Page 63 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

(see Medicaid column) Indiana Code requires reimbursement for video
conferencing for FQHC, Rural Health Clinic, Community
Mental Health Centers, and Critical Access Hospital
providers.

Source: IN Code, 12-15-5-11.

Indiana Medicaid will reimburse for live video, as long as
certain conditions are met.

The hub site provider must determine if it is medically
necessary for a medical professional to be at the spoke
site.

For a medical professional to receive reimbursement for
professional services in addition to payment for spoke
services, medical necessity must be documented. If it is
medically necessary for a medical professional to be with
the member at the spoke site, the spoke site is permitted
to bill an evaluation and management code in addition to
the fee for spoke services. There must be documentation
in the patient's medical record to support the need for the
provider's presence at the spoke site. The documentation
is subject to post-payment review.

Source (authorization): IN Admin. Code, Title 405, 5-38-1 (2012).

Source (hub-spoke provider reimbursement): IN Admin. Code, Title
405, 5-38-4 (2012) & IN Health Coverage Programs Provider Manual,
Chapter 8, Billing Instructions, p. 139 (Jun. 5, 2014).
http://provider.indianamedicaid.com/ihcp/manuals/chapter08.pdf

Reimbursement for the following:

Consultations
Office or other outpatient visit
Individual psychotherapy
Psychiatric diagnostic interview
Pharmacologic management
End-stage renal disease (ESRD) services

Source: IN Health Coverage Programs Provider Manual, Chapter 8,
Billing Instructions, p. 140 (Jun. 5, 2014).

No reimbursement for the following:

• Ambulatory surgical centers;
• Outpatient surgical services;
• Home health agencies or services;
• Radiological services;
• Laboratory services;
• Long-term care facilities, including nursing
facilities, intermediate care facilities, or community
residential facilities for the developmentally
disabled;
• Anesthesia services or nurse anesthetist services;
• Audiological services;

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