DSAMH TELEHEALTH AND BILLING

GUIDE FOR CONTRACTED

PROVIDERS DURING COVID-19
PANDEMIC
TABLE OF CONTENTS
Background ............................................................................................................................ 2
Coverage ................................................................................................................................ 2
Limitations ............................................................................................................................. 2
SCOPE .................................................................................................................................... 2
Delivery .................................................................................................................................. 2
Interactive........................................................................................................................................ 3
Telephonic ....................................................................................................................................... 3
HIPAA Requirements ........................................................................................................................ 3
Prohibited Programs ............................................................................................................................................. 3
Telephonic Services ................................................................................................................ 3
Sites ....................................................................................................................................... 3
Clients Located out of State .............................................................................................................. 4
Established relationship requirements .................................................................................... 4
Provider Eligibility .................................................................................................................. 4
Providers Not Licensed to Practice in Delaware ................................................................................ 4
Client Consent ........................................................................................................................ 4
Client Enrollment .................................................................................................................... 4
Billing ..................................................................................................................................... 4
DSAMH Programs ............................................................................................................................. 4
PROMISE ............................................................................................................................................................... 5
CBHOT/SUDOT/Co-OCCOT/IOP/PHP..................................................................................................................... 5
REIMBURSMENT RATES ........................................................................................................................................ 5
PRIOR AUTHORIZATION ................................................................................................................... 5
 DMES ............................................................................................................................................... 5
Facility FEES ..................................................................................................................................... 5
Interactive Services .......................................................................................................................... 5
Telephonic Services .......................................................................................................................... 5
Services of 45-50 Minutes in Duration .................................................................................................................. 6
Contact Information ............................................................................................................... 6
Division of Medicaid and Medial Assistance ..................................................................................... 6
Division of Substance Abuse and Mental HEalth ............................................................................... 6

BACKGROUND
Telehealth allows providers to deliver services to individuals remotely so that providers can monitor
and address health conditions. The federal Medicaid statute (Title XIX of the Social Security Act)
does not recognize telehealth as a distinct service.

COVERAGE
Medicaid covers medically necessary telehealth services under the State Plan. Any covered State
Plan service that would typically be provided to a client in a face-to-face setting is covered when
provided using telehealth. Similarly, if a service is not covered in a face-to-face setting, it is not
covered if provided through telehealth.
Chart reviews, electronic mail messages, facsimile transmissions or internet services for online
medical evaluations are not covered telehealth services.
In summary, a service provided through telehealth is subject to the same coverage, restrictions, and
limitations that exist when provided in person.

LIMITATIONS
Telehealth is not limited based on the diagnosed medical condition of the eligible recipient or
geographical location.

SCOPE
All telehealth services must be furnished within the limits of provider program policies and within
the scope and practice of the provider’s professional standards as described and outlined by the
Division of Medicaid and Medial Assistance (DMMA).

DELIVERY
DMMA has a longstanding telehealth policy that allows for all covered services under the State Plan
to be provided via telehealth. In response to COVID-19, DMMA has also expanded the methods that
telehealth may be delivered by allowing for both interactive and telephonic communication systems
to be used.

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INTERACTIVE
Provider and client interact in real-time using an interactive telecommunications system that
includes, at a minimum, audio and video equipment permitting two-way, real time interactive
communication between the client, at the originating site, and the physician or practitioner at the
distant site. Interactive telecommunications systems are appropriate for all covered services that
are provided via telehealth.
TELEPHONIC
Provider and client interact in real-time using an audio-only telecommunications system permitting
two-way, real-time communication between the client, at the originating site, and the physician or
practitioner at the distant site. Telephonic telecommunications systems are appropriate when it is
determined that interactive telecommunications systems are unavailable and telephonic
telecommunications systems are medically appropriate for the underlying covered service.
HIPAA REQUIREMENTS
The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS).
OCR published a Notification of Enforcement Discretion (“Notification”) regarding HIPAA
noncompliance in connection with the provision of telehealth services that states it “will exercise its
enforcement discretion and will not impose penalties for noncompliance with the regulatory
requirements under the HIPAA Rules against covered health care providers in connection with the
good faith provision of telehealth” during the public health emergency.
The notification states that telehealth services may be provided using “any non-public facing remote
communication product that is available to communicate with clients.” This means that more widely
used and available consumer services and products that would not typically meet the HIPAA privacy
and security standards for telehealth can be used. Examples of such services and products include
FaceTime and Skype.
PROHIBITED PROGRAMS
Under this notification, however, Facebook Live, Twitch, TikTok, and similar video communication
applications are public facing, and should not be used in the provision of telehealth by covered
health care providers.

TELEPHONIC SERVICES
DMMA has expanded the methods that telehealth may be delivered to include telephonic services in
addition to interactive services, if it is determined that interactive services are unavailable, and
telephonic services are medically appropriate for the underlying covered service.

SITES
Two distinct sites are necessary for delivering telehealth services. The first site, called the
originating site refers to the location of the client during the telehealth encounter and may include
the client’s place of residence or any alternate location in which the client is physically present, and
telehealth can be effectively utilized.
The second site, called the distant site, refers to the site at which the physician or other licensed
practitioner delivering the service is located at the time the telehealth service is provided. Generally,
providers are not required to be physically present at a specific site.
DMMA has lifted all restrictions pertaining to the location of distant and originating sites.

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CLIENTS LOCATED OUT OF STATE
As of March 18, 2020, any requirements under Title 24 of the Delaware Code that clients be present
in Delaware at the time the telemedicine service is provided are suspended, so long as the client is a
Delaware resident.

ESTABLISHED RELATIONSHIP REQUIREMENTS

As of March 18, 2020, any requirements under Title 24 of the Delaware Code that require clients to
present in-person before telehealth services are provided are suspended.

PROVIDER ELIGIBILITY
As of March 18, 2020, DMMA relaxed eligibility requirements for providers utilizing telehealth. To be
covered, providers must do all of the following:
• Act within their scope of practice;
• Be licensed to provide the service for which they are billing;
• Be enrolled, or in the process of enrolling, with DMAP; and,
• Be located within the United States.
PROVIDERS NOT LICENSED TO PRACTICE IN DELAWARE
Any out of state healthcare provider who would be permitted to provide telemedicine services in
Delaware if they were licensed under Title 24 of the Delaware Code may provide telemedicine
services to a Delaware resident if they hold an active license in another jurisdiction.

CLIENT CONSENT
DMMA revised client consent requirements as follows:
Consent is required to assure that the recipient is a willing participant in the telehealth delivered
service and to assure that the recipient retains a voice in their treatment plan. The client must be
informed and given an opportunity to request an in-person assessment before receiving a telehealth
assessment. Verbal consent is acceptable, and written consent is no longer required. However, this
consent must be documented in the client’s record.

CLIENT ENROLLMENT
Effective March 18, 2020 all renewals are suspended to avoid lapses in coverage for DMMA
beneficiaries.

BILLING
In general, services must be billed in accordance with applicable sections of DMAP Provider
manuals. For telehealth services, the same procedure codes and rates apply to the underlying
covered service as if those services were delivered face-to-face.
DSAMH PROGRAMS
The following information is specific to the DSAMH DMAP Provider manual.

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PROMISE
Bill all PROMISE services delivered via telehealth the same as if they were delivered face-to face.
Use all existing codes and modifiers outlined in the DSAMH PROMISE billing manual. Indicate in the
client’s progress note if services were delivered via telehealth or face-to-face.
CBHOT/SUDOT/CO-OCCOT/IOP/PHP
Bill all CBHOT, SUDOT, CO-OCCOT, IOP, and PHP services delivered via telehealth the same as if
they were delivered face-to face.
If services were provided via telehealth prior to the pandemic, continue to bill using the GT modifier
and Q3014 facility fee.
If services are being provided to Medicaid clients via telehealth due to the pandemic continue to bill
DXC following the most recent DMMA, MCO, Commercial Carrier or Medicare requirements.1
Indicate in the client’s progress note if services were delivered via telehealth or face-to-face.
REIMBURSMENT RATES
There will be no associated changes to rates for services provided via telehealth unless changes to
the coding, billing limits and claims billing rules occur. Should new codes be added DSAMH will
reimburse at the Medicaid rate.
PRIOR AUTHORIZATION
No changes have been made to the prior authorization process.
DMES
The Delaware Medicaid Enterprise System (DMES) is currently being updated to conform with the
new telehealth policies. This update may cause delays in payment for telehealth services.
FACILITY FEES
If the provider at the originating site is making a room and telecommunications equipment available,
the provider may bill for an originating facility fee using code Q3014.
INTERACTIVE SERVICES
Providers billing for interactive services should continue to bill their appropriate usual & customary
charge for the service provided and use the place of service value 02 modifier for all charges.
TELEPHONIC SERVICES
Providers billing for Telephonic Services should use the following codes as appropriate, and should
use Place of Service Value 02 Modifier for all Telehealth charges:
• Physician or other qualified health professional:
o 99441: 5-10 minutes of medical discussion
o 99442: 11-20 minutes of medical discussion
o 99443: 21-30 minutes of medical discussion
• Qualified Non-Physician:
o 98966: 5-10 minutes of medical discussion
o 98967: 11-20 minutes of medical discussion
o 98968: 21-30 minutes of medical discussion

1 DSAMH recognizes that not all billing systems allow for different configurations based on the payor (DSAMH, DMMA, MCO,

etc.…) Providers needing assistance with billing assistance configuration should contact DSAMH.

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SERVICES OF 45-50 MINUTES IN DURATION
For example, if a telepsychiatry call lasts for 45 minutes, the provider should use two codes. The
provider should bill for the appropriate 21-30 minutes of medical discussion code (99443 or 98968)
and the appropriate 11-20 minutes of medical discussion code (99442 or 98967).

CONTACT INFORMATION

DIVISION OF MEDICAID AND MEDIAL ASSISTANCE

If you have questions related to Medicaid please contact DMMA Provider Services by phone at 1-
800-999-3371; Option 0, then Option 2, by secure message through the Provider Portal, or by email*
at delawarepret@dxc.com *Reminder: Do not send any correspondence that has protected health
information (PHI) to this mailbox.
DIVISION OF SUBSTANCE ABUSE AND MENTAL HEALTH
If you have any DSAMH billing questions or concerns, please contact Jessica Wilson at
Jessica.Wilson@delaware.gov or Darah Blunt at Darah.Blunt@delaware.gov.