The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Florida Medicaid Update on PT/OT Telehealth Services
Provider Type(s): 81, 82, and 83
Telemedicine Guidance for Therapy Services and Early Intervention Services
The purpose of this alert is to provide guidance to providers on Florida Medicaid coverage of therapy services (occupational, physical, and speech-language pathology) and early intervention services via telemedicine during the 2019 novel coronavirus (COVID-19) state of emergency.
Telemedicine is the practice of health care delivery by a practitioner who is in a site other than the site where a recipient is located, using interactive telecommunications equipment that minimally includes real time, two-way interactive communication between a recipient and a practitioner using audio and video equipment. The Agency’s current telemedicine policy in the fee-for-service delivery system is available at: http://ahca.myflorida.com/medicaid/review/General/59G_1057_TELEMEDICINE.pdf.
Telemedicine Flexibilities During the State of Emergency
It is imperative that services continue for children in need of services. To ensure that Florida Medicaid providers can maintain continuity of care during the state of emergency, the Agency is expanding coverage of therapy services and early intervention services provided through telemedicine. These flexibilities apply to services provided through both the Statewide Medicaid Managed Care program and the fee-for-service delivery system when:
Florida Medicaid will reimburse for evaluation, diagnostic, and treatment recommendations for services included on the respective therapy services fee schedule to the extent services can be delivered in a manner that is consistent with the standard of care and all service components designated in the American Medical Association’s Current Procedural Terminology and the Florida Medicaid coverage policy is provided. Providers must append the GT modifier to the procedure code in the fee-for-service delivery system.
Early Intervention Services
Florida Medicaid will reimburse for the delivery of early intervention sessions via telemedicine when performed by an eligible EIS provider (as defined in the Medicaid coverage policy) to provide family training designed to support the caregiver in the delivery of care. The provider must guide the caregiver in the implementation of certain components of the recipient’s individualized family support plan to promote carryover of treatment gains. Providers are required to ensure caregivers can perform the tasks. Services are covered, as described below:
Early Intervention Individual Session: Family Training
Four 15-minute units per day
Provider Telemedicine Requirements (Applies to Therapy and EIS Providers)
Providers using telemedicine as a modality to deliver services must comply with the following:
Additional EIS Provider Telemedicine Requirements
Early intervention service providers using telemedicine as a modality to deliver services must also comply with the following:
In the fee for service delivery system, Florida Medicaid reimburses at the same rate detailed on the respective fee schedule. Please contact the health plans directly to inquire about their telemedicine requirements and reimbursement rates.
Florida Medicaid does not reimburse for the acquisition, installation, and maintenance of telecommunication devices or systems.
Prior Authorization Requirements
Nothing in this alert relieves the provider of any existing prior authorization requirements that currently exist for therapy or early intervention services (in fee-for-service or managed care).
March 20, 2020