Telehealth - JE Part A
Telehealth
Telehealth, or sometimes referred to as Telemedicine, is the use of telecommunications technology to provide health care services to persons who are not in the same location as the provider. It involves a spectrum of technologies. Coverage and payment for Medicare telehealth includes consultation, office visits, individual psychotherapy, pharmacologic management, and other services delivered via an interactive audio and video telecommunications system as a substitute for an in-person visit.
Temporary Medicare changes through December 31, 2027
- FQHCs and RHCs can serve as a distant site provider for non-behavioral or mental telehealth services
- Beneficiaries can receive telehealth services in their home
- No geographic restrictions for originating site for non-behavioral or mental telehealth services
- Telehealth services can be delivered using audio-only communication if the patient requests audio only or does not consent to video
- An in-person visit within six months of an initial behavioral or mental telehealth service, and annually thereafter, is not required
- Telehealth services can be provided by all eligible Medicare providers
- Continues to allow qualified occupational therapists, qualified physical therapists, qualified speech-language pathologists, and qualified audiologists
- Define direct supervision to permit the presence and "immediate availability" of the supervising practitioner through real-time audio and visual interactive telecommunications
- Allows clinicians to render Telehealth from a hospital when patient is at the home.
- Note: Must use POS code of hospital and append modifier 95.
Permanent Medicare changes
- Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as a distant site provider for behavioral/mental telehealth services.
- Medicare patients can receive telehealth services for behavioral/mental health care in their home
- There are no geographic restrictions for originating site for behavioral/mental telehealth services
- Behavioral/mental telehealth services can be delivered using audio-only communication platforms
- Rural Emergency Hospitals (REHs) are eligible originating sites for telehealth
Access the below related information from this page.
- Service Requirements
- Substitute In Person Encounter
- Distant Site Practitioners
- Originating Sites
- Facility Fee - Originating Site
- Separately Billable for Part B Reimbursement
- Originating Site Fee Payment and Billing Guidelines
- Resources
- Related Latest Updates Articles
Service Requirements
Services must:
- Be furnished by an enrolled physician/practitioner (within practitioner's scope of practice under state law - check with individual state)
- Be provided to a beneficiary at an approved "originating site" within an eligible location
- Be provided using a real-time telecommunications system
- Meet coding eligibility criteria, conditions of payment and billing methodology
Providers must use telecommunication system which substitutes an in-person encounter and permits real time communication between physician/practitioner and beneficiaries
- System must be interactive
- Patient must be present and participating
Asynchronous "store and forward" technology is permitted only in Federal telemedicine demonstration programs in Alaska or Hawaii.
Substitute In Person Encounter
- Professional consultations (for telehealth services only)
- Office visits
- Office psychiatry services
- Limited number of other physician fee schedule services
- Additions or deletions annually: Physician fee schedule proposed and final rule
Distant Site Practitioners
- Eligible Practitioners
- Physicians
- Nurse Practitioners (NPs)
- Physician Assistants (PAs)
- Nurse Midwifes (CNMs)
- Clinical Nurse Specialists (CNSs)
- Certified Registered Nurse Anesthetists (CRNAs)
- Clinical Psychologists (CPs) who bill independently*
- Clinical Social Workers (CSWs)*
- Registered Dietitians (RDs)
- Nutritional Professionals
- Marriage and Family Therapist (MFT) *
- Mental Health Counselors (MHC) *
*Providers cannot bill/receive payment for psychiatric diagnostic interview exams with Evaluation and Management (E/M) services or medical services (CPTs 90792, 90833, 90836, 90838)
- Part B services billed on CMS-1500 claim form/electronic equivalent
- Services provided by distant site practitioner
- Part A telehealth distant site services billed on the UB04 or electronic equivalent
- Physician or practitioner services when distant site is in a Critical Access Hospital (CAH) that has elected Method II and physician or practitioner has reassigned his/her benefits to CAH. In all other cases, except for Medical Nutrition Services, distant site telehealth services are billed to Part B
| Distant Site | Payment Methodology | Type of Bill | Revenue Code |
|---|---|---|---|
| CAH Method II | Separate from cost based (80% of Medicare Physician Fee Schedule (MPFS) facility amount) |
85X | 96X, 97X, or 98X |
Originating Sites
The "originating site" is a beneficiary's location at time of service. To ensure eligibility for these services, he/she must present from an originating site located in:
- Rural health professional shortage area (HPSA) - Determined by Health Resources and Services Administration
- County outside Metropolitan Statistical Area (MSA) - Determined by United States Census Bureau
View the HRSA Data Warehouse Medicare Telehealth Payment Eligibility Analyzer webpage to determine if an address is eligible for Medicare telehealth originating site payment.
- Office of a physician or practitioner
- Hospitals
- Critical Access Hospitals (CAHs)
- Rural Health Clinics (RHCs)
- Federally Qualified Health Centers (FQHCs)
- Hospital-based or CAH-based Dialysis Centers
- Skilled Nursing Facilities (SNFs)
- Community Mental Health Centers (CMHCs)
- Beneficiary's home
- Independent Renal Dialysis Facilities
- Sites within an MSA or not within a HPSA
Submit claim with GY modifier as statutory requirements not met.
Facility Fee - Originating Site
Part B reimburses originating sites an originating site facility fee for these services as described by HCPCS Q3014.
| HCPCS | Year | Allowable | Medicare Economic Index (MEI) Increase | Change Request (CR) |
|---|---|---|---|---|
| Q3014 | 2026 | $31.85 | 2.7% | CR14315 |
| Q3014 | 2025 | $31.01 | 3.5% | CR13887 |
Applicable modifiers: GY for denial or G0 (G zero) to identify telehealth services for treatment of acute stroke symptoms.
Modifiers
93: Use only for synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system. Patient either requests audio only or does not consent to video.
95: Only use when performing telehealth visit with the clinician is in the hospital and the patient is in their home; or outpatient therapy provided by a physical therapist (PT), occupational therapist (OT), or speech language pathologist (SLP)
Note: not required on other telehealth visits
G0 (Gzero): Telehealth services for treatment of acute stroke symptoms
GQ: Alaska and Hawaii Federal Demonstration Project
GT: Continues to be required on distant site services billed under Critical Access Hospital (CAH) Method II on institutional claims.
Separately Billable for Part B Reimbursement
- Physician's or practitioner's office: Lesser of 80% of actual charge or 80% of originating site facility fee
- Geographic practice cost index not applied: Fee statutorily set
- Beneficiary responsibility: Unmet deductible and coinsurance
Originating Site Fee Payment and Billing Guidelines
| Originating Site | Payment Methodology | Type of Bill | Revenue Code |
|---|---|---|---|
| Outpatient hospital | Outside of OPPS | 13X | 078X |
| Inpatient hospital | Outside DRG | 12X | 078X |
| CAH | Separate from cost based (80% of originating site facility fee) | 12X | 078X |
| FQHC or RHC | Separate from Prospective Payment System (PPS) or All Inclusive Rate (AIR) | 77X or 71X | 078X |
| Hospital Based or CAH-Based Renal Dialysis Center | In addition to ESRD PPS or Monthly Capitation payment | 72X | 078X |
| SNF | Outside of SNF PPS (no subject to consolidated billing) | 22X or 23X | 078X |
| CMHC | Not a partial Hospitalization service (or used to determine payment for partial hospitalization) Not bundled in per diem | 76X | 078X |
