Wiki Billing Out of State Telehealth Visits

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marycopus2019

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(Posting this in the General Coding Forum as well, just in case) Does anyone have any information regarding telehealth visits for out of state patients? At AuditCon, my co-worker heard in a webinar that providers cannot bill for telehealth services to out of state patients unless the provider is credentialed in that state. Is that true? I looked here: and here: but there aren't any specifics about being able to bill an encounter if a provider is not credentialed in a specific state. Does anyone have any resources on this issue?
I'm asking now because we came across a claim where the provider is in Arkansas providing telehealth services to someone in New York (they are away at college) but the provider is not licensed in NY. Per the AuditCon track my co-worker attended (Auditing Telemedicine and Telehealth), this would not be billable. In order to support this with my bosses, I need resources but I don't know where to acquire them. Please help!
 
The first link you posted has a link under State Licensing Policies to the Federation of State Medical Boards telehealth requirements which is the only place I have seen specifying the requirements for each state. with numerous links for each state Basically, prior to March 2020, you needed a license in that state to practice medicine (telehealth or otherwise) in the state. When COVID-19 hit hard, many states lifted this requirement because there were areas with a huge influx of patients and not enough healthcare providers to treat them. This often happens on a much smaller level during a more local disaster (like hurricanes, floods, etc).
My understanding is across the entire US, if the visit is related to COVID-19, the federal guideline is you do not need a license for that specific state.
If the visit is not related to covid, it depends on the state and when. This is really a complex legal issue. These types of decisions are better left in the hands of those experienced at reading complex state regulations that are subject to constant change (compliance officers, attorneys, etc.)
This is not legal advice, but it seems it was allowed in NY until 06/25/2021, then the COVID-19 emergency expired. On 09/27/21, the state issued an executive order related to an emergency due to shortage of healthcare professionals that would permit it again. However, best I can tell it expired 10/27/21 and I do not see it being extended. Maybe I'm reading it wrong. Maybe I missed a legal document.

By the way, all these regulations are not really regarding whether or not it's billable, but whether or not the provider is even allowed to provide the service.
 
It depends on what your State has decided, as Christine says above. In Ohio, the provider and the patient must be in-state for a telehealth service to occur. And state law supercedes Medicare on this, so even though Medicare has relaxed their rules on location during the pandemic, if your state doesn't allow it then you can't do it.
 
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