North Dakota 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 needs to be obtained and documented prior to telemedicine.

See Sec. 3 of ND Admin. Code 61.5-01-02-01

Will reimburse for live-video telemedicine services. For more information see:

See Pg. 31 of ND Admin. Code 92-01-02

North Dakota does not reimburse for store and forward.

See Pg. 31 of ND Admin. Code 92-01-02

“Originating site” means a site at which a patient is located at the time health services are provided to the patient by means of telehealth”.

Senate Bill 2052

Under the Worker’s Compensation Act, the originating sites may receive a facility fee, not to exceed $20.

ND Admin. Code 92-01-02-34.

No reference found

Medicaid

No Reference Found

Will reimburse for live-video telemedicine services. For more information see:

ND Dept. of Human Svcs., General Information For Providers, Medicaid and Other Medical Assistance Programs, p. 156

Store and forward is not covered.

See Pg. 157 of ND Dept. of Human Svcs., General Information For Providers, Medicaid and Other Medical Assistance Programs

Originating site can bill a facility fee, however, some limitations do apply.

See Pg. 156-157 of ND Dept. of Human Svcs., General Information For Providers, Medicaid and Other Medical Assistance Programs

One of 19 States that does not specify the type of healthcare provider allowed to practice telemedicine.  Offering the most flexibility.

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

Written or verbal consent needs to be obtained and documented prior to telemedicine.

See Sec. 3 of ND Admin. Code 61.5-01-02-01

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Will reimburse for live-video telemedicine services. For more information see:

See Pg. 31 of ND Admin. Code 92-01-02

Medicaid

Will reimburse for live-video telemedicine services. For more information see:

ND Dept. of Human Svcs., General Information For Providers, Medicaid and Other Medical Assistance Programs, p. 156

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

North Dakota does not reimburse for store and forward.

See Pg. 31 of ND Admin. Code 92-01-02

Medicaid

Store and forward is not covered.

See Pg. 157 of ND Dept. of Human Svcs., General Information For Providers, Medicaid and Other Medical Assistance Programs

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

“Originating site” means a site at which a patient is located at the time health services are provided to the patient by means of telehealth”.

Senate Bill 2052

Under the Worker’s Compensation Act, the originating sites may receive a facility fee, not to exceed $20.

ND Admin. Code 92-01-02-34.

Medicaid

Originating site can bill a facility fee, however, some limitations do apply.

See Pg. 156-157 of ND Dept. of Human Svcs., General Information For Providers, Medicaid and Other Medical Assistance Programs

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No reference found

Medicaid

One of 19 States that does not specify the type of healthcare provider allowed to practice telemedicine.  Offering the most flexibility.

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 Dakota passed SB 2052 requiring telehealth parity.

Medicaid parity also passed:

“ND Medicaid covers the same services for members who are enrolled in Medicaid and IHS as those members who are enrolled in Medicaid only. Coverage and payment of services provided through telemedicine is on the same basis as those provided through face-to-face contact.”

P. 77 of North Dakota Medicaid Manual

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: