MASSACHUSETTS
Massachusetts does not yet have a policy for reimbursing telemedicine or telehealth services in its Medicaid program, although there is a tradition in Massachusetts, mostly among managed care plans, to cover some of the innovation telemedicine provides.
In 2012 Massachusetts passed a law recognizing telemedicine as having an important role in expanding health care access without increasing healthcare costs. Despite the lag in legislation, there is still hope on the horizon as The 2016 Massachusetts State Budget requires the health policy commission to begin a one year regional pilot program to further the development and use of telemedicine in the commonwealth state.
Ready to find out more about Massachusetts’ telemedicine policy? Check out our state guide below!
Parity Law
There is no parity law in the state of Massachusetts. In other words, there is no legislation mandating coverage for telemedicine services in the state. The good news: a parity law has been proposed and is waiting for action!
Type of Telemedicine Covered
Private payers may provide telemedicine services (subject to contract terms and conditions), which includes live video.
In the FY 2014 State Budget, Massachusetts appropriates funds for the reimbursement of telehealth remote patient monitoring provided by home health agencies as a service to clients reimbursable through Medicaid, as long as it is for short term reimbursement.
Covered Health Services
Massachusetts Medicaid offers coverage under select managed care plans, but not under fee-for-service plans.
Billing Codes
If you’ll be billing for telemedicine in Massachusetts, you’ll need to know these codes:
Office or other outpatient visits: 99201 – 99215
Annual wellness visit (started 2015): G0438, G0439
Telehealth consultations, emergency department or initial inpatient: G0425 – G0427
Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs: G0406 – G0408
Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days: 99307 – 99310
Psychiatric diagnostic interview examination: 90791, 90792
Individual psychotherapy: 90832 – 90834, 90836 – 90838
Neurobehavioral status exam: 96116
Psychoanalysis (started 2015): 90845
Family psychotherapy, without or with patient (started 2015): 90846, 90847
Telehealth Pharmacologic management: G0459
Individual and group diabetes self-management training services, with a min. 1 hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training: G0108 – G0109
Individual and group medical nutrition therapy: G0270, 97802-97804
Individual and group kidney disease education (KDE): G0420, G0421
End-stage renal disease (ESRD)-related services included in the monthly capitation payment: 90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961
Prolonged evaluation and management services requiring direct patient contact (started 2015): 99354, 99355
Individual and group health and behavior assessment and intervention (HBAI): 96150 – 96154
Smoking cessation services: G0436, G0437, 99406, 99407
Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services: G0396, G0397
Annual alcohol misuse screening (15 min.): G0442
Brief face-to-face behavioral counseling for alcohol misuse (15 min.): G0443
Annual depression screening (15 min.): G0444
High-intensity behavioral counseling for individuals to prevent sexually transmitted infections (30 min.): G0445
Annual intensive behavioral therapy for cardiovascular disease, individual (15 min.): G0446
Behavioral counseling for obesity (15 min.): G0447
Transitional care management services, moderate and high complexity: 99495, 99496
Eligible Healthcare Providers
Not all healthcare providers can deliver telemedicine in Massachusetts. Here’s a list of providers who are eligible:
Physician
Nurse practitioner
Physician assistant
Nurse midwife
Clinical nurse specialist
Clinical psychologist
Clinical social worker
Registered dietitian or nutrition professional
Online Prescriptions
Prior to any e-prescribing, there must be a physician-patient relationship that conforms to certain minimum norms and standards of care, which includes taking a medical history and conducting an appropriate exam.
Interstate Telemedicine Licensing
Massachusetts passed SB 2400 in 2012, which requires the MA Division of Insurance and Board of Registration in Medicine to review out-of-state physician issues and develop recommendations for legislation to permit use of out- of-state physicians for telemedicine.
Restrictions on Locations
Another key restriction specified by law is that the patient site (“originating” site) be in a rural Health Professional Shortage Area (HPSA). In practice, a site is currently deemed eligible for telehealth coverage if it is in a county without a Metropolitan Statistical Area or, if not, in a non-urban census tract that also lies within a Health Professional Service Area.
In Massachusetts, eligible areas include Franklin, Dukes, and Nantucket Counties, the Outer Cape portions of Barnstable County, and southern regions of Berkshire County.
Helpful Resources
Center for Connected Health Policy
The American Telemedicine Association State Policy Matrix
National Conference of States Legislatures
North East Telemedicine Resource Center