Virginia Reimbursement for Telemedicine PDF Print E-mail

Virginia's parity law mandates private insurance and state managed health plans to reimburse for telemedicine. 

"Telemedicine is the real-time or near real time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment. The Medicaid member is located with a provider at the “originating” site, while the “remote” provider renders services via the audio/video connection." 

-April 2018 Medicaid Document in Virgnia

Feb 2015 Virginia Telemedicine Law signed by the Governor

VA Medicaid Telemed memo May 2014 


VA Board of Medicine Telehealth Guidelines


Telemedicine Billing Information


The following DMAS covered Current Procedural Terminology (CPT) codes are

recognized by DMAS for telemedicine. The services are rendered by providers at the “hub”

site to the Medicaid member located at the distant or “spoke” site:

• CPT 99241-99255, consultations;

• CPT 99201-99215, office visits;

• CPT 90804-90809, individual psychotherapy;

• CPT 90862, pharmacologic management;

• CPT 57452, 57454, 57460, colostomy;

• CPT 76805, 76810, obstetric ultrasound;

• CPT 76825, echocardiography, fetal:

• CPT 93010, cardiography interpretation and report only; and

• CPT 93307, 93308, 93320, 93321, 93325, echocardiography.

The CMS 1500 is to be used to bill for covered telemedicine services, with the appropriate

billing code entered in block 24D and “GT” entered as the modifier. The distant or “spoke”

site provider is where the DMAS member is located for the telemedicine encounter. The

member must be present for the encounter as well as the provider. Code Q3014 is to be

billed for the spoke site service unless the hub provider determines a higher-level service

must be documented in the member’s medical record. Again, “GT” is to be entered as the

modifier when billing. For DMAS covered physician services, a Registered Nurse under

the supervision of a physician may attend the telemedicine encounter and assist the

member. This service is billed using code Q3014. After reviewing the documentation for

the encounter, the physician must sign and date the documentation and billing.





Last Updated on Friday, 09 November 2018 12:10