Indiana Telemedicine & Telehealth Reimbursement Overview

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

A separate consent for telemedicine services may not be required.

See Indiana Code IC 27-8-34-6

Telemedicine services are defined as health care services delivered by the use of interactive audio, video, or other electronic media, including the following:

  • Medical exams and consultations.
  • Behavioral health, including substance abuse evaluations and treatment.
  • The term does not include the delivery of health care services by use of the following:
    • (1) A telephone transmitter for transtelephonic monitoring.
    • (2) A telephone or any other means of communication for the consultation from one (1) provider to another provider.

See Indiana Code 12-15-5-11

Indiana code is vague pertaining to store-and-forward.  The code states that telemedicine is defined as health care services delivered by the use of interactive audio, video, or other electronic media.  The use of the term “interactive” likely excludes store-and-forward from reimbursement.

See Indiana Code 12-15-5-11

No Reference Found

Eligible providers are limited to 4 classifications

See House Enrolled Act No. 1263 Chapter 9.5 Section 4

Medicaid

Prior authorization is required for telehealth/telemedicine services provided to Medicaid covered members.

Indiana Administrative Code 405 IAC 1-4.2-3 and 405 IAC 5-16-3.

Indiana Human Services State Code requires reimbursement for live-video telehealth for FQHC’s, Rural Health Clinics, CMHC’s, Critical Access Hospitals, and eligible providers.

See Indiana Code 27-8-34-5

Store & Forward is not reimbursable but it can be used in conjunction with other reimbursable services.
See Indiana Medicaid Policy Manual, Pg. 291-294

The office shall reimburse the following Medicaid providers for medically necessary telemedicine services:

(1) FQHC
(2) Rural health clinic
(3) A community mental health center
(4) A critical access hospital

An attendant is required to be present at the originating site to help the patient connect to the distant site provider, preventing the home from being a valid location

See IC 12-15-5-11

Indiana Health Coverage Programs – Telemedicine and Telehealth Services

Indiana lists excluded provider types in the IHCP “Telemedicine & Telehealth Services” Provider Reference Module.

See Excluded Provider Types & Services

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

A separate consent for telemedicine services may not be required.

See Indiana Code IC 27-8-34-6

Medicaid

Prior authorization is required for telehealth/telemedicine services provided to Medicaid covered members.

Indiana Administrative Code 405 IAC 1-4.2-3 and 405 IAC 5-16-3.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Telemedicine services are defined as health care services delivered by the use of interactive audio, video, or other electronic media, including the following:

  • Medical exams and consultations.
  • Behavioral health, including substance abuse evaluations and treatment.
  • The term does not include the delivery of health care services by use of the following:
    • (1) A telephone transmitter for transtelephonic monitoring.
    • (2) A telephone or any other means of communication for the consultation from one (1) provider to another provider.

See Indiana Code 12-15-5-11

Medicaid

Indiana Human Services State Code requires reimbursement for live-video telehealth for FQHC’s, Rural Health Clinics, CMHC’s, Critical Access Hospitals, and eligible providers.

See Indiana Code 27-8-34-5

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Indiana code is vague pertaining to store-and-forward.  The code states that telemedicine is defined as health care services delivered by the use of interactive audio, video, or other electronic media.  The use of the term “interactive” likely excludes store-and-forward from reimbursement.

See Indiana Code 12-15-5-11

Medicaid

Store & Forward is not reimbursable but it can be used in conjunction with other reimbursable services.
See Indiana Medicaid Policy Manual, Pg. 291-294

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

No Reference Found

Medicaid

The office shall reimburse the following Medicaid providers for medically necessary telemedicine services:

(1) FQHC
(2) Rural health clinic
(3) A community mental health center
(4) A critical access hospital

An attendant is required to be present at the originating site to help the patient connect to the distant site provider, preventing the home from being a valid location

See IC 12-15-5-11

Indiana Health Coverage Programs – Telemedicine and Telehealth Services

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Eligible providers are limited to 4 classifications

See House Enrolled Act No. 1263 Chapter 9.5 Section 4

Medicaid

Indiana lists excluded provider types in the IHCP “Telemedicine & Telehealth Services” Provider Reference Module.

See Excluded Provider Types & Services

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

Accident and sickness insurance (dental or vision insurance is excluded) policies and individual or group contracts must provide coverage for telemedicine services in accordance with the same clinical criteria as would be provided for services provided in-person.

Coverage for telemedicine services required by subsection (a) may not be subject to a dollar limit, deductible, or coinsurance requirement that is less favorable to a covered individual than the dollar limit, deductible, or coinsurance requirement that applies to the same health care services delivered to a covered individual in person.

Indiana Code IC 27-8-34-6

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: