ModifiedNevada Health AuthorityPolicy N/A

Medicaid Services Manual Chapter 3400 — 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.

Governs Nevada Medicaid and Nevada Check Up reimbursement, provider, originating-site, distant-site, coverage, exclusion, and prior-authorization requirements for clinically appropriate telehealth services delivered within a provider’s professional scope.

Policy Summary

PayerNevada Health Authority

PolicyMedicaid Services Manual Chapter 3400 — Telehealth Services

Policy CodePolicy N/A

Change TypeModified

Effective DateSeptember 8, 2016

Next Review DateN/A

Key ActionConsult the individual medical coverage policy because a telehealth service may require prior authorization.

SourceLink

POLICY UPDATE CHANGES

Telehealth coverage was expanded to establish parity between clinically appropriate in-person and telehealth services and remove restrictions on provider and service categories.

Group therapy was added as an allowable service via telehealth.

New sections define telehealth originating sites, distant sites, synchronous services, and asynchronous services.

An originating site must be an enrolled Medicaid provider to receive a telehealth facility fee, while eligible encounter-based facilities may bill an encounter in lieu of the facility fee for ancillary distant-site services.

Limitations on subsequent hospital care, subsequent nursing-facility care, inpatient telehealth consultations, and language preventing asynchronous telehealth reimbursement were removed.

The policy clarifies that certain qualified mental-health professionals may bill psychotherapy by HIPAA-compliant telehealth but may not bill medical evaluation and management services.

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

Medicaid Services Manual Chapter 3400 — 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

PolicyMedicaid Services Manual Chapter 3400 — Telehealth Services

Policy CodePolicy N/A

Change TypeModified

Effective DateSeptember 8, 2016

Next Review DateN/A

Key ActionConsult the individual medical coverage policy because a telehealth service may require prior authorization.

SourceLink

POLICY UPDATE CHANGES

Telehealth coverage was expanded to establish parity between clinically appropriate in-person and telehealth services and remove restrictions on provider and service categories.

Group therapy was added as an allowable service via telehealth.

New sections define telehealth originating sites, distant sites, synchronous services, and asynchronous services.

Limitations on subsequent hospital care, subsequent nursing-facility care, inpatient telehealth consultations, and language preventing asynchronous telehealth reimbursement were removed.

The policy clarifies that certain qualified mental-health professionals may bill psychotherapy by HIPAA-compliant telehealth but may not bill medical evaluation and management services.

4Communication methods expressly non-covered

4Service categories required in person

1Minimum in-person ESRD visit

2Telehealth delivery modes defined

1Enrollment requirement for originating-site facility fee

Telehealth Overview

Telehealth substitutes telecommunications for an in-person encounter to deliver services when the patient and health care provider are in different locations. Delivery may be synchronous, using real-time interaction with direct visualization of the patient, or asynchronous, using store-and-forward transmission of medical information without the recipient being present. Telehealth services must be clinically appropriate, within the provider’s scope of practice, and delivered through HIPAA-compliant technology.

Telehealth Coverage Criteria

General Telehealth Coverage

Telehealth services are reimbursable when all applicable conditions are met.

General telehealth eligibility

The service is clinically appropriate and within the health care professional's scope of practice as established by the licensing agency.
The originating site is located within Nevada, and the patient is at a different location from the provider.
The service is delivered through information and audiovisual communication technology using a HIPAA-compliant telecommunications system.
The distant-site provider is an enrolled Medicaid provider.

Originating-Site Reimbursement

Originating-site reimbursement depends on the delivery method and site status.

Originating-site reimbursement pathways

An enrolled Medicaid provider is present at the originating site, and the site qualifies for an originating-site facility fee.
An eligible encounter-based facility bills an encounter in lieu of the originating-site facility fee for ancillary distant-site services.

Behavioral-Health Psychotherapy

Certain behavioral-health professionals may receive telehealth reimbursement only for the specified service.

Telehealth psychotherapy

Eligible practitioner
- The practitioner is a Licensed Clinical Psychologist (LCP).
- The practitioner is a Licensed Clinical Social Worker (LCSW).
- The practitioner is clinical staff employed and determined by a state mental health agency to meet established class specification qualifications of a Mental Health Counselor, Clinical Social Worker, or Psychological Assistant.
The service is psychotherapy.

End Stage Renal Disease

ESRD visits may use interactive audio/video telehealth only as an additional visit modality.

ESRD telehealth visits

At least one visit includes an in-person examination of the vascular access site by a provider.At least 1 in-person visit
The medical record documents that at least one visit was furnished in person by a provider.

Telephone calls, facsimile-transmitted images, text messages, and electronic mail are non-covered telehealth services.

Basic skills training and peer-to-peer services provided by a Qualified Behavioral Assistant must be provided in person and are not appropriate for delivery through telehealth.

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

Specified 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.

Telehealth Billing and Coding

Telehealth Billing ReferenceHCPCS

telehealth originating HCPCS code

Telehealth originating HCPCS code referenced for billing by the originating encounter site; the specific code is not stated in the policy.

Provider Requirements and Billing Rules

Prior Authorization

Follow the Underlying Service Policy

Apply the prior-authorization requirements for the underlying service: telehealth follows the same requirements as the corresponding in-person service. Telehealth itself does not require prior authorization, but an individual service delivered by telehealth may require it under the applicable Medicaid Services Manual coverage policy.

Documentation Required

Telehealth Technology and Clinical Documentation

Use a HIPAA-compliant telecommunications system for telehealth and ensure the technology is appropriate for protected health information. When photographs are used, they must be specific to the patient’s condition and adequate to render or confirm a diagnosis or treatment plan; dermatologic photographs may satisfy a single-media-format requirement.

Documentation Required

Telehealth Terms

Telehealth

DeliveryService delivered by a health care provider to a patient at a different location

TechnologyUses information and audiovisual communication technology

Excluded methodsDoes not include standard telephone, facsimile, or electronic mail

Originating Site

Patient locationThe location where the patient receives telehealth services

Provider locationThe provider is located at a distant site

ConnectionServices are received through a HIPAA-compliant telecommunications system

Policy Summary

PayerNevada Health Authority

PolicyMedicaid Services Manual Chapter 3400 — Telehealth Services

Policy CodePolicy N/A

Change TypeModified

Effective DateSeptember 8, 2016

Next Review DateN/A

Key ActionConsult the individual medical coverage policy because a telehealth service may require prior authorization.

SourceLink

On This Page

The service is delivered through a HIPAA-compliant telecommunications system.

ESRD In-Person Visit Record

For ESRD visits, maintain medical records documenting that at least one visit was furnished in person by a provider to examine the vascular access site. Interactive audio/video telecommunications may be used for additional visits.

Billing Rule

Encounter and Facility Fee Billing

Eligible facilities that receive encounter reimbursement may bill an encounter in lieu of the originating-site facility fee when the distant site provides ancillary services, such as a specialist consultation. When the originating and distant sites are separate encounter sites, the originating encounter site bills the telehealth originating HCPCS code and the distant encounter site may bill the encounter code.

Denial Risk

Clinical, Scope, and HIPAA Compliance

Telehealth services must be clinically appropriate and within the health care professional’s licensing scope of practice. Reimbursement may be denied when the service is clinically inappropriate, outside the provider’s scope, or furnished through technology that does not comply with HIPAA requirements.

Billing Rule

Provider Enrollment and Facility Fee

The originating site must be located in Nevada and must be an enrolled Medicaid provider to qualify for a telehealth facility fee; the distant-site provider must also be an enrolled Medicaid provider. An originating site without an enrolled Medicaid provider onsite is not eligible for the facility fee, including cellular devices, home computers, kiosks, and tablets.

Denial Risk

Non-Covered Delivery Methods and Services

Do not bill non-covered delivery methods, including telephone calls, fax-transmitted images, text messages, or email. The following services must be furnished in person and are not appropriate for telehealth: QBA basic skills training and peer-to-peer services; PCA personal care services; home health services; and private duty nursing.

Home health services include services by a registered nurse, physical therapist, occupational therapist, speech therapist, respiratory therapist, dietician, or home health aide.
Private duty nursing refers to services provided by a registered nurse.

Note

Service-Specific Limitations

Service-specific limitations apply even when telehealth is otherwise available. Qualified mental-health professionals and qualifying clinical staff may bill psychotherapy furnished through a HIPAA-compliant telecommunications system, but may not bill medical evaluation and management services; for ESRD, interactive audio/video is limited to additional visits after the required in-person vascular-access examination.

Refer to MSM Chapter 400 for mental-health medical coverage requirements.
Refer to MSM Chapter 600 for ESRD physician-service coverage requirements.

Distant Site

Provider locationThe location where a health care provider provides telehealth services

Patient locationThe patient is located at an originating site

EnrollmentThe distant-site provider must be an enrolled Medicaid provider

Synchronous Telehealth

InteractionA real-time interaction between a recipient at an originating site and a health care provider at a distant site

Patient visibilityThe provider has direct visualization of the patient

Sites involvedThe recipient and provider are located at separate originating and distant sites

Asynchronous Telehealth

TransmissionStore-and-forward transmission of the patient's medical information from an originating site to a distant-site health care provider

No real-time presenceThe recipient is not present when the information is transmitted

Facility feeReimbursable asynchronous services are not eligible for an originating-site facility fee