VIRGINIA
Virginia has many of the basic protections we know are important for telemedicine practice, such as a parity law that mandates equivalent coverage for telemedicine and in-person services from private payers, Medicaid and state employee health plans.
Some of Virginia’s policies could use a little refining, and that’s ok! The state mandates reimbursement for specific services, and allows only some to be covered if performed asynchronously. Additionally, the Virginia telehealth consent law is fairly vague. Luckily, these little policy quirks are nothing too prohibitive!
Ready to find out more about Virginia’s telemedicine policy? Keep on reading.
Parity Law
Hooray! Virginia’s parity law was enacted in 2010 and mandates coverage for telemedicine under both private insurance and state employee health plans.
Type of Telemedicine Covered
Live video telemedicine is the only form of telehealth that private insurers must cover under Virginia law. Medicaid provides live video coverage, and store-and-forward for diabetic retinopathy and dermatological services.
Covered Health Services
These health services are specifically covered by Medicaid when delivered via telemedicine:
Office Visits
Individual psychotherapy
Psychiatric diagnostic interview examinations
Pharmacologic management
Colposcopy
Obstetric ultrasound
Fetal echocardiography
Cardiography interpretation and report only
Echocardiography
Speech Therapy Services
Billing Codes
These CPT codes are used in Virginia for telemedicine:
99241-99255, consultation
99201-99215, office visits
90804-90809, individual psychotherapy
90862, pharmacologic management
57452, 57454, 57460, colostomy
76805, 76810, obstetric ultrasound
76825, echocardiography, fetal
93010, cardiography interpretation and report only
93307, 93308, 93320, 93321, 93325, echocardiography
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.
And don’t forget your “GT” Modifier!
Eligible Healthcare Providers
Virginia telemedicine providers eligible for Medicaid reimbursement include:
Physicians
Nurse practitioners
Nurse midwives
Clinical nurse specialists
Clinical psychologists
Clinical social workers
Licensed professional counselors
Speech pathologists (speech therapy only)
Online Prescriptions
Before prescribing medication via telemedicine, physicians must establish a “bona-fide” relationship, by doing the following:
Obtaining a medical or drug history
Informing the patient about the benefits and risks of the drug
Conducting a patient exam, in person or via telemedicine
Additional requirements apply for the prescription of Schedule VI controlled substances.
Informed Patient Consent
Telemedicine practitioners must obtain and record informed consent.
Interstate Telemedicine Licensing
Virginia requires a full VA license to practice telemedicine in the state, with an exception for physician-to-physician consults. So far, there’s no legislature in Virginia that may increase interstate medical licensing opportunities.
Restrictions on Locations
Providers must by physically present in the state of Virginia during the telemedicine encounter.
Other Reimbursable Fees
Site transmission fees are allowed, but not required.
Reimbursement Rates
Reimbursement must be the same for telemedicine and in-person services.
Helpful Resources