Medicare Telehealth Policy
The Centers for Medicare and Medicaid Services (CMS) has released an updated version of their telehealth fact sheet, expanded into an easy-to-read booklet format [linked at the bottom of the article].
Here’s what you need to know: CMS only reimburses for live video telehealth services under specific circumstances, including…
Scope of Coverage / Type of Encounter
- Office or other outpatient visits
- Individual psychotherapy
- Pharmacologic management
- Psychiatric diagnostic interview examination
- End Stage Renal Disease
- Individual medical nutrition therapy
- Neurobehavioral status examination
- Follow up inpatient telehealth consultations
- Transitional care management services
Reimbursement for telehealth video conferencing can only occur when the originating site is:
- Located in a federal demonstration program;
- In a rural Health Professional Shortage Area (HPSA); OR
- A county that is outside of any Metropolitan Statistical Area (MSA), as defined by HRSA and the US Census Bureau.
Type of Providers
- Nurse Practitioners
- Physician assistants
- Nurse midwives
- Clinical nurse specialists
- Clinical psychologists and clinical social workers
- Registered dietitians or nutrition professionals
Originating Site Facility
- The offices of physicians or practitioners
- Critical Access Hospitals
- Rural Health Clinics
- Federally qualified Health Centers
- Hospital-based or Critical Access Hospital-based Renal Dialysis Centers
- Skilled Nursing facilities
- Community Mental Health Centers
CPT & HCPCS Codes
CMS only reimburses for a limited number of CPT & HCPCS codes when services are delivered through telehealth. To view the list of reimbursable telehealth CPT & HCPCS codes for current year 2018, click here.
Other Telehealth Services
- There is no coverage for remote patient monitoring (RPM).
- CMS only covers store-and-forward for demonstration projects in Alaska and Hawaii.
(Information taken from Telehealth Resource Centers’ Medicare’s Telemedicine/Telehealth Payment Policies https://www.telehealthresourcecenter.org/toolbox-module/medicares-telemedicinetelehealth-payment-policies#current-medicare-policy )
To find out more about reimbursement for telemedicine using SimpleVisit, call us at 877.838.4748
Rob Warlick | 4 min read | January 26, 2021 In response to the global pandemic and the public health emergency, many medical groups have purchased or crafted a solution to treat over video. Due to the lax in federal regulations, many are turning to commonly available...
Allie Clark | 10 min read | December 2, 2020It is time for some kindness. The holiday season can be a rough time for many among us. A report from the National Alliance on Mental Illness shows that this time of the year negatively affects a majority of people suffering...
Allie Clark | 10 min read | November 13, 2020In the midst of an unprecedented healthcare crisis, it’s important to be mindful of some of the most vulnerable members in our communities: our seniors. This particular season has been uniquely challenging for older...