405 IAC 5-38-4 - Limitations

Current through December 29, 2021

Authority: IC 12-15-5-11; IC 12-15-21

Affected: IC 12-13-7-3

Sec. 4.

Telemedicine shall be limited by the following conditions:

(1) The patient must:
(A) be physically present at the originating site; and
(B) participate in the visit.
(2) The physician or practitioner who will be examining the patient from the distant site must determine if it is medically necessary for a medical professional to be at the originating site. Separate reimbursement for a provider at the originating site is payable only if that provider's presence is medically necessary. Adequate documentation must be maintained in the patient's medical record to support the need for the provider's presence at the originating site during the visit. Such documentation is subject to postpayment review. If a health care provider's presence at the originating site is medically necessary, billing of the appropriate evaluation and management code is permitted.
(3) Reimbursement for medically necessary telemedicine services is available to the following providers regardless of the distance between the provider and member:
(A) Federally qualified health centers.
(B) Rural health clinics.
(C) Community mental health centers.
(D) Critical access hospitals.
(E) A provider, as determined by the office to be eligible, providing a covered telemedicine service.
(4) Store and forward technology is not reimbursable by Medicaid. The use of store and forward technology is permissible as defined under section 2(4) of this rule.
(5) The following service or provider types may not be reimbursed for telemedicine:
(A) Ambulatory surgical centers.
(B) Outpatient surgical services.
(C) Home health agencies or services.
(D) Radiological services.
(E) Laboratory services.
(F) Long term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled.
(G) Anesthesia services or nurse anesthetist services.
(H) Audiological services.
(I) Chiropractic services.
(J) Care coordination services with the member not present.
(K) Durable medical equipment (DME) and home medical equipment (HME) providers.
(L) Optical or optometric services.
(M) Podiatric services.
(N) Physical therapy services.
(O) Transportation services.
(P) Services provided under a Medicaid home and community-based waiver.
(Q) Provider to provider consultations.


405 IAC 5-38-4
Office of the Secretary of Family and Social Services; 405 IAC 5-38-4; filed Feb 28, 2007, 2:42 p.m.: 20070328-IR-405060029FRA; readopted filed Sep 19, 2007,12:16p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 9/19/2014, 3:22 p.m.: 20141015-IR-405140194FRA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA Errata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACA Filed 6/1/2018, 2:36 p.m.: 20180627-IR-405180060FRA

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