How do I bill for DSME delivered via telehealth?
Use these resources to expedite the billing process.
Under Ohio Administrative code, telehealth is considered the interaction with a patient via synchronous, interactive, real-time electronic communications that includes both audio and video elements, or the following activities that are asynchronous or do not have both audio and video elements:
- Telephone calls.
- Remote patient monitoring.
- Communication with a patient through secure electronic mail or a secure patient portal.
Medicaid covered individuals can access telehealth services wherever they are located.
Locations include, but are not limited to:
- Home.
- School.
- Temporary housing.
- Homeless shelter.
- Nursing Facility.
- Hospital.
- Group home.
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs).
Billing for Practices
These codes can be used when billing for telehealth:
- G0108 Diabetes management training, individual, 30 minutes.
- G0109 Diabetes management training, group, 30 minutes.
Claims billed with CPT code T1015 and the U1 modifier should be billed directly to the Ohio Department of Medicaid.
In most cases, the “GT” modifier is required to identify the service delivery through telehealth.
Access Ohio Department of Medicaid telehealth billing guide >
Billing for MCPs and MCOPs
The MCPs and MCOPs cover the same telehealth services as in fee-for-service but may have different billing requirements. For questions about submitting claims for telehealth to the MCPs and MCOPs, providers should contact the plans directly.
Contact Medicaid Managed Care plans >
Access Ohio Department of Medicaid MCP telehealth billing guide >
Billing for Behavioral Health Providers
For services rendered by behavioral health providers as defined in rule 5160-27-01 of the Administrative Code, telehealth is further defined in rule 5122-29-31 of the Administrative Code. If you are a behavioral health agency certified by the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and delivering DSMe services, please refer to the billing guidance below.
Access Ohio Department of Medicaid behavioral health billing guide >