The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").
MO HealthNet covers Telehealth services. MO HealthNet allows any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.
Telehealth services may be provided to a MHD participant, while at home, using their telephone. The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.
There is not a separate telehealth fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.
Please find information regarding Telehealth billing and reimbursement here: https://dss.mo.gov/mhd/providers/pdf/bulletin41-20-2018.pdf. You can also view the Missouri Telehealth law here: 191.1145, 191.1146, 208.670, and 208.677.
Newly added (03/23/2020): Hospitals may bill a facility fee for distant site services provided in their facilities. The distant site service must be reported on the UB04 claim form with the procedure code, GT modifier, and zero billed charges. The billed charges for the facility fee must be billed on a separate line of the claim. The physician providing the service will still bill for their distant site services on the medical claim form.
RHCs may use either their RHC provider number or their non-RHC provider number when operating as a distant site. Please find information regarding RHC billing for Telehealth here: https://dss.mo.gov/mhd/providers/pdf/bulletin41-44_3-19.pdf.
RHCs, both Provider Based and Independent, billing for distant site services on a UB04 claim form must include the GT modifier on their claim.
During this event, the MHD is:
- Waiving the requirement that physicians must have an established relationship with the patient before providing services via telehealth.
- Waiving the co-payment for any services provided by means of Telehealth.
- **Allowing the use of telephone for telehealth services.
- **Allowing quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number.
- Waiving the requirement that, in order to treat patients in this state with telemedicine or telehealth, health care providers shall be fully licensed to practice in this state. MHD will allow providers to bill for telehealth services as long as they are licensed in the state in which they practice.
- **Providers must still be enrolled as MHD providers through Missouri Medicaid Audit and Compliance (MMAC).
This Hot Tip applies to providers contracted with the Managed Care Organizations.
**Clarified 3/26/20