Utah Reimbursement for Telemedicine PDF Print E-mail

Utah Reimburses for telemedicne in rural areas, See excerpt from the Utah Medicaid Manual below:

"For Medicaid reimbursement, University of Utah telehealth connections to rural areas must be located within Utah, and health providers must be licensed in Utah. Definitions Telemedicine or telehealth is a technological method of providing an auditory and visual connection between the consultant at a remote site and the patient who is assisted by a Health Department clinician at the rural Health Department clinic.


Authorized providers

The University of Utah telehealth site will provide access for physician and dietitian consultation. Health care providers are limited to physicians and dietitians during the beginning of the Children‟s Special Health Care Needs pilot project. Other specialty areas may be added later as the project continues. Covered Services


Medically necessary diagnostic and therapeutic services, appropriate for the adequate diagnosis or treatment of some Special Health Care Needs Children, are covered services. The services include initial physician consultation, confirmatory consultations, and follow up consults. The service and codes will be limited to those which might be appropriate for evaluation and consultation without hands-on-care. Limitations

For Medicaid and the Special Health Care Needs Children project purposes, health care delivery through telehealth is only relevant for Special Health Care Need‟s Children residing in rural areas. It provides the child with access to a health provider specialist in an urban area without travel from the rural area. Health Department clinics in Milford, Price, and Richfield with telehealth connections to the University of Utah telehealth site are eligible for inclusion in the project.

Providers are limited to physicians and dietitians working through the University of Utah telehealth site as participants in the Special Health Care Needs Child project. Each health provider must have a Medicaid provider number.

Providers will ensure that the legal guardian of the Special Health Care Needs Child signs a consent to authorize the child‟s participation in the telehealth project. Without signed consent, the child is not eligible to participate in telehealth.


Bill on a CMS-1500 (08/05) Claim form. All payments will be made to the Bureau of Children with Special Health Care Needs in the Division of Community and Family Health Services, Department of Health. No payments will be made for telehealth transmission expense or facility charge. Codes


Codes which may be used by telemedicine physician consultants: Utah Medicaid Provider Manual Physician Manual Division of Medicaid and Health Financing Updated January 2012 Page 19 of 71 SECTION 2

99201-99205 - initial outpatient consultations

99211-99215 - outpatient established patient

Codes which may be used for dietician consultation:

1. S9470 dietician nutritional counseling. This is a new code which specifically describes dietician education and consultation for Special Health Care Needs Child during the telehealth project. Dietician consultation for the family will average four per year.


31. Diabetes Self-Management Training

Effective October 1, 1999, code S9455, Diabetes Self-Manageme

GT Each dietician and physician provider consultant must add the GT modifier to indicate the service was provided through telehealth. This modifier is required to monitor and evaluate the financial impact of this project. Non-Covered Modifiers GQ This modifier is used for transmission of data such as radiology or electrocardiogram. This is not a covered service for the Medicaid Telehealth Special Health Care Needs Child project."



Last Updated on Tuesday, 15 August 2017 14:41