West 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

West Virginia law requires consent prior to delivering telemedicine services.

See HB. 2947 Line 63

No Reference Found

No Reference Found

“Telemedicine” means the practice of medicine using tools such as electronic communication, information technology, store and forward telecommunication, or other means of interaction between a physician or podiatrist in one location and a patient in another location, with or without an intervening health care provider.

See HB 2947 Line 13 Passed March 2019

Physician (as defined in Article 3, Section A.2) and podiatrists are eligible to practice, although reimbursement is not guaranteed.

See Pg. 2 in WV House Bill 2509

Medicaid

Patient consent must be obtained.
See WV Behavioral Services Manual Pg. 9

Medicaid will reimburse for a limited amount of services. For a list of covered services:
See WV Provider Manual Pg. 2

Medicaid will not reimburse for store & forward, because it is not considered interactive communication.
See WV Provider Manual Pg. 2

The originating site requires the appropriate codes and modifiers and may charge a facility fee.
See WV Provider Manual Pg. 3

To get specifics concerning Medicaid and your provider class, reference the provider manual specific to your classification.
See WV Provider Manual Pg. 2

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

West Virginia law requires consent prior to delivering telemedicine services.

See HB. 2947 Line 63

Medicaid

Patient consent must be obtained.
See WV Behavioral Services Manual Pg. 9

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

No Reference Found

Medicaid

Medicaid will reimburse for a limited amount of services. For a list of covered services:
See WV Provider Manual Pg. 2

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

No Reference Found

Medicaid

Medicaid will not reimburse for store & forward, because it is not considered interactive communication.
See WV Provider Manual Pg. 2

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

“Telemedicine” means the practice of medicine using tools such as electronic communication, information technology, store and forward telecommunication, or other means of interaction between a physician or podiatrist in one location and a patient in another location, with or without an intervening health care provider.

See HB 2947 Line 13 Passed March 2019

Medicaid

The originating site requires the appropriate codes and modifiers and may charge a facility fee.
See WV Provider Manual Pg. 3

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Physician (as defined in Article 3, Section A.2) and podiatrists are eligible to practice, although reimbursement is not guaranteed.

See Pg. 2 in WV House Bill 2509

Medicaid

To get specifics concerning Medicaid and your provider class, reference the provider manual specific to your classification.
See WV Provider Manual Pg. 2

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

Parity does not currently exist; however, House Bill 2460 has been proposed which would require private insurers to provide parity.  As of May 2019, the bill is currently in the Committee on Banking and Insurance.

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: