Ohio Medicaid Telehealth Billing Guide

Last updated: July 4, 2026.

Ohio Medicaid covers behavioral health delivered by telehealth, and for a therapist the day-to-day question is not "is it covered?" but "am I coding it the way ODM expects?" The governing rule is Ohio Administrative Code 5160-1-18, "Telehealth," and the current version is effective January 1, 2026. The Ohio Department of Medicaid (ODM) also publishes a fee-for-service Telehealth Billing Guidelines document that applies to dates of service on or after January 1, 2026. Read together, they tell you which providers can render telehealth, where the client can be, which place-of-service (POS) code to report, and which modifiers to append.

Bottom line: bill your usual psychotherapy CPT codes, put the POS code that reflects where YOU (the practitioner) physically were, add the "GT" modifier in most cases, and add a U-modifier when the client is at one of six specific locations. Do not use telehealth POS 02 or 10 on Ohio Medicaid claims where Medicaid is primary — ODM will not accept them.

TL;DR: Telehealth Is Covered — Bill It Right

• The rule is OAC 5160-1-18, effective 1/1/2026. It defines telehealth broadly and lets Medicaid members receive telehealth "wherever they are located."

• POS = your location, not the client's. On a professional claim, the place-of-service code must reflect the physical location of the treating practitioner when the service was delivered.

• POS 02 and 10 are rejected. ODM will not accept the telehealth POS codes 02 or 10 on claims where Medicaid is the primary payer, unless a provider-specific guideline says otherwise.

• Append "GT" in most cases. The GT modifier identifies a service delivered through telehealth (unless the fee-schedule description of the code already indicates a telehealth service).

• Add a U-modifier for six client locations. U1-U6 identify the client's site (home, school, inpatient hospital, outpatient hospital, nursing facility, or ICF/IID).

• Managed care can differ. Fee-for-service and each MCO/OhioRISE plan may have different billing requirements — confirm with the plan.

The Governing Rule: OAC 5160-1-18

Ohio Medicaid telehealth lives in one rule: OAC 5160-1-18, "Telehealth." The current version is effective January 1, 2026, and ODM's companion Telehealth Billing Guidelines apply to dates of service on or after that date. When the rule changes, the billing mechanics can change with it, so the effective date matters.

Under the 1/1/2026 rule, telehealth includes:

• Synchronous audio-video: real-time, interactive electronic communication that includes both audio and video elements.

• Asynchronous or non-audio-video methods: telephone (audio-only) calls, remote patient monitoring, and communication through secure electronic mail or a secure patient portal.

For behavioral health providers (as defined in OAC 5160-27-01), telehealth is further defined in OAC 5122-29-31, the Ohio Department of Behavioral Health telehealth rule. If your organization is a behavioral health agency certified by ODBH (formerly OhioMHAS), you follow that BH-specific telehealth guidance rather than the general fee-for-service billing instructions.

One reader-friendly point in the rule: Medicaid members can access telehealth "wherever they are located." ODM lists examples — home, school, temporary housing, a homeless shelter, a nursing facility, a hospital, a group home, and intermediate care facilities. There is no limitation on the client site, and no limitation on your (the practitioner's) site either.

Who Can Deliver Telehealth in Ohio Medicaid

The rule ties telehealth eligibility to your enrolled provider type. For behavioral health, the independently licensed clinicians ODM lists as rendering providers include:

• Psychologist

• Licensed Independent Social Worker (LISW)

• Licensed Professional Clinical Counselor (LPCC)

• Licensed Independent Marriage and Family Therapist (LIMFT)

• Licensed Independent Chemical Dependency Counselor (LICDC)

Supervised practitioners, trainees, residents, and interns (as defined in OAC 5160-4-05 and 5160-8-05) can also render telehealth, but they generally cannot be the billing "pay-to" provider — their services bill through a supervising independent practitioner or agency. If your license tier controls whether you can enroll and bill on your own, start with our guide to Ohio Medicaid license tiers.

Place of Service and Modifiers

This is where Ohio Medicaid trips people up, because its telehealth POS logic is the opposite of what Medicare and many commercial payers do.

Place of service reflects YOUR location

On a professional claim, ODM says the POS code must reflect the physical location of the practitioner when the service was delivered — not the client's location, and not a generic "telehealth" POS. So a therapist working from the office reports the office POS; a therapist working from home reports the home POS.

Do not use POS 02 or 10. ODM states that place-of-service code 02 ("Telehealth provided other than in patient's home") and 10 ("Telehealth provided in patient's home") will not be accepted on claims where Medicaid is the primary payer, unless otherwise stated in provider-specific billing guidelines. The CMS POS code set is the reference ODM points to for the location codes you do use.

There is a narrow exception on the excluded side: POS 09 (penal facility) is normally excluded by federal rule, but as of 1/1/2025 POS 09 may be used when services are delivered to youth under 21 prior to release, per Section 5121 of the Consolidated Appropriations Act.

The GT modifier

In most cases, ODM requires the "GT" modifier to identify that a service was delivered through telehealth. The exception: if the description of a covered procedure code in an ODM fee schedule already indicates a telehealth or electronic service, the GT modifier is not required. When you report more than one modifier, list GT first.

Patient-location U-modifiers

If the client is at one of six specific locations, ODM requires a modifier identifying that location. If the client is somewhere else, no location modifier is required.

• U1 - Client home or place of residence (includes homeless shelter, temporary housing, or a residential facility that is not a nursing facility)

• U2 - School

• U3 - Inpatient hospital

• U4 - Outpatient hospital

• U5 - Nursing facility

• U6 - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)

Important carve-out: these U1-U6 patient-location modifiers do not apply to OhioMHAS/ODBH-certified behavioral health agencies. Certified BH agencies follow the BH telehealth billing guidance instead. So the U-modifier table is most relevant to independently licensed clinicians and groups billing under the general fee-for-service instructions.

Codes, Including the 2025-2026 Changes

For a therapist, the good news is that your bread-and-butter psychotherapy codes are on ODM's covered-telehealth list and are billed as usual, just delivered by telehealth. ODM lists these under "Medical and Behavioral Health Services" (for non-OhioMHAS-certified providers), including:

• 90791 / 90792 - psychiatric diagnostic evaluation (with or without medical services)

• 90832 / 90834 / 90837 - individual psychotherapy (30 / 45 / 60 minutes)

• 90833 / 90836 / 90838 - psychotherapy add-ons performed with an E/M service

• 90846 / 90847 - family psychotherapy (without / with the patient present)

• 90849 - multiple-family group psychotherapy; 90853 - group psychotherapy

• 90785 - interactive complexity add-on

The 2025 change worth knowing: CPT introduced a new telemedicine evaluation-and-management (E/M) family, codes 98000-98016, effective January 1, 2025, and ODM has adopted a range of them onto its covered-telehealth list. These describe telemedicine visits directly — for example, 98000 is a "new patient synchronous audio-video visit with straightforward medical decision making," and the 98008-98015 codes describe audio-only visits. ODM even uses 98000 as its example of a telehealth code that carries the GT modifier.

What this means for therapists: the 98000-98016 codes are E/M codes. They matter most to prescribers and other clinicians who bill evaluation-and-management services. A therapist billing psychotherapy still reports 90791, 90832, 90834, 90837, and the family/group codes — you do not switch those to the 98000 series just because the visit is virtual. Use professional judgment and pick the code that reflects the service you actually provided.

ODM has also said that if a covered telehealth procedure code is deleted in an annual CPT/HCPCS update, it will adopt the replacement code when one is identified — so the covered set moves with the code books each January.

Fee-for-Service vs. Managed Care

The POS and modifier rules above come from ODM's fee-for-service Telehealth Billing Guidelines. But most Ohio Medicaid members are enrolled in one of the seven managed-care plans (or, for eligible youth with complex behavioral health needs, OhioRISE, administered by Aetna Better Health of Ohio). ODM is explicit that managed-care plans "cover the same telehealth services as in fee-for-service but may have different billing requirements."

Practically, that means a claim routed to a managed-care plan may not follow the fee-for-service POS/modifier conventions exactly, and each plan can publish its own telehealth policy. Confirm which lane the member is in before you build the claim, and check the plan's telehealth requirements directly. For the full FFS-versus-managed-care claim-routing picture, see our Ohio Medicaid claims guide.

Documentation, Consent, and Licensure

Telehealth billing sits on top of clinical and compliance requirements — coding it correctly does not replace them. At a high level:

• Licensure and enrollment. You must be an eligible, enrolled Ohio Medicaid provider type to render and bill telehealth. Supervised clinicians bill through their supervising independent practitioner or agency.

• Consent and clinical suitability. The BH telehealth rule (OAC 5122-29-31) addresses client consent regarding the risks of telehealth, confidentiality protections, equipment standards, and contingency planning for technical failures. Confirm the current version before you rely on any specific requirement.

• Documentation. Document that the service was delivered via telehealth and the modality used, and keep your records consistent with all applicable state and federal law, including HIPAA.

Action Steps for Providers

1. Confirm the member's lane. Check eligibility and whether the member is fee-for-service, in one of the seven MCOs, or in OhioRISE, because billing requirements can differ.

2. Pick the right code for the service. Use your standard psychotherapy CPT codes (90791, 90832/90834/90837, 90846/90847, 90853, etc.); reserve the 98000-98016 E/M codes for E/M visits.

3. Set POS to the practitioner's location. Report the POS where you physically were. Never use POS 02 or 10 when Ohio Medicaid is primary.

4. Append GT (usually) and the right U-modifier. Add GT to identify telehealth, then U1-U6 if the client is at one of the six listed locations — remembering the carve-out for ODBH-certified BH agencies.

5. Match the managed-care plan's rules. For MCO/OhioRISE claims, confirm the plan's telehealth policy instead of assuming the fee-for-service conventions apply.

6. Document modality and consent. Note that the session was by telehealth, the modality, and that telehealth consent and confidentiality requirements were met.

7. Re-check when the rule changes. OAC 5160-1-18 and ODM's billing guidelines are dated — refresh your internal cheat sheet whenever a new effective date or annual code update lands.

Where Bomi Fits

Ohio Medicaid telehealth is a place where a small coding detail — the wrong POS, a missing GT, a U-modifier that should not have been on a BH-agency claim — quietly turns into a denial weeks later. That is the operational layer Bomi works in.

Bomi helps therapy practices with credentialing and enrollment workflows, eligibility checks, claim submission, denial follow-up, and revenue tracking, working inside the EHR a practice already uses. We do not decide clinical coding for you or guarantee any payer outcome, but we can help make sure telehealth claims are built and followed the way ODM and each plan expect. See how Bomi approaches billing operations and our Ohio resources.

Start with the big picture in our Ohio Medicaid credentialing pillar guide (ODM, PNM, and the MCOs), then work down into the claims and license-tier guides linked above.

This post is for general operational education and is not legal, compliance, or billing advice. Always confirm current ODM and managed-care-plan requirements before submitting enrollment, claims, or authorizations.

FAQ

What rule governs Ohio Medicaid telehealth billing?

Ohio Administrative Code 5160-1-18, "Telehealth." The current version is effective January 1, 2026, and ODM's fee-for-service Telehealth Billing Guidelines apply to dates of service on or after that date.

What place-of-service code do I use for Ohio Medicaid telehealth?

On a professional claim, report the POS code that reflects the physical location of the practitioner when the service was delivered. ODM will not accept telehealth POS codes 02 or 10 on claims where Medicaid is the primary payer, unless a provider-specific guideline says otherwise.

Which modifiers does Ohio Medicaid require for telehealth?

In most cases, append the "GT" modifier to identify a telehealth service (unless the fee-schedule description already indicates telehealth). If the client is at home (U1), school (U2), inpatient hospital (U3), outpatient hospital (U4), nursing facility (U5), or an ICF/IID (U6), add the matching U-modifier. Those U-modifiers do not apply to ODBH-certified behavioral health agencies.

Can therapists bill the new 98000-98016 telehealth codes?

The 98000-98016 codes are new-for-2025 telemedicine evaluation-and-management (E/M) codes, and ODM has adopted a range of them. But they are E/M codes. A therapist billing psychotherapy still uses the standard codes (90791, 90832, 90834, 90837, and the family/group codes) delivered via telehealth — you do not switch to the 98000 series just because the visit is virtual.

Do managed-care plans follow the same telehealth billing rules?

Not necessarily. ODM says the managed-care plans and OhioRISE cover the same telehealth services as fee-for-service but may have different billing requirements. Confirm the member's plan and check that plan's telehealth policy before building the claim.

Can Ohio Medicaid members do telehealth from home?

Yes. Under OAC 5160-1-18, Medicaid members can access telehealth wherever they are located, including at home. When the client is at home, add the U1 patient-location modifier (except for ODBH-certified BH agencies, which follow separate guidance).

Sources

• OAC 5160-1-18 "Telehealth" (Ohio Administrative Code, effective 1/1/2026)

• ODM Telehealth Billing Guidelines (fee-for-service, dates of service on/after 1/1/2026)

• ODM Telehealth Services: Guidelines for Managed Care Entities

• OAC 5122-29-31 "Telehealth" (Ohio Department of Behavioral Health rule)

• Ohio Medicaid Behavioral Health provider resources

• CMS Place of Service code set

• Ohio Medicaid credentialing pillar guide

• Ohio Medicaid claims: fee-for-service vs managed care

• Bomi Billing