Telehealth Frequently Asked Questions
The Frequently Asked Questions (FAQs) resource for telehealth is currently being revised to reflect our recent policy clarifications around telehealth in the Medi-Cal program. As a result, we encourage interested parties to check back on our website periodically for updates. Please not that the FAQ for telehealth reflecting the proposed Medi-Cal policy will be posted on the DHCS website when DHCS publishes the revised Medi-Cal Provider Manual section for telehealth.
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Medi-Cal Special Programs
What is telehealth?
California law defines telehealth as “a 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 health care provider is at the distant site." – see
Business and Professions Code 2290.5
What types of services provided via telehealth does Medi-Cal cover?
Medi-Cal's telehealth policy gives providers flexibility to determine if a particular service or benefit is clinically appropriate based upon evidence-based medicine and/or best practices to be delivered via audio-visual, two-way, real time communication or store and forward. Services must meet the procedural definitions and components of the CPT or HCPCS code. Please see the Frequently Asked Questions for
Medi-Cal Special Programs for information specific to those programs.
Medi-Cal pays providers an originating site fee when services are provided either for store and forward or audio-visual two-way communication. Medi-Cal will also pay transmission fees to providers at both the originating and distant site for services provided via audio-visual, two-way, real time communication.
Does Medi-Cal pay a different rate for services provided through telehealth than it pays for the same service provided in-person?
No. Medi-Cal pays the same rate for professional medical services provided by telehealth as it pays for services provided in-person. Please see the
Payments and Claims section.
Who decides whether or not to provide services via telehealth?
The health care provider determines if a benefit or service is clinically appropriate to be provided via a telehealth modality, subject to consent by the patient.
Does the patient need to consent prior to receiving services by telehealth?
Yes. State law requires the health care provider initiating the use of telehealth to inform the beneficiary, obtain consent, and maintain appropriate documentation. Providers at both the originating and distant site should maintain documentation in the beneficiary's medical record in the event health records are not shared. If a health care provider or health care group/organization has a general consent protocol that specifically references use of telehealth as a modality, then this would satisfy the consent requirement.
What resources are available to providers?
The
California Telehealth Resource Center (CTRC) is a federally designated resource center dedicated to helping providers implement and sustain telehealth programs. Services include: program needs assessment for implementation or expansion, equipment selection, telehealth presenter training; operational workflow; contracting with specialists; billing; and credentialing and staff roles. In addition, CTRC also produces a Telehealth Program Developer Kit that can be downloaded from the
CTRC website. It provides a step-by-step guide to help providers develop a telehealth program.
The
Center for Connected Health Policy (CCHP) is a federally designated national telehealth resource center on policy. The CCHP works closely with all telehealth resource centers in the United States and provides technical assistance to state agencies and lawmakers on telehealth policy. For recent information on telehealth legislation and policy, visit the
CCHP website.
Who can I call if I have questions about submitting claims?
