Washington State Telehealth Insurance Coverage Requirements
Yes, Washington state requires insurance companies to cover audiovisual telehealth visits. Washington is among the 42 states plus the District of Columbia that mandate commercial insurance plans to cover telehealth services, including audiovisual visits 1.
Current Coverage Requirements
- Washington state law requires private insurance plans originating in the state to cover telehealth services, though not necessarily at parity with in-person services 2.
- All 50 states and the District of Columbia provide some form of reimbursement for telehealth care through their Medicaid programs 2.
- Commercial insurance plans in Washington must cover interactive audio and video telecommunications that permit real-time communication between the patient and provider 2.
Types of Telehealth Covered
The coverage requirements in Washington state typically include:
- Live video (synchronous) telehealth visits
- Store-and-forward technology (asynchronous)
- Remote patient monitoring in some cases
Billing and Reimbursement Considerations
- Telehealth services are billed using standard CPT codes with a telemedicine modifier ("95") to indicate services were provided using telemedicine technology 2.
- To qualify for the modifier "95," providers must use an interactive audio and video telecommunications system that permits real-time communication between the patient and provider 2.
- The telehealth modifier cannot be used with asynchronous (store and forward) technology alone 2.
Important Caveats
- While coverage is mandated, payment parity (reimbursing telehealth at the same rate as in-person visits) is not guaranteed in all states 2.
- Commercial insurance plans originating in different states and Employee Retirement Income Security Act (ERISA) plans may not be subject to Washington state mandates 2.
- Providers should verify specific coverage details with individual insurance carriers, as accepted services and reimbursement rules can vary 2.
Impact of Telehealth Parity Laws
Research shows that states with telehealth parity laws (like Washington) have seen significant increases in the utilization of telehealth services. The odds of receiving a telehealth visit in a parity state were 29.8% greater than in a non-parity state 3.
For providers practicing telehealth in Washington state, it's essential to understand the specific requirements and limitations of both Medicaid and commercial payer policies. The Center for Connected Health Policy website provides state-by-state resources for telehealth coverage information 2.