Kentucky Telemedicine & Telehealth Reimbursement Overview

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

Patient consent is to be obtained by the provider delivering/facilitating telehealth services prior to the session.

See Kentucky Revised Statutes § 311.5975

 

Kentucky law requires reimbursement for live video.
See Kentucky Revised Statutes § 304.17A-138

Store and forward will be covered effective July 1, 2019

KY Rev Stat § 304.17A-005 (2017)

A health benefit plan shall not require a provider to be physically present with a patient or client unless the provider determines that it is necessary to perform those services in person. Effective July 1, 2019.  KY SB112

Provider type is vague but must be licensed in the state of Kentucky.

See Kentucky Revised Statutes § 304.17A-138

Medicaid

Informed consent is required.  See KY Admin. Regs. Title, 907, 3:170, Sec. 7

April 26th, 2018 – The state passed a new bill requiring telemedicine parity for Medicaid recipients. “The Medicaid program or a Medicaid managed care organization shall reimburse 12 for covered services provided to a Medicaid recipient through telehealth, as 13 defined in Section 2 of this Act” SB112

Effective July 1, 2019

Kentucky Medicaid reimburses for telehealth consultations, which include live video.

See Kentucky Revised Statutes § 205.559

Store and forward no reimbursable under the requirement for 2-way interactive video.  See Pg. 4 of KY Admin. Regs. Title, 907, 3:170, Sec. 1(47).

However, effective July 1, 2019, store and forward will be covered.  See Kentucky Revised Statutes § 205.559

A Medicaid managed care organization shall not require a provider to be physically present with a patient or client, 5 unless the provider determines that it is necessary to perform those 6 services in person.  This effectively makes the home a valid originating site. Effective July 1, 2019. KY SB112

Provider eligibility differs between Community Mental Health Center and other sites.
See KY Admin. Regs. Title, 907, 3:170, Sec. 1(47)

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

Patient consent is to be obtained by the provider delivering/facilitating telehealth services prior to the session.

See Kentucky Revised Statutes § 311.5975

 

Medicaid

Informed consent is required.  See KY Admin. Regs. Title, 907, 3:170, Sec. 7

April 26th, 2018 – The state passed a new bill requiring telemedicine parity for Medicaid recipients. “The Medicaid program or a Medicaid managed care organization shall reimburse 12 for covered services provided to a Medicaid recipient through telehealth, as 13 defined in Section 2 of this Act” SB112

Effective July 1, 2019

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Kentucky law requires reimbursement for live video.
See Kentucky Revised Statutes § 304.17A-138

Medicaid

Kentucky Medicaid reimburses for telehealth consultations, which include live video.

See Kentucky Revised Statutes § 205.559

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store and forward will be covered effective July 1, 2019

KY Rev Stat § 304.17A-005 (2017)

Medicaid

Store and forward no reimbursable under the requirement for 2-way interactive video.  See Pg. 4 of KY Admin. Regs. Title, 907, 3:170, Sec. 1(47).

However, effective July 1, 2019, store and forward will be covered.  See Kentucky Revised Statutes § 205.559

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

A health benefit plan shall not require a provider to be physically present with a patient or client unless the provider determines that it is necessary to perform those services in person. Effective July 1, 2019.  KY SB112

Medicaid

A Medicaid managed care organization shall not require a provider to be physically present with a patient or client, 5 unless the provider determines that it is necessary to perform those 6 services in person.  This effectively makes the home a valid originating site. Effective July 1, 2019. KY SB112

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Provider type is vague but must be licensed in the state of Kentucky.

See Kentucky Revised Statutes § 304.17A-138

Medicaid

Provider eligibility differs between Community Mental Health Center and other sites.
See KY Admin. Regs. Title, 907, 3:170, Sec. 1(47)

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

Kentucky has a parity law requiring private payors to reimburse telemedicine services on the same basis that they do in person services.  Also, the home is a valid originating site for Medicaid and health insurance plans.

See Kentucky Statute KRS 79.080 amended by KY SB112

Effective July 1, 2019

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: