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The purpose of this bulletin is to notify providers of several updates to  coverage for telehealth services. The Telehealth Services Supplement will be updated to reflect  the following changes:

• Clarification of coverage for remote patient monitoring services for high-risk pregnant patients, including pregnant patients with maternal diabetes and maternal hypertension in compliance with the 2025 Acts of Assembly Chapter  (House Bill 1976).

• Clarification of coverage for remote patient monitoring services for patients with chronic or acute health conditions. 

• Clarification of provider requirements in compliance with the 2023  Acts of Assembly  (HB 1602, SB 1418) 

  • Licensed health care providers who provide health care services exclusively through telemedicine are not required to maintain a physical presence in the Commonwealth to be considered an eligible provider for enrollment as a Virginia Medicaid provider.

  • Telemedicine services rendered by provider groups with licensed health care providers are not required to have an in-state service address to be eligible to enroll as a Virginia Medicaid vendor or Medicaid provider group.

• Updates made to the Reimbursable Telehealth Services Tables 1-8, to reflect that coverage is available for the following codes:

  • Table 1, Medicaid-covered medical services authorized for delivery by telemedicine. 

  • CPT Code 96041 - Genetic Counseling 

  • Table 5, Medicaid-covered services authorized for delivery via remote patient monitoring.

  • CPT Code 95249 – Ambulatory continuous glucose monitoring (CGM) when patient provided equipment is used (bill 1x per device).

  • CPT Code 95250 -Ambulatory CGM equipment, setup, training, data collection, and reporting (bill 1x per month) the 

  • CPT Code 95251 - Ambulatory CGM  of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report. (bill 1x per month) 

  • Table 6, Virtual Check-In Services. 

  • CPT Code 98016 - Virtual check-in, Evaluation and Management E&M-eligible providers, 5-10 mins 

  • Table 7, Medicaid-covered services authorized for delivery by audio-only telehealth (do not require 93 modifier) Service

  • CPT Code 98008 - New patient synchronous audio-only visit with straightforward medical decision making and 10 minutes or more of medical discussion, if using time 15 minutes or more

  • CPT Code 98009 - New patient synchronous audio-only visit with low medical decision making and 10 minutes or more of medical discussion, if using time 30 minutes or more

  • CPT Code 98010 - New patient synchronous audio-only visit with moderate medical decision making and 10 minutes or more of medical discussion, if using time 45 minutes or more

  • CPT Code 98011 - New patient synchronous audio-only visit with high medical decision making and 10 minutes or more of medical discussion, if using time 60 minutes or more

  • CPT Code 98012 - Established patient synchronous audio-only visit with straightforward medical decision making and 10 minutes or more of medical discussion, if using time 10 minutes or more

  • CPT Code 98013 - Established patient synchronous audio-only visit with low medical decision making and 10 minutes or more of medical discussion, if using time 20 minutes or more

  • CPT Code 98014 - Established patient synchronous audio-only visit with moderate medical decision making and 10 minutes or more of medical discussion, if using time 30 minutes or more

  • CPT Code 98015 - Established patient synchronous audio-only visit with high medical decision making and 10 minutes or more of medical discussion, if using time 40 minutes or more

  • Table 8, Table 8. Synchronous Audio-Video (codes do not require 93 modifier)

  • CPT Code 98000 - New patient synchronous audio-video visit with straightforward medical decision making, if using time 15 minutes or more

  • CPT Code 98001 - New patient synchronous audio-video visit with low medical decision making, if using time 30 minutes or more

  • CPT Code 98002 - New patient synchronous audio-video visit with moderate medical decision making, if using time 45 minutes or more

  • CPT Code 98003 - New patient synchronous audio-video visit with high medical decision making, if using time 60 minutes or more

  • CPT Code 98004 - Established patient synchronous audio-video visit with straightforward medical decision making, if using time 10 minutes or more

  • CPT Code 98005 - Established patient synchronous audio-video visit with low medical decision making, if using time 20 minutes or more

  • CPT Code 98006 - Established patient synchronous audio-video visit with moderate medical decision making, if using time 30 minutes or more

  • CPT Code 98007 - Established patient synchronous audio-video visit with high medical decision making, if using time 40 minutes or more

Providers may also bill  telehealth eligible CPT codes with the appropriate modifiers.

Please see below for contact information for any questions.

To avoid disruption of claims payment through fee-for-service (FFS) and the managed care organizations (MCOs), providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions.  Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.