Minnesota 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

Covered under state statutes chapter 256B medical assistance for needy persons.

MN Statute 256B.0625 Subd 3b.d

 

It is additionally provided under Chapter 62A concerning accident and health insurance.

Section 62A.671 subd.9

 

And under

Chapter 147 Section147.033

Store & Forward is included under the definition of telemedicine.

MN Statute 256B.0625 Subd 3b.d

And under

Section 62A.671 subd.9

Chapter 147 Section147.033

“Originating site means a site including, but not limited to, a health care facility at which a patient is located at the time health care services are provided to the patient by means of telemedicine”.

Minnesota Statutes – Chapter 62A.671

Minnesota Statutes Concerning Telemedicine Coverage reference specific providers related to accident & health insurance.

See Chapter 62A Section 62A.671 that references related chapter and sections concerning Board of Medical Practice.

Medicaid

Consent is required for alcohol and drug abuse services provided via telemedicine.

MN Dept. of Human Svcs., Provider Manual, Alcohol & Drug Abuse Services Telemedicine, Oct. 19, 2017

MHCP will reimburse for interactive audio and video telecommunications that are functionally equivalent to a face-to-face encounter.
See MN Medicaid Manual

MHCP reimburses for store & forward as a substitution for an interactive encounter, only for information to be reviewed by a provider at a distant site.
See MN Medicaid Manual

A list of eligible originating sites is available, including the home.

See MN Medicaid Manual

For Early Intensive Developmental and Behavioral Intervention (EIDBI) MHCP does not reimburse for connection charges, origination, set-up or site fees.

MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telemedicine Services

A list of providers eligible to practice telemedicine is listed.
See MN Medicaid Manual

Providers must also complete Provider Assurance Statement for Telemedicine (DHS-6806)

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

Consent is required for alcohol and drug abuse services provided via telemedicine.

MN Dept. of Human Svcs., Provider Manual, Alcohol & Drug Abuse Services Telemedicine, Oct. 19, 2017

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Covered under state statutes chapter 256B medical assistance for needy persons.

MN Statute 256B.0625 Subd 3b.d

 

It is additionally provided under Chapter 62A concerning accident and health insurance.

Section 62A.671 subd.9

 

And under

Chapter 147 Section147.033

Medicaid

MHCP will reimburse for interactive audio and video telecommunications that are functionally equivalent to a face-to-face encounter.
See MN Medicaid Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store & Forward is included under the definition of telemedicine.

MN Statute 256B.0625 Subd 3b.d

And under

Section 62A.671 subd.9

Chapter 147 Section147.033

Medicaid

MHCP reimburses for store & forward as a substitution for an interactive encounter, only for information to be reviewed by a provider at a distant site.
See MN Medicaid Manual

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

“Originating site means a site including, but not limited to, a health care facility at which a patient is located at the time health care services are provided to the patient by means of telemedicine”.

Minnesota Statutes – Chapter 62A.671

Medicaid

A list of eligible originating sites is available, including the home.

See MN Medicaid Manual

For Early Intensive Developmental and Behavioral Intervention (EIDBI) MHCP does not reimburse for connection charges, origination, set-up or site fees.

MN Dept. of Human Services, EIDBI Benefit Policy Manual, EIDBI Telemedicine Services

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Minnesota Statutes Concerning Telemedicine Coverage reference specific providers related to accident & health insurance.

See Chapter 62A Section 62A.671 that references related chapter and sections concerning Board of Medical Practice.

Medicaid

A list of providers eligible to practice telemedicine is listed.
See MN Medicaid Manual

Providers must also complete Provider Assurance Statement for Telemedicine (DHS-6806)

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

Telemedicine consults shall be paid at the same rate as in-person services under statute covering medical assistance for needy persons. See MN Statute Section 256B.0625 Subd. 3b. 

Additional state statute covering accident and health insurance states that a health carrier shall not exclude telemedicine services and must reimburse at the same rate as in-person visits.  See MN Statute Section 62A.672 Subd. 2 & 3.

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: