Currently there are more questions than answers on the topic of tele-audiology reimbursement. There are no standards on reimbursement. It is necessary to look at individual state laws (ASHA, 2012).
- Forty-four states have reimbursement (live-video procedures only) and seven states reimburse partly for store-and-forward applications.
- Fifteen states have telehealth legislation regarding private payers.
- Privately held insurance companies are not required to follow state laws on insurance coverage –only those who are “insurance companies” must comply.
- As of October 29, 2013, there were only 20 states plus the District of Columbia, that require insurance companies to pay for some form of telemedicine services: Arizona, California, Colorado, Georgia, Hawaii, Kansas, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, New Hampshire, New Mexico, Oklahoma, Oregon, Texas, Vermont, and Virginia.
Centers for Medicare and Medicaid Services (CMS)
- Medicare regulations do not include audiologists or speech pathologists as eligible providers for telemedicine.
- The telehealth Healthcare Common Procedure Coding System (HCPCS) codes recommended by CMS are not reimbursable for audiologists (G0425-G0427). However, some states’ Medicaid will reimburse all audiology codes with a GT modifier as long as there is justification for how services will be completed (e.g., hearing aid electroacoustic analysis and reprogramming would be feasible but earmold impressions would not).
- Many grants are available for private practices, government agencies, and non-government agencies to create tele-practice programs. The Health Resources and Services Administration (HRSA) division of the U.S. Department of Health and Human Services is a valuable resource for grant information.
American Speech-Language-Hearing Association. (2012) State Provisions Update for Telepractice. www.asha.org/Practice-Portal/Professional-Issues/Telepractice/State-Provisions-Update-for-Telepractice (accessed April 1, 2012).