ModifiedNevada Health AuthorityPolicy N/A

Telehealth Services

Customize your policy alerts

Sign up for all Nevada Health Authority policy alerts

Know when Nevada Health Authority releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy governs coverage, delivery, site requirements, limitations, non-covered modalities, and prior authorization for telehealth services reimbursed by Nevada Medicaid and Nevada Check Up. It applies to participating Medicaid-enrolled providers, including behavioral health providers.

Policy Summary

PayerNevada Health Authority

PolicyTelehealth Services

Policy CodePolicy N/A

Change TypeModified

Effective DateNovember 29, 2023

Next Review DateN/A

Key ActionApply the same prior authorization requirements to telehealth services as to services provided in person.

SourceLink

POLICY UPDATE CHANGES

Behavioral health counseling and treatment for mental health conditions or substance use disorders may be delivered through audio-only interaction without prior service-delivery limitations when medically necessary and clinically appropriate for the recipient's treatment needs.

Limitations were removed for Basic Skills Training and Psychosocial Rehabilitation service delivery through telehealth.

Audio-only telehealth must be supported by medical necessity and clinical appropriateness documented in the recipient's medical record.

The chapter was reorganized and edited for grammar, punctuation, capitalization, duplication removal, acronym standardization, clarity, and section renumbering.

1In-person ESRD visit required to examine vascular access

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.

ModifiedNevada Health AuthorityPolicy N/A

Telehealth Services

Customize your policy alerts

Sign up for all Nevada Health Authority policy alerts

Know when Nevada Health Authority releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerNevada Health Authority

PolicyTelehealth Services

Policy CodePolicy N/A

Change TypeModified

Effective DateNovember 29, 2023

Next Review DateN/A

Key ActionApply the same prior authorization requirements to telehealth services as to services provided in person.

SourceLink

POLICY UPDATE CHANGES

Limitations were removed for Basic Skills Training and Psychosocial Rehabilitation service delivery through telehealth.

Audio-only telehealth must be supported by medical necessity and clinical appropriateness documented in the recipient's medical record.

The chapter was reorganized and edited for grammar, punctuation, capitalization, duplication removal, acronym standardization, clarity, and section renumbering.

1In-person ESRD visit required to examine vascular access

Electronic modalities expressly non-covered: fax, text message, and email

2Telehealth site roles: originating site and distant site

1Originating site must be located within Nevada

Same as in-personPrior authorization standard for telehealth services

Telehealth Coverage Criteria

General telehealth coverage

Telehealth services are reimbursable when all applicable requirements are met.

General telehealth requirements

The service is clinically appropriate and within the health care professional's licensing scope of practice.
The originating site is located within Nevada.
The distant-site provider is an enrolled Medicaid provider.

ESRD visits

ESRD telehealth visits are covered when all of the following are met.

ESRD telehealth requirements

At least one visit includes an in-person examination of the vascular access site by a provider.At least 1 in-person visit
Any additional telehealth visits use an interactive audio/video telecommunications system.
The medical record documents that at least one visit was furnished in person.

Audio-only behavioral health and other telehealth

Audio-only telehealth is covered when both conditions are met.

Audio-only telehealth

The service is medically necessary for the recipient and clinically appropriate based on the recipient's treatment needs.
Medical necessity and clinical appropriateness are documented in the recipient's medical record.

Asynchronous services

Asynchronous telehealth services are reimbursable when the underlying service meets applicable coverage requirements.

Asynchronous telehealth

The patient's medical information is transmitted from the originating site to the distant-site provider without the recipient being present.

Images transmitted by facsimile machines (faxes), text messages, and electronic mail (email) are not covered telehealth services.

Personal care services provided by a Personal Care Attendant must be provided in person and are not appropriate for delivery through telehealth.

Home Health Services provided by a Registered Nurse, Physical Therapist, Occupational Therapist, Speech Therapist, Respiratory Therapist, Dietician, or Home Health Aide must be provided in person and are not appropriate for delivery through telehealth.

Private Duty Nursing services provided by a Registered Nurse must be provided in person and are not appropriate for delivery through telehealth.

Audio-only telehealth is not covered unless it is medically necessary and clinically appropriate for the recipient based on the recipient's treatment needs, and those determinations are documented in the recipient's medical record.

Provider Requirements and Denial Risks

Prior Authorization

Prior Authorization Follows the Underlying Service

Apply the underlying service’s prior authorization requirements to telehealth services. Telehealth delivery does not independently require prior authorization, but individual services delivered via telehealth may require it under the applicable Medicaid Services Manual policy.

Documentation Required

Document Audio-Only Clinical Justification

Audio-only telehealth must be medically necessary and clinically appropriate for the recipient, with the justification documented in the recipient’s medical record.

Documentation Required

Maintain the ESRD In-Person Visit Record

For ESRD services, the medical record must show that at least one visit was furnished in person by a provider. The record should support compliance with the applicable MSM Chapter 600 medical coverage requirements.

Telehealth Overview

Telehealth uses telecommunications to deliver health care when the provider and patient are in different locations. Delivery may be synchronous, involving real-time interaction with direct visualization of the patient, or asynchronous, using store-and-forward transmission of medical information without the recipient being present. Covered telehealth services must be clinically appropriate and within the health care professional's scope of practice, with coverage parity to in-person services.

Key Telehealth Terms

Telehealth

DeliveryDelivery of a health care service from a provider to a patient at a different location through telecommunications technologies.

Excluded technologiesFacsimile and electronic mail are not included in the definition of telehealth.

Clinical standardTelehealth services must be clinically appropriate and within the health care professional's scope of practice.

Originating site

Patient locationThe originating site is the location where the patient receives telehealth services from a provider located at a distant site.

Technology requirementServices are received through a HIPAA-compliant telecommunications system.

Policy Summary

PayerNevada Health Authority

PolicyTelehealth Services

Policy CodePolicy N/A

Change TypeModified

Effective DateNovember 29, 2023

Next Review DateN/A

Key ActionApply the same prior authorization requirements to telehealth services as to services provided in person.

SourceLink

On This Page

Documentation Required

Telehealth Photographs Must Support Care

Ensure telehealth photographs are specific to the patient’s condition and adequate to render or confirm a diagnosis or treatment plan.

Dermatologic photographs, such as images of a skin lesion, may satisfy the single-media-format requirement.

Billing Rule

Use HIPAA-Compliant Technology

Use an appropriate HIPAA-compliant telecommunications medium for telehealth and protect all protected health information. The DHCFP will not participate in a medium that its HIPAA Security Officer has determined is inappropriate for protected health information.

Denial Risk

Verify Provider and Site Eligibility

Confirm that the originating site is located in Nevada and that the applicable providers are enrolled Medicaid providers before billing. Failure to meet originating- or distant-site eligibility requirements can result in denial or loss of the originating-site facility fee.

The originating site must be an enrolled Medicaid provider to receive a facility fee.
The distant-site provider must be an enrolled Medicaid provider.
A provider may not bill as both the originating and distant site for the same patient on the same date of service.
Non-enrolled originating sites—including cellular devices, home computers, kiosks, and tablets—are not eligible for a DHCFP facility fee.
Eligible IH, FQHC, and RHC facilities may bill an encounter instead of an originating-site facility fee when the distant site provides ancillary services.

Denial Risk

Avoid Non-Covered Modalities and Services

Do not bill non-covered telehealth modalities or services. Faxes, text messages, and email are excluded, and specified services must be furnished in person rather than through telehealth.

Images transmitted by facsimile machines (faxes), text messages, and electronic mail (email) are not covered telehealth services.
Personal care services provided by a Personal Care Attendant must be provided in person.
Home health services provided by an RN, PT, OT, speech therapist, respiratory therapist, dietician, or home health aide must be provided in person.
Private duty nursing services provided by an RN must be provided in person.

Denial Risk

Complete the ESRD In-Person Vascular-Access Examination

ESRD visits must include at least one in-person provider visit to examine the vascular access site. Additional visits may be delivered using an interactive audio/video telecommunications system when otherwise appropriate.

Denial Risk

Confirm Clinical Appropriateness and Scope

Telehealth services may be denied when they are not clinically appropriate, fall outside the health care professional’s licensing scope of practice, or are delivered through audio-only technology without documented medical necessity and clinical appropriateness.

Follow the Medicaid Services Manual policy for the specific service being provided.
Confirm that the selected telehealth modality can safely and effectively support the examination, diagnosis, treatment, or treatment planning.

Nevada locationThe originating site must be located within Nevada.

Facility fee eligibilityTo receive coverage for a telehealth facility fee, the originating site must be an enrolled Medicaid provider.

Distant site

Provider locationThe distant site is the location where a provider of health care provides telehealth services.

Patient relationshipThe provider serves a patient located at an originating site.

Enrollment requirementThe distant-site provider must be an enrolled Medicaid provider.

Synchronous telehealth

InteractionSynchronous telehealth consists of real-time interaction.

Participant locationsThe recipient is located at an originating site and the health care provider is located at a distant site.

VisualizationThe provider has direct visualization of the patient.

Asynchronous telehealth

Transmission methodAsynchronous telehealth, also known as Store-and-Forward, transmits the patient's medical information from an originating site to the distant-site provider.

Recipient presenceThe recipient is not present during the transmission.

ReimbursementThe DHCFP reimburses services delivered via asynchronous telehealth, but they are not eligible for an originating-site facility fee.