Maryland 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 required.

Code of Maryland Admin. Regs. Sec. 10.32.05.06

Law requires private payers to provide coverage for telemedicine services, subject to terms.
See Insurance Code Statute 15-139

Store and forward may be reimbursable, pending the limitations of the state budget and regulation.
See Insurance Code Statute 15-139 General Health Code 15-105.2

No Reference Found

Provider type is not limited but must meet licensure specifications.  See Sec A.2 of General Health Code 15-105.2

Medicaid

The originating site must obtain consent prior to the delivery of care via telemedicine.
See Maryland Telehealth Provider Manual Pg. 1

Medicaid will reimburse for live video.
See Maryland Telehealth Provider Manual Pg. 1

Medicaid will not reimburse for store & forward.
See Maryland Telehealth Provider Manual Pg. 5

Certain originating sites are eligible.  These sites are eligible for a facility fee.

See Maryland Telehealth Provider Manual Pgs. 2 & 5

Eligible providers must be licensed in Maryland as distant site providers.  A full list is available.
See Maryland Telehealth Provider Manual Pg. 3

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site | Medicare will pay the originating (patient location) site 80% of the lesser of the actual charge, or $26.15 per live video session.  See “Originating Site Section” for Medicare’s definition of an originating site.

 

Exceptions | There are new exceptions for the originating site rule for Chronic Care Management & Behavioral Health Integration in Primary Care, End Stage Renal Disease,  Acute Stroke Care, and Evaluation & Management brief Check-ins.  See “Live Video Reimbursement” two columns to the left.

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 required.

Code of Maryland Admin. Regs. Sec. 10.32.05.06

Medicaid

The originating site must obtain consent prior to the delivery of care via telemedicine.
See Maryland Telehealth Provider Manual Pg. 1

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Law requires private payers to provide coverage for telemedicine services, subject to terms.
See Insurance Code Statute 15-139

Medicaid

Medicaid will reimburse for live video.
See Maryland Telehealth Provider Manual Pg. 1

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store and forward may be reimbursable, pending the limitations of the state budget and regulation.
See Insurance Code Statute 15-139 General Health Code 15-105.2

Medicaid

Medicaid will not reimburse for store & forward.
See Maryland Telehealth Provider Manual Pg. 5

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

No Reference Found

Medicaid

Certain originating sites are eligible.  These sites are eligible for a facility fee.

See Maryland Telehealth Provider Manual Pgs. 2 & 5

Medicare

Originating Site | Medicare will pay the originating (patient location) site 80% of the lesser of the actual charge, or $26.15 per live video session.  See “Originating Site Section” for Medicare’s definition of an originating site.

 

Exceptions | There are new exceptions for the originating site rule for Chronic Care Management & Behavioral Health Integration in Primary Care, End Stage Renal Disease,  Acute Stroke Care, and Evaluation & Management brief Check-ins.  See “Live Video Reimbursement” two columns to the left.

Eligible Practitioners
State Law

Provider type is not limited but must meet licensure specifications.  See Sec A.2 of General Health Code 15-105.2

Medicaid

Eligible providers must be licensed in Maryland as distant site providers.  A full list is available.
See Maryland Telehealth Provider Manual 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

There is a parity law requiring private payers and state employee health plans to reimburse as they would an in-person session.

See Insurance Code Statute 15-139

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: