Telehealth and/or Telemedicine is the use of telecommunications technology to provide health care services to persons who are at some distance from the provider. It involves a spectrum of technologies. To access Telehealth vs Telemedicine, Distant Site, Originating Site, Eligible Providers, Eligible Services, Acceptable Equipment, Billing, Federal Demonstration Project information, go to the Telehealth/Telemedicine webpage.

View the below telehealth/telemedicine enrollment related information on this page.

• Group Billing for their Reassignments
• Sole Proprietors
• Resource

Group Billing for their Reassignments

• Group must have an approved enrollment record in the state where the provider is providing the services
• Group must add the providers location as a practice location on their enrollment
  • This cannot include: privately owned boat, hotel room or car
• Provider must then reassign benefits to the group
• Provider must be licensed in state where the services are provided

Example: If patient is seen in California and x-ray reading is out of Florida, then group must establish a practice location in Florida and provider must be reassigned newly established group enrollment in Florida. Provider must be licensed in Florida.

Applications needed

• Group will submit an 855B to initially enroll or add the location in the state the provider rendering services
• Provider will submit an 855R to reassign to the group
  • If the provider is not actively enrolled, or new to Medicare; an 855I will need to be submitted
• All of these updates can be completed via PECOS or Paper

Sole Proprietor

• Sole Proprietor who bills Telehealth/Telemedicine must enroll the practice location where the services are rendered
• Provider will set up a practice location with either his/her home as the practice location or a rented/leased office space where the services are rendered
• Provider must be licensed in state where the services are rendered
• Example: If patient is seen in California and provider is rendering services in Florida, the provider must enroll in Florida and add that practice location to their enrollment

Applications needed

• Provider will submit an 855I application to the correct MAC
• This can be completed via paper or PECOS

Resources

• 42 CFR Part 410.78 - Telehealth Services background information
• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 5
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual Chapter 12
• CMS IOM, Publication 100-04, Medicare Claim Processing Manual, Chapter 12, Section 190
• CMS Telehealth Website
• Telehealth Service Booklet