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

  1. Consultations
  2. Office or other outpatient visits
  3. Individual psychotherapy
  4. Pharmacologic management
  5. Psychiatric diagnostic interview examination
  6. End Stage Renal Disease
  7. Individual medical nutrition therapy
  8. Neurobehavioral status examination
  9. Follow up inpatient telehealth consultations
  10. Transitional care management services

Geographic Location

Reimbursement for telehealth video conferencing can only occur when the originating site is:

  1. Located in a federal demonstration program;
  2. In a rural Health Professional Shortage Area (HPSA); OR
  3. A county that is outside of any Metropolitan Statistical Area (MSA), as defined by HRSA and the US Census Bureau.

Type of Providers

  1. Physicians
  2. Nurse Practitioners
  3. Physician assistants
  4. Nurse midwives
  5. Clinical nurse specialists
  6. Clinical psychologists and clinical social workers
  7. Registered dietitians or nutrition professionals

Originating Site Facility

  1. The offices of physicians or practitioners
  2. Hospitals
  3. Critical Access Hospitals
  4. Rural Health Clinics
  5. Federally qualified Health Centers
  6. Hospital-based or Critical Access Hospital-based Renal Dialysis Centers
  7. Skilled Nursing facilities
  8. 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

CTRC Publishes Guide

CTRC Publishes Guide

Allie Clark | 1 min read | September 20, 2019The telehealth community is often heard clamoring for more comprehensive guides to help practices and providers navigate the confusing and murky waters of reimbursement. The California Telehealth Resource Center has stepped...

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