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Policy for Telemedicine Services

Telemedicine is the real time or near real time two-way transfer of medical data and information between places of lesser and greater medical capability and expertise.

Medical data exchanged can take the form of multiple formats: text, graphics, still images, audio and video. The information/data exchange can occur in real time (synchronous) through interactive video or multimedia collaborative environments, or in near real time (asynchronous) through store and forward applications such as electronic mail, fax or phone-mail.

The South Dakota Medical Assistance Program coverage for telemedicine technology is limited to physician consultation services, follow-up office visits for established patients, and pharmacological management services.

Coverage of telemedicine physician consultations is treated like all other consultation services as defined in the Physician’s Current Procedural Terminology (CPT). Appropriate CPT codes for telemedicine physician consultation services are within the CPT procedure code range of 99241 – 99275.

The South Dakota Medical Assistance Program also reimburses telemedicine technology services for follow-up visits of established patients. Specifically, reimbursement for follow-up visits for established patients delivered via telemedicine are limited to CPT evaluation and management procedure code range of 99211 – 99215. South Dakota covers CPT code 90801, psychiatric examinations, via telemedicine when provided by a psychiatrist. Additionally, telepsychiatric services for pharmacological management, procedure code 90862 are also covered.

When billing the South Dakota Medical Assistance Program for telemedicine services, the addition of the procedure code modifier “GT” is required. The “GT” modifier denotes the service was provided via telemedicine technology. The modifier has no bearing on the reimbursement amount made for the procedure provided, and there is no additional reimbursement payable for the use of the telemedicine network.

It is not appropriate to bill the Medical Assistance Program for telemedicine network costs under any additional CPT procedure code.

Reimbursement is allowed at both ends of the telemedicine service and is limited to providers who are allowed to bill the CPT codes identified above. Both the ‘hub’ and ‘spoke’ providers must use the appropriate CPT procedure code and the modifier code in accordance to the services provided.

If you have questions regarding the provision of telemedicine services, please contact the provider telephone service unit at one of the numbers below:

  • In-state providers: 1-800-452-7691
  • Out-of state providers: 605-773-3495