CurrentMississippi Division of MedicaidPolicy N/A

Telehealth Services Coverage Criteria

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Rules governing Medicaid coverage of telehealth services in Mississippi, including covered originating/distant sites, permitted provider types, required telepresenter, and non-covered telehealth services. Applies to providers and beneficiaries under Mississippi Division of Medicaid.

Policy Summary

PayerMississippi Division of Medicaid

PolicyTelehealth Services Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateFeb 1, 2024

Last ReviewFeb 1, 2024

Next Review DateN/A

Key ActionEnsure telehealth visits meet CPT E/M and HCPCS descriptions and require a telepresenter at originating sites unless the beneficiary's home is the originating site or the Division determines otherwise.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

11Originating sites listed

14Distant provider types

EPSDTNot covered: EPSDT well child

E/M IV/VNot covered: E/M Level IV/V for non-established

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CurrentMississippi Division of MedicaidPolicy N/A

Telehealth Services Coverage Criteria

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Know when Mississippi Division of Medicaid releases new policies or updates existing guidance.

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Policy Summary

PayerMississippi Division of Medicaid

PolicyTelehealth Services Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateFeb 1, 2024

Last ReviewFeb 1, 2024

Next Review DateN/A

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

11Originating sites listed

14Distant provider types

EPSDTNot covered: EPSDT well child

E/M IV/VNot covered: E/M Level IV/V for non-established

Coverage Criteria

Covered Telehealth Services

Covered when ALL of the following are met

Telehealth substitution criteria: Service is medically necessary and substitutes an in-person consultation, office visit, or outpatient visit; meets medically appropriate criteria aligning with CPT E/M and HCPCS descriptions

From Rule 1.3.A

Allowed originating sites: Originating site must be one of the listed locations (office of a physician or practitioner; outpatient hospital including Critical Access Hospital; Rural Health Clinic (RHC); Federally Qualified Health Center (FQHC); community mental health/private mental health centers; therapeutic group homes; Indian Health Service clinic; school-based clinic; school which employs a school nurse; inpatient hospital setting; beneficiary's home)

From Rule 1.3.B.1

Allowed distant providers: Distant site provider must be one of the listed types (physicians; physician assistants; [additional distant provider types listed in source])

From Rule 1.3.B.2

Telepresenter requirement: A telepresenter meeting Mississippi Administrative Code Part 225, Rule 1.1.D. is required at the originating site unless the originating site is the beneficiary's home or as otherwise determined by the Division

From Rule 1.3.C (policy brief)

The Division will not reimburse for a telehealth service when that same service is not an approved benefit when provided in-person. This means providers should confirm that the service is covered under standard, face-to-face Medicaid benefits before delivering it via telehealth. In addition, the Division does not provide separate payment for installation or maintenance of telehealth hardware, software, equipment, videotapes, or transmissions; these items are not billable as distinct services or reimbursable line items.

If a service is excluded from coverage when delivered in-person, providing that service via telehealth does not change its coverage status. Such telehealth delivery is considered not medically necessary for Medicaid payment purposes and will not be covered. Providers should therefore avoid submitting telehealth claims for services that are not covered in-person because those claims are subject to denial.

Procedure Codes and Billing

Covered CPT/HCPCS CodesmixedCovered

CPT E/M	Evaluation and management CPT codes as described; telehealth must align with CPT evaluation and management descriptions.
HCPCS	HCPCS guidelines referenced for telehealth coverage alignment.

Covered HCPCS/CPT CategoriesmixedCovered

HCPCS	HCPCS guidelines referenced for telehealth coverage alignment.
CPT E/M	Evaluation and management CPT codes as described; telehealth must align with CPT evaluation and management descriptions.

Provider Actions and Requirements

Prior Authorization

Prior authorization not specified

No prior authorization is specified in Rule 1.3; providers should not assume there are explicit PA requirements in this policy.

Note

Step therapy not specified

No step therapy or related requirement is specified in the telehealth rules provided.

Documentation Required

Document alignment with CPT E/M, HCPCS, and telepresenter rules

Align telehealth encounters to CPT E/M and HCPCS descriptions and ensure medically appropriate criteria are met; a telepresenter who meets Miss. Admin. Code Part 225, Rule 1.1.D. must be present at the originating site unless the originating site is the beneficiary's home or the Division determines otherwise.

Definitions

Originating site — locations covered for telehealth services

Physician/practitioner officeOffice of a physician or practitioner

Outpatient hospital (including CAH)Outpatient Hospital (including a Critical Access Hospital (CAH))

Rural Health Clinic (RHC)Rural Health Clinic (RHC)

Federally Qualified Health Center (FQHC)Federally Qualified Health Center (FQHC)

Community/private mental health centersCommunity Mental Health/Private Mental Health Centers

Therapeutic group homesTherapeutic Group Homes

Indian Health Service, school, inpatient, or home

Background

Telehealth may be used as a substitute for in-person consultations, office visits, or outpatient visits when the service meets the applicable CPT Evaluation and Management (E/M) and HCPCS definitions and is medically appropriate. When these criteria are met, the telehealth encounter can replace an in-person visit; however, the same coverage rules that apply to face-to-face services continue to govern telehealth encounters (for example, EPSDT well child visits are explicitly not covered via telehealth).