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Printed Date: 9/22/2015
Medicare pays a limited number of Part B telehealth services. Medicare telehealth services are Part B services that a practitioner provides to an eligible beneficiary through a telecommunications system. To support rural access to care, Medicare covers telehealth services provided through live, interactive videoconferencing between a beneficiary located at a certified rural originating site and a practitioner located at a distant site.
An eligible originating site must be an authorized medical facility, not a beneficiary’s home or office. CMS publishes an annual Telehealth Services Medicare Learning Network fact sheet that provides telehealth guidance for practitioners at distant sites. Distant-site practitioners of telehealth services must be licensed to provide the services under State law. Practitioners who may furnish and receive payment for covered telehealth services include, for example, physicians, nurse practitioners, and physician assistants.
The Office of the Inspector General (OIG) analyzed telehealth claims in 2014 and 2015 and found that more than half of the professional telehealth claims paid by Medicare did not have matching originating site facility fee claims. A Medicare Payment Advisory Commission study of 2009 claims found that Medicare professional fee claims without associated claims for originating site facility fees were more likely to be associated with unallowable telehealth payments. Medicare Paid a total of $17.6 million in telehealth payments on 2015, compared to $61,302 in 2001.
Providers must use a telecommunication system which substitutes an in-person encounter and permits real time communication between physician/practitioner and beneficiaries
Asynchronous 'store and forward' technology is permitted only in Federal telemedicine demonstration programs in Alaska or Hawaii.
Substitute In-Person Encounter
Distant Site Practitioners
*CP and CSWs cannot bill/receive payment for psychiatric diagnostic interview exams with Evaluation and Management (E/M) services or medical services (CPTs 90792, 90833, 90836, 90838)
Distant Site Payment Methodology TOB Revenue Code
CAH Method II Separate from cost based (80 percent of MPFS facility amount) 85X, 96x, 97x or 98x
The 'originating site' is a beneficiary's location at time of service. To ensure eligibility for these services, he/she must present from an originating site located in:
View the HRSA Data Warehouse Medicare Telehealth Payment Eligibility Analyzer to determine if an address is eligible for Medicare telehealth originating site payment.
Facility Fee - Originating Site
Part B reimburses originating sites an originating site facility fee for these services as described by HCPCS Q3014.
Do not append any modifier to HCPCS Q3014. Exception: Modifier GY is appropriate for denial.
Separately Billable for Part B Reimbursement
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Last Updated: 09/05/2018