Indiana Family & Social Services Administration Telemedicine Reimbursement Rules

This rule defines telemedicine services and describes the circumstances under which Medicaid will reimburse for such services. The coverage for telemedicine services is an added benefit to providers and recipients. Billing would occur within existing formats. Billing requirements would include a specific procedure code for the spoke site and a specific modifier to be used by the hub site along with established procedure codes, of which the provider is already aware.

The Indiana Family and Social Services Administration (FSSA) anticipates that this rule will save the state approximately $23,760 annually. This is based on a hundred mile round trip to a provider for which Medicaid would be responsible at a base rate of $20 (round trip) and mileage of $1.25 for 80 miles (round trip Medicaid does not pay mileage for the first 10 miles of each one-way trip). These expenses amount to $120. Subtracting the facility fee of $21 (currently planned to be priced at the Medicare rate of approximately $21) would result in savings of $99 for each instance of telemedicine. The FSSA estimates that at least 20 patients per month will use the service, which will save FSSA  $1,980 per month.