Telemedicine and Telehealth Services — Coverage Criteria
Defines coverage, billing, and clinical requirements for telemedicine/telehealth (including audio/video and audio-only) services for Neighborhood Health Plan of Rhode Island members across Medicaid (excl. EFP), INTEGRITY, and Commercial lines.
Updated T1016 from telemedicine only to telemedicine & audio; added CPTs T1017 and H2000 to coding grid.
Updated coding section to align with CMS and EOHHS guidance, removed section on waiving cost share for 99211 and 99212.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.