Skip to Main Content
 
 
 
Web Content Viewer

Web Content Viewer

Telehealth Services

General Information

Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter.

Originating Sites

An originating site is the location of an eligible Medicare beneficiary at the time the service furnished via a telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:

  • a rural HPSA located either outside of an MSA or in a rural census tract; or
  • a county outside of an MSA.

The HRSA determine HPSAs, and the U.S. Census Bureau determine MSAs. You can access HRSA’s Medicare Telehealth Payment Eligibility Analyzer to determine a potential originating site’s eligibility for Medicare telehealth payment.

Originating sites authorized by law are listed below:

  • The office of a physician or practitioner
  • A hospital (inpatient or outpatient)
  • A CAH
  • An RHC
  • An FQHC 
  • A hospital-based or critical access hospital-based renal dialysis center (including satellites)
  • A SNF
  • A CMHC
  • Renal dialysis facilities; home of beneficiaries with ESRD getting home dialysis*
  • Mobile stroke units**

*Applies only to physicians, providers and suppliers participating in the CEC and providing telehealth services to Medicare ESRD beneficiaries associated with the CEC model. Please see MLN Matters Article MM10314 Revised: Comprehensive ESRD Care (CED) Model Telehealth - Implementation for all billing requirements.

**Geographic HPSA restrictions for approved originating sites (now including mobile stroke units) have been removed. Please see MLN Matters Article MM10883: New Modifier for Expanding the Use of Telehealth for Individuals with Stroke for specific billing guidelines.

Distant Site

The term “distant site” means the site where the physician or practitioner providing the professional service is located at the time the service is provided via a telecommunications system.

List of Covered Medicare Telehealth Services

The various services and corresponding current procedural terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes are listed on the CMS website.

Billing

Facility Fee for Originating Site

The originating site facility fee is a separately billable Part B payment. The payment amount to the originating site is the lesser of 80 percent of the actual charge or 80 percent of the originating site facility fee, except CAHs. The beneficiary is responsible for any unmet deductible amount and Medicare coinsurance. The contractor pays the facility fee outside of other payment methodologies. The originating site facility fee payment methodology for each type of facility can be found by referencing the the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 190, “Medicare Payment for Telehealth Services.” 

Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014. When billing for the originating site, the POS is 11 and the location address is where the beneficiary was located.

You can bill National Government Services for the originating site facility fee, which is a separately billable Part B payment.

G0 Modifier

Effective for claims with dates of service on and after 1/1/2019, Medicare will accept HCPCS modifier G0 to be used to identify telehealth services furnished for purposes of diagnosis, evaluationor treatment of symptoms of an acute stroke. Modifier G0 is valid for all telehealth distant site codes billed with POS code 02 or critical access hospitals, CAH method II (revenue codes 096X, 097X or 098X) or telehealth originating site facility fee billed with HCPCS code Q3014.

Payment for Professional Fee

Claims for telehealth services are submitted to the contractors that process claims for the performing physician/practitioner’s service area. Physicians/practitioners submit the appropriate HCPCS procedure code for covered professional telehealth services with POS code 02 (Telehealth).

Medicare Practitioners Who May Bill for Covered Telehealth Services (Subject to State Law)

  • Physician
  • Nurse practitioner
  • Physician assistant
  • Nurse-midwife
  • Clinical nurse specialist
  • Clinical psychologist*
  • Clinical social worker*
  • Registered dietitian or nutrition professional
  • Certified registered nurse anesthetist

*Clinical psychologists and clinical social workers cannot bill for psychotherapy services that include medical evaluation and management services under Medicare. They cannot bill or get paid for CPT codes 90792, 90833, 90836 and 90838.

Related Content

Last Reviewed/Updated 4/23/2019

Telehealth Services
Web Content Viewer
Complementary Content