Reminder: Telehealth Services
| Date: | September 3, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Providers |
| Type: | Informational/Educational |
| Subject: | Reminder: Telehealth Services |
| Business: | Medi-Cal Managed Care |
Due to recent federal immigration changes, it may potentially cause members to be fearful of visiting your clinic, which may lead to missed or canceled appointments. Since in-person health services may be difficult for some members, we encourage you to inform them about telehealth as an available option, whenever applicable.
As a reminder, telehealth is a reimbursable benefit. The amount paid for a service rendered via telehealth is the same as the amount paid for the applicable service when rendered in person.
Please see below for Telehealth definition and billing guidance:
Telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.
Reimbursable Telehealth Services
Medi-Cal covered benefits or services, identified by CPT or HCPCS codes and subject to all existing Medi-Cal coverage and reimbursement policies, including any prior authorization requirements, may be provided via a telehealth modality, only if all of the following are satisfied:
- The treating health care provider at the distant site believes that the benefits or services being provided are clinically appropriate based upon evidence-based medicine and/or best practices to be delivered via telehealth;
- The benefits or services delivered via telehealth meet the procedural definition and components of the CPT or HCPCS code(s), as defined by the American Medical Association (AMA), associated with the Medi-Cal covered service or benefit, as well as any extended guidelines as described in the Medi-Cal provider manual;
- The benefits or services provided via telehealth meet all laws regarding confidentiality of health care information and a patient’s right to his or her medical information.
Telehealth Billing
To ensure proper payment, the modifiers defined in the Medi-Cal Provider Manual must be used with the appropriate CPT or HCPCS codes when coding for services delivered through both synchronous interactions and asynchronous store and forward telecommunications. In addition, through the new Claims Editing System (CES), a combination of correct place of service and modifier is required and must be billed on the same claim line, under the appropriate field.
For additional guidance on telehealth, please visit the Medi-Cal Provider Manual at https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/D5289F68-C42E-4FE8-B59F-FA44A06D2863/mednetele.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO
For additional resources for Health Plan members navigating Medi-Cal and the federal immigration changes, please see the attached flyer.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
