Wyoming is getting closer every day to better coverage for telemedicine. Without a telemedicine parity law in place, there’s no mandate for private payers to reimburse for telemedicine services, although many still do. However, Wyoming Medicaid is one of the few states to offer coverage for specialty telemedicine services for substance abuse. Plus, Wyoming has adopted legislation to join the Interstate Medical Licensure Compact! The compact makes it easier for out-of-state telehealth providers to practice in Wyoming.
Wyoming Medicaid reimburses for live video under some circumstances. There is no reference to store-and-forward or remote patient monitoring reimbursement.
Telehealth is the use of an electronic media to link beneficiaries with health professionals in dif-ferent locations. The examination of the client is performed via a real-time interactive audio and video telecommunications system. This means that the client must be able to see and interact with the off-site practitioner at the time services are provided via telehealth technology.”
Reimbursement is made for exams performed via a real-time interactive audio and video telecommunications system. The quality must be sufficient enough to assure the accuracy of the assessment, diagnosis, and visible evaluation of symptoms and potential medica-tion side effects. A medical professional is not required to be present with the client at the originating site unless medically indicated. See manual for additional billing requirements.
For ESRD-related services, at least one face-to-face “hands on” visit must be furnished each month to examine the vascular access site by a qualified provider.
Source: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 109-111 (Jan. 1 2020). (Accessed Feb. 2020). Diabetes Prevention Program (DPP)
The first session of a DPP program cannot be performed via telehealth, but sessions 2-16 can be. The GT modifier should be used. Source: WY Dept. of Public
• Physicians;
• Advanced practice nurses with a specialty of psychiatry/mental health;
• Physician’s assistant;
• Psychologists and neuropsychologists;
• Licensed Mental health professionals (LCSW, LPC, LMFT, LAT);
• Board Certified Behavioral Analysts;
• Speech therapist.
Provisionally licensed mental health professionals cannot bill Medicaid directly, but must provide services through a supervising provider. Source: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 109 (Jan. 1 2020). (Accessed Feb. 2020). Any telehealth provider such as Community Mental Health Centers and Substance Abuse Treatment Centers can bill telehealth services where the provider is at one location and the client is at a different location even though the pay to provider is the same. A single pay to provider can bill both the originating site (spoke site) and the distant site provider (hub site)
when applicable. Source: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 108 (Jan. 1 2020). (Accessed Feb. 2020)
Each site will be able to bill for their own services as long as they are an enrolled Medicaid
provider (this includes out-of-state Medicaid providers). Providers shall not bill for both the
spoke and hub site.
Examples of eligible originating sites:
• Hospitals;
• Physician or practitioner offices (includes medical clinics);
• Psychologists or neuropsychologists offices;
• Community mental health or substance abuse treatment centers (CMHC/SATC);
• Advanced practice nurses with specialty of psychiatry/mental health offices;
• Office of a Licensed Mental Health Professional;
• Federally Qualified Health Centers;
• Rural Health Clinics;
• Skilled nursing facilities;
• Indian Health Services Clinics;
• Hospital-based or Critical Access Hospital-based renal dialysis centers (including
satellites). Independent renal dialysis facilities are not eligible originating sites;
• Development Center;
• Family Planning Clinics;
• Public Health Offices;
• Client’s Home (Telehealth consent required).
A medical professional is not required to be present at the originating site, unless medically
indicated.
Each site is able to bill their own services as long as they are an enrolled Medicaid provider
(includes out-of-state Medicaid providers).
Source: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 107-109 (Jan. 1 2020). (Accessed Feb. 2020).