Idaho Telemedicine & Telehealth Reimbursement Overview

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

Providers must obtain patient consent before providing telemedicine.

See ID House Bill & ID Code Sec 54-5708

No Reference Found

No Reference Found

“Nothing in this section shall prohibit electronic communications: Between a provider and a patient with a preexisting provider-patient relationship.”  In conjunction with the Idaho Telehealth Access Act, this interpretation permits the home as an originating site but does not guarantee eligibility for reimbursement.

ID Code § 54-5705 (2016)

No Reference Found

Medicaid

Idaho Medicaid requires written consent from the participant.
See Pg. 3 of the Idaho Medicaid Telehealth Policy

Idaho Medicaid reimburses for specific services, including:

  • Mental Health
  • Developmental disability services related to therapeutic consultation and crisis intervention
  • Early Intervention Services for infants and toddlers
  • Primary Care
  • Physical Therapy, Occupational Therapy, & Speech Pathology

See Pg. 2 of the Idaho Medicaid Telehealth Policy

Idaho Medicaid will not reimburse store & forward.

See Pg. 2-3 of the Idaho Medicaid Telehealth Policy

Medicaid’s qualifications for originating sites are open.

See Pg. 3 of the Idaho Medicaid Telehealth Policy  

“Services delivered via telehealth as defined in Title 54, Chapter 57, Idaho Code, must be identified as such in accordance with billing requirements published in the Idaho Medicaid Provider Handbook.”  This interpretation likely includes the home as an eligible and reimbursable originating site.

Idaho Telehealth Access Act – Medicaid Administrative Code, Pg 2

To find out if your provider class is eligible for medicaid reimbursement reference the appropriate medicaid manual for your specialty.
See Pg. 1-2 of the Idaho Medicaid Telehealth Policy

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

Providers must obtain patient consent before providing telemedicine.

See ID House Bill & ID Code Sec 54-5708

Medicaid

Idaho Medicaid requires written consent from the participant.
See Pg. 3 of the Idaho Medicaid Telehealth Policy

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

No Reference Found

Medicaid

Idaho Medicaid reimburses for specific services, including:

  • Mental Health
  • Developmental disability services related to therapeutic consultation and crisis intervention
  • Early Intervention Services for infants and toddlers
  • Primary Care
  • Physical Therapy, Occupational Therapy, & Speech Pathology

See Pg. 2 of the Idaho Medicaid Telehealth Policy

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

No Reference Found

Medicaid

Idaho Medicaid will not reimburse store & forward.

See Pg. 2-3 of the Idaho Medicaid Telehealth Policy

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

“Nothing in this section shall prohibit electronic communications: Between a provider and a patient with a preexisting provider-patient relationship.”  In conjunction with the Idaho Telehealth Access Act, this interpretation permits the home as an originating site but does not guarantee eligibility for reimbursement.

ID Code § 54-5705 (2016)

Medicaid

Medicaid’s qualifications for originating sites are open.

See Pg. 3 of the Idaho Medicaid Telehealth Policy  

“Services delivered via telehealth as defined in Title 54, Chapter 57, Idaho Code, must be identified as such in accordance with billing requirements published in the Idaho Medicaid Provider Handbook.”  This interpretation likely includes the home as an eligible and reimbursable originating site.

Idaho Telehealth Access Act – Medicaid Administrative Code, Pg 2

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 Pg. 1-2 of the Idaho Medicaid Telehealth Policy

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

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: