Maine Telemedicine & Telehealth Reimbursement Overview

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

Informed consent is advised, but only required through by Board of Licensure in Medicine & Board of Osteopathic Licensure

See Pg. 4 of ME Regulation Sec. 02-373-6 & 02-383-6

Maine law requires coverage for services provided via telemedicine, including live video.

Title 24-A Chapter 56-A: Subchapter 1: Section 4316

Store and forward is included in the telehealth definition, but reimbursement not guaranteed unless it’s comparable to an in-person service.

See LD 1263 Sec. 2 24-A MRSA §4316, 1.C

Effective January 1, 2020, store-and-forward, alongside other synchronous services under “telemonitoring” and “telephonic” services are covered.

ME Code § S.P. 383 – L.D. 1263

“Enrollee originating site” means a site where an enrollee is physically located at the time that health care services are provided through telehealth.  It does not specify that a provider has to be present at the originating site unless Health care services that require direct physical contact with an enrollee by a provider that cannot be delegated to another provider at the enrollee originating site.

Effective January 1, 2020, geographical restrictions for the originating site have been removed and the home is considered an eligible originating site.

ME Code § S.P. 383 – L.D. 1263

Specific provider types are vague, but eligibility and requirements apply.

See LD 1263 Sec. 2 24-A MRSA §4316, 7

Medicaid

Written informed consent is required for telemedicine.

MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.06, Pg. 9.

Live video is covered between a patient and a provider.  No reimbursement for communication between healthcare providers.

MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.04, Pg. 5.

Provider manual indicates coverage of “telehealth services”, however, only discusses interactive telehealth and remote patient monitoring in detail, omitting store and forward.

MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.

The originating site is usually defined as a health care provider’s office, but the home is a valid originating site provided the necessary equipment is available.  See MaineCare Benefits Manual 10-144 Ch. 101, Ch. 1, Sec. 4.01-7

A facility fee is provided to a health care provider at the originating site.  See MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.07, Pg. 10

Provider type is open, however other requirements need to be met.

MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.03, Pg. 3.

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

Informed consent is advised, but only required through by Board of Licensure in Medicine & Board of Osteopathic Licensure

See Pg. 4 of ME Regulation Sec. 02-373-6 & 02-383-6

Medicaid

Written informed consent is required for telemedicine.

MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.06, Pg. 9.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Maine law requires coverage for services provided via telemedicine, including live video.

Title 24-A Chapter 56-A: Subchapter 1: Section 4316

Medicaid

Live video is covered between a patient and a provider.  No reimbursement for communication between healthcare providers.

MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.04, Pg. 5.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store and forward is included in the telehealth definition, but reimbursement not guaranteed unless it’s comparable to an in-person service.

See LD 1263 Sec. 2 24-A MRSA §4316, 1.C

Effective January 1, 2020, store-and-forward, alongside other synchronous services under “telemonitoring” and “telephonic” services are covered.

ME Code § S.P. 383 – L.D. 1263

Medicaid

Provider manual indicates coverage of “telehealth services”, however, only discusses interactive telehealth and remote patient monitoring in detail, omitting store and forward.

MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

“Enrollee originating site” means a site where an enrollee is physically located at the time that health care services are provided through telehealth.  It does not specify that a provider has to be present at the originating site unless Health care services that require direct physical contact with an enrollee by a provider that cannot be delegated to another provider at the enrollee originating site.

Effective January 1, 2020, geographical restrictions for the originating site have been removed and the home is considered an eligible originating site.

ME Code § S.P. 383 – L.D. 1263

Medicaid

The originating site is usually defined as a health care provider’s office, but the home is a valid originating site provided the necessary equipment is available.  See MaineCare Benefits Manual 10-144 Ch. 101, Ch. 1, Sec. 4.01-7

A facility fee is provided to a health care provider at the originating site.  See MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.07, Pg. 10

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Specific provider types are vague, but eligibility and requirements apply.

See LD 1263 Sec. 2 24-A MRSA §4316, 7

Medicaid

Provider type is open, however other requirements need to be met.

MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4.03, Pg. 3.

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

Yes, Maine requires parity for telemedicine.  A carrier offering a health plan in this State may not deny coverage on the basis that the health care service is provided through telehealth if the health care service would be covered if it was provided through in-person consultation between an enrollee and a provider.  Effective January 1, 2020.

ME Code § S.P. 383 – L.D. 1263

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: