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Georgia Medicaid Expansion of PT/OT Telehealth Services
March 26, 2020
Dear Medicaid/PeachCare for Kids® Providers:
The Department of Community Health (DCH) has received requests for additional clarification of the telehealth guidance released 3/17/20 and further clarified in a message dated 3/18/20. In response to requests for clarification of service delivery locations and the term “distant site locations” DCH is issuing additional guidance to clarify these outstanding questions.
Qualified providers permitted to furnish Medicaid-reimbursed telehealth services during the Public Health Emergency include physicians and certain non-physician providers such as nurse practitioners, physician assistants and certified nurse midwives. Other practitioners enrolled in Georgia Medicaid such as certified nurse anesthetists, licensed clinical social workers, clinical psychologists and therapists (PT, ST and OT) may also deliver services within their scope of practice, consistent with Medicaid reimbursement rules, and in the category of service in which they are enrolled.
Service Delivery Location: Originating Site
The Coronavirus Preparedness and Response Supplemental Appropriations Act as signed into law by the President on March 6, 2020 allows states broad authority to waive limitations on settings where members are eligible to receive telehealth and where telehealth services can be delivered during the emergency. All members with access to video or telephone communication may receive services in their homes to reduce exposure to themselves and others. Under the emergency declaration and waivers, these services may be provided by professionals regardless of patient location. The services must meet established medical necessity criteria relevant to the procedure or treatment.
Service Delivery Location: Distant Site
Qualified providers deliver services from distant sites. During the COVID-19 state of emergency, providers may deliver medically necessary services in various settings including their homes or other settings in which the privacy and confidentiality of the member can be assured. Qualified providers should continue to follow all applicable licensure rules specific to their profession. Services delivered from distant sites will be billed using the provider billing address associated with the enrolled Medicaid practice or facility. Claims must be billed using the associated procedure code, GT modifier and place of service code 02 to indicate telehealth delivery.
Providers should reference the 3/18/20 banner message relating to COVID-19 and the Use of Telehealth for additional requirements related to member consent and patient confidentiality. DCH will continue to review all categories of service, adding services and procedure codes that can be reimbursed through telehealth service delivery as identified. MMIS will be modified to include new codes following DCH review. The Department will post additional information as needed.
Consent to receive services must be provided verbally by the member and noted in the member’s file or medical record. Providers are not required to obtain a hard copy of the consent form as noted in the Telehealth Guidance manual.
If you have questions related to the waiver of originating or distant site requirements, please contact the DXC Technology Provider Contact Center at 1-800-766-4456 and/or your assigned Provider DXC Representative.