California Implements Billing for Telehealth LEA Speech Therapy Services

Effective July 1, 2016, speech-language assessment services and speech therapy treatment services, as defined in the Speech Therapy section of the LEA Medi-Cal Billing Option Program Provider Manual when performed via telemedicine, may be reimbursed to LEAs when provided to Medi-Cal eligible students with an Individualized Education Plan (IEP) or Individualized Family Services Plan (IFSP).

In order to bill for telemedicine speech services, conditions outlined in the Department of Health Care Service’s Policy and Procedure Letter (PPL) 15-024R must be met. These include telemedicine system requirements, provider requirements (on both the provider performing the service via telehealth and the provider with ultimate responsibility for the care of the student), consent requirements, and record retention requirements.

PPL 15-024R was originally published in December 2015, but was revised this month to include new language around provider requirements. Specifically, “The health care provider who has the ultimate responsibility for the care of the student must be licensed in the State of California and enrolled as a Medi-Cal provider. The provider performing services via telemedicine whether from California or out of state, must be licensed in California, and if contracted by the LEA to provide the direct medical service, must be enrolled as a Medi-Cal provider.”