| Provider Reimbursement Eligibility | |||||
|---|---|---|---|---|---|
| Consent for Telemedicine | Live Video Reimbursement | Store & Forward Reimbursement | Originating Site & Transmission Fees | Eligible Practitioners | |
| State Law |
No Reference Found |
No Reference Found |
No Reference Found |
No Reference Found |
No Reference Found |
| Medicaid |
The referring provider is required to obtain written consent prior to performing telemedicine services. |
Georgia Medicaid reimburses for live video when the service is: “medically necessary, the procedure is individualized, specific, consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.” |
Georgia Medicaid requires an interactive telecommunication system in order to be reimbursed for telemedicine services. Therefore, store & forward is not reimbursable. |
Rural Health Clinics and FQHCs can collect a telehealth origination site facility fee. |
To find out if your provider class is eligible for medicaid reimbursement reference the appropriate medicaid manual for your specialty. (Georgia Medicaid Provider Manuals) |
| Medicare |
No Reference Found |
Only applicable for rural areas at this time. See Rural Telehealth Services Document Medicare does offer new telehealth reimbursement opportunities for chronic care management and behavioral health integration. This initiative removes previous face-to-face requirements and geographic restrictions. Download the FREE guides for Primary Care or FQHC/RHC Here. |
No Reference Found |
Medicare will pay 80% of the lesser of the actual charge of $25.10 per live video session to the originating site(patient location). |
|
| Private Payors |
Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth. |
||||
| Self Pay |
There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services. |
||||
| Provider Reimbursement Eligibility | |||||
|---|---|---|---|---|---|
| Consent for Telemedicine | |||||
| State Law |
No Reference Found |
||||
| Medicaid |
The referring provider is required to obtain written consent prior to performing telemedicine services. |
||||
| Medicare |
No Reference Found |
||||
| Live Video Reimbursement | |||||
| State Law |
No Reference Found |
||||
| Medicaid |
Georgia Medicaid reimburses for live video when the service is: “medically necessary, the procedure is individualized, specific, consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs.” |
||||
| Medicare |
Only applicable for rural areas at this time. See Rural Telehealth Services Document Medicare does offer new telehealth reimbursement opportunities for chronic care management and behavioral health integration. This initiative removes previous face-to-face requirements and geographic restrictions. Download the FREE guides for Primary Care or FQHC/RHC Here. |
||||
| Store & Forward Reimbursement | |||||
| State Law |
No Reference Found |
||||
| Medicaid |
Georgia Medicaid requires an interactive telecommunication system in order to be reimbursed for telemedicine services. Therefore, store & forward is not reimbursable. |
||||
| Medicare |
No Reference Found |
||||
| Originating Site & Transmission Fees | |||||
| State Law |
No Reference Found |
||||
| Medicaid |
Rural Health Clinics and FQHCs can collect a telehealth origination site facility fee. |
||||
| Medicare |
Medicare will pay 80% of the lesser of the actual charge of $25.10 per live video session to the originating site(patient location). |
||||
| Eligible Practitioners | |||||
| State Law |
No Reference Found |
||||
| Medicaid |
To find out if your provider class is eligible for medicaid reimbursement reference the appropriate medicaid manual for your specialty. (Georgia Medicaid Provider Manuals) |
||||
| Medicare | |||||
| Private Payors |
Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth. |
||||
| Self Pay |
There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services. |
||||
Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.
Georgia has a parity law that was enacted in 2006. It includes private payors and state-employee health plans as well.
Telehealth services are equal to in person services and reimbursed at the same rate.
The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.
The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.
The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.
Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites:
