Virginia Medicaid Telehealth Billing
By George Ruan • July 9, 2026
Last updated: July 9, 2026.
Virginia Medicaid telehealth billing is not just “use modifier 95 and move on.” Therapists need to check whether the service is covered by telehealth, which manual or supplement applies, whether the member is fee-for-service or assigned to a Cardinal Care MCO, and whether the plan adds service-specific rules.
Bottom line: Use the current DMAS Telehealth Services Supplement and the service-specific manual before billing. For behavioral health and ARTS, telehealth rules can depend on the exact service, code, provider type, modality, documentation, and whether the claim is FFS or MCO-managed.
Sections
The Telehealth Source Stack
Telehealth Services Supplement. DMAS publishes a telehealth supplement across multiple programs and updates it through memos and provider manual revisions.
Service manual. Mental Health Services, Psychiatric Services, ARTS, practitioner, and other manuals may narrow or add service-specific requirements.
Eligibility and plan assignment. The member’s FFS or Cardinal Care MCO lane determines the payer workflow and may affect authorization or claim-submission requirements.
MCO policy. When the member is in managed care, check the assigned plan’s provider guidance before assuming the state supplement is the whole answer.
What to Check Before Billing
Is the service listed as telehealth-eligible in the current supplement or manual?
Does the service require audio-video, allow audio-only, or have exceptional-circumstance limits?
Which modifier, place of service, or documentation rule applies?
Does the service require authorization, and if so, is it FFS/Acentra or MCO-specific?
Does the provider type, license level, group setup, or service location support the telehealth claim?
Why MCO Assignment Still Matters
A telehealth service can be covered in principle but still deny if the claim goes to the wrong payer, the authorization lane is wrong, or the MCO has a participation issue. Start with eligibility verification, then follow the appropriate FFS or MCO billing path.
For the routing sequence, read Virginia Medicaid Claims for Therapists and Virginia Medicaid Service Authorization for Behavioral Health.
Action Steps for Providers
Create a telehealth billing note that lists the source checked, allowed modality, modifier/POS, authorization status, and plan lane.
Review the Telehealth Services Supplement again after DMAS updates or plan bulletins.
For managed-care members, confirm plan-side telehealth and authorization guidance before the first billed session.
Where Bomi Fits
Bomi helps therapy practices keep Medicaid billing and credentialing workflows organized: enrollment follow-up, portal handoffs, eligibility checks, claims, denials, EOB review, revalidation tracking, payer follow-up, and revenue operations. We still separate access correctly: your practice keeps control of provider accounts, and each user gets the access needed for their role.
Operational note: This post is general operational education, not legal, compliance, or billing advice. Confirm current DMAS, MES/PRSS, Cardinal Care MCO, Acentra/Atrezzo, provider-manual, and contract requirements before submitting enrollment, claims, or service authorizations.
Sources
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