Vermont Telemedicine & Telehealth Reimbursement Overview

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

Originating site providers must obtain consent for a store and forward teleophthalmology or teledermatology service.  See VT Statutes Annotated, Title 18 Sec. 9361

Private payers reimburse for live-video telemedicine to the same extent as in-person services.

See VT Statutes Annotated, Title 8 Sec. 4100k.

Allows, but doesn’t require, reimbursement for teleophthalmology and teledermatology.

See VT Statutes Annotated, Title 8 Sec. 4100k.

Reimbursement subject to specifications.  See Item (G) and (H,5) VT Statutes Annotated, Title 8 Sec. 4100k.

No reference found

Medicaid

The Vermont Patients’ Bill of Rights provides that “the patient has the right to receive from the patients’ physician information necessary to give informed consent prior to the start of any procedure or treatment.”

See Dept. of VT Health Access, Provider Manual, p 66, 9.8.1

Live video is reimbursed with GT modifiers.  See Dept. of VT Health Access, Provider Manual, p 105, 10.3.54

No reimbursement for teleophthalmology or teledermatology; no reference to other store and forward technologies.

See Dept. of VT Health Access, Provider Manual, p 106, 10.3.54

Originating site providers are required to document the reason the service is being provided by telemedicine rather than in person and may be reimbursed a facility fee.

See Dept. of VT Health Access, Provider Manual, p 106, 10.3.54

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

Originating site providers must obtain consent for a store and forward teleophthalmology or teledermatology service.  See VT Statutes Annotated, Title 18 Sec. 9361

Medicaid

The Vermont Patients’ Bill of Rights provides that “the patient has the right to receive from the patients’ physician information necessary to give informed consent prior to the start of any procedure or treatment.”

See Dept. of VT Health Access, Provider Manual, p 66, 9.8.1

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Private payers reimburse for live-video telemedicine to the same extent as in-person services.

See VT Statutes Annotated, Title 8 Sec. 4100k.

Medicaid

Live video is reimbursed with GT modifiers.  See Dept. of VT Health Access, Provider Manual, p 105, 10.3.54

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Allows, but doesn’t require, reimbursement for teleophthalmology and teledermatology.

See VT Statutes Annotated, Title 8 Sec. 4100k.

Medicaid

No reimbursement for teleophthalmology or teledermatology; no reference to other store and forward technologies.

See Dept. of VT Health Access, Provider Manual, p 106, 10.3.54

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

Reimbursement subject to specifications.  See Item (G) and (H,5) VT Statutes Annotated, Title 8 Sec. 4100k.

Medicaid

Originating site providers are required to document the reason the service is being provided by telemedicine rather than in person and may be reimbursed a facility fee.

See Dept. of VT Health Access, Provider Manual, p 106, 10.3.54

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

VT’s parity law was enacted in 2012.  It includes telemedicine coverage for state employee health plans.
VT is 1 of 4 states that cover interactive audio-video only as a condition of their parity law.

Although the law does not require coverage of services via store-and-forward, it does require informed consent from any patient receiving teledermatology and teleophthalmology via store-and-forward.
The parity law also limits telemedicine coverage to services provided in health care facilities only.

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: