Reimbursement

Center for Medicare & Medicaid Services (CMS)

Medicare – Federal Guidelines

Telemedicine service must meet the following CMS criteria as summarized in the Telehealth Services Fact sheet for 2014 (PDF).

North Carolina Medicaid Guidelines

3.2.1 Specific criteria covered by both Medicaid and NC Health Choice

Medicaid and NCHC shall cover Telemedicine and Telepsychiatry services when medically necessary under all of the following conditions:

1. The beneficiary shall be present at the time of consultation.
2. The medical examination of the beneficiary must be under the control of the consulting provider.
3. The distant site of the service(s) must be of a sufficient distance from the originating site to provide service(s) to a beneficiary who does not have readily available access to such specialty services.
4. The consultation must take place by two-way real-time interactive audio and video telecommunications system.

Note: The licensed provider using Telemedicine or Telepsychiatry Services shall ensure the availability for appropriate follow-up care and maintain a complete health record that is available to the beneficiary and other treating providers.

Extracted from Policy No: 1H: NC Division of Medical Assistance Medicaid and Health Choice Telemedicine and Telepsychiatry Clinical Coverage. NC Medicaid Telemedicine Policy in its entity can be found: https://files.nc.gov/ncdma/documents/files/1-H_3.pdf