Illinois 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

September 2018, SB 3049 applies to state Medicaid programs, and expands coverage of telehealth for behavioral care and requires that it be reimbursed at the same rate as in-person care for clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing, and mental health professionals and clinicians authorized by Illinois law to provide behavioral for mental health services.

No Reference Found

No Reference Found

No Reference Found

Medicaid

No Reference Found

September 2018, SB 3049 expanded coverage of telehealth for behavioral care and requires that live video be reimbursed at the same rate as in-person care.

The distant site provider must be a physician, physician assistant, podiatrist or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.  However, there is not a reference to reimbursement outside of stating that participating providers shall be reimbursed for the appropriate AMA Current Procedural Terminology (CPT) code for the telehealth service rendered.  Unlike telebehavioral care, there is no reference to reimbursement rates being equal to in-person care.

See TITLE 89 – CHAPTER I – SUBCHAPTER d – PART 140 MEDICAL PAYMENT – SECTION 140.403

Store & Forward is included for reimbursement under the definition of telemedicine, but reimbursement does not appear to be covered.
See Provider Handbook A-220.6.7

Medicaid will reimburse for an originating site fee for the following:

  • Physician’s Office
  • Podiatrist’s Office
  • Local Health Departments
  • Community Mental Health Centers
  • Outpatient Hospitals.

See Provider Handbook pg. 8

SB3049 expands eligible originating sites for telebehavioral care to include substance abuse centers.

As of November 2018, A legislative task force is recommending that reimbursement be equal to in-person care and that originating site restrictions be removed to allow for the home, school, and work.

The distant site provider must be a physician, physician assistant, podiatrist or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.

See TITLE 89 – CHAPTER I – SUBCHAPTER d – PART 140 MEDICAL PAYMENT – SECTION 140.403

 

SB3049 requires Medicaid to include telehealth coverage for behavioral services provided psychologists, clinical social workers, advanced practice registered nurses, and mental health professionals and clinicians authorized by state law.

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

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

September 2018, SB 3049 applies to state Medicaid programs, and expands coverage of telehealth for behavioral care and requires that it be reimbursed at the same rate as in-person care for clinical psychologists, clinical social workers, advanced practice registered nurses certified in psychiatric and mental health nursing, and mental health professionals and clinicians authorized by Illinois law to provide behavioral for mental health services.

Medicaid

September 2018, SB 3049 expanded coverage of telehealth for behavioral care and requires that live video be reimbursed at the same rate as in-person care.

The distant site provider must be a physician, physician assistant, podiatrist or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.  However, there is not a reference to reimbursement outside of stating that participating providers shall be reimbursed for the appropriate AMA Current Procedural Terminology (CPT) code for the telehealth service rendered.  Unlike telebehavioral care, there is no reference to reimbursement rates being equal to in-person care.

See TITLE 89 – CHAPTER I – SUBCHAPTER d – PART 140 MEDICAL PAYMENT – SECTION 140.403

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

No Reference Found

Medicaid

Store & Forward is included for reimbursement under the definition of telemedicine, but reimbursement does not appear to be covered.
See Provider Handbook A-220.6.7

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

No Reference Found

Medicaid

Medicaid will reimburse for an originating site fee for the following:

  • Physician’s Office
  • Podiatrist’s Office
  • Local Health Departments
  • Community Mental Health Centers
  • Outpatient Hospitals.

See Provider Handbook pg. 8

SB3049 expands eligible originating sites for telebehavioral care to include substance abuse centers.

As of November 2018, A legislative task force is recommending that reimbursement be equal to in-person care and that originating site restrictions be removed to allow for the home, school, and work.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No Reference Found

Medicaid

The distant site provider must be a physician, physician assistant, podiatrist or advanced practice nurse who is licensed by the State of Illinois or by the state where the patient is located.

See TITLE 89 – CHAPTER I – SUBCHAPTER d – PART 140 MEDICAL PAYMENT – SECTION 140.403

 

SB3049 requires Medicaid to include telehealth coverage for behavioral services provided psychologists, clinical social workers, advanced practice registered nurses, and mental health professionals and clinicians authorized by state law.

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

No law currently exists mandating parity; however, SB0027 was proposed in January 2019.  It will mandate payment parity and remove originating site restrictions for Medicaid and private payers.  This bill appears to be a direct result of the findings from a legislative task force that concluded in November 2018.  There is a high probability that this bill will be approved.

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: