Delaware Telemedicine & Telehealth Reimbursement Overview

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

Informed consent must be obtained.

See House Bill #69 Section 3 Amendments

 

 

No Reference Found

Private payers must include reasonable compensation to the originating or distant site for their transmission costs.
See Title 18 Section 3370

No Reference Found

Medicaid

Patient must provide consent to use telemedicine.
See Medicaid Manual Section 16.6.1

For purposes of DMAP, telemedicine is the use of medical or behavioral health information exchanged from one site to another site via an electronic interactive telecommunications system to improve a patient’s health.

An interactive telecommunications system is defined as multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient, and the physician or practitioner at the distant site.

The same procedure codes and rates apply as for services delivered in person (enrolled providers will bill Usual and Customary).

DELAWARE MEDICAL ASSISTANCE PROGRAM PRACTITIONER PROVIDER SPECIFIC POLICY MANUAL

Medicaid will not reimburse Store & Forward.
See Medicaid Manual Section 16.3.4.1

DELAWARE MEDICAL ASSISTANCE PROGRAM PRACTITIONER PROVIDER SPECIFIC POLICY MANUAL

16.2.5 Originating Site refers to the facility in which the Medicaid patient is located at the time the telemedicine service is being furnished.

16.2.5.1 An approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present and telemedicine can be effectively utilized.

Medicaid will reimburse a facility fee for eligible originating site providers.
See Medicaid Manual Section 16.2.5.4.1

To find out if your provider class is eligible for medicaid reimbursement reference the appropriate  medicaid manual for your specialty.
See New Jersey newsletter Vol. 23 #21

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

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

Informed consent must be obtained.

See House Bill #69 Section 3 Amendments

Medicaid

Patient must provide consent to use telemedicine.
See Medicaid Manual Section 16.6.1

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

 

 

Medicaid

For purposes of DMAP, telemedicine is the use of medical or behavioral health information exchanged from one site to another site via an electronic interactive telecommunications system to improve a patient’s health.

An interactive telecommunications system is defined as multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient, and the physician or practitioner at the distant site.

The same procedure codes and rates apply as for services delivered in person (enrolled providers will bill Usual and Customary).

DELAWARE MEDICAL ASSISTANCE PROGRAM PRACTITIONER PROVIDER SPECIFIC POLICY MANUAL

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

No Reference Found

Medicaid

Medicaid will not reimburse Store & Forward.
See Medicaid Manual Section 16.3.4.1

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Private payers must include reasonable compensation to the originating or distant site for their transmission costs.
See Title 18 Section 3370

Medicaid

DELAWARE MEDICAL ASSISTANCE PROGRAM PRACTITIONER PROVIDER SPECIFIC POLICY MANUAL

16.2.5 Originating Site refers to the facility in which the Medicaid patient is located at the time the telemedicine service is being furnished.

16.2.5.1 An approved originating site may include the DMAP member’s place of residence, day program, or alternate location in which the member is physically present and telemedicine can be effectively utilized.

Medicaid will reimburse a facility fee for eligible originating site providers.
See Medicaid Manual Section 16.2.5.4.1

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No Reference Found

Medicaid

To find out if your provider class is eligible for medicaid reimbursement reference the appropriate  medicaid manual for your specialty.
See New Jersey newsletter Vol. 23 #21

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

Yes, there is a parity law requiring reimbursement based upon in-person services.

See House Bill #69 Section 1(e) Amendments

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: