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Here are a few things you need to know about Medicare and reimbursement for telemedicine services:
Defining Originating and Distant Site. Defining the Originating and Distant Sites. Medicare reimburses for telehealth services offered by a healthcare provider at a Distant Site, to a Medicare beneficiary (the patient) at an Originating Site. The originating site must be in a HPSA (Health Professional Shortage Area). The types of originating sites authorized by law are:
Physicians or practitioner offices
Critical Access Hospitals (CAH)
Rural Health Clinics
Federally Qualified Health Centers
Hospital-based or CAH-based Renal Dialysis Centers
Skilled Nursing Facilities (SNF)
Community Mental Health Centers (CMHC)
Note: Independent Renal Dialysis Facilities are not eligible originating site
The patient must be in a HPSA. In order to be eligible for Medicare reimbursement, the patient (Medicare beneficiary) needs to be receiving virtual care at one of the clinical settings mentioned above, that is also located within a Health Professional Shortage Area (HPSA). To see if the health facility is in a HPSA, type in their address to this CMS tool.
Only certain CPT and HCPCS codes are eligible for telemedicine reimbursement. Medicare has a specific list of CPT and HCPCS codes that are covered under telemedicine services. You can use our printable list of the eligible CPT and HCPCS codes in our complete PDF Guide to Telemedicine Reimbursement as a quick cheatsheet. Since that list is subject to change each year, we also recommend you check the CMS website.
Use the proper modifier. When billing for telemedicine visits, you need to use the 95 modifier code for commercial insurance plans, while the “GT” modifier must be included for Medicare and Medicaid plans.
Billing a facility fee. Medicare will also pay the originating site a facility fee, as reimbursement for hosting the telemedicine visit. For details on the facility fee, look up the HCPCS code Q3014. A new place of service (POS) code 02 has been created for telehealth.
Telemedicine reimbursement rates. Medicare reimburses telemedicine services at the same rate as the comparable in-person medical service, based on the current Medicare physician fee schedule. Plus, the facility serving as the originating site can charge an additional facility fee.