Connecticut Telemedicine & Telehealth Reimbursement Overview

Provider Reimbursement Eligibility
Consent for Telemedicine Live Video Reimbursement Store & Forward Reimbursement Originating Site & Transmission Fees Eligible Practitioners
State Law

Consent for telemedicine is required.  More details can be found under

See Public Act No. 15-88 Section 1-11B-2 & 11-D

Live video is Reimbursable.

See Public Act No. 15-88 Section 1-11b

Law does specify medicaid reimbursement for telehealth and lays foundation for classification in medicaid state plan.

See Public Act No. 16-198

Reimbursement for services provided via store-and-forward.

See Public Act No. 15-88 Section 11

Connecticut state law concerning health insurance defines an originating site as “a site at which a patient is located at the time health care services are provided to the patient by means of telehealth.”  This neither requires a provider to be present with the patient at the originating site nor restricts the home from being a valid originating site.

No telehealth provider can charge a facility fee.

See Public Act No. 15-88 Section 1-11G

State law specifies an expansive list of provider types that are eligible to practice telemedicine.

Public Act No. 15-88 Section 1-11

Medicaid

See Telemedicine Reimbursement Guide – Medicare Section

The department shall, within available state and federal resources, provide coverage under the Medicaid program for telehealth services for categories of health care services that the commissioner determines are (1) clinically appropriate to be provided by means of telehealth, (2) cost effective for the state, and (3) likely to expand access to medically necessary services for Medicaid recipients for whom accessing appropriate health care services poses an undue hardship.

Public Act No. 16-198

Exception:

Case management behavioral health services for clients age eighteen and under.

See Provider Manual Chapter 7 Licensed Behavioral Health Clinicians Sec 17b-262-918

Federally Qualified Health Centers, outpatient office settings, outpatient hospital settings and clinic settings can be reimbursed for electronic consults (e-consults) for specialty care (provider to provider communication).

See the June 2017 Connecticut Medical Assistance Program Policy Transmittal from June 2017.

No Reference Found

Medicaid offers limited reimbursement at this time for any telemedicine services.  Should coverage expand, state law concerning applicable license types will likely be the basis for eligible providers.

Medicare

No Reference Found

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Provider Reimbursement Eligibility
Consent for Telemedicine
State Law

Consent for telemedicine is required.  More details can be found under

See Public Act No. 15-88 Section 1-11B-2 & 11-D

Medicaid

See Telemedicine Reimbursement Guide – Medicare Section

Medicare

No Reference Found

Live Video Reimbursement
State Law

Live video is Reimbursable.

See Public Act No. 15-88 Section 1-11b

Law does specify medicaid reimbursement for telehealth and lays foundation for classification in medicaid state plan.

See Public Act No. 16-198

Medicaid

The department shall, within available state and federal resources, provide coverage under the Medicaid program for telehealth services for categories of health care services that the commissioner determines are (1) clinically appropriate to be provided by means of telehealth, (2) cost effective for the state, and (3) likely to expand access to medically necessary services for Medicaid recipients for whom accessing appropriate health care services poses an undue hardship.

Public Act No. 16-198

Exception:

Case management behavioral health services for clients age eighteen and under.

See Provider Manual Chapter 7 Licensed Behavioral Health Clinicians Sec 17b-262-918

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Reimbursement for services provided via store-and-forward.

See Public Act No. 15-88 Section 11

Medicaid

Federally Qualified Health Centers, outpatient office settings, outpatient hospital settings and clinic settings can be reimbursed for electronic consults (e-consults) for specialty care (provider to provider communication).

See the June 2017 Connecticut Medical Assistance Program Policy Transmittal from June 2017.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Connecticut state law concerning health insurance defines an originating site as “a site at which a patient is located at the time health care services are provided to the patient by means of telehealth.”  This neither requires a provider to be present with the patient at the originating site nor restricts the home from being a valid originating site.

No telehealth provider can charge a facility fee.

See Public Act No. 15-88 Section 1-11G

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

State law specifies an expansive list of provider types that are eligible to practice telemedicine.

Public Act No. 15-88 Section 1-11

Medicaid

Medicaid offers limited reimbursement at this time for any telemedicine services.  Should coverage expand, state law concerning applicable license types will likely be the basis for eligible providers.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Telemedicine CPT Codes

Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.

  • For interactive audio and video sessions, place a GT modifier in front of the CPT codes you typically use for in person services.
  • For services provided via an asynchronous telecommunication system, simply add a GQ modifier in front of the CPT codes you typically use for in person services.

Telehealth Parity

Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for medical advice, diagnosis, care or treatment provided through telehealth, to the extent coverage is provided for such advice, diagnosis, care or treatment when provided through in-person consultation between the insured and a health care provider. Such coverage shall be subject to the same terms and conditions applicable to all other benefits under such policy.

Definitions

Telehealth Parity

Telehealth services are equal to in person services and reimbursed at the same rate.

Asynchronous Communication

The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.

Distant or Hub Site

The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.

Originating Site

The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.

Additional Telemedicine Resources

Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites: