Pennsylvania 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

No Reference Found

No Reference Found

No Reference Found

No Reference Found

Medicaid

Informed consent is required for the use of any telemedicine service.

See Pg. 6 of PA House Bill 1648

Telemedicine, in this definition, includes the real-time encounter through interactive video.  See Pg. 3 of PA House Bill 1648

Different restrictions apply to FQHCs and RHCs.  See CMS-1500 Billing Guide for PROMISe™

Pennsylvania Medicaid states that telemedicine does not include store & forward technology.
See Pg. 2 of the Pennsylvania Medical Assistance (Special Consults.)

 

Originating site providers may bill for a facility fee.
See Pg. 3 of the Pennsylvania Medical Assistance (Special Consults.)

See Pg. 4 of the Pennsylvania Medical Assistance Bulletin (Telepsych)

To find out if your provider class is eligible for telemedicine reimbursement reference the appropriate Medicaid manual for your specialty.

See Pg. 1 of the Pennsylvania Medical Assistance (Special Consults.)

See Pg. 1 of the Pennsylvania Medical Assistance Bulletin (Telepsych)

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

Informed consent is required for the use of any telemedicine service.

See Pg. 6 of PA House Bill 1648

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

No Reference Found

Medicaid

Telemedicine, in this definition, includes the real-time encounter through interactive video.  See Pg. 3 of PA House Bill 1648

Different restrictions apply to FQHCs and RHCs.  See CMS-1500 Billing Guide for PROMISe™

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

No Reference Found

Medicaid

Pennsylvania Medicaid states that telemedicine does not include store & forward technology.
See Pg. 2 of the Pennsylvania Medical Assistance (Special Consults.)

 

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

No Reference Found

Medicaid

Originating site providers may bill for a facility fee.
See Pg. 3 of the Pennsylvania Medical Assistance (Special Consults.)

See Pg. 4 of the Pennsylvania Medical Assistance Bulletin (Telepsych)

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No Reference Found

Medicaid

To find out if your provider class is eligible for telemedicine reimbursement reference the appropriate Medicaid manual for your specialty.

See Pg. 1 of the Pennsylvania Medical Assistance (Special Consults.)

See Pg. 1 of the Pennsylvania Medical Assistance Bulletin (Telepsych)

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

No reference found to state parity.  Numerous bills have been presented, such as Senate Bill 780, however, nothing has yet to become law.

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: