Georgia Telemedicine & Telehealth Reimbursement Overview

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

No Reference Found

Live video is covered and reimbursable as part of Georgia’s parity law.

GA Code § 33-24-56.4 (2016)

SB118 includes store and forward and remote patient monitoring as reimbursable services. Effective Jan. 1, 2020.

“Originating site’ means a site in this state at which a patient is located at the time health care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used; provided, however, that notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.”

This interpretation of SB118 allows the home to serve as an originating site.  Effective Jan. 1. 2020.

“Any person who performs such acts through such means [Section 1A] shall be required to have a license to practice medicine in this state or a telemedicine license issued pursuant to Code Section 43-34-31.1 and shall be subject to regulation by the board.”

SB115 allows providers outside of Georgia to provide telemedicine services to patients located within the state of Georgia, in addition to providers within the state of Georgia.  Effective Jan. 1. 2020.

Medicaid

The referring provider is required to obtain written consent prior to performing telemedicine.

Page 20 of the Georgia Telemedicine Guide 

Live video or synchronous communication is reimbursable by Medicaid.  Georgia Medicaid Management Information System regulations spell out requirements for coverage.

Georgia Telemedicine Guide

Georgia Medicaid requires an interactive telecommunication system for reimbursement, therefore, store & forward is not reimbursable.

Page 5 of Georgia Telemedicine Handbook

Georgia includes a list of originating sites are eligible for an originating site fee, the home is included.

Page 5 of the Georgia Telemedicine Guide

Practitioners at the distant site who may furnish and receive payment for covered telehealth services are listed.

Page 9-10 of Georgia Telemedicine Guide

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

No Reference Found

Medicaid

The referring provider is required to obtain written consent prior to performing telemedicine.

Page 20 of the Georgia Telemedicine Guide 

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Live video is covered and reimbursable as part of Georgia’s parity law.

GA Code § 33-24-56.4 (2016)

Medicaid

Live video or synchronous communication is reimbursable by Medicaid.  Georgia Medicaid Management Information System regulations spell out requirements for coverage.

Georgia Telemedicine Guide

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

SB118 includes store and forward and remote patient monitoring as reimbursable services. Effective Jan. 1, 2020.

Medicaid

Georgia Medicaid requires an interactive telecommunication system for reimbursement, therefore, store & forward is not reimbursable.

Page 5 of Georgia Telemedicine Handbook

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

“Originating site’ means a site in this state at which a patient is located at the time health care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used; provided, however, that notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.”

This interpretation of SB118 allows the home to serve as an originating site.  Effective Jan. 1. 2020.

Medicaid

Georgia includes a list of originating sites are eligible for an originating site fee, the home is included.

Page 5 of the Georgia Telemedicine Guide

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

“Any person who performs such acts through such means [Section 1A] shall be required to have a license to practice medicine in this state or a telemedicine license issued pursuant to Code Section 43-34-31.1 and shall be subject to regulation by the board.”

SB115 allows providers outside of Georgia to provide telemedicine services to patients located within the state of Georgia, in addition to providers within the state of Georgia.  Effective Jan. 1. 2020.

Medicaid

Practitioners at the distant site who may furnish and receive payment for covered telehealth services are listed.

Page 9-10 of Georgia Telemedicine Guide

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

Georgia has a parity law that was enacted in 2006. It includes private payors and state-employee health plans as well.

GA Code § 33-24-56.4 (2016)

Georgia SB118 increases payment parity throughout the state, effective January 1, 2020.

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: