Rhode Island Telemedicine & Telehealth Reimbursement Overview

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

Informed consent is recommended for the use of patient-physician care provided via telemedicine, however, it is not a state-mandated law.

Health insurers that provide coverage for in-person services must provide coverage for telemedicine services.

R.I. GEN. LAWS § 27-81-4.

Store & forward is included under Rhode Island’s definition of telemedicine, therefore payors must provide coverage for it as well.
R.I. GEN. LAWS § 27-81-3.

Originating site is the patient location at the time of service, which can, but is not guaranteed to be, the patient’s home where medically appropriate.

See Pg. 2 of H 7160B

The state leaves the definition open “”Health care provider” means a health care professional or a health care facility.”  Please check with your insurance provider for other restrictions.

See Pg. 2 of H 7160B

Medicaid

No Reference Found

Fee schedule outlines opportunities for reimbursement related to follow-up and inpatient telehealth services requiring live video.

See RI Medicaid Fee Schedule

No Reference Found

No Reference Found

Initial inpatient consultations and follow-ups conducted via telehealth are available for reimbursement.

See RI Medicaid Fee Schedule

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

Informed consent is recommended for the use of patient-physician care provided via telemedicine, however, it is not a state-mandated law.

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Health insurers that provide coverage for in-person services must provide coverage for telemedicine services.

R.I. GEN. LAWS § 27-81-4.

Medicaid

Fee schedule outlines opportunities for reimbursement related to follow-up and inpatient telehealth services requiring live video.

See RI Medicaid Fee Schedule

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store & forward is included under Rhode Island’s definition of telemedicine, therefore payors must provide coverage for it as well.
R.I. GEN. LAWS § 27-81-3.

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Originating site is the patient location at the time of service, which can, but is not guaranteed to be, the patient’s home where medically appropriate.

See Pg. 2 of H 7160B

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

The state leaves the definition open “”Health care provider” means a health care professional or a health care facility.”  Please check with your insurance provider for other restrictions.

See Pg. 2 of H 7160B

Medicaid

Initial inpatient consultations and follow-ups conducted via telehealth are available for reimbursement.

See RI Medicaid Fee Schedule

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

Rhode Island enacted H 7160B requires that a health insurer shall not exclude a health care service for coverage solely because the health care service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such health care services are medically appropriate to be provided through telemedicine services and as such may be subject to the terms and conditions of a telemedicine agreement between the insurer and the participating health care provider or provider group.   The law took effect January 1st, 2018.

It mandates that there must be coverage, but it leaves reimbursement rates up to individual contracts between each insurer and each provider group.  This law is more of a partial parity law due to this.

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: