Medicare billing is covered in-depth here. Let’s get started. Telehealth is being utilized more every day across the United States, so you need to be knowledgeable about the topic. It would help if you were prepared when you are ready to submit Medicare telehealth claims in your office.
Medicare Telehealth Vocabulary Words
In this section, we’ll go over the key Medicare telehealth terms you’ll encounter.
A Medicare beneficiary is an individual who receives Medicare Part A and Medicare Part B coverage and who is enrolled in either Medicare Part A or B, living in the United States. The beneficiary’s coinsurance and deductible for many services and items are 20%.
Medicare beneficiaries receive services at an originating site through a telecommunications system. An MSA or an HPSA in a rural census tract is an originating site.
Geographic eligibility at an originating site is based on the area’s status on December 31 of the prior calendar year (CY). The site is eligible for a full calendar year starting on December 31 of the prior calendar year (CY).
A list of authorized originating sites is as follows:
- Physician and practitioner offices
- Hospitals
- Critical Access Hospitals (CAHs)
- Rural Health Clinics
- Federally Qualified Health Centers
- Hospital-based or CAH-based Renal Dialysis Centers (satellite locations included)
- Skilled Nursing Facilities (SNFs)
- Community Mental Health Centers (CMHCs)
- Renal Dialysis Facilities
- Homes of beneficiaries with End-Stage Renal Disease (ESRD) who are receiving home dialysis
- Mobile Stroke Units
A distant site is where the provider is located when providing a professional service via a telecommunications system.
An insurance firm that can handle Medicare Part A and Part B medical claims or Durable Medical Equipment (DME) payments for Medicare Fee-For-Service (FFS) enrollees is known as a Medicare Administrative Contractor (MAC).
Medicare Telehealth Providers
Remote site practitioners who can offer professional services and receive payment for covered telehealth services include:
- Physicians
- Nurse practitioners (NP)
- Physician assistants (PA)
- Nurse-midwives
- Clinical nurse specialists (CNSs)
- Certified registered nurse anesthetists
- Registered dietitians or nutrition professionals
- Clinical psychologists (CPs) and clinical social workers (CSWs)
During the COVID-19 Pandemic, Updates were Made
Providers are now permitted to offer telehealth services through several Section 1135 waivers.
Medicare beneficiaries may receive these services, including evaluation and management visits (regular office visits, mental health counseling, and preventive health screenings) and telehealth services in any healthcare facility, including doctor offices, hospitals, nursing homes, or rural health clinics and at home. These services allow Medicare beneficiaries, who are at a higher risk for COVID-19, to visit their doctor from where they are rather than go out to get the care they need.
People With Medical Conditions Can Receive Treatment Via Telehealth Services
Medicare pays providers for a limited number of medical conditions using telehealth services.
Medicare has expanded the range of telehealth services it covers in recent years. Although these changes do not appear to be sanctioned by CMS, they are nevertheless covered.
Because the modifications do not match Medicare’s definition of Telehealth, there are no geographic or originating limits.
Starting in 2013, providers can charge for telehealth-related transitional care management using transitional care management codes instead of telehealth codes. In 2015, providers could instead use chronic care management codes for invoicing for telehealth-related chronic care management.
Medicare reimbursed for remote health data collection and interpretation “unbundled” in 2019, providing users with a payment code to directly reimburse providers for those actions. CMS separated the code into two distinct parts, one for collection and one for interpretation, so Medicare recipients no longer have to wait for providers to approve their claims before receiving payment.
During COVID-19, there were no Updates
During the worldwide Pandemic, Medicare can now provide certain services via Telehealth.
The following are examples of paraphrases:
99201 – Office/outpatient visit – New Patient
99218 – Initial observation care
97161 – PT evaluation – low complexity – 20 mins
97166 – OT evaluation – moderate complexity – 45 mins
97802 – Medical nutrition therapy; initial assessment and intervention, face to face, 15 mins
The List of Telehealth Services on the Centers for Medicare and Medicaid Services site reveals all the temporary additions during the COVID-19 Pandemic.
Medicare Covers Telehealth Services
Medicare covers three main types of telehealth services, including:
- Medicare Telehealth Visits
- Virtual Check-Ins
- E-visits
To See a Doctor Via Telehealth, you Must have Health Insurance and be Enrolled in Medicare.
Provide telehealth services, such as office visits, psychotherapy, consultations, and other services provided by an eligible practitioner not at the beneficiaries’ locations using a 2-way interactive telecommunication system.
In some cases, these services are available in rural areas, but the beneficiary must be located at one of the following:
- A doctor’s office
- A hospital
- A critical access hospital (CAH)
- A rural health clinic
- A federally qualified health center
- A hospital-based dialysis facility
- A skilled nursing facility
- A community mental health center
During the COVID-19 Pandemic, Medicare updates their telehealth visits
Starting on the service date of March 6, 2020, Medicare will cover telehealth services provided to patients in more diverse settings. Outpatient care provided via Telehealth will be paid for in the same manner as in-person care. During the Pandemic, Medicare will pay for telehealth services provided in healthcare facilities and at the patient’s home.
Virtual Check-Ins
The benefits can chat with their doctor or other specified professionals, such as NPs or PAs, using a mobile device like a phone, tablet, laptop, or computer with integrated audio/visual and captured video images, so they don’t have to go to their clinic.
Providers can respond to beneficiaries by utilizing the following:
- Phone
- Audio/visual
- Secure text messages
- A patient portal
The following practitioners may offer the services:
- Doctors
- Nurse practitioners
- Physician assistants
- Licensed clinical social workers, in specific circumstances
- Clinical psychologists, in specific circumstances
- Physical therapists
- Occupational therapists
- Speech-language pathologists
Updates to Virtual Check-Ins during COVID-19:
Providers must have a pre-existing relationship with patients before reporting virtual check-ins. There are no geographical restrictions during this time. Patients may agree to services, but providers may describe the advantages before approval.
During the Pandemic, use HCPCS codes G2012 and G2010 to report these services.
Unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication, virtual check-ins can be conducted with more communication methods.
See this announcement for the entire update to virtual check-ins during the COVID-19 Pandemic.
Online Visits
Online patient portals allow patients to contact their doctors without going to the clinic. Because there is no need to visit the doctor’s office, E-Visits are particularly valuable for patients who cannot leave their homes.
These providers may provide these telehealth services:
- Doctors
- Nurse practitioners
- Physician assistants
- Licensed clinical social workers, in specific circumstances
- Clinical psychologists, in specific circumstances
- Physical therapists
- Occupational therapists
- Speech-language pathologists
The E-Visits During the COVID-19 Pandemic were Updated
During an e-visit, patients’ providers can communicate with them via patient portals, but the patients must initiate the services. There are no geographical restrictions during this time. Providers can educate their patients about the services before the services take place.
These codes can be used to bill services of 99421 to 99423.
An Explanation of How Medicare Pays for Telemedicine Visits More Broadly
Using the correct CPT or HCPCS codes, file a CMS-1500 form to bill Medicare for telehealth claims. The CPT or HCPCS code for telehealth services should be modified to 99201 GQ if performed using an “asynchronous telecommunications system.” To denote a distant service, use the Place of Service (POS) 02 – Telehealth. The Medicare physician Fee Schedule (PFS) amount was used to cover Medicare telehealth services billed to your MAC.
An Overview of Medicare Telehealth Reimbursement
The Medicare.gov website provides detailed information and up-to-date guidelines on reimbursement for Medicare telehealth.
In closing, always keep your wits about you, especially in dangerous situations.
Medicare payment for the use of Telehealth can be a bit nebulous. There are many rules to follow that must be followed, so let’s take review Medicare reimbursement. The most important things to be aware of:
- Live video Telehealth visits are covered. Visits to store and forward are only available in two states- Alaska and Hawaii. The Distant site has no limitations. However, the patient must be at an originating site that meets the following criteria:
- You must be in a Health Professional Shortage Area (HPSA)
- Are classified into any of these types:
- Doctors’ offices or physician 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)
- Certain HCPCS and CPT codes are suitable for reimbursement. CMS regularly updates the list annually. CMS has increased the number of covered services during the COVID-19 Pandemic.
- It is essential to include modifications on your bills. If you have the right CPT or HCPCS code, utilize “GT” or the “GT” modifier to show the service was performed through
Telehealth. If you reside within Alaska or Hawaii, you can use “GQ. “GQ” modifier.
- Certain professionals are qualified for reimbursement through the telehealth system. These include doctors, NPs, PAs, Nurse Midwives, clinical nurse specialists, Clinical Psychologists, Clinical Social Workers, Nutrition professionals, and registered dietetics.
CMS has extended its list of acceptable providers during the COVID-19 epidemic.
- The original site may charge a facility fee as described by HCPCS code Q3014. You may bill the MAC separately on behalf of the Part B origin site facility fee.
- Medicare reimbursement for Telehealth should be comparable to the cost of an in-person visit. For instance, CPT number 99213, regardless of whether services are delivered in person or via Telehealth, should be reimbursed in the same amount according to the Medicare Physician Fee Schedule.
