Medicare reimburses for telesychiatry at the same rate as face-to-face.  Medicare also reimburses $18 per session for the staff person presenting with the client (Telehealth originating site facility fee - CPT code Q3014).  Medicare imposes three restrictions on the use of telepsychiatry/telehealth:

1. Geographic - The consumer must be located in a non-metropolitan statistical area (see sample map).
2. Facility - The consumer must be located in a qualifying facility and accompanied by a qualified staff person.
3. Procedure - Must be an approved procedure for telehealth (see below).

1. Consultations (CPT codes 99241-99275)
2. Office or other outpatient visits (CPT codes 99201 - 99215)
3. Individual psychotherapy (CPT codes 90804 - 90809)
4. Pharmacologic management (CPT code 90862)
5. Psychiatric diagnostic interview examination (CPT code 90801)
6. Neurobehavioral status exam (HCPCS code 96116)
7. Initial Assessment (96150)
8. Intervention - Individual (96152)
9. Problem Focused (G0425)
10. G0426 (Detailed): HCPCS G0427 (Comprehensive):
11. G0406: Follow-up inpatient telehealth consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth;
12. G0407: Follow-up inpatient telehealth consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth; and
13. G0408: Follow-up inpatient telehealth consultation, complex, physicians typically spend 35 minutes or more communicating with the patient via telehealth.

Medicare Telehealth Billing and Payment Policies as of January, 2010:

Medicare telehealth services can only be furnished to an eligible telehealth beneficiary in an originating site. An originating site is defined as one of the specified sites where an eligible telehealth individual is located at the time the service is being furnished via a telecommunications system. In general, originating sites must be located in a rural Health Professional Shortage Area (HPSA) or in a county outside of an Metropolitan Statistical Area (MSA). The originating sites authorized by the statute are as follows:

• Offices of a physician or practitioner

• Hospitals

• CAHs

• RHCs

• FQHCs

• Hospital-Based or Critical Access Hospital-Based Renal Dialysis Centers (including Satellites)

• SNFs

• CMHCs

Currently approved Medicare telehealth services include the following:

• Initial inpatient consultations

• Follow-up inpatient consultations

• Office or other outpatient visits

• Individual psychotherapy

• Pharmacologic management

• Psychiatric diagnostic interview examination

• End Stage Renal Disease (ESRD) related services

• Individual medical nutrition therapy (MNT)

• Neurobehavioral status exam

• Individual health and behavior assessment and intervention (HBAI)

In general, the practitioner at the distant site may be any of the following, provided that the practitioner is licensed under State law to furnish the service being furnished via a telecommunications system:

• Physician

• Physician assistant (PA)

• Nurse practitioner (NP)

• Clinical nurse specialist (CNS)

• Nurse midwife

• Clinical psychologist

• Clinical social worker

• Registered dietitian or nutrition professional