23 Miss. Code. R. 225-1.5 - Reimbursement

A. The Division of Medicaid reimburses the provider at the originating site the Mississippi Medicaid telehealth originating site facility fee for telehealth services per completed transmission, in addition to a separately identifiable covered service if performed.

1. The following providers are eligible to receive the originating site facility fee for telehealth services per transmission:

a) The office of a physician or practitioner,

b) An outpatient hospital, including a Critical Access Hospital (CAH),

c) A Rural Health Clinic (RHC),

d) A Federally Qualified Health Center (FQHC),

e) A Community Mental Health/Private Mental Health Center,

f) A Therapeutic Group Home,

g) An Indian Health Service Clinic,

h) A School-Based Clinic, or

i) School which employs a nurse.

2. The originating site provider can only bill for an encounter or Evaluation and Management (E&M) visit if a separately identifiable covered service is performed.

3. An inpatient hospital's originating site fee is included in the All Patient Refined/Diagnosis Related Group (APR-DRG) payment.

B. The Division of Medicaid reimburses all providers delivering a medically necessary telehealth service at the distant site at the current applicable Mississippi Medicaid fee-for-service rate or encounter for the service provided. The provider must include the appropriate modifier on the claim indicating the service was provided through telehealth.

C. Providers delivering simultaneous distant and originating site services to a beneficiary are reimbursed:

1. The current applicable Mississippi Medicaid fee-for-service rate for the medical service(s) provided, and

2. Either the originating or distant site facility fees, not both, except for RHC, FQHC and CMHC when such services are appropriately provided by the same organization.

Notes

23 Miss. Code. R. 225-1.5

42 C.F.R. § 410.78; Miss. Code Ann. §§ 43-13-117, 43-13-121; SPA 15-003.

New to correspond with SPA 15-003 (eff. 01/01/2015); Adopted 7/1/2015 Amended 5/1/2016 Amended 7/1/2018 Amended 8/1/2020 Amended 7/1/2021