Medicare’s Telehealth Coverage – Know the Reimbursement Rules

1
Medicares Telehealth Coverage Know the
Reimbursement Rules
1-800-670-2809
www.outsourcestrategies.com
2
The rare bipartisan legislation that was recently
introduced to expand Medicares telehealth
services are being hailed as a development that
could potentially reduce costs and improve
patient health. Healthcare providers are advised
to follow CMS specific reimbursement guidelines
to benefit from Medicares telehealth
coverage. Medicare payers, under the direction
of CMS, reimburse for a variety of telehealth
services, but only within carefully defined
circumstances. Here are a few basics to
accurately report telehealth services to
Medicare.
1-800-670-2809
1-800-670-2809
www.outsourcestrategies.com
www.outsourcestrategies.com
3
Know the Covered Services Currently, CMS limits
reimbursement for telehealth services to those
represented by approximately 85 CPT and HCPCS
Level II codes, including

• Psychiatric diagnostic procedures (90791-90792)
• Select psychotherapy services (90832-90838)
• End-stage renal disease services (90951-90952,
  90954-90956)
• Outpatient evaluation management (E/M)
  services (99201-99215)
• Advanced care planning (99497-99498)
• Annual depression screening (G0444), and more

1-800-670-2809
www.outsourcestrategies.com
4
Patient Must Be in an Approved Originating Site

• The patient receiving the service must be in an
  approved originating site
• CMS defines this as, "the location of an
  eligible Medicare beneficiary at the time the
  service being furnished via a telecommunications
  system occurs.
• The originating sites authorized by law include

• Physician or practitioner office
• Hospitals
• Critical Access Hospitals (CAH)
• Rural Health Clinics (RHC)
• Federally Qualified Health Centers (FQHC)
• Skilled Nursing Facilities (SNF)
• Community Mental Health Centers (CMHC)
• Hospital-based or CAH-based Renal Dialysis
  Centers (Independent Renal Dialysis Facilities
  are not eligible)

1-800-670-2809
www.outsourcestrategies.com
5
Only Approved Providers Are Eligible Practitioner
s who are approved to bill Medicare for
telehealth services include

• Physicians
• Nurse practitioners (NP)
• Physician assistants (PA)
• Nurse midwives
• Clinical nurse specialists (CNS)
• Registered dietitians or nutrition professionals
• Clinical psychologists (CP)
• Clinical social workers (CSW)

1-800-670-2809
www.outsourcestrategies.com
6
Services Must Be Interactive

• CMS pays only for telehealth sessions that are
  interactive.
• CMS recommends using an interactive audio and
  video telecommunications system during the
  session that permits real-time communication
  between the provider at the distant site, and the
  beneficiary or patient at the originating site.

1-800-670-2809
www.outsourcestrategies.com
7
Add Modifier GT to the Claim

• Along with suitable CPT and HCPCS codes, it is
  important to add a GT modifier to the claim.
• This modifier confirms that the beneficiary was
  present at an eligible originating site.
• Telehealth modifier GQ should be used if the
  provider performed telehealth services via an
  asynchronous telecommunications system.

1-800-670-2809
www.outsourcestrategies.com
8
Place of Service Must Be Reported

• A new Place of Service (POS) 02 for telehealth
  services was introduced by CMS the location
  where health services and health related services
  are provided or received, through telehealth
  telecommunication technology.
• Medicare will pay for these services using the
  Medicare Physician Fee Schedule (MPFS).
• Telehealth POS code is not applicable to
  originating site facilities billing a facility
  fee.

1-800-670-2809
www.outsourcestrategies.com
9

• Claims for Telehealth services with POS code 02
  without the GT or GQ modifier, will be denied.
• Lack of understanding about reimbursement rules
  for telemedicine visits may be preventing many
  providers and delivery systems from making
  informed decisions about implementing this
  technology.
• Medical billing and coding outsourcing could be
  the right option for providers to successfully
  report telehealth services to Medicare and
  prevent denials.

1-800-670-2809
www.outsourcestrategies.com
10
Contact Us
Headquarters 8596 E. 101st Street, Suite
HTulsa, OK 74133 Call us [phone] E-mail
sales_at_managedoutsource.com
1-800-670-2809
www.outsourcestrategies.com