Medicaid Banner Message: Telehealth and Telemedicine

Dear Provider Community,

In accordance with the Georgia Telehealth Act, enrolled providers may render medically necessary covered services, when appropriate, with Telehealth or Telemedicine. The provisions below apply to in-state providers and out-of-state providers.

Licensing and Credentialing Requirements for Providers Rendering Services via Telehealth or Telemedicine

All enrolled providers, rendering services using Telemedicine or Telehealth must possess the required credentials and be legally allowed to practice within the state of Georgia. All enrolled providers must be credentialed by DCH’s Centralized Credentialing Verification Organization (CVO) or through a delegated credentialing arrangement with a Care Management Organization (CMO).

All individual practitioners must possess the appropriate Georgia license (this includes a Telemedicine License, Temporary License or Emergency Practice Permit), permit, certificate, approval, registration, or other form of permission issued by an entity other than the Department of Community Health (DCH), which form of permission is required by law. All enrolled individual practitioners must act within the scope of his or her practice as defined by federal and state laws, rules, and regulations.

Telemedicine/Telehealth services shall be subject to utilization review and auditing requirements.

Providers must maintain documentation of all services provided by Telemedicine/Telehealth in accordance with DCH policy.

Admitting Hospital Privileges

In-state physicians providing services using Telemedicine/Telehealth must have admitting privileges at a Georgia hospital or an arrangement with a local physician who has admitting privileges.

Out of state physicians providing services via Telehealth must have an arrangement with a local physician who has admitting privileges or a local hospitalist.

Prescribing Medications Via Telehealth

Providers may prescribe medications with Telemedicine/Telehealth. All prescribers, whether in-state or out-of-state, must have and use his or her unique Drug Enforcement Administration (DEA) registration number to authorize controlled substance prescriptions. DEA regulations require practitioners to obtain a separate DEA registration in each state in which he or she prescribes controlled substances.

Accordingly, out of state practitioners, must obtain a Georgia DEA registration number if prescribing controlled substances to Georgia Medicaid and PeachCare for Kids members who are located within the state of Georgia. Out-of-state practitioners who do not prescribe controlled substances to Georgia Medicaid and PeachCare for Kids members within the state of Georgia are not required to have a Georgia DEA registration number.

Ordering, Prescribing, and Referring (OPR) Requirements for Telehealth Services:

1. The physician or non-physician practitioner who wrote the order, prescription or referral must be enrolled in Medicaid as either a participating Medicaid provider or as an OPR provider and his or her NPI number must be included on the claim.

2. The provider’s NPI number must be for an individual physician or non-physician practitioner (not an organizational NPI).

3. The physician or non-physician practitioner must be of a specialty type that is eligible to order, prescribe, or refer.

For addition information pertaining to OPR requirements, please click the following link: OPR FAQ.