California Mandates Payment for Telehealth

March 19, 2020
 / 
Rick Gawenda
 / 

Effective immediately, all health plans in the state of California shall comply with the following:

  1. Health plans shall reimburse providers at the same rate, whether a service is
    provided in-person or through telehealth, if the service is the same regardless of
    the modality of delivery, as determined by the provider’s description of the
    service on the claim. For example, if a health plan reimburses a mental health
    provider $100 for a 50-minute therapy session conducted in-person, the health
    plan shall reimburse the provider $100 for a 50-minute therapy session done via
    telehealth.
  2. For services provided via telehealth, a health plan may not subject enrollees to
    cost-sharing greater than the same cost-sharing if the service were provided in-person.
  3. Health plans shall provide the same amount of reimbursement for a service
    rendered via telephone as they would if the service is rendered via video, provided the modality by which the service is rendered (telephone versus video is medically appropriate for the enrollee.

Click HERE to read it for your self. Click HERE to read the notice that is posted on the California Physical Therapy Associations website.


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    1. Per the CPTA website: “Regarding payment for PT services via telehealth, the California Emergency Services Act (Gov. Code sections 8566, et seq.), states all health plans and Medi-Cal managed care health plans operating under the Department of Managed Health Care and the Department of Health Care Services shall, effective immediately, reimburse providers at the same rate, whether a service is provided in-person or through telehealth, if the service is the same regardless of the modality of delivery, as determined by the provider’s description of the service on the claim.”

  1. Rick, This is very open, does this order open the allow for Telehealth in addition to E visits for PT, OT and ST in CA? Does this order now allow PT/OT/ST to use any of the therapy always codes in additions to the Telehealth/E visit codes?

    1. This order will allow PTs in California to provide telehealth services and have insurance companies operating under the Department of Managed Health Care and the Department of Health Care Services pay for those services.

  2. There has been mention of specific modifiers, place of service, etc all needing to be billed a certain way per payer for telehealth. Can you elaborate on some of those guidelines?

  3. Rick do you have any updates on NY state regarding telehealth? If they approved it or only E visit for PT is approved for now ? I tried looking at NY PT association but their page has no information for PT with regards to COVID 19.
    Thank you