Section 405IAC5-38-4. Limitations

   Telemedicine shall be limited by the following conditions:

(1) The patient must:

(A) be physically present at the spoke site; and

(B) participate in the visit.

(2) The physician or practitioner who will be examining the patient from the hub site must determine if it is medically necessary for a medical professional to be at the spoke site. Separate reimbursement for a provider at the spoke site is payable only if that provider's presence is medically necessary. Adequate documentation must be maintained in the patient's medical record to support the need for the provider's presence at the spoke site during the visit. Such documentation is subject to postpayment review. If a health care provider's presence at the spoke site is medically necessary, billing of the appropriate evaluation and management code is permitted.

(3) Reimbursement for telemedicine services is available to the following providers regardless of the distance between the provider and member:

(A) Federally qualified health centers.

(B) Rural health clinics.

(C) Community mental health centers.

(D) Critical access hospitals.

(4) Reimbursement for telemedicine services for all other eligible providers is available only when the distance between the hub and spoke sites are greater than twenty (20) miles. Adequate documentation must be maintained as service is subject to postpayment review.

(5) Store and forward technology is not reimbursable by Medicaid. The use of store and forward technology is permissible as defined under section 2(4) of this rule.

(6) The following service or provider types may not be reimbursed for telemedicine:

(A) Ambulatory surgical centers.

(B) Outpatient surgical services.

(C) Home health agencies or services.

(D) Radiological services.

(E) Laboratory services.

(F) Long term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled.

(G) Anesthesia services or nurse anesthetist services.

(H) Audiological services.

(I) Chiropractic services.

(J) Care coordination services.

(K) DME, medical supplies, hearing aids, or oxygen.

(L) Optical or optometric services.

(M) Podiatric services.

(N) Services billed by school corporations.

(O) Physical or speech therapy services.

(P) Transportation services.

(Q) Services provided under a Medicaid waiver.

(Office of the Secretary of Family and Social Services; 405 IAC 5-38-4; filed Feb 28, 2007, 2:42 p.m.: 20070328-IR-405060029FRA; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Sep 19, 2014, 3:22 p.m.: 20141015-IR-405140194FRA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; errata filed Nov 1, 2016, 9:36 a.m.: 20161109-IR-405160493ACA)

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