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    Medicaid is a State and Federally funded Program for eligible individuals and families
  • Welcome to USVI Medicaid Online Portal
    Serving the Medicaid population to improve health care outcomes
    Medicaid is a State and Federally funded Program for eligible individuals and families.
  • Welcome to USVI Medicaid Online Portal
    Serving the Medicaid population to improve health care outcomes
    Medicaid is a State and Federally funded Program for eligible individuals and families.
    
4/8/2020 3:38 PM

Virgin Islands Medical Assistance Program (VIMAP) Telemedicine and Telehealth Policy Statement

Background:
In response to the need to limit the spread of community COVID-19 the Centers for Medicare & Medicaid Services (CMS) has expanded the options and flexibilities for Medicaid programs to broaden their use of telemedicine and telehealth services so that Medicaid beneficiaries can receive a wider range of services from Medicaid providers without having to travel to a health care facility. These policy options build on the President’s emergency declaration, the Department of Health and Human Services public health emergency declaration, and the direction of Governor Bryan to maintain maximum social distancing. The VIMAP intends to take advantage of these policy options to ensure that all Virgin Island Medicaid beneficiaries, particularly those at high risk from COVID-19, are able take advantage of easily accessible benefits that can keep you healthy while also helping to contain the community spread of the virus.

Policy:
The VIMAP will cover medically necessary telemedicine services between a Medicaid beneficiary and their physician or, other medical practitioner, that is within their scope of practice under Virgin Islands law and Medicaid program requirements. These providers must be enrolled as Medicaid providers with VI MAP. Telemedicine services include a real-time, interactive electronic communication using interactive telecommunication equipment that includes at a minimum audio and video equipment (e.g., cell phones and computers and communications software such as face time, skype, zoom, etc.) in lieu of a face-to-face encounter at a health care facility. In this situation, the provider would be at a distant site and the Medicaid patient would be at the originating site.

The VIMAP will also cover medically necessary telehealth services between a Medicaid beneficiary and their physician or other medical practitioner that is within their scope of practice under Virgin Islands law and Medicaid program requirements. These providers must be enrolled as Medicaid providers with VI MAP. Telehealth services include using such technologies as telephones, facsimile machines, electronic mail systems, and remote monitoring devices, to collect and transmit medical data for monitoring and interpretation, and to perform follow-up and virtual check-ins with Medicaid patients.
The difference between telemedicine and telehealth is that in telemedicine, the interaction between the patient and the provider occurs in real time. Whereas, telehealth communications are data transmissions about the patient’s status where the patient and the provider may not be in simultaneous communication. In either event, these services provided to Medicaid beneficiaries are covered by the VIMAP. The service has to be medically necessary and appropriate, the beneficiary must be eligible, the provider must be enrolled, and the service provided with the provider’s scope of practice.
The VIMAP will not require a referral or a VIMAP prior authorization for telemedicine or telehealth services to be provided by Medicaid providers to Medicaid beneficiaries. While any VIMAP provider may provide a telemedicine or telehealth service when medically necessary, we would expect that these services will be provided primarily by the Department of Health (DOH) Clinics, Federally Qualified Health Centers (FQHCs), physicians and other practitioners, and our hospitals.


Reimbursement:
The VIMAP will reimburse physicians or other medical practitioners for their telemedicine or telehealth services in the same manner as when that service is performed in a face-to-face setting. For example, if a physician completes an “office visit” via telemedicine that physician would be reimbursement for that “office visit” at the allowable Medicaid rate for that service. Similarly, if an FQHC complete a “patient visit/encounter” via telemedicine the FQHC would receive its applicable rate for that visit/encounter. Providers should use the Place of Service (POS) code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.
In summary, we are strongly encouraging our Medicaid provider community and our Medicaid beneficiaries to utilize the provision of medically necessary telemedicine or telehealth services to the greatest extent possible. The use of these services will not only support the ease of access to Medicaid benefits but will support the over health of our community and its citizens be containing the community spread of COVID-19.

If you have any questions please contact: (340)227-4686 and (340)725-5675.


4/8/2020 3:31 PM

Dental Prosthodontics, Removable CDT Code
COMPLETE DENTURES (INCLUDING ROUTINE POST-DELIVERY CARE)
D5110 Complete denture - maxillary
D5120 Complete denture - mandibular
D5130 Immediate denture - maxillary
D5140 Immediate denture - mandibular
PARTIAL DENTURES (INCLUDING ROUTINE POST-DELIVERY CARE)
D5211 Maxillary partial denture - resin base (including any conventional clasps, rests and teeth)
D5212 Mandibular partial denture - resin base (including any conventional clasps, rests and teeth)
D5213 Maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)
D5214 Mandibular partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)
D5221 Immediate maxillary partial denture - resin base (including any conventional clasps, rests and teeth
D5222 Immediate mandibular partial denture - resin base (including any conventional clasps, rests and teeth)
D5223 Immediate maxillary partial denture - cast metal framework with resin denture bases (including any conventional clasps, rests and teeth)
D5225 Maxillary partial denture - flexible base (including any clasps, rests and teeth)
D5226 Mandibular partial denture - flexible base (including any clasps, rests and teeth)
D5281 Removable unilateral partial denture – one-piece cast metal (including clasps and teeth)
INTERIM PROSTHESIS
D5810 Interim complete denture (maxillary)
D5811 Interim complete denture (mandibular)
D5820 Interim partial denture (maxillary)
D5821 Interim partial denture (mandibular)
OTHER REMOVABLE PROSTHETIC SERVICES
D8660 Pre-orthodontic treatment examination to monitor growth and development
D8670 Periodic orthodontic treatment visit
D8680 Orthodontic retention (removal of appliances, construction and placement of retainer(s))
D8681 Removable orthodontic retainer adjustment
D8691 Repair of orthodontic appliance
D8692 Replacement of lost or broken retainer
D8693 Re-cement or re-bond fixed retainer
D8694 Repair of fixed retainers, includes reattachment

Dental Prosthodontics, Fixed CDT Code range D6200-D6999
FIXED PARTIAL DENTURE PONTICS
FIXED PARTIAL DENTURE RETAINERS - INLAYS/ONLAYS
OTHER FIXED PARTIAL DENTURE SERVICES

Implant Services CDT D6000-D6199
SURGICAL SERVICES
IMPLANT SUPPORTED PROSTHETICS

Dental Orthodontics CDT Code range D8000-D8999
LIMITED ORTHODONTIC TREATMENT
INTERCEPTIVE ORTHODONTIC TREATMENT
COMPREHENSIVE ORTHODONTIC TREATMENT
MINOR TREATMENT TO CONTROL HARMFUL HABITS
OTHER ORTHODONTIC SERVICES

Durable Medical Equipment (Medicare Allowed items)
Commode chairs
• Hospital beds 
• Infusion pumps & supplies 
• Lancet devices & lancets 
• Nebulizers & nebulizer medications 
• Oxygen equipment & accessories 
• Patient lifts 
• Pressure-reducing beds, mattresses, and mattress overlays 
• Suction pumps 
• Traction equipment 
• Walkers 
• Wheelchairs & scooters

Incontinence Devices and Supplies HCPCS Code range A5102-A5200 Incontinence Supplies HCPCS Code range T4521-T4545
Enteral and Parenteral Therapy HCPCS code range B4000-B9999

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Virgin Islands Medical Assistance Program (VIMAP) Telemedicine and Telehealth Policy StatementNew
4/9/2020 7:16 AM
Medicaid News - Revised 04/01/2019
4/2/2019 12:28 PM

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2/17/2016 1:54 PM

“Please keep in mind that VI Medicaid members do not have freedom of choice of provider. VI Medicaid members should obtain health care in one of the Federally Qualified Health Center clinics located in the U.S. Virgin Islands, or Department of Health clinics located in the U.S. Virgin Islands.  Prior authorization must be obtained from the VI Medicaid Program for services rendered outside of said facilities”.