Medicare Reimburses for Telehealth PDF Print E-mail

Medicare reimburses for telehealth 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 (click here to download list),(or a rural census tract within a metropolitan statistical area) (click here to search for your census tract by street address). (click here to see a list of rural census tracts).  Note:  you need to provide State code + County code + census tract from your street address search.
  2. Facility type - The consumer must be located in a qualifying facility such as a Skilled Nursing Facility, and accompanied by a staff person.
  3. Procedure - Must be an approved procedure for telehealth (see below).
Services conducted via telehealth and reimbursed by Medicaid and Medicare use the same billing codes as face-to-face (with a "GT" modifier).   These services include:
  1. 90791 - 90792: Psychiatric diagnostic interview examination
    90832 – 90834 and 90836 – 90838: Individual psychotherapy
    90845: Psychoanalysis
    90846 - 90847: Family psychotherapy
    90951 - 90952, 90954 - 90955, 90957 - 90958, and 90960 - 90961: End-Stage Renal Disease-related services included in the monthly capitation payment 
    96116: Neurobehavioral status examination 
    96150 – 96154: Individual and group health and behavior assessment and intervention 
    97802 – 97804 and G0270: Individual and group medical nutrition therapy 
    99201 – 99215: Office or other outpatient visits 
    99231 – 99233: Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days 
    99307 – 99310: Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days
    99354 - 99355: Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service
    99406 - 99407 and G0436 - G0437: Smoking cessation services
    99495 - 99496: Transitional care management services
    G0108 - G0109: Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training 
    G0396 - G0397: Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services
    G0406 – G0408: Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs 
    G0420 - G0421: Individual and group kidney disease education services 
    G0425 – G0427: Telehealth consultations, emergency department or initial inpatient 
    G0438 - G0439: Annual wellness visit
    G0442: Annual alcohol misuse screening
    G0443: Brief face-to-face behavioral counseling for alcohol misuse
    G0444: Annual depression screening

    G0445: High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually
    G0446: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual
    G0447: Face-to-face behavioral counseling for obesity
    G0459: Inpatient pharmacologic management

The American Telemedicine Association has published a summary of Medicare reimbursement for Telehealth as of January, 2013.  Read it here along with other importnat Mediacre related documents.

 

CMS has published Telehealth rules for 2015.  Read about them here  (click the link and search for Telehealth)

CMS has added three psychotherapy codes to its telehealth benefits package for 2015.    Read about them here. 

Three services provided by psychologists — psychoanalysis (90845), family psychotherapy without patient present (90846) and family psychotherapy (conjoint therapy) with patient present (90847) — are newly eligible as of Jan. 1, 2015, for Medicare reimbursement under the telehealth benefit.

 

Medicare Telehealth Billing and Payment Policies as of January, 2015:

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

Last Updated on Wednesday, 16 August 2017 09:20