New Jersey Telemedicine & Telehealth Reimbursement Overview

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

Oral, written, or digital consent is required for telemedicine.

See C.45:1-62 of NJ Statute SB 291-2017

New Jersey reimburses telemedicine as an option for ‘interactive, real-time, two-way communication technologies” as part of their parity law.

See Senate Bill S291 Section 7

See C.45:1-62 in NJ Statute SB 291-2017

Store and forward is allowed and reimbursable.

See C.45:1-62 in NJ Statute SB 291-2017

“Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider.”  This allows the home to be a valid originating site.

See NJ Nos. 291 SCS, 652 and 1954 section 1 definition of “Telemedicine”

No Reference Found

Medicaid

No resource found

Medicaid will reimburse for live video.

See Senate Bill No.652 Pg. 2

Medicaid reimburses store and forward on a similar basis to private payer reimbursement.

NJ Statute C.30:4D-6k

See NJ Nos. 291 SCS, 652 and 1954 section 1 definition of “Telemedicine”.  The definition states that Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, <strong>either with or without the assistance of an intervening health care provider.”  This allows the home to be a valid originating site and section 7 mandates equivalent coverage by NJ Medicaid.  

Telepsychiatry is approved.
NJ Division of Medical Assistance & Health Services. Newsletter. Vol. 23, No. 21, Dec. 2013

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

Oral, written, or digital consent is required for telemedicine.

See C.45:1-62 of NJ Statute SB 291-2017

Medicaid

No resource found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

New Jersey reimburses telemedicine as an option for ‘interactive, real-time, two-way communication technologies” as part of their parity law.

See Senate Bill S291 Section 7

See C.45:1-62 in NJ Statute SB 291-2017

Medicaid

Medicaid will reimburse for live video.

See Senate Bill No.652 Pg. 2

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store and forward is allowed and reimbursable.

See C.45:1-62 in NJ Statute SB 291-2017

Medicaid

Medicaid reimburses store and forward on a similar basis to private payer reimbursement.

NJ Statute C.30:4D-6k

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

“Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, either with or without the assistance of an intervening health care provider.”  This allows the home to be a valid originating site.

See NJ Nos. 291 SCS, 652 and 1954 section 1 definition of “Telemedicine”

Medicaid

See NJ Nos. 291 SCS, 652 and 1954 section 1 definition of “Telemedicine”.  The definition states that Telemedicine means the delivery of a health care service using electronic communications, information technology, or other electronic or technological means to bridge the gap between a health care provider who is located at a distant site and a patient who is located at an originating site, <strong>either with or without the assistance of an intervening health care provider.”  This allows the home to be a valid originating site and section 7 mandates equivalent coverage by NJ Medicaid.  

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No Reference Found

Medicaid

Telepsychiatry is approved.
NJ Division of Medical Assistance & Health Services. Newsletter. Vol. 23, No. 21, Dec. 2013

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

See NJ Nos. 291 SCS, 652 and 1954 requires parity of commercial health insurance and maedicaid.

“8.    a.  A carrier that offers a health benefits plan in this State shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey.  Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate.”

“7.    a.  The State Medicaid and NJ FamilyCare programs shall provide coverage and payment for health care services delivered to a benefits recipient through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey.  Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate.”

 

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: