Methods for healthcare service delivery using telecommunications technologies.
What is telehealth?
Telehealth means methods for healthcare service delivery using telecommunications technologies. Telehealth includes telemedicine, store and forward, and telemonitoring.
The term telehealth is also often used more generally to describe electronic information and telecommunications technologies to support long-distance clinical healthcare, as well as patient and professional health-related education, public health and health administration.
What is telemedicine?
Telemedicine means health care delivered by a provider who is located at a distant site to a beneficiary at an originating site for purposes of evaluation, diagnosis, consultation, or treatment using telecommunications technology via two-way, real-time, audio and video interactive communication, through a secure connection that complies with HIPAA.
The term "telemedicine" is sometimes used interchangeably with "telehealth." Telehealth encompasses the following:
- Real-time, audio-video communication tools that connect providers and patients in different locations. Tools can include interactive videoconferencing or videoconferencing using mobile health (mHealth) applications (apps) that are used on a computer or hand-held mobile device.
- Store-and-forward technologies that collect images and data to be transmitted and interpreted later, which may also involve the use of mHealth apps.
- Remote patient-monitoring tools such as home blood pressure monitors, Bluetooth-enabled digital scales and other devices that can communicate biometric data for review, which may also involve the use of mHealth apps.
Is telemedicine a covered service under Vermont Medicaid?
Yes - this type of service is reimbursable through Vermont Medicaid as long as it is clinically appropriate and within the provider’s licensed scope of practice. This includes the provision of mental health and substance use disorder treatment. Vermont Medicaid has an established telemedicine Place of Service (POS) code 02 (Telehealth) for use by practitioners providing telehealth services from off site.
Is audio-only (telephone) a covered service under Vermont Medicaid?
Yes - Vermont Medicaid will provide reimbursement at the same rate for medically necessary, clinically appropriate services delivered by telephone. Reimbursement will be at the same rate as currently established for Medicaid-covered services provided through telemedicine/face-to-face as long as the claim is submitted to Vermont Medicaid with a V3 modifier (to indicate “service delivered via telephone, i.e., audio-only”).
List of Audio-Only covered codes by Vermont Medicaid. Effective July 1, 2023 (update posted 10/1/23).
- The enforcement discretion by the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) expired with the end of the COVID-19 PHE on May 11, 2023. OCR is affording a 90-day transition period to come into HIPPA compliance for telehealth ending on August 9, 2023. For more information see Federal Register: Notice of Expiration of Certain Notifications of Enforcement Discretion Issued in Response to the COVID-19 Nationwide Public Health Emergency
- If you hold an active out-of-state license which is in good standing in a healthcare profession, you may practice in Vermont under certain circumstances. Visit the Office of Professional Regulation (OPR) for Updates to Telehealth Registrations and Licensing.
- Visit the Vermont Medicaid Banners webpage and search for Telehealth to stay informed about all Telehealth updates.
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Click below for additional resources. Want more information or have questions? Contact your Gainwell provider representative at (800) 925-1706.