WISCONSIN TELEMEDICINE LAW
Parity Law
A telemedicine parity law requires private payers to reimburse telemedicine services in the same way as in-person services. Unfortunately, Wisconsin does not currently have a telemedicine parity law in place.
This just means commercial payers are not yet legally obligated to reimburse for telemedicine services. Many private payers will still cover select services.
Type of Telemedicine Covered
Wisconsin’s Medicaid program currently covers medical and mental health services provided via live video telemedicine. There’s no coverage for store-and-forward or other types of telemedicine solutions at the moment.
Covered Health Services
Wisconsin Medicaid reimburses for a range of telemedicine services, including:
Office or other outpatient services
Office or other outpatient consults
Initial inpatient consults
Outpatient mental health services
Health and behavior assessment/intervention
End stage renal disease-related services
Outpatient substance abuse services
Billing Codes
Need a list of the eligible Wisconsin Medicaid codes for telemedicine? We’ve got you covered:
Just use the appropriate CPT/HCPCS code for the covered health service, along with the “GT” modifier to document that it was provided via telemedicine:
· Office or other outpatient services (99201-99205, 99211-99215)
· Office or other outpatient consultations (99241-99245)
· Initial inpatient consultations (99251-99255)
· Outpatient mental health services (90785, 90791-90792, 90832-90834, 90836-90840, 90845-90847, 90849, 90875, 90876, and 90887)
· Health and behavior assessment/intervention (96150-96152, 96154-96155)
· ESRD-related services (90951-90952, 90954-90958, 90960-90961)
· Outpatient substance abuse services (H0022, H0047, T1006)
Want more details? Check the Wisconsin Medicaid provider manual.
Eligible Healthcare Providers
Not all healthcare providers can do telemedicine under Wisconsin Medicaid. Here’s the list of the eligible providers:
Physicians and physician clinics
Rural Health Centers
Federally Qualified Health Center
Physician assistants
Nurse practitioners
Nurse midwives
Psychiatrists
Ph.D. psychologists
Mental health providers must be certified for telehealth by the Medicaid program, and do not need to be located in Wisconsin.
Online Prescriptions
Wisconsin has no stated policy on medications prescribed via telehealth.
Informed Patient Consent
Wisconsin does not have a state-wide policy requirement on getting a patient’s informed consent for telemedicine. However, Wisconsin Medicaid does require this.
We recommend this anyway as a telemedicine best practice. You can find the recommended patient consent form here.
Cross-State Telemedicine Licensing
Wisconsin is one of the telemedicine-forward states to join the Interstate Medical Licensing Compact. The compact allows providers in one of the compact states to go through an expedited medical licensing process for any of the other member states. In other words, it’s good news for any Wisconsin providers interested in practicing telemedicine across state lines!
Helpful Resources