Posted by Teresa Iafolla
As a telemedicine company, we know that navigating issues around telemedicine policy and reimbursement can be tricky. Afterall, your job as a provider isn’t to be an expert on telemedicine rules – it’s to provide the very best care to your patients.
And that’s where we want to keep your focus. Leave the telemedicine reimbursement research to us.
So for this first piece in our telemedicine reimbursement blog series, I’ll cover the basics when it comes to Medicare and telemedicine. What are the current Medicare guidelines for telemedicine? What medical procedures can be done via telemedicine? How does billing work? Which providers and patients are eligible?
I’ll walk you through answers to these common questions and more. The bottom line on Medicare and telemedicine is – Medicare is reimbursing for more telemedicine services now than ever, and CMS is consistently adding more eligible CPT codes every year. The tide is turning based on popular demand and studies showing the cost-savings of telemedicine. That’s good news for everyone!
Ready to dive in? Here’s what you need to know about Medicare and telemedicine.
What is an Originating Site and a Distant Site?
If you’ve been reading up on Medicare and telemedicine, you’ve probably seen the terms “Originating Site” and “Distant Site.” The Originating site refers to the location of the Medicare beneficiary (the patient) and the Distant Site refers to the location of the eligible healthcare provider.
Does the patient’s location at the time of telemedicine service affect Medicare coverage?
Yes. While there are no restrictions on the Distant Site, the Originating Site has to meet these conditions:
- It has to be located within a Health Professional Shortage Area (HPSA)
- It must be one of the following types of health facilities:
- Physicians or practitioner offices
- Hospitals
- Critical Access Hospitals (CAH)
- Rural Health Clinics
- Federally Qualified Health Centers
- Hospital-based or CAH-based Renal Dialysis Centers
- Skilled Nursing Facilities (SNF)
- Community Mental Health Centers (CMHC)
In other words, your patient needs to be at health facility that falls into one of those categories and is located in a health professional shortage area for the telemedicine service to be covered under Medicare.
How do I find out if the Originating site/location of my patient is in a HPSA?
Luckily this part’s easy. To see if the health facility is in a HPSA, type in their address to this CMS tool.
What is a facility fee and how do I bill for it?
Medicare not only reimburses for the actual telemedicine service, but will also pay the originating site a facility fee for hosting the patient. For instance, if you have a patient in your office and you host a telemedicine visit with a physician in another location, you could bill for the facility fee. Lookup HCPCS code Q3014 for the full details on facility fees.
What type of telemedicine does Medicare cover?
In almost all cases, Medicare only reimburses for live telemedicine – in other words, a real-time videochat between a physician and patient. The idea is to model a face-to-face visit as closely as possible. Medicare also reimburses for store-and-forward telemedicine services, but only in Hawaii and Alaska.
What medical procedures are eligible for telemedicine reimbursement under Medicare?
For a full list of the eligible medical procedures and their CPT codes, see pages 3-4 of this handout from the Medicare Learning Network.
What healthcare providers can practice and bill for telemedicine services under Medicare?
According to Medicare guidelines, the following healthcare providers are eligible:
- Physicians
- Nurse Practitioners
- Physician Assistants
- Nurse Midwives
- Clinical nurse specialists
- Clinical Psychologists
- Clinical Social Workers
- Registered dietitians or nutrition professionals
How do I bill for telemedicine under Medicare?
There are a few points to remember here. First, reference this handout from the Medicare Learning Network for a full list of eligible procedures and their CPT/HCPCS codes. When billing, you’ll need to use one of those codes, along with the “GT” modifier to note that the procedure took place virtually.
Will Medicare reimburse me at the same rates as an in-person visit?
Yes! The health professional delivering the telemedicine service will be reimbursed at the current fee schedule rate for the comparable in-person medical service.