Telehealth Service Reminder

Many MaineCare-covered services may be delivered via Telehealth. This is especially useful when patients have trouble making appointments due to transportation, weather, work, or other challenges. To ensure that members receive 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. 

The service must meet the following requirements: 

  • 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 healthcare provider to appropriately deliver the service(s). A Telehealth Service must be performed on a secure telecommunications line or utilize an encryption method 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 

Billing when Services are Rendered via Telehealth   

  • Providers must submit claims in accordance with Department billing instructions.   
  • Unless otherwise specified, all services must be billed in accordance with applicable sections of the MBM.   
  • The same procedure codes and rates apply to the covered service billed for both telehealth and services delivered in-person.   
  • 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 correct modifier to the claim.  
  • Modifier 93 for telephonic services 
  • Modifier GT for interactive telehealth services 

For questions, please contact your Provider Relations Specialist.