Medicare Coverage for Telehealth Visits
Yes, Medicare currently covers telehealth visits, but with specific limitations regarding eligible services, provider types, and patient locations. 1
Medicare Telehealth Coverage Details
Eligible Services
Medicare covers a wide range of telehealth services including:
- Consultations (CPT codes 99241-99245)
- Office or outpatient visits for new patients (CPT codes 99201-99205)
- Office or outpatient visits for established patients (CPT codes 99211-99215)
- Individual psychotherapy (CPT codes 90832-90838)
- Pharmacologic management (CPT code 90863)
- Emergency department consultations
- Hospital care services (limited to 1 telehealth visit every 3 days)
- Nursing facility care services (limited to 1 telehealth visit every 3 days or 30 days, depending on the service)
- Various behavioral health and assessment services 1
Eligible Providers
Medicare allows the following practitioners to provide and receive payment for telehealth services:
- Physicians
- Physician assistants
- Nurse practitioners
- Nurse-midwives
- Clinical nurse specialists
- Clinical psychologists
- Clinical social workers
- Registered dieticians or nutrition professionals 1
Location Requirements
For standard Medicare telehealth coverage (outside of pandemic waivers):
The patient must be at an eligible "originating site" which includes:
- Physician offices
- Hospitals
- Critical access hospitals
- Rural health clinics
- Federally qualified health centers
- Skilled nursing facilities
- Community mental health centers 1
The originating site must be located in:
- A rural Health Professional Shortage Area
- A county outside of a Metropolitan Statistical Area
- A location participating in a federal telemedicine demonstration project 1
Technical Requirements
- An interactive audio and video telecommunications system must be used that permits real-time communication between the provider and patient
- The patient must be present and participating in the telehealth visit
- The medical examination must be under the control of the physician or practitioner at the distant site 1
Special Considerations
Store-and-Forward Technology
Medicare permits payment for asynchronous "store and forward" technology (transmission of medical information to be viewed later) only in federal telemedicine demonstration programs in Alaska or Hawaii. 1
Billing Requirements
Claims for telehealth services should be submitted using the appropriate CPT or HCPCS code along with the telemedicine modifier GT ("via interactive audio and video telecommunications systems"). 1
COVID-19 Pandemic Changes
During the COVID-19 public health emergency, Medicare significantly expanded telehealth coverage by:
- Removing location restrictions so patients could receive telehealth from their homes
- Expanding covered services
- Providing full reimbursement for telehealth visits 2
These temporary waivers were expected to expire when the public health emergency ended, potentially creating a "telehealth cliff" for Medicare beneficiaries. 2
Recent Developments
Recent data shows that telehealth usage among Medicare beneficiaries increased dramatically during the pandemic, from less than 1% of all Medicare Fee-for-Service outpatient visits in 2019 to 46% in April 2020. 3
Common Pitfalls to Avoid
- Failing to verify that the patient is at an eligible originating site (for standard Medicare coverage)
- Not using the required interactive audio-video technology
- Omitting the telehealth modifier (GT) when billing
- Attempting to bill for services not included in Medicare's list of covered telehealth services
- Overlooking state-specific licensing requirements when providing telehealth across state lines
Remember that Medicare coverage for telehealth is more limited than many state Medicaid programs and commercial insurers, particularly regarding eligible originating sites and geographic requirements. 1