​​​​​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.

Telehealth in Medi-Cal During the Public Health Emergency (PHE)

In addition, DHCS posted guidance about telehealth flexibilities on its website 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 Institutions Code, which requires DHCS to post guidance on its website regarding reimbursement and submission of claims for telehealth or telephonic services rendered during a state of emergency. 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.

Telehealth in Medi-Cal After the Public Health Emergency (PHE)

Pursuant to a telehealth-related provision of a health-related trailer bill to the 2021-22 Budget Act, Assembly Bill (AB) 133 (Committee on Budget), Chapter 143, Statutes of 2021, DHCS will seek to temporarily continue flexibilities that were in place as of July 1, 2021, related to the delivery and reimbursement of services via telehealth. Specifically​,​DHCS will continue those flexibilities through December 31, 2022, subject to approval from the federal Centers for Medicare & Medicaid.

In addition, for purposes of informing the 2022-2023 proposed Governor's Budget, released in January 2022, AB 133 requires DHCS to convene an advisory group consisting of consultants, subject matter experts, and other affected stakeholders to provide recommendations to inform DHCS in establishing and adopting billing and utilization management protocols for telehealth modalities to increase access and equity and reduce disparities in the Medi-Cal program.

For additional information, please refer to the Telehealth Advisory Workgroup webpage.

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: 9/8/2021 3:51 PM