North Carolina Telemedicine & Telehealth Reimbursement Overview

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

Written or verbal consent is required prior to the delivery of telemedicine.

See § 90-21.133 in Senate Bill DRS35322-BCz-4B*

 

Live video reimbursement is only required by law when treating newborn infants with heart defects.

See Pg. 2 of North Carolina General Statute 130A-12

No Reference Found

No Reference Found

Any healthcare provider licensed in the state of NC may provide services via telemedicine, but restrictions do apply between insurance options.  See § 90-21.132 in Senate Bill DRS35322-BCz-4B*

Medicaid

Prior patient approval for specific medical or psychiatric services is required.

See Pg. 5, Sec. 5.1 of the North Carolina Medicaid Telemedicine Policy

North Carolina Medicaid and Health Choice will reimburse for live video telepsychiatry and medical services subject to conditions.

See Pg. 4 of the North Carolina Medicaid Telemedicine Policy

North Carolina Medicaid does not reimburse for store & forward services.

See Pg. 5 of the North Carolina Medicaid Telemedicine Policy

North Carolina Medicaid will reimburse a facility fee to originating site providers, with some restrictions.
See Pgs. 6,8 of the North Carolina Medicaid Telemedicine Policy

Some telemedicine and telepsychiatry providers are eligible for reimbursement.
See Pg. 6 of the North Carolina Medicaid Telemedicine Policy

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

<a href=”https://visuwell.io/telemedicine-reimbursement/#medicare”>See Telemedicine Reimbursement Guide – Medicare Section</a>

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

Written or verbal consent is required prior to the delivery of telemedicine.

See § 90-21.133 in Senate Bill DRS35322-BCz-4B*

 

Medicaid

Prior patient approval for specific medical or psychiatric services is required.

See Pg. 5, Sec. 5.1 of the North Carolina Medicaid Telemedicine Policy

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Live video reimbursement is only required by law when treating newborn infants with heart defects.

See Pg. 2 of North Carolina General Statute 130A-12

Medicaid

North Carolina Medicaid and Health Choice will reimburse for live video telepsychiatry and medical services subject to conditions.

See Pg. 4 of the North Carolina Medicaid Telemedicine Policy

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

No Reference Found

Medicaid

North Carolina Medicaid does not reimburse for store & forward services.

See Pg. 5 of the North Carolina Medicaid Telemedicine Policy

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

No Reference Found

Medicaid

North Carolina Medicaid will reimburse a facility fee to originating site providers, with some restrictions.
See Pgs. 6,8 of the North Carolina Medicaid Telemedicine Policy

Medicare

<a href=”https://visuwell.io/telemedicine-reimbursement/#medicare”>See Telemedicine Reimbursement Guide – Medicare Section</a>

Eligible Practitioners
State Law

Any healthcare provider licensed in the state of NC may provide services via telemedicine, but restrictions do apply between insurance options.  See § 90-21.132 in Senate Bill DRS35322-BCz-4B*

Medicaid

Some telemedicine and telepsychiatry providers are eligible for reimbursement.
See Pg. 6 of the North Carolina Medicaid Telemedicine Policy

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

North Carolina does not currently support parity, but state legislature mandated that the Department of Health and Human Services provide a report that details the application of telemedicine.  In May of 2018, the State House filed a bill that would mandate parity for telemedicine but it is yet to pass.

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: