California Telemedicine Policy, Simplified.

Healthcare legislation is complicated. Let’s clarify a few things.

We strive to keep this information updated and current. It is intended to be an informative guide, and not a comprehensive legal resource. Always consult with your local team of experts and administrators.

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California Telemedicine Policy

updated October 2019

Telemedicine in California: Policies

With its first telemedicine parity laws passed in 1996, California has a long history in telemedicine reimbursement and was one of the first states to acknowledge the value of telemedicine. In fact, the Center for Connected Health Policy has a dedicated page for California.

Like many other U.S. states, California recognizes the importance of telemedicine in improving healthcare access for patients challenged by distance or mobility. California has been actively pursuing legislation to expand telemedicine access, from developing guidelines for using telehealth in schools to including Associate Marriage and Family Therapists as appropriate telehealth providers.

State Policy Overview

Medicaid
Private Payers
Parity

Additional state telemedicine information

  • Parity Laws

    California telemedicine parity law mandates private payer reimbursement.

  • Medicaid

    Medi-Cal considers telemedicine to be the “use of medical information exchanged…using interactive telecommunication equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and physician or practitioner.”

    Medi-Cal reimburses for live video telemedicine (use the billing modifiers GT or 95), and store-and-forward services for dermatology, dentistry, and ophthalmology.

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

    As of August 2019 Medi-Cal is now allowing providers in fee-for-service to decide what modality, live video or store-and-forward, will be used to deliver eligible services to a Medi-Cal enrollee as long as the service is covered by Medi-Cal and meets all other Medi-Cal guidelines and policies, can be properly provided via telehealth and meets the procedural and definition components of the appropriate CPT or HCPCS code.  Additionally, Medi-Cal specifically allows the home to be an originating site and they will reimburse for one specific code for e-consult (as a sub-set of store-and-forward).

    Other programs that have updated policies as of August 2019 include:

    • Indian Health Services, Memorandum of Agreement (IHS-MOAs) 
    • Family Plan, Access, Care and Treatment (Family PACT)
    • Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
    • Local Education Agency
    • Vision Care

  • Type of Telemedicine Covered

    California’s Medicaid program covers live video telemedicine and store-and-forward services for teledermatologyteledentistry, and teleophthalmology.

  • Covered Health Services

    California reimburses for wide variety of evaluative and management health services as well as psychiatric services. For more detail, see the Medi-Cal Provider Manual

  • Eligible Healthcare Providers

    Medi-Cal does limit which healthcare providers can get reimbursed for telemedicine. Here’s who qualifies:

    • Physicians
    • Physician assistants
    • Nurse practitioners
    • Clinical nurse specialists
    • Registered dietitians or nutrition professionals
    • Nurse midwives
    • Certified registered nurse anesthetists
    • Clinical psychologists
    • Clinical social workers
    • Dentists
    • Dermatologists
    • Ophthalmologists
    • Speech-language pathologists
    • Audiologists
    • OTs and PTs

  • Online Prescriptions

    Providers are prohibited from prescribing or dispensing dangerous drugs or dangerous devices on the Internet without an appropriate prior examination and medical indication.

  • Informed Patient Consent

     Medi-Cal providers will need to get patient consent and document it in their medical record. California state regulations also say that the originating site provider (where the patient is) must get patient consent prior to care.

  • Cross-State Telemedicine Licensing

    California is not yet part of the Interstate Medical Licensure Compact. Providers doing telemedicine in California need to have a California license.

  • Restrictions on Locations

    Medi-Cal has no limitations on where the patient or provider has to be during the telemedicine visit. That makes it easy for providers to offer quick, convenient virtual care.

  • Reimbursement Rates

    Good news! California Medicaid reimburses telemedicine services according to the current physician fee schedule amount for that medical service. So reimbursement rates for a telemedicine service should be the same as the comparable in-person medical service.

  • Billing Codes

    Need a list of the eligible CA Medicaid codes for telemedicine? We’ve got you covered:

    CPT E&M Codes

    • 99201 – 99215 Office or other outpatient visit (new or established patient)
    • 99231 – 99233 Initial hospital care or subsequent hospital care (new or established patient)
    • 99241 – 99255 Consultations: Office or other outpatient, initial or follow-up inpatient, and confirmatory

    CPT Psychiatric Codes

    • 90791 Psychiatric diagnostic evaluation
    • 90792 Psychiatric diagnostic evaluation with medical services
    • 90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
    • 90832 Psychotherapy, 30 minutes with patient
    • 90837 Psychotherapy, 60 minutes with patient
    • G0508 Telehealth consultation, critical care, initial, physicians typically spend 60 minutes communicating with the patient and providers via telehealth
    • G0509 Telehealth consultation, critical cae, subsequent, physicians typically spend 50 minutes communicating with the patient and providers via telehealth
    • Telehealth originating site facility fee : Q3014 (Once per day, same recipient & provider)
    • Transmission costs for telehealth services via audio/video communication: T1014
    • (Maximum of 90 minutes per day same recipient, same provider)

    Plus, make sure you use the GT or 95 modifier with your CPT code to indicate live video telemedicine. If you’re using a store-and-forward solution, use the GQ modifier.

    Need more details? Check out the Medi-Cal Telehealth Handbook.

  • Helpful Resources

Additional resources to help you get started.

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