In order to serve the needs of Virginia’s diverse and distributed population, state leaders have been out in front of the new healthcare delivery options made possible by telemedicine. In 2010, Virginia became just the 10th state to require private payer parity for telehealth visits.
History of telemedicine regulations in Virginia
- Senate Bill 675, Health insurance; mandated coverage for telemedicine services (2010) – On March 2, the Virginia Legislature unanimously approved a bill (SB 675) that would require private health insurers, health care subscription plans and HMOs to cover for the cost of health care services provided through telemedicine technology.
- SB 1227 Telemedicine services; provision of health care services. (2015) – Enacted on February 26th, 2015, SB 1227, expanded access to care for minor illnesses by amending Virginia law to clarify that a prescriber licensed in Virginia may prescribe Schedule VI controlled substances via telemedicine, provided the prescriber conforms to the same standard of care expected of an in-person visit.
Private payer reimbursement for telemedicine in Virginia
Virginia can be considered a leader in achieving private payer reimbursement parity for telehealth. In 2010, they became just the 10th state to mandate reimbursement for this important method of patient care.
The law defines telemedicine services as, “The use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient or consulting with other health care providers regarding a patient’s diagnosis or treatment.”
Reimbursement is not required for the following:
- An audio-only telephone conversation
- An electronic mail message
- A facsimile transmission
The law applies to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended on and after January 1, 2011, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.
It does not apply to short-term travel, accident-only, or limited or specified disease policies or contracts, nor to policies or contracts designed for people eligible for Medicare, or any other similar coverage under state or federal governmental plans.
Insurers must reimburse treating providers for the diagnosis, consultation, or treatment of the insured delivered through telemedicine “on the same basis” that insurer is responsible for coverage for the provision of the same service through face-to-face contact.
An insurer may offer a health plan containing a deductible, copayment, or coinsurance requirement for a health care service provided through telemedicine as long as it does not exceed the deductible, copayment, or coinsurance applicable if the same services were provided face-to-face. Insurers may not impose any annual or lifetime dollar maximum on coverage for telemedicine services other one that applies to all items and services covered under the policy.
Patient Site Requirements
A policy can not distinguish between patients in rural or urban locations.
Code of Virginia Physician Regulations
Virginia’s State Medical Board
For the purpose of regulating physician practices in Virginia “telemedicine services,” as it pertains to the delivery of health care services, means the use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient or consulting with other health care providers regarding a patient’s diagnosis or treatment. “Telemedicine services” does not include an audio-only telephone, electronic mail message, facsimile transmission, or online questionnaire.”
Practitioners recognize the obligations, responsibilities, and patient rights associated with establishing and maintaining a practitioner-patient relationship. Where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a this relationship. Relationships may be established using telemedicine services provided the standard of care is met.
Identity and Consent
A practitioner is discouraged from rendering medical advice and/or care using telemedicine services without (1) fully verifying and authenticating the location and, to the extent possible, confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s identity and applicable credential(s); and (3) obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telemedicine services.
Evidence documenting appropriate patient informed consent for the use of telemedicine services must be obtained and maintained.
The medical record should include, if applicable, copies of all patient-related electronic communications, including patient-practitioner communication, prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telemedicine services.
Prescribing medications, in-person or via telemedicine services, is at the professional discretion of the prescribing practitioner.
Frequently Asked Questions (FAQ)
Yes. A prior in-person, face-to-face interaction is not required. However, where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a relationship consistent with the standard of care.
Can I prescribe medication based on a telehealth visit?
Yes. A prescriber licensed in Virginia may prescribe Schedule VI controlled substances via telemedicine, provided the prescriber conforms to the same standard of care expected of an in-person visit.
How often do I have to see the patient in person?
Neither the Code of Physicians nor the private payer reimbursement regulations address this.
Is the standard of care the same for telehealth care as it is for in-person care?
Yes. As are the standards related to medical records documentation and confidentiality.
Can I get reimbursement from Medicaid if I treat a patient through telemedicine?
Virginia’s parity law mandates private insurance and state managed health plans to reimburse for telemedicine.
The following DMAS covered Current Procedural Terminology (CPT) codes are recognized by DMAS for telemedicine. The services are rendered by providers at the “hub” site to the Medicaid member located at the distant or “spoke” site:
• CPT 99241-99255, consultations;
• CPT 99201-99215, office visits;
• CPT 90804-90809, individual psychotherapy;
• CPT 90862, pharmacologic management;
• CPT 57452, 57454, 57460, colostomy;
• CPT 76805, 76810, obstetric ultrasound;
• CPT 76825, echocardiography, fetal:
• CPT 93010, cardiography interpretation and report only; and
• CPT 93307, 93308, 93320, 93321, 93325, echocardiography.
The CMS 1500 is to be used to bill for covered telemedicine services, with the appropriate billing code entered in block 24D and “GT” entered as the modifier. The distant or “spoke” site provider is where the DMAS member is located for the telemedicine encounter. The member must be present for the encounter as well as the provider. Code Q3014 is to be billed for the spoke site service unless the hub provider determines a higher-level service must be documented in the member’s medical record. Again, “GT” is to be entered as the modifier when billing. For DMAS covered physician services, a Registered Nurse under the supervision of a physician may attend the telemedicine encounter and assist the member. This service is billed using code Q3014. After reviewing the documentation for the encounter, the physician must sign and date the documentation and billing.