Medicare Telehealth Billing: Provider vs. Patient Responsibility
No, patients cannot bill Medicare for telehealth visits—only the healthcare provider (physician or practitioner at the distant site) can submit claims and receive payment for Medicare telehealth services. 1
Who Bills Medicare for Telehealth
The distant site practitioner (the provider delivering the telehealth service) is responsible for billing Medicare, not the patient. 1 This includes:
- Physicians 1
- Physician assistants 1
- Nurse practitioners 1
- Clinical nurse specialists 1
- Clinical psychologists 1
- Clinical social workers 1
- Registered dieticians or nutrition professionals 1
The originating site (where the patient is located) may also receive a separate facility fee, but again, this is billed by the facility, not the patient. 1
How Providers Bill Medicare for Telehealth
Providers must submit claims using the appropriate CPT code along with the telemedicine modifier GT ("via interactive audio and video telecommunications systems"), which certifies that the beneficiary was present at an eligible originating site when the service was furnished. 2
Reimbursement is provided to both the consulting (distant site) and referring practitioners, but the patient is never the billing entity. 1
Patient's Financial Responsibility
Patients remain responsible for their standard Medicare cost-sharing obligations (deductibles, coinsurance, or copayments) for telehealth services, just as they would for in-person visits. 2 However, the patient does not submit the claim to Medicare—the provider handles all billing and receives payment directly from Medicare. 1
Documentation Requirements (Provider Responsibility)
For Medicare reimbursement, providers must document: 2
- Patient consent to telemedicine 2
- Method of telemedicine (secure 2-way interactive video connection) 2
- Patient location 2
- Provider location 2
- Clinical participants' roles and actions 2
Common Pitfall to Avoid
The most critical requirement is that Medicare telehealth services must use an interactive audio and video telecommunications system that permits real-time communication—telephone calls alone (audio-only) do not qualify as eligible Medicare telemedicine services. 2 Audio-only visits have variable reimbursement and are unlikely to remain on par with in-person and video telemedicine visits. 2