Wisconsin Medicaid Reimbursement for Telehealth In Mental Health Programs
A Medicaid enrolled certified mental health or substance abuse treatment program may be eligible for Medicaid reimbursement for telehealth services if it is also certified to provide treatment via telehealth. Medicaid-covered services provided via telehealth are reimbursed in the same way Medicaid reimburses for face-to-face contacts between providers and consumers. The Medicaid Handbook Update #2004-88 at https://www.forwardhealth.wi.gov/kw/pdf/2004-88.pdf, described coverage requirements.
1. The agency must be a certified program under one of the specified program standards: Wis. Admin. Code DHS34, 35, 36, 40, 61, 63, or 75 (except for the provision of opioid treatment under DHS 75.15).
2. Persons providing mental health or substance abuse treatment services via telehealth must be a rostered staff member of one of these certified programs.
3. Medicaid will not accept claims from individual professional staff.
4. The certified program also is certified for telehealth by the Division of Quality Assurance.
5. The treatment service must be a covered service under one of the Medicaid mental health or substance abuse benefits.
6. The treatment service may not be group therapy.
7. The provider must indicate the “GT” modifier on the claim detail for the specific procedure code. The “GT” modifier definition is “Via interactive audio and video telecommunication systems.”
8. Providers must continue to follow all Medicaid coverage policies and all other requirements for each underlying service in the same manner as if the service was provided on face-to-face basis.
For more information concerning telehealth program issues for mental health care or other provider types, contact John Fisher at through the contact information on this site.
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