Pennsylvania State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Pennsylvania Medical Assistance Program (MA)

Pennsylvania
Medicaid Program: Pennsylvania Medical Assistance Program (MA)

Medicaid Program Administrator: Department of Public Welfare Regional Telehealth Resource Center:

PO Box 800711
Charlottesville, VA 22908-0711

(434) 906-4960 / (855) MATRC4U
www.matrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

No reference found. Telemedicine is the use of real-time interactive
telecommunications technology that includes, at a
minimum, audio and video equipment as a mode of
delivering consultation services.
Source: PA Department of Public Welfare, Medical Assistance
Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (accessed Oct.
2017).

Live Video Reimbursement

No reference found. Pennsylvania Medicaid will reimburse for live video for

specialty consultations.
Eligible Providers (fee for service):
Physicians
Certified registered nurse practitioners
Certified nurse midwives
Providers under a managed care system should contact
the appropriate managed care organization.
Source: PA Department of Public Welfare, Medical Assistance
Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (accessed Oct.
2017).
Telepsychiatry Services
PA Medicaid will reimburse licensed psychiatrists and
licensed psychologists for telepsychiatry outpatient
services including:
Psychiatric diagnostic evaluations
Psychological Evaluations
Pharmacological management
Consultations (with patient/family)
Psychotherapy
Providers must have documented endorsement to
deliver mental services through telepsych from the
county mental health program and the HealthChoices
Behavioral Health Managed Care Organization, and this
endorsement must be submitted to the PA Office of
Mental Health and Substance Abuse Services regional

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

office for final approval.

Source: PA Department of Public Health, Medical Assistance
Bulletin OMHSAS-14-01, Mar. 18, 2014 (accessed Oct. 2017).
For FQHCs & RHCs
Telepsychiatry Services – Only applicable to Behavioral
Health Managed Care delivery system claims and not
fee-for-service delivery. Service is in real-time,
interactive audio-video transmission and do not include
phone, email or facsimile transmission. Consultation
between two healthcare practitioners do not count as a
qualifying service. Service providers are limited to
psychologists and psychiatrists.
Source: PA PROMISe, 837 Professional/CMS-1500 Claim Form,
Provider Handbook, Appendix E – FQHC/RHC. p. 10 (Apr. 22,
2014). (Accessed Oct. 2017).

Store and Forward Reimbursement

No reference found. Pennsylvania Medicaid will not reimburse for store and
forward.
Source: PA Department of Public Welfare, Medical Assistance
Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (accessed Oct.
2017).

Remote Patient Monitoring Reimbursement

No reference found. No reference found.

Email/Phone/FAX

No reference found. No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.
Source: PA Department of Public Welfare, Medical Assistance
Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (accessed Oct.
2017).

Online Prescribing

No reference found. No reference found.

Consent

No reference found. Informed consent is required from individuals
participating in any services utilizing telepsych.
Source: PA Department of Public Health, Medical Assistance
Bulletin OMHSAS-14-01, Mar. 18, 2014 (accessed Oct. 2017).

Location

No reference found. No reference found.

Cross-State Licensing

Recently Passed Legislation No reference found.
PA adopted the Interstate Medical Licensure Compact.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: HB 1619 (2015).

Pennsylvania issues extraterritorial licenses to

physicians residing or practicing in an adjoining state,
near the Pennsylvania boundary, and whose practice
extends into Pennsylvania to practice in Pennsylvania.

Pennsylvania bases the granting of this license on the

availability of medical care in the area involved, and
whether the adjoining state extends similar privileges to
Pennsylvania physicians.

Source: PA Statutes Annotated, Title 63 Sec. 422.34(a) and (c) (2).

Private Payers

No reference found. No reference found.

Site/Transmission Fee

No reference found. Originating site may bill for facility fee.
Source: PA Department of Public Welfare, Medical Assistance
Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012 (accessed Oct.
2017).
Source: PA Department of Public Health, Medical Assistance
Bulletin OMHSAS-14-01, Mar. 18, 2014 (accessed Oct. 2017).

Miscellaneous

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