​​​Medi-Cal & Telehealth

Background

The Department of Health Care Services (DHCS) considers telehealth a cost-effective alternative to health care provided in-person, particularly to underserved areas. Telehealth is not a distinct service, but a way that providers deliver health care to their patients that approximates in-person care. The standard of care is the same whether the patient is seen in-person or through telehealth.

DHCS’s coverage and reimbursement policies for telehealth align with the California Telehealth Advancement Act of 2011 and federal regulations. State law defines telehealth as “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site.”

For additional information about Medi-Cal coverage and reimbursement telehealth policies, as well as resources for providers, please see the Telehealth Resources page and Frequently Asked Questions.

Medi-Cal Telehealth Proposal

For post-COVID-19 PHE, DHCS is proposing to implement broad changes with the DHCS Telehealth Proposal to continue to allow additional Medi-Cal covered benefits and services to be provided via telehealth modalities across all delivery systems, when clinically appropriate. DHCS believes that providing health care services through various telehealth modalities can help provide beneficiaries, especially those residing in rural and underserved areas of the State, with increased access to critically needed subspecialties, and could improve access to culturally appropriate care, such as allowing care with a provider whose language, race, or culture are the same as that of the beneficiary.

Temporary flexibilities

DHCS posted guidance on its website about telehealth flexibilities that are available to providers during the COVID-19 public health emergency (PHE). The federal flexibilities will expire at the end of the federally-declared PHE.

Assembly Bill 1494 added Section 14132.724 to the Welfare and Institutioins Code, which requires the Department of Health Care Services (DHCS) to post guidance on its website regarding reimbursment and submission of claims for telehealth or telephonic services rendered during a state of emeregency. Please note that this guidance is not specific to any particular state-declared emergency and/or federally-declared public health emergency, but rather provides information regarding potential state and federal flexibilities that DHCS may be able to request and implement during a state-declared or federally-declared emergency.

Policy highlights

DHCS' Medi-Cal telehealth policy gives providers flexibility to use telehealth as a modality for delivering medically necessary services to their patients. Program specific details on DHCS's telehealth policy are available in the Provider Manuals for the following:

DHCS also published All Plan Letter 19-009 regarding telehealth services in managed care health plans.

Highlights of Medi-Cal's telehealth policy include the following: 

  • Medi-Cal providers have flexibility to determine if a particular service or benefit is clinically appropriate for telehealth via audio-visual two-way real time communication and store and forward.
  • No limitations on origination or distant sites.
  • CPT-4 Code 99451 may be used for e-consults under the auspice of store and forward.

To stay informed about updates for telehealth and other DHCS topics, sign up for DHCS Stakeholder Announcements

Providers can also sign up to receive notices when Provider Manuals are updated. Providers are also encouraged to check this webpage for updates.

Last modified date: 3/23/2021 9:08 AM