Not all services on the Medicare Physician Fee Schedule (PFS) are eligible for payment when performed via telehealth. If the beneficiary receives a telehealth service at an originating site that is not qualified for Medicare telehealth payment, then the visit is essentially unbillable (For example: An office visit with a specialist at an originating site that is not eligible per Medicare guidelines). If the telehealth service delivered does not meet the requirements outlined above, the service cannot be billed. Registered dietitians or nutrition professionals.Clinical psychologists and clinical social workers (may not bill for psychiatric diagnostic interviews or E/M services).Certified registered nurse anesthetists.Providers at the distant site who are eligible to receive payment for telehealth services include: The distant site is where the provider delivering the service is located. The Health Resources and Services Administration (HRSA) provides an online Medicare Telehealth Payment Eligibility Analyzer to determine if a site qualifies for Medicare telehealth payment. Hospital-based or CAH-based renal dialysis centers (including satellites)Įach calendar year, geographic eligibility for originating sites is established.Federally qualified health centers (FQHCs).Per CMS, authorized originating sites include: In addition, sites that participate in a federal telemedicine demonstration program qualify as originating sites in most cases. A rural Health Professional Shortage Area (HPSA) located in a rural census tract.A county outside of a Metropolitan Statistical Area (MSA). ![]() ![]() Telehealth is only a covered benefit if the originating site is: The originating site is the location of the beneficiary at the time the service is furnished. The exceptions are Alaska and Hawaii, where asynchronous technology - defined as the transmission of medical information to the distant site and reviewed later by the physician or practitioner - is permitted in federal telemedicine demonstration programs. ![]() Understanding these terms is critical for both providers and originating sites to ensure eligibility, service delivery and proper reimbursement.Īccording to CMS, telehealth services must be provided via an interactive audio and video telecommunications system that allows for real-time communication between the provider and the beneficiary. Medicare Part B covers a limited range of telehealth services, and the Centers for Medicare & Medicaid Services (CMS) provides guidelines for reporting these services using specific terminology. For an updated telehealth billing article specific to the COVID-19 emergency from this author, click here. Editor's note: This article was originally published in June 2018.
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