Utah license if:

The individual is licensed in good standing as a physician in another state with no licensing action pending and no less than 10 years of professional experience
The services are rendered as a public service and for a noncommercial purpose;
No fee or other consideration of value is charged, expected or contemplated, beyond an amount necessary to cover the proportionate cost of malpractice insurance; and
The physician does not otherwise engage in unlawful or unprofessional conduct.

SOURCE: UT Code Annotated Sec. 58-67-305(7). (Accessed Nov. 2023).

A mental health therapist licensed in another state and in good standing can provide short term transitional mental health therapy remotely if:

The mental health therapist is present in the state where he/she is licensed;
The client relocates to Utah, and was a client immediately before the relocation;
The therapy or counseling is provided for a maximum of 45 days after the client relocates;
Within 10 days of the client’s relocation, the mental health therapist provides a written notice to the Division of Occupational and Professional Licensing of their intent to provide therapy/counseling remotely; and
The mental health therapist does not engage in unlawful or unprofessional conduct.

SOURCE: UT Code, 58-61-307(k) (Accessed Nov. 2023).

An individual with a temporary license issued under this section is authorized to provide a telemedicine service if:

the telemedicine service is a service the individual is licensed to perform under the nonresident health care license of the state, district, or territory that issued the nonresident health care license;
at the time the telemedicine service is performed, the patient is located in Utah; and
performing the telemedicine service would not otherwise violate state law.

The division shall issue a temporary license described in Subsection (2) to an individual who has a nonresident health care license in good standing if:

the individual has completed an application for a license by endorsement in accordance with Section 58-1-302; and
the division determines that they will not be able to process the application within 15 days from the day on which the application is submitted.

The division may not charge a fee for a temporary license issued under this section beyond the fee required for a license issued under Section 58-1-302.

SOURCE: UT Code 58-1-302.1, (Accessed Nov. 2023).

In addition to the exemptions from licensure in Section 58-1-307, the following may engage in acts included within the definition of practice as a mental health therapist, subject to the stated circumstances and limitations, without being licensed under this chapter: …

an individual who is licensed, in good standing, to practice mental health therapy or substance use disorder counseling in a state or territory of the United States outside of Utah may provide short term transitional mental health therapy remotely or short term transitional substance use disorder counseling remotely to a client in Utah if:
- the individual is present in the state or territory where the individual is licensed to practice mental health therapy or substance use disorder counseling;
- the client relocates to Utah;
- the client is a client of the individual immediately before the client relocates to Utah;
- the individual provides the short term transitional mental health therapy or short term transitional substance use disorder counseling remotely to the client only during the 90 day period beginning on the day on which the client relocates to Utah;
- within one day after the day on which the individual first provides mental health therapy or substance use disorder counseling remotely to the client in Utah the individual provides written notice to the division of the individual’s intent to provide short term transitional mental health therapy or short term transitional substance use disorder counseling remotely to the client; and
- the individual does not engage in unlawful conduct or unprofessional conduct.

Except as otherwise provided in an interstate compact enacted under this title, an individual who is licensed, in good standing, to practice mental health therapy or substance use disorder counseling in a state or territory of the United States outside of Utah, and who provides mental health therapy remotely or substance use disorder counseling remotely to a client in Utah:

may not prescribe a prescription drug for a client in Utah unless the individual is licensed in Utah to prescribe the prescription drug;
shall, before providing mental health therapy remotely or substance use disorder counseling remotely to a client in Utah, be aware of:
- how to access emergency services and resources in Utah; and
- all applicable laws and rules regarding the required or permitted reporting or disclosing of confidential client communications;
shall, within one day after the day on which the individual first provides mental health therapy remotely or substance use disorder counseling remotely to a client in Utah, submit to the division a signed notice, in the form required by the division, notifying the division that the individual is providing therapy or counseling under the exemption in this Subsection (3); and
shall obtain a Utah license:
- within nine months after the day on which the individual first provides mental health therapy remotely or substance use disorder counseling remotely to a client in Utah; or
- if at any time the individual provides mental health therapy remotely or substance use disorder counseling remotely to more than one client in Utah.

The division shall report to the Health and Human Services Interim Committee at or before the committee’s October 2026 meeting regarding the exemption described in Subsection (3), including information about any complaints the division has received concerning individuals who have provided therapy or counseling under that exemption.

SOURCE: UT Code Sec. 58-60-107, (Accessed Nov. 2023).

Last updated 11/29/2023

Definitions

“Telehealth services” means the transmission of health-related services or information through the use of electronic communication or information technology.

“Telemedicine services” means telehealth services including:

clinical care;
health education;
health administration;
home health;
facilitation of self-managed care and caregiver support; or
remote patient monitoring occurring incidentally to general supervision; and

provided by a provider to a patient through a method of communication that:

uses asynchronous store and forward transfer or synchronous interaction; and
meets industry security and privacy standards, including compliance with the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health Act.

SOURCE: UT Code Sec. 26B-4-704 (Accessed Nov. 2023).

“Teledentistry” means the practice of dentistry using synchronous or asynchronous technology.

SOURCE: UT Code, 58-69-102 (12), (Accessed Nov. 2023).

Last updated 11/29/2023

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Nov. 2023).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Compact. (Accessed Nov. 2023).

Member of the Nurse Licensure Compact.

SOURCE: Nurse Licensure Compact (Accessed Nov. 2023).

Member of the Physical Therapy Licensure Compact.

SOURCE: PT Compact. Compact Map. (Accessed Nov. 2023).

Member of the Audiology and Speech-language Pathology Interstate Compact.

SOURCE: ASLP-IC Compact. Compact Map. (Accessed Nov. 2023).

Member of the Emergency Medical Services Compact.

SOURCE: EMS Compact. (Accessed Nov. 2023).

Member of the Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact. (Accessed Nov. 2023).

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Nov. 2023).

Advanced Practice Registered Nurse (APRN) Compact

SOURCE: NCSBN, APRN Compact, (Accessed Nov. 2023).

Physician Assistant Compact

SOURCE: PA Compact, Physician Assistant Compact Legislation, (Accessed Nov. 2023).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 11/29/2023

Miscellaneous

If a licensee participates in telehealth, it shall develop and implement policies governing the practice of telehealth in accordance with the scope and practice of the hospital and in accordance with Section 26B-4-704.

The licensee’s telehealth policies shall address security, access, and retention of telemetric data.

The licensee’s telehealth policies shall define the privileging of physicians and allied health professionals who participate in telehealth.

SOURCE: UT Admin. Code R432-100-33. (Accessed Nov. 2023).

Utah established the Early Childhood Psychotherapeutic Telehealth Consultation Program.

SOURCE: UT Code Sec. 26B-1-328, (Accessed Nov. 2023)

Last updated 11/29/2023

Online Prescribing

A provider offering telehealth services shall at all times:

act within the scope of the provider’s license; and
be held to the same standards of practice as those applicable in traditional health care settings

If the provider does not already have a provider-patient relationship with the patient, establish a provider-patient relationship during the patient encounter in a manner consistent with the standards of practice, including providing the provider’s licensure and credentials to the patient;

Before providing treatment or prescribing a prescription drug, establish a diagnosis and identify underlying conditions and contraindications to a recommended treatment after:

obtaining from the patient or another provider the patient’s relevant clinical history; and
documenting the patient’s relevant clinical history and current symptoms;

Be available to a patient who receives telehealth services from the provider for subsequent care related to the initial telemedicine services, in accordance with community standards of practice.

Be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated.

Make available to each patient receiving telehealth services the patient’s medical records; and

If the patient has a designated health care provider who is not the telemedicine provider:

Consult with the patient regarding whether to provide the patient’s designated health care provider a medical record or other report containing an explanation of the treatment provided to the patient and the telemedicine provider’s evaluation, analysis, or diagnosis of the patient’s condition;
Collect from the patient the contact information of the patient’s designated health care provider; and
Within two weeks after the day on which the telemedicine provider provides services to the patient, and to the extent allowed under HIPAA as that term is defined in Section 26-18-17, provide the medical record or report to the patient’s designated health care provider, unless the patient indicates that the patient does not want the telemedicine provider to send the medical record or report to the patient’s designated health care provider.

A provider offering telemedicine services may not diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of the following:

an online questionnaire;
an email message; or
a patient-generated medical history.

A provider may not offer telehealth services if:

the provider is not in compliance with applicable laws, rules, and regulations regarding the provider’s licensed practice; or
the provider’s license under Title 58, Occupations and Professions, is not active and in good standing.

SOURCE: UT Code, 26B-4-704. (Accessed Nov. 2023).

may not prescribe a prescription drug for a client in Utah unless the individual is licensed in Utah to prescribe the prescription drug

See cross-state licensing section for more details.

SOURCE: UT Code Sec. 58-60-107 (Accessed Nov. 2023).

It is considered unprofessional conduct to issue, or aid and abet in the issuance of, an order or prescription for a drug or device:

without first obtaining information in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify conditions, and to identify contraindications to the proposed treatment; or
with prescriptive authority conferred by an exception issued under this title, or a multi-state practice privilege recognized under this title, if the prescription was issued without first obtaining information, in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify underlying conditions, and to identify contraindications to the proposed treatment.

SOURCE: UT Code, 58-1-501. (Accessed Nov. 2023).

Last updated 11/29/2023

Professional Board Standards

Utah has scope of telehealth practice that applies to providers offering telehealth services. See regulations for details.

SOURCE: R156-1-603, (Accessed Nov. 2023).

A provider offering telehealth services shall at all times:

act within the scope of the provider’s license; and
be held to the same standards of practice as those applicable in traditional health care settings

Before providing treatment or prescribing a prescription drug, establish a diagnosis and identify underlying conditions and contraindications to a recommended treatment after:

obtaining from the patient or another provider the patient’s relevant clinical history; and
documenting the patient’s relevant clinical history and current symptoms;

Be available to a patient who receives telehealth services from the provider for subsequent care related to the initial telemedicine services, in accordance with community standards of practice.

Be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated.

Make available to each patient receiving telehealth services the patient’s medical records; and

If the patient has a designated health care provider who is not the telemedicine provider:

Consult with the patient regarding whether to provide the patient’s designated health care provider a medical record or other report containing an explanation of the treatment provided to the patient and the telemedicine provider’s evaluation, analysis, or diagnosis of the patient’s condition;
Collect from the patient the contact information of the patient’s designated health care provider; and
Within two weeks after the day on which the telemedicine provider provides services to the patient, and to the extent allowed under HIPAA as that term is defined in Section 26-18-17, provide the medical record or report to the patient’s designated health care provider, unless the patient indicates that the patient does not want the telemedicine provider to send the medical record or report to the patient’s designated health care provider.

A provider offering telemedicine services may not diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of the following:

an online questionnaire;
an email message; or
a patient-generated medical history.

A provider may not offer telehealth services if:

the provider is not in compliance with applicable laws, rules, and regulations regarding the provider’s licensed practice; or
the provider’s license under Title 58, Occupations and Professions, is not active and in good standing.

SOURCE: UT Code, 26B-4-704. (Accessed Nov. 2023).

Utah

MEDICAID REIMBURSEMENT

PRIVATE PAYER LAW

PROFESSIONAL REQUIREMENTS

STATE RESOURCES

Private Payer

Definition

Parity

SERVICE PARITY

PAYMENT PARITY

Requirements

Medicaid

Consent Requirements

Definitions

Email, Phone & Fax

Live Video

POLICY

ELIGIBLE SPECIALTIES/SERVICES

ELIGIBLE PROVIDERS

ELIGIBLE SITES

GEOGRAPHIC LIMITS

FACILITY/TRANSMISSION FEE

Miscellaneous

Out of State Providers

Overview

Remote Patient Monitoring

POLICY

CONDITIONS

PROVIDER LIMITATIONS

OTHER RESTRICTIONS

Store and Forward

POLICY

ELIGIBLE SERVICES/SPECIALTIES

GEOGRAPHIC LIMITS

TRANSMISSION FEE

Professional Requirements

Consent Requirements

Cross State Licensing

Definitions

Licensure Compacts

Miscellaneous

Online Prescribing

Professional Board Standards