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Telehealth

Coverage and payment for Medicare telehealth includes consultation, office visits, individual psychotherapy and pharmacologic management delivered via a telecommunications system. Beneficiaries are eligible for telehealth services only if they are treated at an originating site located either in a rural health professional shortage areas (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA). Originating sites authorized by law are:

  • The office of physicians or practitioners
  • Hospitals
  • Critical Access Hospitals (CAHs)
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospital-based or CAH-based Renal Dialysis Centers
  • Skilled Nursing Facilities (SNF)
  • Community Mental health Centers

If the above statutory requirements for the originating site are not met, the claim for both the originating site and distant site must be submitted with the GY modifier.

The distant site is where the physician or non-physician practitioner (NPP) is located and provides services using an interactive audio and video telecommunication system that permits real-time communication with the beneficiary. Distant site practitioners (subject to State law) are:

  • Physicians
  • Nurse practitioners (NP)
  • Physician assistants (PA)
  • Nurse-midwives
  • Clinical nurse specialists (CNSs)
  • Certified registered nurse anesthetists
  • Clinical psychologist (CP) and clinical social workers (CSWs)
  • Registered dietitians or nutrition professionals

For CY 2016, the payment amount for HCPCS Q3014 (Telehealth originating site facility fee) is $25.10. The beneficiary is responsible for any unmet deductible and Medicare coinsurance.

The use of a telecommunications system may substitute for an in-person encounter for professional consultations, office visits, office psychiatry services and a limited number of other physician fee schedule (PFS) services. These services are listed below.

  • Telehealth consultations, emergency department or initial inpatient (G0425-G0427)
  • Follow-up inpatient telehealth consultations (G0406-G0408)
  • Office or other outpatient visits (99201-99215)
  • Subsequent hospital care services (with the limitation of one telehealth visit every 3 days) (99231-99233)
  • Subsequent nursing facility care services (with the limitation of one telehealth visit every 30 days) (99307-99310)
  • Individual psychotherapy (90832-90834 and 90836-90838)
  • Pharmacologic management (G0459)
  • Psychiatric diagnostic interview examination (90791 and 90792)
  • End stage renal disease related services (90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961, 90963, 90964, 90965 and 90966)
  • Individual and group medical nutrition therapy (G0270 and 97802-97804)
  • Neurobehavioral status exam (96116)
  • Individual and group health and behavior assessment and intervention (96150-96154)
  • Individual and group kidney disease education (KDE) services (G0420 and G0421)
  • Individual and group diabetes self-management training (DSMT) services (with a minimum of 1 hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training) (G0108 and G0109)
  • Smoking Cessation Services (G0436, G0437, 99406, 99407)
  • Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services (G0396 and G0397)
  • Annual alcohol misuse screening (G0442)
  • Brief face-to-face behavioral counseling for alcohol misuse (G0443)
  • Annual Depression Screening (G0444)
  • High-intensity behavioral counseling to prevent sexually transmitted infections (G0445)
  • Annual, face-to-face Intensive behavioral therapy for cardiovascular disease (G0446)
  • Face-to-face behavioral counseling for obesity (G0447)
  • Transitional care management services (99495 and 99496)
  • Annual wellness visits (G0438 and G0439)
  • Psychoanalysis (90845)
  • Family psychotherapy (90846 and 90847)
  • Prolonged evaluation and management services (99354-99357)

Resources

Last Updated Mar 16, 2016