Washington Telemedicine & Telehealth Reimbursement Overview

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

The standard components of informed consent are expected for telemedicine, equal to traditional care services.

See Pg. 5 Washington State Telehealth Implementation Guidebook

Insurers (including employee health plans and Medicaid Managed Care) are required to reimburse for live video telemedicine, but there are some limitations.
See Private Payers Section 48.43.735

Store & forward is reimbursed when there is an associated office visit between the patient and referring provider, and the services are specified.
See Revised Code of WA Sec. 48.43,735.

An originating site can charge a facility fee. However, it is subject to the existing agreement between the site and the health plan.  Home qualifies as an originating site.
See Revised Code of WA Sec. 48.43.735.

Eligible providers are referenced as those documented under Title 18 of the Revised Code for Washington State.

 

Medicaid

Written consent is required for store & forward technology.

See Pg. 91 of Washington Medicaid Provider Guide

 

Washington Medicaid will reimburse for live video telemedicine when it is medically necessary, which is determined by the referring provider.
See Pages 87 & 190 of the Washington Medicaid Provider Guide

Store & forward is reimbursed when there is an associated office visit between the patient and referring provider, and the services are specified.
See Pg. 87 of the Washington Medicaid Provider Guide

Facility fees can be billed for by originating sites, excluding inpatient hospitals.  Home qualifies as an originating site, with a complete list of eligible locations listed.

See Pg. 88-89 of the Washington Medicaid Provider Guide

To find out if your provider class is eligible for Medicaid reimbursement, reference the appropriate Medicaid manual for your specialty.
Washington Provider Manual Manual

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

The standard components of informed consent are expected for telemedicine, equal to traditional care services.

See Pg. 5 Washington State Telehealth Implementation Guidebook

Medicaid

Written consent is required for store & forward technology.

See Pg. 91 of Washington Medicaid Provider Guide

 

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

Insurers (including employee health plans and Medicaid Managed Care) are required to reimburse for live video telemedicine, but there are some limitations.
See Private Payers Section 48.43.735

Medicaid

Washington Medicaid will reimburse for live video telemedicine when it is medically necessary, which is determined by the referring provider.
See Pages 87 & 190 of the Washington Medicaid Provider Guide

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store & forward is reimbursed when there is an associated office visit between the patient and referring provider, and the services are specified.
See Revised Code of WA Sec. 48.43,735.

Medicaid

Store & forward is reimbursed when there is an associated office visit between the patient and referring provider, and the services are specified.
See Pg. 87 of the Washington Medicaid Provider Guide

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

An originating site can charge a facility fee. However, it is subject to the existing agreement between the site and the health plan.  Home qualifies as an originating site.
See Revised Code of WA Sec. 48.43.735.

Medicaid

Facility fees can be billed for by originating sites, excluding inpatient hospitals.  Home qualifies as an originating site, with a complete list of eligible locations listed.

See Pg. 88-89 of the Washington Medicaid Provider Guide

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Eligible providers are referenced as those documented under Title 18 of the Revised Code for Washington State.

 

Medicaid

To find out if your provider class is eligible for Medicaid reimbursement, reference the appropriate Medicaid manual for your specialty.
Washington Provider Manual Manual

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

Washington has a payment parity law that requires private insurers to pay providers for telehealth services provided they meet basic criteria.  Unfortunately, the law does not mandate payment equal to in-person care.

See RCW 48.43.735

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: