Iowa 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

Telehealth” means the delivery of health care services through the use of interactive audio and video.

514C.34

“Telehealth” does not include the delivery of health care services through an audio-only telephone, electronic mail message, or facsimile transmission.

See 514C.34

Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth.  There is no clear definition of an originating site.  As such, the law should allow any location to be acceptable, including the home.

514C.34

One of 19 States that does not specify the type of healthcare provider allowed to practice telemedicine.  Offering the most flexibility.

Medicaid

No Reference Found

Chapter 137 – Sec 12-23 requires that services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement through Medicaid, but it doesn’t define the term “telehealth” or “telemedicine”.

Chapter 137 – Sec 12-23 requires that services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement through Medicaid, but it doesn’t define the term “telehealth” or “telemedicine”.  Coverage for store-and-forward unknown based on this.

The Centers for Medicare and Medicaid Services (CMS) has authorized the following originating sites: The offices of physicians or practitioners, Hospitals – inpatient and outpatient, Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Hospital-based or CAH-based Renal Dialysis Centers (including satellites), Skilled Nursing Facilities (SNFs) and, Community Mental Health Centers (CMHCs).  The home is not allowed.  

 

No reference found.

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

Telehealth” means the delivery of health care services through the use of interactive audio and video.

514C.34

Medicaid

Chapter 137 – Sec 12-23 requires that services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement through Medicaid, but it doesn’t define the term “telehealth” or “telemedicine”.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

“Telehealth” does not include the delivery of health care services through an audio-only telephone, electronic mail message, or facsimile transmission.

See 514C.34

Medicaid

Chapter 137 – Sec 12-23 requires that services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement through Medicaid, but it doesn’t define the term “telehealth” or “telemedicine”.  Coverage for store-and-forward unknown based on this.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth.  There is no clear definition of an originating site.  As such, the law should allow any location to be acceptable, including the home.

514C.34

Medicaid

The Centers for Medicare and Medicaid Services (CMS) has authorized the following originating sites: The offices of physicians or practitioners, Hospitals – inpatient and outpatient, Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Hospital-based or CAH-based Renal Dialysis Centers (including satellites), Skilled Nursing Facilities (SNFs) and, Community Mental Health Centers (CMHCs).  The home is not allowed.  

 

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

One of 19 States that does not specify the type of healthcare provider allowed to practice telemedicine.  Offering the most flexibility.

Medicaid

No reference found.

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

A policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth.  This law provides coverage parity for patients but not payment parity for providers.

See Iowa 514C.34

 

Health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement.

Chapter 137 – Sec 12-23

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: