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Telehealth Services for Sunflower Members

Date: 04/01/26

A Message for KanCare Medicaid Providers

Providing care through telehealth can improve access and continuity for KanCare members when delivered in accordance with KanCare requirements. This bulletin provides a high-level overview of telehealth requirements, covered services and key compliance considerations to support appropriate use.

Benefits of Telemedicine

When clinically appropriate, telemedicine can support timely, patient-centered care while reducing common barriers to treatment.

  • Reduced appointment and office wait times for patients.
  • Faster and more equitable access to care and prescription services.
  • Fewer missed appointments by reducing barriers such as childcare needs, missed work or school, and transportation challenges.
  • Improved access to specialists, including providers who speak the member’s preferred language or have similar cultural backgrounds.
  • Greater patient comfort discussing sensitive concerns (including mental health and substance use) compared to an office setting.
  • Expanded scheduling flexibility, helping practices serve more patients.

What Is Telehealth Under KanCare

Kansas Medicaid generally uses the term telemedicine to describe covered telehealth services. Telemedicine is defined as the delivery of healthcare services when the member is at an originating site and the provider is at a distant site using real-time, two-way interactive audio and visual communication or approved store-and-forward technology. Telephone-only, email or facsimile communications alone are not considered telemedicine.

Telemedicine may be used to establish a valid provider-patient relationship, and the same standards of practice, documentation and follow-up that apply to in-person care also apply to services delivered via telemedicine.

Eligible Providers and Licensure

Providers delivering telehealth services to Sunflower members must:

  • Hold an active Kansas license in their profession or meet applicable Kansas licensure compact requirements.
  • Be enrolled with the Kansas Medical Assistance Program (KMAP).
  • Be credentialed and contracted with Sunflower.

Out-of-state providers are required to comply with current Kansas licensure and authorization requirements. Temporary licensure flexibilities related to the COVID-19 public health emergency have ended.

Covered Telehealth Services

Sunflower covers certain medically necessary services when provided via telemedicine, consistent with state policy and provider manuals. Examples include, but are not limited to:

  • Office or outpatient visits.
  • Behavioral health services such as individual psychotherapy or substance use treatment.
  • Pharmacological management services.

Coverage is subject to benefit limitations, medical necessity and any applicable prior authorization requirements. Services that are not covered when provided in person are also not covered when provided via telemedicine. Telemedicine is not appropriate for emergencies or other conditions that require immediate in-person evaluation or treatment.

Member Consent and Privacy

Before providing telehealth services, providers must obtain the member’s informed consent. Kansas Medicaid allows verbal consent when documented in the medical record. Providers must ensure that:

  • Member consent is documented.
  • Services are delivered using HIPAA-compliant technology.
  • Privacy and confidentiality requirements are met, consistent with in-person services.

Billing and Documentation Requirements

Documentation requirements for telehealth services are the same as for face-to-face care and must support medical necessity.

When billing for telehealth services:

  • Use the appropriate place of service code for telehealth.
  • Include any required modifiers as outlined in KanCare and Sunflower guidance.
  • Follow coding and billing instructions in the applicable Sunflower and KMAP provider manuals.

Telehealth services are generally reimbursed at the same rate as comparable in-person services when all requirements are met.

Additional Resources

Providers are encouraged to review the Kansas Medicaid provider manuals and applicable KMAP bulletins for detailed telehealth coverage and billing guidance.

If you have questions about this bulletin or telehealth requirements for KanCare, please contact your Provider Relations Representative or call us at 1-877-644-4623 (TTY 711).