Missouri reimbursement for telemedicine PDF Print E-mail

Missouri pays for telepsychiatry and other services + a separate facility fee.

Feb 2018 MO Medicaid Bulletin

2017 Provider Manual (Search for Telehealth or jump to page 208)

Physician Manual (jump to page 284)

Missouri Behavioral Health Services Manual describes Telehealth reimbursement starting on page 200

Excerpt below:

(2) Covered Services.

(A) A Telehealth service shall be covered

only if it is medically necessary.

(B) A Telehealth service shall require use

of two (2)-way interactive video and shall not

include store and forward services. The participant

must be able to see and interact with

the off-site provider at the time services are

provided via Telehealth.

(C) The distant site is the location where

the physician or practitioner is physically

located at the time of the Telehealth service.

Coverage of services rendered through Telehealth

at the distant site is limited to:

1. Consultations made to confirm a

diagnosis; or

2. Evaluation and management services;


3. A diagnosis, therapeutic, or interpretive

service; or

4. Individual psychiatric or substance

abuse assessment diagnostic interview examinations;


5. Individual psychotherapy; or

6. Pharmacologic management.

(D) The participant must be present for the


(3) Eligible Providers.

(A) A health care provider utilizing Telehealth

at either a distant site or an originating

site shall be enrolled as a MO HealthNet

provider pursuant to 13 CSR 70-3.020 and

licensed for practice in Missouri. A health

care provider utilizing Telehealth must do so

in a manner that is consistent with the provisions

of all laws governing the practice of the

provider’s profession.

(B) A provider agrees to conform to MO

HealthNet program policies and instructions

as specified in the provider manuals and bulletins,

which are incorporated by reference

and made a part of this rule as published by

the Department of Social Services, MO

HealthNet Division, 615 Howerton Court,

Jefferson City, MO 65109, at its website

www.dss.mo.gov/mhd, April 1, 2009. This

rule does not incorporate any subsequent

amendments or additions.

(4) Prior Authorization and Utilization

Review. All services are subject to utilization

review for medical necessity and program

compliance. Reviews can be performed

before services are furnished, before payment

is made, or after payment is made.

(A) Prior Authorization. Certain procedures

or services can require prior authorization

from the MO HealthNet Division or its

authorized agents. Services for which prior

authorization was obtained remain subject to

utilization review at any point in the payment

process. A service provided through Telehealth

is subject to the same prior authorization

and utilization review requirement which

exist for the service when not provided

through Telehealth.

(B) Eligibility Determination. Prior authorization

of services does not guarantee an

individual is eligible for a MO HealthNet service.

Providers must verify that an individual

is eligible for a specific program at the

time services are furnished and must determine

if the participant has other health insurance.

(5) Reimbursement.

(A) Reimbursement to the health care

provider delivering the medical service at the

distant site is made at the same amount as the

current fee schedule for the service provided

without the use of a telecommunication system.

(B) The claim for service will use the

appropriate procedure code for the covered

services addressed in (2)(C) and the GT modifier

indicating interactive communication

was used.

(C) The originating site is eligible to

receive a facility fee. Facility fees are not

payable to the distant site.

(D) Services provided by practitioners

must be within their scope(s) of practice and

according to MO HealthNet policy.

(E) Reimbursement for services furnished

by interns or residents in hospitals with

approved teaching program or services furnished

in other hospitals that participate in

teaching programs is made through institutional

reimbursement. The division cannot

be billed directly by interns or residents for

Telehealth services.

(6) Documentation for the Encounter. Patient

records at the distant and originating sites are

to document the Telehealth encounter consistent

with the service documentation described

in MO HealthNet provider manuals and bulletins.

(A) A request for a Telehealth service from

a referring provider and the medical necessity

for the Telehealth service shall be documented

in the participant’s medical record.

(B) A health care provider shall keep a

complete medical record of a Telehealth service

provided to a participant and follow

applicable state and federal statutes and regulations

for medical record keeping and confidentiality

in accordance with 13 CSR 70-

3.030 and 13 CSR 70-98.015.

(C) Documentation of a Telehealth service

by the health care provider shall be included

in the participant’s medical record maintained

at the participant’s location and shall


1. The diagnosis and treatment plan

resulting from the Telehealth service and

progress note by the health care provider;

2. The location of the distant site and

originating site;

3. A copy of the signed informed consent

form; and

4. Documentation supporting the medical

necessity of the Telehealth service.

(7) Confidentiality and Data Integrity. All

Telehealth activities must comply with the

requirements of the Health Insurance Portability

and Accountability Act of 1996, as

amended, and all other applicable state and

federal laws and regulations.

(A) A Telehealth service shall be performed

on a private, dedicated telecommunications

line approved through the Missouri

Telehealth Network (MTN). The telecommunications

line must be secure and utilize a

method of encryption adequate to protect the

confidentiality and integrity of the Telehealth

service information. The Missouri Telehealth

Network must also approve the equipment

that will be used in Telehealth service.

(B) Both a distant site and an originating

site shall use authentication and identification

to ensure the confidentiality of a Telehealth


(C) A provider of a Telehealth service shall

implement confidentiality protocols that


1. Identifying personnel who have

access to a Telehealth transmission; and

2. Preventing unauthorized access to a

Telehealth transmission.

(D) A provider’s protocols and guidelines

shall be available for inspection by the department

upon request.

(8) Informed Consent.

(A) Before providing a Telehealth service

to a participant, a health care provider shall

document written informed consent from the

participant or the participant’s legal guardian

and shall ensure that the following written

information is provided to the participant in a

format and manner that the participant is able

to understand:

1. The participant shall have the option

to refuse the Telehealth service at anytime

without affecting the right to future care or

treatment and without risking the loss or

withdrawal of a MO HealthNet benefit to

which the participant is entitled;

2. The participant shall be informed of

alternatives to the Telehealth service that are

available to the participant;

3. The participant shall have access to

medical information resulting from the Telehealth

service as provided by law;

4. The dissemination, storage, or retention

of an identifiable participant image or

other information from the Telehealth service

shall not occur without the written informed

consent of the participant or the participant’s

legally authorized representative;

5. The participant shall have the right to

be informed of the parties who will be present

at the originating site and the distant site

during the Telehealth service and shall have

the right to exclude anyone from either site;


6. The participant shall have the right to

object to the videotaping or other recording

of a Telehealth service.

(B) A copy of the signed informed consent

shall be retained in the participant’s medical

record and provided to the participant or the

participant’s legally authorized representative

upon request.

(C) The requirement to obtain informed

consent before providing a service shall not

apply to an emergency situation if the participant

is unable to provide informed consent

and the participant’s legally authorized representative

is unavailable.


For more information see the ATA Wiki page for Missouri here.


Last Updated on Thursday, 16 August 2018 13:33