Virginia 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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Virginia Telemedicine Policy

updated October 2019

Virginia Telemedicine Policy

Virginia has many of the basic protections crucial to the success of telemedicine, such as a parity law that mandates equivalent coverage for telemedicine and in-person services from private payers, Medicaid and state employee health plans.

Some of Virginia’s policies could use a little refining, and that’s ok! The state mandates reimbursement only when medical services are provided via live video, with limited coverage for other types of telemedicine. Luckily, these policy quirks are nothing too prohibitive!

State Policy Overview

Medicaid
Private Payers
Parity

Additional state telemedicine information

  • Parity Laws

    Since 2010, Virginia’s telehealth parity law has mandated coverage for telemedicine by private insurance companies and state employee health plans.

  • Medicaid

    Virginia’s Medicaid program defines telemedicine as “the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment.” So, Medicaid mostly covers live video telemedicine services. However, some plans are allowed to reimburse for store-and-forward and remote patient monitoring at their discretion.

  • Type of Telemedicine Covered

    Under Virginia’s parity law, private insurers are required to cover live video. Virginia Medicaid reimburses for live video, and under certain plans, store-and-forward and remote patient monitoring.

  • Covered Health Services

    These health services are specifically covered by Medicaid when delivered via telemedicine:

    • Evaluation and management
    • Psychiatric care
    • Specialty medical procedures
    • Speech therapy
    • Radiology service and procedures
    • Diabetic retinopathy
    • Outpatient teledermatology
    • Obstetric and gynecological services (ultrasounds)

  • Eligible Healthcare Providers

    Under Virginia Medicaid, the following healthcare providers can bill for telemedicine:

    • Physicians
    • Nurse practitioners
    • Nurse midwives
    • Psychiatrist
    • Psychiatric clinical nurse specialist
    • Psychiatric nurse practitioner
    • Marriage and family therapist/counselor
    • School psychologist
    • Substance abuse practitioner
    • Clinical nurse specialists
    • Clinical psychologists
    • Clinical social workers
    • Local Education Agency (billing speech therapy)

  • Online Prescriptions

    Before prescribing controlled substances via telemedicine, physicians must establish a patient relationship. This includes gathering a medical history, informing patients about risks of the drug, and conducting an exam (which can be done virtually). 

  • Informed Patient Consent

    Telemedicine practitioners must get a patient’s consent for the telemedicine services and document it in the patient’s record.

  • Cross-State Telemedicine Licensing

     Virginia requires a full VA license to practice telemedicine in the state, with an exception for physician-to-physician consults. So far, Virginia has not joined the Interstate Medical Licensure Compact, which makes it easier for out-of-state telemedicine providers to practice in the state. Check back for updates! 

  • Restrictions on Locations

    Virginia Medicaid requires telemedicine patients to receive their treatment at an eligible originating site. Here are the locations that qualify:

    • Provider offices
    • Local Education Agency
    • Rural Health Clinics
    • Federally Qualified Health Centers
    • Hospitals
    • Nursing Facilities
    • Health Department Clinics
    • Renal Units
    • Community Services Boards
    • Residential Treatment Centers

  • Reimbursement Rates

    Reimbursement is the same rate for telemedicine as in-person services.

  • Billing Codes

    Billing for telemedicine usually involves using the relevant CPT code along with the GT (telemedicine) modifier. Here are some of the included codes for billing Virginia Medicaid:

    • 99241-99255, consultation
    • 99201-99215, office visits
    • 90804-90809, individual psychotherapy
    • 90862, pharmacologic management
    • 57452, 57454, 57460, colostomy
    • 76805, 76810, obstetric ultrasound
    • 76825, echocardiography, fetal
    • 93010, cardiography interpretation and report only
    • 93307, 93308, 93320, 93321, 93325, echocardiography

  • Helpful Resources

    We used the sites below to gather information for this guide. Check them out for more details on your state’s policy!

 

Additional resources to help you get started.

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