Page 135 State Telehealth Laws and Reimbursement Policies A Comprehensive Scan of the 50 States and District of Columbia

Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

All services must be:

• Medically necessary;
• The procedure, product, or service is individualized,
specific, and consistent with symptoms or confirmed
diagnosis of the illness or injury under treatment, and
not in excess of the recipient’s needs;
• The procedure, product, or service can be safely
furnished, and no equally effective and more
conservative or less costly treatment is available
statewide;
• The procedure, product, or service is furnished in a
manner not primarily intended for the convenience of
the recipient, the recipient’s caretaker, or the provider.

Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 3, Nov. 15, 2013.

Providers must obtain prior approval from NC Medicaid
for all services delivered via telemedicine and tele-
psychiatry. Providers must submit:

• Prior approval request;
• All health records and any other records to
document that the patient has met the specific
criteria for telemedicine services;
• If the patient is under age 21, information
supporting that all Medicaid Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT)
criteria are met, and evidence-based literature
supporting the request, if available.

Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 5, Nov. 15, 2013.
Store and Forward Reimbursement

No reference found. North Carolina Medicaid will not reimburse for Store and
Forward.

Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 7, Nov. 15, 2013.
Remote Patient Monitoring Reimbursement

No reference found. No reference found.
Email/Phone/FAX Restrictions

No reference found. No reimbursement for email.
No reimbursement for telephone.
No reimbursement FAX.

Source: NC Div. of Medical Assistance, Medicaid and Health
Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine
and Telepsychiatry, p. 7, Nov. 15, 2013.

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