CPT-Chart: Econsult Medicaid Fee Schedule
This document, the "eConsult Medicaid Fee Schedule (January 1, 2024)", outlines the reimbursement policies for interprofessional consultation codes (commonly referred to as "eConsult" codes) under state Medicaid programs in the United States. Key points include:
- Definition of eConsult:
- Refers to telehealth services where a primary physician or qualified healthcare professional consults with a specialist remotely to manage a patient's care without a face-to-face visit.
- Details on CPT Codes:
- Lists and explains codes 99446 through 99452, covering consultations ranging from 5 to 30+ minutes.
- Highlights specific requirements for reporting these codes, including time thresholds.
- State-by-State Coverage:
- Provides a comprehensive chart indicating which states reimburse for each code under Medicaid, including notes for states with unique implementations (e.g., FQHC-specific provisions or telepsychiatry-only coverage).
- FQHC Considerations:
- Discusses how Federally Qualified Health Centers (FQHCs) may handle these codes differently depending on state-specific policies.
- Variability in Reimbursement:
- Indicates that Medicaid coverage for these codes varies significantly across states, emphasizing the need to consult local fee schedules.
- Support and Acknowledgments:
- This document is supported by the National Association of Community Health Centers (NACHC) and the Center for Connected Health Policy (CCHP) and highlights ongoing efforts to standardize telehealth reimbursement.
It serves as a resource for healthcare providers to navigate Medicaid reimbursement for telehealth interprofessional consultations.
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