CALIFORNIA TELEMEDICINE LAW
With its first telemedicine parity laws passed in 1996, California has a long history in telemedicine reimbursement and was one of the first states to acknowledge the value of telemedicine.
Like many other U.S. states, California recognizes how important telemedicine is improving healthcare access for patients challenged by distance or mobility. Pending legislation in Californiaillustrates a movement toward utilizing telemedicine as a way to reach those with special needs and those in need of behavioral health care services.
Ready to find out more about California’s telemedicine policy? Check out our state guide below!
Parity Law
Yes. California has a telemedicine parity law mandating private payer reimbursement for telemedicine.
Type of Telemedicine Covered
California’s Medicaid program covers live video telemedicine. The state also covers store-and-forward services for Teledermatology, teledentistry, and teleophthalmology.
Covered Health Services
California reimburses for wide variety of evaluative & management health services, and psychiatric services. Check out our Billing Codes section below for more details.
Billing Codes
Need a list of the eligible CA Medicaid codes for telemedicine?
We’ve got you covered:
CPT E&M Codess
99201 – 99215 Office or other outpatient visit (new or established patient)
99221 – 99233 Initial hospital care or subsequent hospital care (new or established patient)
99241 – 99275 Consultations: Office or other outpatient, initial or follow-up inpatient, and confirmatory
CPT Psychiatric Codes
90785 Interactive complexity 90791 Psychiatric diagnostic evaluation
90792 Psychiatric diagnostic evaluation with medical services
90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services
90832 Psychotherapy, 30 minutes with patient and/or family member
90837 Psychotherapy, 60 minutes with patient and/or family member
90839 Psychotherapy for crisis; first 60 minutes
90840 Additional 30 minutes
Telehealth originating site facility fee : Q3014 (Once per day, same recipient & provider)
Transmission costs for telehealth services via audio/video communication: T1014
(Maximum of 90 minutes per day same recipient, same provider)
Plus, make sure you use the GT modifier with your CPT code to indicate live video telemedicine. If you’re using a store-and-forward solution, use the GQ modifier.
Want more details? Check out the California Medicaid Handbook.
Eligible Healthcare Providers
Medi-Cal does limit which healthcare providers can get reimbursed for telemedicine. Here’s who qualifies:
Physicians
Physician assistants
Nurse practitioners
Clinical nurse specialists
Registered dietitians or nutrition professionals
Nurse midwives
Certified registered nurse anesthetists
Clinical psychologists
Clinical social workers
Online Prescriptions
Providers are prohibited from prescribing or dispensing dangerous drugs or dangerous devices on the Internet without an appropriate prior examination and medical indication.
Informed Patient Consent
Yes. Providers need to get patients’ oral consent before they can start a telemedicine service. Providers also need to document consent in the patient’s medical record.
Cross-State Telemedicine Licensing
There’s no interstate licensing available for California right now. Providers doing telemedicine in California need to have a California license.
Restrictions on Locations
Medi-Cal has no limitations on where the patient or provider has to be during the telemedicine visit. That makes it easy for providers to offer quick, convenient virtual care – and get paid for it.
Other Reimbursable Fees
Medi-Cal reimburses the originating site a facility fee, and pays the originating and distant sites for live video transmission costs.
Reimbursement Rates
Good news! California Medicaid reimburses telemedicine services according to the current physician fee schedule amount for that medical service. So reimbursement rates for a telemedicine service should be the same as the comparable in-person medical service.
Helpful Resources
California Telehealth Resource Center
Center for Connected Health Policy
American Telemedicine Association State Policy Matrix
University of California Davis Center for Health and Technology
California Office of Health Information Integrity — eHealth (CalOHII)
The Medical Board of California: Practicing Medicine Through Telehealth Technology