Md. Code Regs. 10.09.49.07

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.49.07 - Limitations

A. A service delivered via telehealth is subject to the same program restrictions, preauthorizations, limitations, and coverage that exist for services delivered in person.

B. A service delivered via telehealth does not include:

(1) An audio-only telephone conversation between a health care provider and a patient unless provided on dates of service between July 1, 2021, and June 30, 2025, inclusive;

(2) An electronic mail message between a health care provider and a patient;

(3) A facsimile transmission between a health care provider and a patient; or

(4) A telephone conversation, electronic mail message, or facsimile transmission between providers without direct interaction with the patient.

C. Store and forward technology does not meet the Maryland Medical Assistance Program's definition of telehealth. The Maryland Medical Assistance Program covers services such as dermatology, ophthalmology, and radiology according to COMAR 10.09.02.07.

D. The provider may not bill the Maryland Medicaid Assistance Program for services delivered via telehealth when technical difficulties preclude the delivery of all or part of the telehealth session.

E. The Department may not reimburse for services that:

(1) Require in-person evaluation; or

(2) Cannot be reasonably delivered via telehealth as specified in provider specific COMAR chapters, and subregulatory guidance issued by the Department.

F. A provider eligible to bill a professional fee for a health care service shall bill a professional fee for the health care service instead of a clinic facility fee.

Md. Code Regs. 10.09.49.07

Regulation .07 amended effective December 22, 2014 (41:25 Md. R. 1479)
Regulation .07 amended effective 42:21 Md. R. 1300, eff.10/26/2015; amended effective 43:7 Md. R. 449, eff.4/11/2016; amended effective 43:21 Md. R. 1166, eff. 10/24/2016; amended effective 44:21 Md. R. 983, eff. 10/23/2017; amended effective 45:6 Md. R. 319, eff. 3/26/2018; recodified from .08 effective 46:20 Md. R. 843, eff. 10/7/2019; amended and recodified from .09 effective 50:14 Md. R. 593, eff. 7/24/2023