State Telemedicine Policy Information

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Virginia Telemedicine Policy

Virginia Telemedicine Policy

Virginia has many of the basic protections crucial to the success of telemedicine, such as a parity law that mandates equivalent coverage for telemedicine and in-person services from private payers, Medicaid, and state employee health plans. The state mandates reimbursement only when medical services are provided via live video, with limited coverage for other types of telemedicine.

State Policy Overview

Medicaid

Yes

Private Payer

Yes

Parity

Yes

Additional State Telemedicine Info

Parity Laws

Since 2010, Virginia’s telehealth parity law has mandated coverage for telemedicine by private insurance companies and state employee health plans.

Medicaid

Virginia’s Medicaid program defines telemedicine as “the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment.” So, Medicaid mostly covers live video telemedicine services. However, some plans are allowed to reimburse for store-and-forward and remote patient monitoring at their discretion.

Type Of Telemedicine Covered

Under Virginia’s parity law, private insurers are required to cover live video. Virginia Medicaid reimburses for live video, and under certain plans, store-and-forward and remote patient monitoring.

Covered Health Services

These health services are specifically covered by Medicaid when delivered via telemedicine:

 

  • Evaluation and management
  • Psychiatric care
  • Specialty medical procedures
  • Speech therapy
  • Radiology service and procedures
  • Diabetic retinopathy
  • Outpatient teledermatology
  • Obstetric and gynecological services (ultrasounds)

 

Eligible Healthcare Providers

Under Virginia Medicaid, the following healthcare providers can bill for telemedicine:

 

  • Physicians
  • Nurse practitioners
  • Nurse Midwives
  • Psychiatrist
  • Psychiatric clinical nurse specialist
  • Psychiatric nurse practitioner
  • Marriage and family therapist/counselor
  • School psychologist
  • Substance abuse practitioner
  • Clinical nurse specialists
  • Clinical psychologists
  • Clinical social workers
  • Local Education Agency (billing speech therapy)

 

Online Prescriptions

Before prescribing controlled substances via telemedicine, physicians must establish a patient relationship. This includes gathering a medical history, informing patients about risks of the drug, and conducting an exam (which can be done virtually). 

Informed Patient Consent

Telemedicine practitioners must get a patient’s consent for the telemedicine services and document it in the patient’s record.

Cross-State Telemedicine Licensing

 Virginia requires a full VA license to practice telemedicine in the state, with an exception for physician-to-physician consults. So far, Virginia has not joined the Interstate Medical Licensure Compact, which makes it easier for out-of-state telemedicine providers to practice in the state. 

Restrictions On Locations

Virginia Medicaid requires telemedicine patients to receive their treatment at an eligible originating site. Here are the locations that qualify:

  • Provider offices
  • Local Education Agency
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospitals
  • Nursing Facilities
  • Health Department Clinics
  • Renal Units
  • Community Services Boards
  • Residential Treatment Centers

Reimbursement Rates

Reimbursement is the same rate for telemedicine as in-person services.

Billing Codes

Billing for telemedicine usually involves using the relevant CPT code along with the GT (telemedicine) modifier. Here are some of the included codes for billing Virginia Medicaid:

  • 99241-99255, consultation
  • 99201-99215, office visits
  • 90804-90809, individual psychotherapy
  • 90862, pharmacologic management
  • 57452, 57454, 57460, colostomy
  • 76805, 76810, obstetric ultrasound
  • 76825, echocardiography, fetal
  • 93010, cardiography interpretation and report only
  • 93307, 93308, 93320, 93321, 93325, echocardiography

 

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