With its first telemedicine parity laws passed in 1996, California has a long history in telemedicine reimbursement and was one of the first states to acknowledge the value of telemedicine.

Like many other U.S. states, California recognizes how important telemedicine is improving healthcare access for patients challenged by distance or mobility.  Pending legislation in California illustrates a movement toward utilizing telemedicine as a way to reach those with special needs and those in need of behavioral health care services.

Parity Law

Yes. California has a telemedicine parity law mandating private payer reimbursement for telemedicine.

Type of Telemedicine Covered

California’s Medicaid program covers live video telemedicine. The state also covers store-and-forward services for Teledermatology, teledentistry, and teleophthalmology.

Covered Health Services

California reimburses for wide variety of evaluative & management health services, and psychiatric services. Check out our Billing Codes section below for more details.

Billing Codes

 

CPT E&M Codess

• 99201 – 99215 Office or other outpatient visit (new or established patient)
• 99221 – 99233 Initial hospital care or subsequent hospital care (new or established patient)
• 99241 – 99275 Consultations:  Office or other outpatient, initial or follow-up inpatient, and confirmatory

CPT Psychiatric Codes

• 90785 Interactive complexity 90791 Psychiatric diagnostic evaluation
• 90792 Psychiatric diagnostic evaluation with medical services
• 90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
• 90832 Psychotherapy, 30 minutes with patient and/or family member
• 90837 Psychotherapy, 60 minutes with patient and/or family member
• 90839 Psychotherapy for crisis; first 60 minutes
• 90840 Additional 30 minutes
• Telehealth originating site facility fee : Q3014 (Once per day, same recipient & provider)
• Transmission costs for telehealth services via audio/video communication: T1014
• (Maximum of 90 minutes per day same recipient, same provider)
• Plus, make sure you use the GT modifier with your CPT code to indicate live video telemedicine. If you’re using a store-and-forward solution, use the GQ modifier.

 

Eligible Healthcare Providers

Medi-Cal does limit which healthcare providers can get reimbursed for telemedicine. Here’s who qualifies:

• Physicians
• Physician assistants
• Nurse practitioners
• Clinical nurse specialists
• Registered dietitians or nutrition professionals
• Nurse midwives
• Certified registered nurse anesthetists
• Clinical psychologists
• Clinical social workers

Online Prescriptions

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

Informed Patient Consent

Yes. Providers need to get patients’ oral consent before they can start a telemedicine service. Providers also need to document consent in the patient’s medical record.

Cross-State Telemedicine Licensing

There’s no interstate licensing available for California right now. Providers doing telemedicine in California need to have a California license.

Restrictions on Locations

Medi-Cal has no limitations on where the patient or provider has to be during the telemedicine visit. That makes it easy for providers to offer quick, convenient virtual care – and get paid for it.

Other Reimbursable Fees

Medi-Cal reimburses the originating site a facility fee, and pays the originating and distant sites for live video transmission costs.

Reimbursement Rates

Good news! California Medicaid reimburses telemedicine services according to the current physician fee schedule amount for that medical service. So reimbursement rates for a telemedicine service should be the same as the comparable in-person medical service.

Helpful Resources

• California Telehealth Resource Center
• Center for Connected Health Policy
• American Telemedicine Association State Policy Matrix
• University of California Davis Center for Health and Technology
• California Office of Health Information Integrity — eHealth (CalOHII)
• The Medical Board of California: Practicing Medicine Through Telehealth Technology
• Centers for Medicare and Medicaid Services: Telemedicine
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Dear Readers,

We are inviting doctors and investors to join us in a telemedicine health application, being developed by Motherhealth to fill in the gaps in the current mobile health apps.

Email motherhealth@gmail.com to join.

Regards,

Connie Dello Buono

http://www.motherhealth.net

San Jose CA 95124