Telehealth and Telemedicine Billing and Reimbursement
Customize your policy alerts
Sign up for Delaware First Health Policy DE.PP.009 alerts
Get alerted when Policy DE.PP.009 changes without checking for updates manually.
Monitor payer policy activity
Governs Delaware First Health (DFH) telehealth/telemedicine program billing, reimbursement, and provider requirements for Medicaid product types; applies to DFH claims operations, configuration, telehealth providers, originating and distant sites.
Updated place of service requirements
Coverage and Eligibility Criteria for Telehealth Services
inv-01: Telehealth Coverage Criteria
Telehealth and telemedicine services are covered when the underlying service is a covered benefit under DFH Medicaid and when provider, technology, documentation, and billing requirements are met.
inv-02: Telehealth coding and modifier criteria
Listed procedure codes and modifier combinations for telehealth services that are recognized for claims processing.
ALL of the following
- Behavioral health modifier guidance: Appendix B and Appendix A include modifier mappings and behavioral health-specific modifier assignments (examples: HP, HO, U2, U4) to guide correct modifier use on telehealth claims for behavioral health providers and master-level providers.
Refer to appendix for provider-type-specific modifier guidance.
- Appendix shows per-code modifier columns (MOD1–MOD4) and internal status/modifier flags used for claim handling; these mappings are informational and may not represent explicit per-code coverage decisions in this extract.
Internal flags include codes such as HP, HO, U2, U4, HF, HN as shown in appendix.
inv-03: Appendix A — informational mapping
Appendix lists procedure codes and payer-specific internal mappings/status flags; the extract does not include explicit coverage criteria or clinical authorization rules.
ALL of the following
- Appendix A presents a large list of procedure codes with associated internal modifier/status flags (examples shown in the appendix: HP, HO, U2, U4, HF and others). These mappings are informational and intended to guide claims processing rather than constitute per-code coverage determinations in this extract.
Appendix entries include multiple MOD columns and per-code flags.
- Product and effective date: The appendix mappings are shown for Product type: Medicaid; the policy effective date appears in the extract (Effective 1/16/2025).
- Scope of appendix in extract: Appendix spans pages included in this extract (page references shown across the appendix), but the extract may not include the full policy context or any explicit per-code covered/denied status decisions.
Refer to full policy document for any per-code coverage determinations.
Procedure, HCPCS, Place of Service and Modifier Guidance
| Q3014 | Originating site facility fee (HCPCS Level II) |
| POS 10 | Place of Service - patient's home (use when telehealth provided in patient's home) |
| POS 02 | Place of Service - telehealth other locations (use for all other locations). Important: When billing Q3014, provider must use POS 02 only; DFH will not pay an originating site fee if the originating site is the member's home. |
| 90785 | Psychiatric diagnostic procedures / complex interactive |
| 90791 | Psychiatric diagnostic evaluation |
| 90832 | Psychotherapy, 30 minutes with patient |
| 90834 | Psychotherapy, 45 minutes with patient |
| 90837 | Psychotherapy, 60 minutes with patient |
| Q3014 | Telehealth originating site facility fee |
| T1032 | Prenatal visit performed by a Doula, 15 minutes |
| 99441 | Telephone E/M, 5-10 minutes |
| 99442 | Telephone E/M, 11-20 minutes |
| 99443 | Telephone E/M, 21-30 minutes |
| 90832-90840, 90846-90853, 90785, 90791-90792 | Psychotherapy and related E/M telehealth procedure codes appearing in appendix |
| 96130-96159 | Psychological/neuropsych testing and assessment codes included |
| 99201-99215, 99354-99355, 99408-99409 | Evaluation and management and prolonged services codes shown in appendix |
Billing, Claims and Provider Requirements
Prior authorization: Telehealth delivery itself does not require PA; other services may
Prior authorization is not required for the delivery of services via telehealth; however, providers must obtain prior approval for any other covered services that would normally require prior authorization (this applies to participating and non‑participating providers). Document member consent (verbal consent is acceptable and must be in the medical record).
- No PA needed solely because the service is delivered via telehealth.
- If the underlying service normally requires prior authorization, obtain prior approval before providing that service via telehealth.
- Document member consent (written not required; verbal consent acceptable and must be recorded).
Claims and Place of Service: follow updated POS guidance (revision 1/23/2025)
A policy revision updates place of service requirements — follow Delaware First Health claims procedures for telehealth submissions and apply the most recent POS guidance in the policy (see revision entry for 1/23/2025).
- Refer to the 1/23/2025 revision note: "Updated place of service requirements."
- Use the POS guidance in the policy when determining POS codes (e.g., POS 10 for patient home scenarios and POS 02 for other originating-site billing as described elsewhere in the policy).
- Ensure claims reflect correct originating site and facility fee rules (see Q3014 and POS guidance).
Appendix A: Refer to the telehealth procedure code list and modifier/status mappings
See Appendix A for the list of most common telehealth procedure codes and the payer-specific modifier/status mappings to use for claims processing; Appendix A provides the code-to-modifier/status assignments used by DFH.
- Appendix A contains numerous CPT/HCPCS/G-codes commonly billed for telehealth with assigned modifier/status flags (examples shown throughout the appendix).
- Use Appendix A mappings to determine appropriate modifier usage on telehealth claims (e.g., behavioral health modifiers and U‑type flags).
- Appendix B (referenced in the appendix) provides behavioral health modifier guidance supporting correct modifier selection.
Key Terms and Appendix References
Appendix A & B — Procedure Code Lists and Modifier Guidance
inv-03: Appendix A — informational mapping (duplicate)
Appendix lists procedure codes and payer-specific internal mappings/status flags; the extract does not include explicit coverage criteria or clinical authorization rules.
ALL of the following
- Per-code mappings: Appendix entries show multiple modifier columns (MOD1–MOD4) with assigned internal modifier/status flags for many CPT/HCPCS codes; assignments vary by code and provider type (examples visible throughout the appendix rows).
These are internal mappings; consult full policy or claims guidance for authoritative billing instructions.
- Behavioral health modifier crosswalk: Appendix B cross-references behavioral health modifier guidance to many psychotherapy and assessment codes (examples: HP, HO assignments for psychologists and master-level providers).
Modifiers shown are to aid correct submission for behavioral health telehealth claims.
- No explicit per-code coverage determination in extract: Although Appendix A/B list codes and flags, this extract does not state explicit covered/denied status for each code — mappings are informational for claims processing configuration and payer systems.
For coverage decisions, refer to benefit policies or full DFH code tables.
- Product applicability and document range: Mappings are presented for DFH Medicaid product and appear within pages labeled in the extract (appendix spans pages included in the source extract).
Effective date shown elsewhere in the policy.
Appendix A — consult full code list for claims and modifier mappings
Appendix A is the authoritative code list for telehealth claims processing and includes many commonly billed procedure codes along with their modifier/status mappings—consult it when preparing telehealth claim submissions.
- Appendix A lists numerous CPT/HCPCS/G-codes (e.g., psychotherapy, E/M, telephone E/M) with corresponding modifier guidance.
- Reference the appendix to align submitted codes and modifiers with Delaware First Health's internal mappings.
Policy Changes and Revision Notes
Updated place of service requirements for telehealth claims submission.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.