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    OpenPayerPolicy UpdatesReimbursement/Payment PolicyLouisiana Medicaid Telehealth Update | OpenPayer
    Ask Trek AI about this page
    ModifiedLouisiana Department of HealthPolicy 20-7

    Telemedicine/Telehealth Facilitation of Outpatient Substance Use Disorder (OP-SUD) Treatment Services during the COVID-19 Declared Emergency

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    Temporarily allows Louisiana Medicaid outpatient substance use disorder treatment services, including assessments, evaluations, individual, group, family, and intensive outpatient services, to be delivered through telemedicine/telehealth during the COVID-19 declared emergency, subject to provider, documentation, authorization, communication, safety, and billing requirements.

    Policy Summary
    PayerLouisiana Department of Health
    PolicyTelemedicine/Telehealth Facilitation of Outpatient Substance Use Disorder Treatment Services
    Policy CodePolicy 20-7
    Change TypeTemporary COVID-19 emergency policy modification
    Effective DateMarch 21, 2020
    Next Review DateN/A
    Key ActionObtain and document informed consent for telemedicine/telehealth before initiating services, including parent or legal guardian consent for recipients age 18 or under.
    SourceLink
    POLICY UPDATE CHANGES

    LDH authorizes eligible outpatient substance use disorder treatment services to be delivered through telemedicine/telehealth during the COVID-19 declared emergency.

    Audio-only telemedicine/telehealth is permitted when an audio/video system is unavailable or not feasible, provided there is at least an audio connection.

    Managed care organizations may extend existing prior authorizations for outpatient substance use disorder services that expire during the emergency.

    Telemedicine/telehealth claims must include modifier 95 and place of service 02.

    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.

    95Required claim modifier
    02Required place of service
    18 or underConsent required through age
    14Provider toolkit videos

    Telemedicine/Telehealth Coverage Requirements

    Telemedicine/telehealth OP-SUD coverage requirements

    Telemedicine/telehealth delivery is permitted for OP-SUD services during the COVID-19 declared emergency when all applicable requirements are satisfied.

    ALL of the following

    • The service is delivered during the COVID-19 declared emergency and is an eligible Medicaid-reimbursable OP-SUD treatment service, substance use disorder screening, assessment, or re-evaluation.
    • The service is medically necessary as determined by a physician or fully licensed mental health professional.
    • The provider and staff meet the qualifications and requirements in the Medicaid Behavioral Health Services Provider Manual, including applicable licensure, accreditation, and professional licensing-board requirements.
    • The provider obtains and documents informed consent for telemedicine/telehealth, including the rationale, risks and benefits, alternatives and their risks and benefits, and the risks and benefits of no treatment.

    • ONE of

      • The recipient is older than 18.

      • ALL of the following

        • The recipient provides consent before service initiation.
        • The recipient's parent or legal guardian provides consent before service initiation, and the parent's or guardian's contact information is documented.

    • An approved communication method is used

      • A secure, HIPAA-compliant platform is used when available.
      • If a secure HIPAA-compliant platform is unavailable, videoconferencing with reasonable security and privacy measures is used with the recipient's consent.

      • ALL of the following

        • Audio-only delivery is used only when an audio/video system is unavailable or not feasible.

          At least an audio connection is required.

        • The recipient consents to the audio-only delivery.
    • Texting, email, and public-facing applications such as Facebook Live, Twitch, and TikTok are not used for the service.
    • The provider maintains the required clinical record, including the telemedicine/telehealth modality and, for audio-only delivery, the rationale for using audio-only communication.
    • The provider documents required clinical, safety, consent, participant, identity-verification, technical back-up, service-time, intervention, location, referral, and refusal information in the progress note.

    • If prior authorization applies

      • An existing prior authorization remains eligible for telemedicine/telehealth delivery without an addendum solely because the service is delivered through telemedicine/telehealth.
      • When an existing authorization expires during the emergency, the recipient's MCO may extend it for the same duration as the previously authorized units; new requests follow the MCO's standard process.
    • The claim includes modifier 95 and place of service 02 when the service is delivered through telemedicine/telehealth.

    Telemedicine/telehealth group therapy requirements

    Telemedicine/telehealth group therapy is permitted only when all general OP-SUD requirements and the following additional safeguards are met.

    ALL of the following

    • The group service relates to the recipient's goals, objectives, and interventions in the treatment plan.
    • The recipient attempts to participate from a private room or other private setting to reduce the risk of being overheard by persons near the recipient.
    • The recipient agrees not to disclose information outside the group that could identify another group member.
    • The recipient agrees to waive confidentiality before the session begins.
    • The recipient acknowledges and signs a confidentiality agreement requiring protection of the privacy of other persons receiving treatment.

    Billing and Communication Requirements

    Telemedicine/telehealth claim indicatorsModifierCovered
    95Telemedicine/telehealth modifier
    02Telemedicine/telehealth place of service
    Relevant OP-SUD procedure codesHCPCSCovered
    H0001Alcohol and/or drug assessment
    H0004Alcohol and/or drug services, individual
    H0005Alcohol and/or drug services, group per person; family per family member
    H0015Alcohol and/or drug services, intensive outpatient
    Published telemedicine/telehealth service billing attributesmixedCovered
    H0001Place of service 02; visit unit
    H0004Place of service 02; visit unit
    H0005Place of service 02 for group services; family entry lists 02HR and HS
    H0015Place of service 02; 15-minute unit, with HQ for group intensive outpatient services
    Minimum communication connection
    Minimum connectionAt least an audio connection is required for telemedicine/telehealth services.
    Preferred methodA combined audio/video system is preferred when available and appropriate.
    Approved audio-only exampleTelephonic communication, such as telephone delivery, may be used when permitted.
    Audio-only limitation
    When permittedAudio-only delivery is allowed only when an audio/video system is unavailable or not feasible.
    Group servicesAudio-only group therapy may be used only when clinically indicated and medically necessary.

    Provider Documentation and Operational Actions

    Prior Authorization

    Prior Authorization Continuity

    An existing prior authorization does not require an addendum when services are delivered by telemedicine/telehealth, and reimbursement requirements otherwise remain unchanged. During the COVID-19 declared emergency, an MCO may extend an existing OP-SUD authorization that expires during the emergency for the same duration as the previously authorized units; new requests must follow the recipient’s MCO standard process.

    • Document continuation and service needs when requested by the MCO, including needs for continued service continuity or expanded service coordination.
    • The extension applies only when the recipient’s MCO requires a prior authorization and remains available through the end of the COVID-19 declared emergency.
    Documentation Required

    Consent and Signature Documentation

    Obtain informed consent before delivering telemedicine/telehealth. Discuss the rationale for telehealth, its privacy-related risks and benefits, alternatives and their risks and benefits, and the risks and benefits of no treatment; document required recipient, guardian, participation, agreement, and signature information.

    Key Terms

    Telemedicine/telehealth
    DefinitionTelemedicine/telehealth is the delivery of OP-SUD treatment and related services through approved audio/video or, when permitted, audio-only communication rather than an in-person encounter.
    Communication methodsApproved delivery may use a secure HIPAA-compliant platform, or reasonable-security videoconferencing or telephone when a secure platform is unavailable and the recipient consents.
    Minimum requirementAudio-only delivery is permitted only when an audio/video system is unavailable or not feasible, and at least an audio connection must be present.
    OP-SUD
    DefinitionOP-SUD means outpatient substance use disorder treatment services provided by agencies rendering American Society of Addiction Medicine (ASAM) level services.
    Covered services
    Policy Summary
    PayerLouisiana Department of Health
    PolicyTelemedicine/Telehealth Facilitation of Outpatient Substance Use Disorder Treatment Services
    Policy CodePolicy 20-7
    Change TypeTemporary COVID-19 emergency policy modification
    Effective DateMarch 21, 2020
    Next Review DateN/A
    Key ActionObtain and document informed consent for telemedicine/telehealth before initiating services, including parent or legal guardian consent for recipients age 18 or under.
    SourceLink
    On This Page
    Telemedicine/Telehealth Coverage RequirementsBilling and Communication RequirementsProvider Documentation and Operational ActionsKey Terms
  1. The provider documents the recipient's confidentiality waiver or agreement in the session note.

  2. The group communication method meets ONE of the following

    • Audio-visual technology is used.

    • ALL of the following

      • Audio-only delivery is clinically indicated.
      • Audio-only delivery is medically necessary.
  3. The provider continues to comply with all telemedicine/telehealth-related requirements of the applicable professional licensing board.
    4. Not approvedTexting, email, and public-facing applications such as Facebook Live, Twitch, and TikTok must not be used.
    Social distancing for necessary in-person encounters
    When applicableLimit in-person encounters to those that cannot be completed through telemedicine/telehealth technologies and that are urgent and medically necessary.
    Required distanceStay at least six feet from the recipient or the recipient's family member during the encounter.
    Setting considerationWhile maintaining privacy and confidentiality, meet in an open, ventilated space; consider conducting the encounter outside the home or apartment.
    • For recipients age 18 or under, obtain consent from the recipient and the parent or legal guardian, including the guardian’s contact information, before initiating services.
    • Inform the recipient of every person present at each end of the transmission and that person’s role; document identity verification when needed and that the recipient may refuse telehealth services.
    • Verbally review documents requiring signature, including the treatment plan, informed consent, and confidentiality agreement, with the recipient or family during the visit.
    • Record the recipient or family’s participation and agreement on the document’s signature line and in the corresponding progress note, including the meeting date and time. Obtain physical signatures at the next in-person treatment-planning meeting when possible.
    Documentation Required

    Progress Note Requirements

    Record all aspects of telephonic, telehealth, and face-to-face encounters in the recipient’s clinical record. The record must support reimbursement and identify the service, participants, clinical purpose, interventions, progress, and applicable telehealth safeguards.

    • Name the recipient and all others present or participating; record the service date, start time, and stop time, as well as the name and functional title of the person making the entry and providing the service.
    • Document the content and reason for the contact; goals and objectives addressed; specific interventions; progress toward functional and clinical improvement; and all units of service provided.
    • Record the service location for each intervention and state that the service was provided via telemedicine/telehealth. For audio-only services, document why audio-only was necessary or feasible instead of audio/video.
    • Document the crisis plan and changes related to COVID-19 risks; new treatment-plan goals, objectives, or interventions; and referrals for COVID-19 screening, testing, or treatment.
    • Document the technical back-up plan, including a number where the recipient can be reached to restart or reschedule the session, and the safety plan with at least one emergency contact and the closest emergency-room location.
    • Document identity verification when needed, the persons present at each end of the transmission and their roles, any refusal of telehealth services, and required recipient and parent/legal-guardian consent for recipients age 18 or under.
    Documentation Required

    Group Therapy Confidentiality

    Telemedicine/telehealth group therapy is permitted when related to the recipient’s treatment-plan goals, objectives, and interventions. Protect group-member privacy and obtain documented agreement to the confidentiality requirements before the session begins.

    • The recipient should participate from a private room and agree not to disclose information that could identify another group member to anyone outside the group.
    • Obtain a signed confidentiality agreement requiring protection of the privacy of other recipients; the recipient must agree to waive confidentiality risks before beginning the group session.
    • Document the recipient’s confidentiality waiver in the session note.
    • Audio-visual technology is preferred; audio-only group therapy may be used when clinically indicated and medically necessary, consistent with applicable professional licensing-board requirements.
    Note

    Approved Communication Methods

    Use a secure, HIPAA-compliant platform for telemedicine/telehealth and staff supervision when available. If it is unavailable, use a reasonable-security videoconferencing platform or telephone/audio-only service only with the required consent and safeguards.

    • Audio-only delivery is allowed only when an audio/video system is unavailable or not feasible; at minimum, an audio connection is required. Audio/video is preferred, but telephone delivery may be used when appropriate.
    • Videoconferencing alternatives such as Skype or FaceTime may be used only when they have reasonable security and privacy measures and the recipient consents.
    • Do not use public-facing applications, including Facebook Live, Twitch, TikTok, or similar platforms. Texting and email are not approved forms of telemedicine/telehealth or supervision.
    • Maintain a technical back-up plan, safety plan, privacy, and adequate medical documentation regardless of the originating site; comply with all telemedicine/telehealth requirements of the applicable professional licensing board.
    Services include Medicaid-reimbursable outpatient substance use disorder treatment services across all levels of staffing, including licensed and nonlicensed staff.
    Provider requirementsAgencies and staff must meet the qualifications and requirements in the Medicaid Behavioral Health Services Provider Manual, including applicable licensure and accreditation requirements.
    Originating site
    DefinitionThe originating site is the location where the recipient is located during the telemedicine/telehealth encounter.
    Permitted settingsThe originating site may include a healthcare facility, a school, or the recipient's home.
    Site limitationThere is no formal limitation on the originating site, but providers must maintain adequate medical documentation to support reimbursement of the visit.