Reminder: Providers Delivering Services Via Telehealth

To ensure that members are receiving high-quality care, the Office of MaineCare Services (OMS) requests that providers review the Telehealth Policy within the MaineCare Benefits Manual (MBM). Please review your current practices and ensure compliance with the MBM.

Many MaineCare-covered services may be delivered via Telehealth Services, provided the following requirements are met:

  • The member is otherwise eligible for the covered service, as described in the appropriate section of the MBM
  • The service delivered via telehealth is of comparable quality to what it would be if delivered in person
  • The delivery of the covered service via Telehealth Services is medically appropriate

Healthcare providers must ensure that the telecommunication technology and equipment used at the receiving (provider) site and the originating (member) site are sufficient to allow the health care provider to appropriately deliver the service(s). A Telehealth Service shall be performed on a secure telecommunications line or utilize a method of encryption adequate to protect the confidentiality and integrity of the Telehealth Service information in accordance with state and federal laws, rules, and regulations.

Provider requirements: To be eligible for reimbursement for Telehealth Services, a healthcare provider must:

  • Act within the scope of their license
  • Be enrolled as a MaineCare provider
  • Be appropriately licensed, accredited, certified, and/or registered in the state where the member is located during the provision of the telehealth service
  • Comply with all applicable sections of the MBM, including, but not limited to:
    • Section(s) covering the service(s) being delivered
    • Chapter I, Section 4 – Telehealth Services
    • Chapter I, Section 1 – General Administrative Policies and Procedures

Telehealth Services are voluntary. Providers must give members the option to refuse Telehealth Services and receive services “in person” without affecting the member’s right to future care or treatment. 

Billing when Services are Rendered via Telehealth  

Providers must submit claims in accordance with Department billing instructions.  

When billing for Telehealth Services, healthcare providers at the receiving (provider) site must bill for the covered service, using the same procedure code they would use if it were delivered in-person, and must add the GT modifier to the claim. 

For questions, please contact your Provider Relations Specialist.