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. Providers are located at the distant site and beneficiaries are located at the originating site.
View the below related information on this page.
- Distant Site
- Originating Site
- Eligible Services
- Acceptable Equipment
- Federal Demonstration Project
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. The location must be on the provider's enrollment file. For example, if the provider uses their home as an office location, the home must be listed on the enrollment file. A hotel, boat and car are not valid locations. The provider must be licensed and enrolled in the state the services are provided in. For example, if a beneficiary is in California and the provider is in Florida, the provider must be licensed and enrolled with the Medicare Administrative Contractor (MAC) for Florida.
Distant site practitioners (subject to State law) are:
- Nurse practitioners (NP)
- Physician assistants (PA)
- Clinical nurse specialists (CNSs)
- Certified registered nurse anesthetists
- Clinical psychologist (CP) and clinical social workers (CSWs)
- Registered dietitians or nutrition professionals
A medical professional is not required to present the beneficiary to the physician or practitioner unless it is medically necessary. The decision of medical necessity is made by the physician or practitioner at the distant site.
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). The Health Resources and Services Administration (HRSA) provides a tool to determine the originating site's eligibility. The originating site fees are billed by Part A providers.
Originating sites authorized by law are:
- Office of physicians or practitioners
- Critical Access Hospitals (CAHs)
- Rural Health Clinics (RHCs)
- Federally Qualified Health Centers (FQHCs)
- 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 modifier GY. The beneficiary's home is not a covered originating site.
The originating site may be paid an originating site fee, HCPCS Q3014.
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 services if the beneficiary is present and participating. These services are listed below.
|90785||Interactive complexity for diagnostic psychiatric evaluation|
|90791 and 90792||Psychiatric diagnostic interview examination|
|90832, 90833, 90834, 90836, 90837, 90838||Individual psychotherapy|
|90839, 90840||Psychotherapy for crisis|
|90846, 90847||Family psychotherapy|
|90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970||End Stage Renal Disease (ESRD) related services|
|96116||Neurobehavioral status exam|
|96150, 96151, 96152, 96153, 96154||Individual and group health and behavior assessment and intervention (HBAI)|
|96160, 96161||Health risk assessment|
|97802, 97803, 97804||Medical Nutrition Therapy (MNT)|
|99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215||Office or other outpatient Evaluation and Management (E/M) visits|
|99231, 99232, 99233||Subsequent hospital care services (with the limitation of one telehealth visit every three days)|
|99307, 99308, 99309, 99310||Subsequent nursing facility care services (with the limitation of one telehealth visit every 30 days)|
|99354, 99355, 99356, 99357||Prolonged E/M visits|
|99406, 99407||Smoking cessation services|
|99495, 99496||Transitional care management (TCM) services|
|99497, 99498||Advanced care planning (ACP)|
|G0108, G0109||Individual and group Diabetes Self-Management Training (DSMT) services (with a minimum of one hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training)|
|G0270||MNT reassessment and subsequent interventions for change in diagnosis|
|G0296||Visit to determine Low Dose Computed Tomography (LDCT) eligibility|
|G0396, G0397||Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services|
|G0406, G0407, G0408||Follow-up inpatient telehealth consultations|
|G0420, G0421||Individual and group kidney disease education (KDE) services|
|G0425, G0426, G0427||Telehealth consultations, emergency department or initial inpatient|
|G0436, G0437||Tobacco-use counsel|
|G0438, G0439||Annual Wellness Visit (AWV)|
|G0442||Annual alcohol misuse screening|
|G0443||Brief face-to-face behavioral counseling for alcohol misuse|
|G0444||Annual depression screening|
|G0445||High-intensity behavioral counseling to prevent sexually transmitted infections|
|G0446||Annual, face-to-face intensive behavioral therapy for cardiovascular disease|
|G0447||Face-to-face behavioral counseling for obesity|
|G0506||Extended care planning for Chronic Care Management (CCM)|
|G0508, G0509||Critical care telehealth consultation|
Additional information regarding inpatient hospital, emergency department and follow-up consultations, ESRD-related services, subsequent hospital care and subsequent nursing facility visits and Diabetes Self-Management Training (DSMT) is available in the CMS Internet Only Manual (IOM), Publication 100-04, Chapter 12.
Common Skype is not acceptable for telehealth purposes; however, professional Skype-like products are available. Health Insurance Portability and Accountability Act (HIPAA) guidelines require that any software transmitting protected personal health information meet a 128-bit level of encryption, at a minimum, need auditing, archival and backup capabilities. State laws must also be followed.
|Place of Service|| |
Federal Demonstration Project
In Alaska and Hawaii only, federal demonstration project allows the following differences:
- Use of asynchronous "store and forward" technology is allowed
- Providers must bill modifier GQ with distant site code. This indicates asynchronous medical file was collected and transmitted to provider at distant site
- Geographic location can be anywhere; rural HPSA or non-MSA does not apply
Last Updated Aug 24, 2018
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.