CALIFORNIA

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Medi-Cal reimburses for select services via live video. Medi-Cal will also reimburse store-andforward for certain CPT/HCPCS codes. Specific CPT/HCPCS codes are outlined in the Medi-Cal manual. As of January 2019, Medi-Cal is also reimbursing for codes G0071, G2010 and G2012.

 

Definitions

Telehealth [according to the Telehealth Advancement Act of 2011] “is the mode of delivering health care services and public health utilizing information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at the distant site.”
“Telemedicine [according to CMS] is the use of medical information exchanged from one site to another using interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time, interactive communication between the patient and physician or practitioner at the distant site to improve a patient’s health. Medi-Cal uses the term telemedicine when it makes a distinction from telehealth.”

 

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2019) (Accessed Feb. 2019).

Live Video

Policy

Medi-Cal will reimburse for services provided via live video. Services must be billed with modifiers GT or 95.

 

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2019), (Accessed Feb. 2019).

Medi-Cal will reimburse for services provided via live video.

Source: Sec. 14132.72 of the Welfare and Institutions Code. (Accessed Mar. 2019).

For Denti-Cal, live transmissions are only billable if the beneficiary requests it.

Source: Denti-Cal Provider Handbook. (4-14 to 4-15). (Mar. 2019). (Accessed Mar. 2019).
Eligible Services / Specialties

Specific eligible CPT/HCPCS codes are provided in Medi-Cal and Denti-Cal manuals.

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Sept. 2017), & Denti-Cal Provider Handbook. (4-13 to 4-15). (Mar. 2019). (Accessed Mar. 2019).

 

Live video telehealth may be used to deliver a face-to-face encounter related to the primary reason a recipient requires home health services or a durable medical equipment item.

Source: Department of Health Care Services. Home Health Agencies (HHA) Provider Handbook. (May 2016). & Department of Health Care Services. Durable Medical Equipment (DME): An Overview. (June 2018), (Accessed Feb. 2019).

 

CA Children’s Services Program lists eligible CPT/HCPCS codes in Numbered Letters 16-1217 & 09-0718. Codes specifically include tele-speech, tele-auditory verbal therapy, tele-auditory habilitation and tele-auditory rehabilitation services in the home, with the parent or guardian working with the speech therapist at the distant site.

Source: Department of Health Care Services. Numbered letter 16-1217 to the CA Children’s Services Program and Genetically Handicapped Persons Program (GHPP). Dec. 22, 2017. & Number Letter 09-0718 to CA Children’s Services Program. Jul. 10, 2018. (Accessed Feb. 2019).

 

Drug Medi-Cal certified providers may receive reimbursement for individual counseling provided through telehealth. However, implementation is dependent on the extent of federal participation and federal approval. The Department of Health Care Services must adopt regulations by July 1, 2022 to implement this section in accordance with the Administrative Procedure Act.

Source: Sec. 14132.731 of the Welfare and Institutions Code. (Accessed Mar. 2019).
Eligible Providers

Allied dental professionals are not permitted to bill for teledentistry.

Source: Denti-Cal Provider Handbook. (4-13 to 4-15). (Mar. 2019). (Accessed Mar. 2019).

Psychiatrists may bill for services delivered through telehealth in accordance with the Medicaid state plan.

Source: Sec. 14132.73 of the Welfare and Institutions Code. (Accessed Mar. 2019).
Geographic Limits

The type of setting where services are provided is not limited.

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2019), (Accessed Feb. 2019)

 

CA Children’s Services Program lists eligible CPT/HCPCS codes related to tele-speech, tele-auditory verbal therapy, tele-auditory habilitation and tele-auditory rehabilitation services in the home, with the parent or guardian working with the speech therapist at the distant site.

Source: Department of Health Care Services. Number Letter 09-0718 to CA Children’s Services Program. (Jul. 10, 2018). (Accessed Feb. 2019)
Facility/Transmission Fee

Medi-Cal will reimburse the originating site a facility fee, and originating and distant site for live video transmission costs.

 

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2019),(Accessed Feb. 2019).

Store-and-Forward

Policy

Medi-Cal will reimburse for store-and-forward services for certain specialties.

 

Source: Sec. 14132.725 of the Welfare and Institutions Code. (Accessed Mar. 2019).
Eligible Services / Specialties

Eligible specialties include tele-dermatology, tele-ophthalmology and teledentistry.
Medi-Cal will also reimburse for G2010 which is a remote evaluation of recorded video and/or images submitted by an established patient, including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
See Medi-Cal and Denti-Cal manual for eligible codes.

 

Source: SSec. 14132.725 of the Welfare and Institutions Code & CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2019), (Accessed Feb. 2019) & Denti-Cal Provider Handbook. (4-14 to 4-15). (Accessed Feb. 2019).
Transmission Fee

The originating site is eligible for a facility fee. A transmission fee is only reimbursed for live video; therefore, store-and-forward is not eligible.

 

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2019),(Accessed Feb. 2019).
Email / Phone / Fax

Medi-Cal does not reimburse services delivered by telephone, electronic mail or facsimile transmissions.

 

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2019). (Accessed Feb. 2019).
Consent

Provider must obtain oral consent from the patient and document it in the patient record.

 

Source: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2019). (Accessed Feb. 2019).
Miscellaneous

Medi-Cal covers telehealth to the extent services are allowable and reimbursed according to the department’s telehealth manual in the California Children’s Services Program (CCS), Genetically Handicapped Person’s Program (GHPP) and Child Health and Disability Prevention Program (CHDP).

 

Source: CA Department of Health Care Services. Medi-Cal Special Programs FAQs. (Accessed Feb. 2019).

Telehealth services and supports are among the services and supports authorized to be included by individual program plans developed for disabled individuals by regional centers that contract with the State Department of Developmental Disabilities.

Source: Welfare and Institutions Code Sec. 4512. (Accessed Feb. 2019).

Medicaid must ensure that all managed care covered services are available and accessible to enrollees of Medicaid managed care plans in a timely manner. Telecommunications technologies can be used as a means to meet time and distance standards in some circumstances. See regulation for details

Source: CA Welfare and Institutions Code Sec. 14197. (Accessed Feb. 2019).

Private Payer Laws

Requirements

Private payers cannot require that in-person contact occur before payment is made for covered telehealth services, subject to contract terms and conditions. Health plans cannot limit the settings where services are provided. Settings are still subject to contract terms and conditions.

 

Source: CA Health & Safety Code Sec. 1374.13. (Accessed Feb. 2019).
Definitions

“Telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store-and-forward transfers.”

 

Source: CA Business & Professions Code Sec. 2290.5. (Accessed Feb. 2019).

Parity

Payment Parity

No explicit payment parity.

 

Service Parity

Private payers cannot require that in-person contact occur before covering a telehealth delivered service, but it is subject to the terms and conditions of the contract.

 

Source: CA Health & Safety Code Sec. 1374.13. (Accessed Feb. 2019). (Accessed Feb. 2019).

Professional Regulation /
Health & Safety

Online Prescribing

Providers are prohibited from prescribing or dispensing dangerous drugs or dangerous devices on the Internet without an appropriate prior examination and medical indication.

 

Source: CA Business & Professions Code Sec. 2242.1(a). (Accessed Feb. 2019).

Remote Dispensing Site Pharmacies
Remote dispensing site pharmacies are permitted to dispense or provide pharmaceutical care services in medically underserved areas. A supervising pharmacy must provide
telepharmacy services to the remote dispensing site pharmacy and shall not be located greater than 150 road miles from the remote dispensing site pharmacy.

Source: : CA Business & Professionals Code Sec. 4130-4135. (Accessed Feb. 2019).
Consent

The originating site provider must obtain and document verbal or written patient consent prior to service delivery

 

Source: CA Business & Professions Code Sec. 2290.5. (Accessed Feb. 2019).

Occupational Therapy
An occupational therapist must obtain patient’s consent prior to providing services via telehealth.

Source: CA Code of Regulations, Title 16, Div. 39, Art. 8, Sec. 4172. (Accessed Feb. 2019).

Behavioral Sciences
A licensee must obtain informed consent from a client upon initiation of telehealth services.

Source: CA Code of Regulations, Title 16, Div. 18, Art. 1, Sec. 1815.5. (Accessed Feb. 2019).
Miscellaneous

Professional Board Telehealth-Specific Regulations
• CA Board of Occupational Therapy (Source: Title 16, Div. 39, Sec. 4172). (Accessed Feb. 2019).
• CA Board of Behavioral Sciences (Source: Title 16, Div. 18, Art. 1, Sec. 1815.5). (Accessed Feb. 2019).

 

Definitions

“Telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store–and-forward transfers.”

 

Source: CA Business & Professions Code Sec. 2290.5. (Accessed Feb. 2019).

Contact us to discuss your telehealth initiatives in California


[recaptcha]

*Required