New York 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

An insurance payor is not to exclude covering telemedicine services that they already cover on an in-person basis.
See New York State Insurance Law § 3217-H (2014)

Private payors can, but are not required to, reimburse for store & forward services.
See New York State Insurance Law § 3217-H (2014)

Section 2999-CC defines an originating site as “a site at which a patient is located at the time health care services are delivered to him or her by means of telehealth.”   Subsection 3 provides a detailed list of valid originating sites that is inclusive of medical settings, schools, and it additionally specifies the patient’s residence.

Article 32 – 3217-H – Telehealth delivery of services.
(b) For purposes of this section, “telehealth” means the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured individual while such individual is located at a site that is different from the site where the health care provider is located.

List of “Providers Eligible for Reimbursement” See Pg. 13 on Telehealth Reimbursement Policy in New York State

 

Medicaid

A provider of services approved to utilize telepsychiatry services must have written protocols and procedures that address informed consent.  To view the requirements:  See Pg. 7 of NY Code of Rules and Regs. Title 14, Sec. 596.

New York Medicaid will reimburse live video telemedicine as a fee-for-service. To view the requirements:
See Pg. 18 of the 2015 New York Medicaid Update

See Medicaid State Telehealth Law Here: New York Senate Bill S7852

NY Medicaid is authorized to establish fees to reimburse the cost of telehealth store-and-forward technology, per a State Plan Amendment, submitted and approved by CMS, for certain specialities as determined by the Commissioner.  To view the specifications: CMS Approved State Plan Amendment 1600015.  Attachment 3.1A.

For further regulations see: See Pg. 21 of the 2015 New York Medicaid Update

Originating site definition includes the patient’s place of residence located within the state of New York or other temporary location located within or outside the state of New York.
See Pg. 3 of the 2019 New York Medicaid Update

When services are provided via telemedicine to a member located at an Article 28 originating site (outpatient department/clinic, emergency room), the originating site may bill only CPT code Q3014 (telehealth originating-site facility fee) through APGs to recoup administrative expenses associated with the telemedicine encounter.
See Pg. 8 of the 2019 New York Medicaid Update

To find out if your provider class is eligible for Medicaid telemedicine reimbursement reference the appropriate Medicaid manual for your specialty.
(New York Medicaid Manual Pg. 15-19)

 

The New York OMH’s Telemental Health Services increased practitioners able to expand options for telebehavioral services – see here.

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

A provider of services approved to utilize telepsychiatry services must have written protocols and procedures that address informed consent.  To view the requirements:  See Pg. 7 of NY Code of Rules and Regs. Title 14, Sec. 596.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

An insurance payor is not to exclude covering telemedicine services that they already cover on an in-person basis.
See New York State Insurance Law § 3217-H (2014)

Medicaid

New York Medicaid will reimburse live video telemedicine as a fee-for-service. To view the requirements:
See Pg. 18 of the 2015 New York Medicaid Update

See Medicaid State Telehealth Law Here: New York Senate Bill S7852

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Private payors can, but are not required to, reimburse for store & forward services.
See New York State Insurance Law § 3217-H (2014)

Medicaid

NY Medicaid is authorized to establish fees to reimburse the cost of telehealth store-and-forward technology, per a State Plan Amendment, submitted and approved by CMS, for certain specialities as determined by the Commissioner.  To view the specifications: CMS Approved State Plan Amendment 1600015.  Attachment 3.1A.

For further regulations see: See Pg. 21 of the 2015 New York Medicaid Update

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Section 2999-CC defines an originating site as “a site at which a patient is located at the time health care services are delivered to him or her by means of telehealth.”   Subsection 3 provides a detailed list of valid originating sites that is inclusive of medical settings, schools, and it additionally specifies the patient’s residence.

Article 32 – 3217-H – Telehealth delivery of services.
(b) For purposes of this section, “telehealth” means the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured individual while such individual is located at a site that is different from the site where the health care provider is located.

Medicaid

Originating site definition includes the patient’s place of residence located within the state of New York or other temporary location located within or outside the state of New York.
See Pg. 3 of the 2019 New York Medicaid Update

When services are provided via telemedicine to a member located at an Article 28 originating site (outpatient department/clinic, emergency room), the originating site may bill only CPT code Q3014 (telehealth originating-site facility fee) through APGs to recoup administrative expenses associated with the telemedicine encounter.
See Pg. 8 of the 2019 New York Medicaid Update

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

List of “Providers Eligible for Reimbursement” See Pg. 13 on Telehealth Reimbursement Policy in New York State

 

Medicaid

To find out if your provider class is eligible for Medicaid telemedicine reimbursement reference the appropriate Medicaid manual for your specialty.
(New York Medicaid Manual Pg. 15-19)

 

The New York OMH’s Telemental Health Services increased practitioners able to expand options for telebehavioral services – see here.

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

New York has a parity law that was enacted in 2014. It requires parity under private payors, Medicaid, and state employee health plans.

See New York State Insurance Law § 3217-H (2014)

 

“The commissioner shall not exclude from the payment of medical assistance funds the delivery of health care services through telehealth, as defined in subdivision four of section two thousand nine hundred ninety-nine-cc of the public health law.  Such services shall meet the requirements of federal law, rules and regulations for the provision of medical assistance pursuant to this title.”

New York Consolidated Laws, Social Services Law – SOS § 367-u

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: