​Payment and Claims

Back to Telehealth FAQs

How do I get paid for telehealth services?

Providers need to use Place of Service code “02" on their claims to indicate that the service was provided via telehealth. In addition, providers need to use either modifier 95 for services or benefits provided via synchronous, interactive audio visual telecommunication systems or modifier GQ for services or benefits provided via asynchronous store and forward.

The originating site would not use telehealth modifiers on their claims or since all services would be provided in-person. 

Does Medi-Cal pay for set-up costs and transmission fees?

Medi-Cal pays an originating site fee per transmission to the provider at the originating site for providing services via telehealth, via synchronous and/or asynchronous. The maximum is once per day per patient using HCPCS code Q3014. 

Medi-Cal pays both the originating site and the distant site a transmission fee up to 90 minutes per beneficiary per day for services provided using a two-way, real time interactive telecommunications system (synchronous). The HCPCS code is T1014.
 
Questions about claims and billing may be directed to Telephone Service Center (TSC) at (800) ​541-5555 (outside of California, please call (916) 636-1980.

Does Medi-Cal pay the provider for professional services at the originating site?

Medi-Cal will only pay providers at the originating site if they perform a medically necessary professional service for the patient, as determined by the physician or practitioner at the distant site. Providers at the originating site should not use modifiers for telehealth on their claims for professional services. Please see the Medi-Cal Provider Manuals for Rural Health Clinics/Federally Qualified Health Centers and Indian Health Services Memorandum of Agreement (MOA) 638 clinics for requirements specific to the originating site.

Does Medi-Cal pay for equipment to set-up telehealth operations?

No. Medi-Cal does not pay for telehealth equipment purchases. 

How is the examining room paid for in telehealth?

There is no reimbursement specific to exam room expenses; the originating site may submit a claim for facility fee and transmission fees.

Are there any restrictions on the type of setting for the originating or distant site?

No. Medi-Cal does not limit the type of setting where services are provided for the patient or by the health care provider. Please see the Medi-Cal Provider Manuals for Rural Health Clinics/Federally Qualified Health Centers and Indian Health Services MOA 638 clinics for requirements specific to the originating site.

Does a licensed provider need to be with the patient if the home is the originating site?

No, unless the distant site provider determines it is medically necessary for a health care provider to be with the patient. However, please see the Medi-Cal Provider Manuals for Rural Health Clinics/Federally Qualified Health Centers and Indian Health Services MOA 638 clinics for requirements specific to the originating site.

Do Medi-Cal Managed Care Plans (MCP) cover telehealth services?

Medi-Cal reimburses MCPs for providing services via telehealth as part of their capitated rates. 

Does Medi-Cal cover telehealth services provided in Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Indian Health Services (IHS) clinics?

Yes, allowable costs associated with telehealth services may be included in the clinic’s Prospective Payment System (PPS) rate; however, FQHCs, RHCs, and IHS clinic PPS sites may not bill for originating site or transmission fees. Please see the Provider Manuals for RHCs/FQHCs and IHS MOA 638 clinics for scenarios about billing for services provided by telehealth.
Last modified date: 3/23/2021 8:57 AM