Virginia 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 must be obtained and maintained.

See Telemedicine Guidance Doc. 85-12

Private payers are required to reimburse for telemedicine, subject to their own terms and conditions.
See Bill 38.2-3418.16

Telemedicine services are required to be interactive and store & forward appears to be excluded
See Virginia Act 38.2-3418.16 (b)

The states telemedicine law does not define an originating site.

 

No Reference Found

Medicaid

No Reference Found

Medicaid will reimburse subject to coverage requirements.
See Physician/Practitioner Manual Chapter IV Pg. 21

Medicaid will reimburse for radiology, diabetic retinopathy, and outpatient teledermatology.
See Practitioner Billing Manual Pg. 20

Telemedicine is the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment. The Medicaid member is located with a provider at the “originating” site, while the “remote” provider renders services via the audio/video connection.
See Pg. 14 of the Physician/Practitioner Manual

To find out if your provider class is eligible for Medicaid reimbursement reference the appropriate Medicaid manual for your specialty.
See Medicaid Memo Pg.5

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 must be obtained and maintained.

See Telemedicine Guidance Doc. 85-12

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Private payers are required to reimburse for telemedicine, subject to their own terms and conditions.
See Bill 38.2-3418.16

Medicaid

Medicaid will reimburse subject to coverage requirements.
See Physician/Practitioner Manual Chapter IV Pg. 21

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Telemedicine services are required to be interactive and store & forward appears to be excluded
See Virginia Act 38.2-3418.16 (b)

Medicaid

Medicaid will reimburse for radiology, diabetic retinopathy, and outpatient teledermatology.
See Practitioner Billing Manual Pg. 20

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

The states telemedicine law does not define an originating site.

 

Medicaid

Telemedicine is the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment. The Medicaid member is located with a provider at the “originating” site, while the “remote” provider renders services via the audio/video connection.
See Pg. 14 of the Physician/Practitioner Manual

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 Medicaid reimbursement reference the appropriate Medicaid manual for your specialty.
See Medicaid Memo Pg.5

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

An insurer, corporation, or health maintenance organization shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis that the insurer, corporation, or health maintenance organization is responsible for coverage for the provision of the same service through face-to-face consultation or contact.

See Bill 38.2-3418.16 Section D.

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: