Understanding Medicare’s reimbursement rules for telemedicine is crucial for providers to successfully report telehealth services.

1. Medicare’s Telehealth Coverage
– Know the Reimbursement Rules
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2. 1-800-670-2809www.outsourcestrategies.com
The rare bipartisan legislation that was recently introduced to expand Medicare’s
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 Medicare’s
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.
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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
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 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

4. Patient Must Be in an Approved Originating Site
 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)
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 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:

5. Only Approved Providers Are Eligible
Practitioners who are approved to bill Medicare for telehealth services
include:
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 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)

6. Services Must Be Interactive
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 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.

7. Add Modifier GT to the Claim
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 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.”

8. Place of Service Must Be Reported
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 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.

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.
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10. Contact Us
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Tulsa, OK 74133
Call us: (800) 670 2809
E-mail: sales@managedoutsource.com
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