Medi-Cal & Telehealth
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.”
Medi-Cal complies with federal regulations for telehealth, which are the same for Medicaid as they are for Medicare. Medicaid regulations authorize telehealth using “interactive communications” and asynchronous store and forward technologies. Interactive telecommunications must include, at a minimum, audio and video equipment permitting real-time two-way communication, according to the Centers for Medicare and Medicaid Services.
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.
Stakeholder Engagement - DHCS has been working with stakeholders to revise its telehealth policy. These updates include the following:
- Allow Medi-Cal providers flexibility to determine if a particular service or benefit is clinically appropriate for telehealth via audio-visual two-way real time communication.
- Place no limitations on origination or distant sites.
- Implement Place of Service Code 02 and modifier 95 for services delivered via telehealth.
- Maintain modifier GQ for store and forward, originating site fees, and transmission fees.
- Authorize a code for e-consults under the auspice of store and forward.
DHCS sent a draft update of the Medi-Cal Provider Manual section for telehealth, draft All Plan Letter, and other Provider Manual sections for telehealth to more than 1,500 stakeholders in October 2018 and received comments from more than 30 organizations. In responses to these comments, DHCS held a webinar on December 17, 2018, to share the feedback it received from providers and DHCS' responses.
Stakeholders may access DHCS's responses to all of the comments received. DHCS also held a stakeholder webinar, where questions and comments were received during the webinar, and DHCS has provided responses to those questions and comments.
DHCS will publish the revised Medi-Cal Provider Manual: Telehealth, as well as Provider Manual sections for Federally-Qualify Health Centers/Rural Health Clinics; Indian Health Services Memorandum of Agreement 638 Clinics; and Family Planning, Access, Care, and Treatment in the spring of 2019. DHCS will also post the final All Plan Letter for telehealth on the webpage for All Plan Letters.
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 the Provider Manual is updated. Providers are also encouraged to check this webpage frequently for updates.
Telehealth Webinar Presentation - December 17, 2018