Medicare Well Visits Cannot Be Conducted Over the Phone
Medicare well visits cannot be conducted over the phone and require an interactive audio and video telecommunications system that permits real-time communication between the provider and patient. 1
Medicare Telemedicine Requirements
- Medicare requires that telemedicine visits use an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site and the beneficiary at the originating site 1
- The patient must be present and participating in the telemedicine visit, with the medical examination under the control of the physician or practitioner at the distant site 1
- Telephone calls alone (without video) do not qualify as eligible Medicare telemedicine services for well visits 1
Eligible Medicare Telemedicine Services
- Medicare covers specific telemedicine services including consultations, office visits, psychotherapy, and pharmacologic management when conducted with both audio and video components 1
- Covered services include:
- Office or other outpatient visits (new and established patients)
- Consultations
- Individual psychotherapy
- Pharmacologic management 1
Documentation Requirements for Telemedicine
- For Medicare telemedicine visits, providers must document:
- Patient consent to telemedicine
- Method of telemedicine (secure 2-way interactive video connection)
- Patient location
- Provider location
- Clinical participants' roles and actions
- Other individuals present at the visit 1
Billing and Reimbursement Considerations
- Claims for telemedicine services should be submitted using the appropriate CPT code along with the telemedicine modifier GT, "via interactive audio and video telecommunications systems" 1
- The GT modifier certifies that the beneficiary was present at an eligible originating site when the telemedicine service was furnished 1
- Audio-only visits have variable reimbursement and are unlikely to remain on par with in-person and video telemedicine visits 1
Exceptions and Special Considerations
- Medicare payment for asynchronous "store and forward technology" is permitted only in Federal telemedicine demonstration programs conducted in Alaska or Hawaii 1
- Asynchronous telecommunications systems in single media format specifically do NOT include telephone calls, fax, text messages, or email without real-time visualization of the patient 1
- Certain patient populations face barriers to video visits, including those who are older than 65 years, racial/ethnic minorities, and those with limited technology access 2, 3
Impact on Quality of Care
- Telemedicine visits that include both audio and video components can provide appropriate care while saving travel time and distance for patients 1
- Follow-up visits are somewhat higher after telemedicine compared with in-person primary care visits, varying by specific clinical condition 4
- Telemedicine adoption has been associated with modestly lower use of certain low-value tests without increasing overall healthcare spending 5