GEORGIA
Like many other U.S. states, Georgia is on the road to better coverage for telemedicine. Georgia has a telemedicine parity law in place, which requires private payers to cover telemedicine services. Georgia’s Medicaid program also covers a wide range of medical services delivered via live-video.
However, there’s still room for Georgia to grow! Similar to Medicare’ telemedicine regulations, Georgia Medicaid places some restrictions on the location of patient and provider at the time of the telemedicine visit. Georgia also does not cover other forms of telemedicine, like store-and-forward or remote patient monitoring solutions.
Ready to find out more about Georgia’s telemedicine policy? Keep on reading.
Parity Law
Georgia is one of the lucky states that currently has a telemedicine parity law in place! A telemedicine parity law requires private payers to reimburse telemedicine services in the same way as in-person services. So if you’re in Georgia, you know those commercial payers will cover telemedicine.
Type of Telemedicine Covered
Live video is a go! Private payers and state Medicaid will both reimburse for telemedicine visits done over video. However, there’s currently no coverage for store-and-forward, remote patient monitoring, or other electronic communication (like email, phone or fax).
Covered Health Services
Georgia Medicaid reimburses for live video telemedicine, as long as the service is considered medically necessary and appropriate for the patient.
Here’s what’s covered:
1. Office visits
2. Pharmacologic management
3. Limited office psychiatric services
4. Limited radiological services
5. A limited number of other physician fee schedule services
Billing Codes
Need a list of the eligible GA Medicaid codes for telemedicine? We’ve got you covered:
|
99201-99205: |
Office or Other Outpatient Visit, New patient |
|
99211-99215: |
Office or Other Outpatient Visit, Established patient |
|
G0425-G0427: |
Initial Inpatient telehealth consultations (30, 50, 70 minutes) |
|
G0406-G0408: |
Follow-up telehealth consultations furnished to members in hospitals or SNFs (15, 25, 35 minutes) |
|
99231-99233: |
Subsequent Hospital care |
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99307-99309: |
Subsequent Nursing facility care Subsequent hospital care services are limited to one telehealth visit every 3 days |
|
90801: |
Psychiatric diagnostic interview examination |
|
90804-90809: |
Individual psychotherapy (office or outpatient facility) |
|
90816-90818: |
Individual psychotherapy (inpatient hospital) |
|
90862: |
Pharmacologic management (reimbursable by MD only) |
|
H0039: |
Assertive Community Treatment |
|
Q3014: |
Telemedicine originating site facility fee. |
Don’t forget your GT modifier! Providers should also use the GT modifier with the relevant code to note telemedicine.
Want more details? Check out the Georgia Medicaid Handbook.
Eligible Healthcare Providers
Not all healthcare providers can do telemedicine under Georgia Medicaid. Here’s the list of the eligible providers:
· Physicians
· Nurse Practitioners
· Physician Assistants
· Clinical Nurses
· Clinical Psychologists
Providers also must be licensed in Georgia and currently enrolled in the Georgia Medicaid program
Online Prescriptions
Georgia does not allow physicians to prescribe patients controlled substances and dangerous drugs based only on a virtual telemedicine visit.
Informed Patient Consent
Georgia requires providers to get a patient’s written consent before a telemedicine visit. We recommend this anyway as a telemedicine best practice. You can find the recommended patient consent form here.
Cross-State Telemedicine Licensing
There’s no cross-state licensing available for Georgia right now. Providers doing telemedicine in Georgia need to have a Georgia license.
Restrictions on Locations
Like with Medicare, Georgia’s Medicaid program restricts where the patient and provider can be located during the telemedicine visit. Here are the eligible originating and distant sites under Georgia Medicaid:
· Provider offices
· Hospitals
· Critical Access Hospitals (CAH)
· Rural Health Clinics (RHC)
· Federally Qualified Health Centers (FQHC)
· Skilled nursing facilities
· Community mental health centers
· GA public health clinics
· School-based clinics
That means both the patient and provider will need to be at one of the eligible sites during the visit for GA Medicaid to cover it.
Other Reimbursable Fees
The originating site can bill a facility fee (rate of $20.52) using the Q3014 HCPCS code. Any claims need to be submitted with revenue code 780 (telemedicine) and type of bill 130.
Reimbursement Rates
Good news! Georgia 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
· Center for Connected Health Policy – Georgia State Page
· Georgia Medicaid Telemedicine Handbook
· The American Telemedicine Association State Policy Matrix
· Georgia Partnership for Telehealth