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.

Announcements - New Provider Manual Published

DHCS recently revised the Medi-Cal telehealth policy to allow providers increased flexibility in their use of telehealth as a modality for delivering medically necessary services to their patients. The policy is effective July 1, 2019, and fee-for-service providers must submit claims for services provided via telehealth according to the new policy. DHCS also revised telehealth policies in the Provider Manuals for Federally Qualify Health Centers/Rural Health Clinics; Indian Health Services Memorandum of Agreement 638 Clinics; and Family Planning, Access, Care, and Treatment with information about telehealth. DHCS also published All Plan Letter 19-009 regarding telehealth services in managed care health plans.

Updates to the telehealth policy 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 and store and forward.
  • Place no limitations on origination or distant sites.
  • Implement Place of Service Code 02 for all services delivered via telehealth and modifier 95 for services delivered via audio-visual two-way communication.
  • Maintain modifier GQ for store and forward. 
  • Authorize CPT-4 Code 99451 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: 9/3/2019 2:17 PM