Telemedicine service must meet the following CMS criteria as summarized in the Telehealth Services Fact sheet for 2014 (pdf).
3.2.1 Specific criteria covered by both Medicaid and NC Health Choice
Medicaid and NCHC shall cover Telemedicine and Telepsychiatry services when medically necessary under all of the following conditions:
Note: The licensed provider using Telemedicine or Telepsychiatry Services shall ensure the availability for appropriate follow-up care and maintain a complete health record that is available to the beneficiary and other treating providers.
Extracted from Policy No: 1H: NC Division of Medical Assistance Medicaid and Health Choice Telemedicine and Telepsychiatry Clinical Coverage. NC Medicaid Telemedicine Policy in its entity can be found: http://www.ncdhhs.gov/dma/mp/1H.pdf