Page 21 50 State Telemedicine Gaps Analysis Coverage and Reimbursement

50 State Telemedicine Gaps Analysis: Coverage & Reimbursement

H. Physician-provided Telemedicine Services

Physician-provided telemedicine services are commonly covered and reimbursed by Medicaid
health plans. However, some plans base coverage on a prescribed set of health conditions or
services, place restrictions on patient or provider settings, the frequency of covered telemedicine
encounters, or exclude services performed by other medical professionals.

For this report, we measured components of state Medicaid policies that broaden or restrict a
physician’s ability to use telemedicine for conditions of coverage and payment.

Scale – Medicaid: Physician-
provided Services
A 13 points
B 10-12 points
C 7-9 points
F ≤ 6 points

Ten states and D.C. rank the highest for coverage of telemedicine-provided physician services.
These states have no restrictions on service coverage or additional conditions of payment for
services provided via telemedicine. Additionally, these states also allow a physician assistant
and/or advanced practice nurse as eligible distant site providers.

Moreover, most states cover an office visit or consultations, with ultrasounds and
echocardiograms being the least covered telemedicine-provided services (Figure 11).

Figure 11

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American Telemedicine Association
2015