Federal

Last updated 02/26/2023

Consent Requirements

Communication Technology-Based Services:  Brief Communication Technology-Based Service, Remote Evaluation of Pre-Recorded Patient Information, Interprofessional Internet Consultation

Consent is required.  It can be verbal and noted in the beneficiaries’ medical record. It is only necessary to obtain consent once annually.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40 & CY 2020 Final Physician Fee Schedule. CMS, p. 435, (Accessed Feb. 2023).

Chronic Care Management

Get the patient’s written or verbal consent for CCM services before you bill for them. This helps ensure patients are engaged and aware of their cost sharing responsibilities. This also helps prevent duplicate practitioner billing. You must also inform the patient of these items and document it in their medical record:

• Availability of CCM services
• Possible cost sharing responsibilities
• Only 1 practitioner can furnish and bill CCM services during a calendar month
• Patient’s right to stop CCM services at any time (effective the end of calendar month)

Patients need to provide informed consent only once unless they switch to a different CCM practitioner.

SOURCE:  CMS MLN Booklet Chronic Care Management Services (Sept. 2022), p. 7. (Accessed Feb. 2023).

Virtual Check-In

The patient verbally consent to the virtual check-in, and the provider documents consent in the medical record. The provider may get one consent for a year’s worth of these services.

SOURCE:  CMS Your Medicare Coverage, Virtual Check-Ins.  (Accessed Feb. 2023).

Last updated 02/26/2023

Definitions

Interactive telecommunications system means, except as otherwise provided in this paragraph, multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner. For services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology. A modifier designated by CMS must be appended to the claim for services described in this paragraph to verify that these conditions have been met.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

Telehealth services:  You must use an interactive audio and video telecommunications system that permits real-time communication between you at the distant site, and the beneficiary at the originating site.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p.4, June 2021, (Accessed Feb. 2023).

Telehealth is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance. At one time, telehealth in Medicaid had been referred to as telemedicine.

Telehealth seeks to improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the distant site. This  communication often requires  the use of interactive telecommunications equipment that can include both audio and video components, but can also be conducted via audio-only, as states deem appropriate.

Telehealth includes such technologies as telephones, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation.

SOURCE: Medicaid.gov.  Telehealth (Accessed Feb. 2023).

 

Last updated 02/26/2023

Email, Phone & Fax

Temporary Policy – Ends Dec. 31, 2024

Treatment of telehealth services furnished using audio-only telecommunications technology. In the case that the emergency period described in section 1135(g)(1)(B) ends before December 31, 2024, the Secretary shall continue to provide coverage and payment under this part for telehealth services identified in paragraph (4)F()(i) as of the date of the enactment of this paragraph that are furnished via an audio-only communications system during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024. For purposes of the previous sentence, the term “telehealth service” means a telehealth service identified as of the date of the enactment of this paragraph [enacted March 15, 2022] by a HCPCS code (and any succeeding codes) for which the Secretary has not applied the requirements of paragraph (1) and the first sentence of section 410.78(a)(3) of title 42, Code of Federal Regulations, during such emergency period.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Interactive telecommunications system means, except as otherwise provided in this paragraph, multimedia communications equipment that includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner. For services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology. A modifier designated by CMS must be appended to the claim for services described in this paragraph to verify that these conditions have been met.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

Mental Health Services

CMS revised definition of ‘interactive telecommunications system’ above to include audio-only communication technology.  They will create a service-level modifier for use to identify mental health telehealth services furnished to a beneficiary in their home using audio-only communications technology.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215, (Accessed Feb. 2023).

The 2 additional modifiers for CY 2022 relate to telehealth mental health services. The modifiers are:

• FQ – A telehealth service was furnished using real-time audio-only communication technology
• FR – A supervising practitioner was present through a real-time two-way, audio/video communication technology

SOURCE: CY2022 Telehealth Update Medicare Physician Fee Schedule, MLN Matters 12549, (Jan. 1, 2022), (Accessed Feb. 2023).

FQHCs & RHCs Mental Health Services

Mental health visit includes audio-only interaction in cases where beneficiaries are not capable of, or do not consent to, the use of devices that permit a two-way, audio/video interaction for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

RHCs and FQHCs can report and be paid for furnishing those visits in the same way they currently do when these services are furnished in-person. RHCs and FQHCs will be paid for mental health visits furnished via telecommunications technology at the same rate they are paid for in-person mental health visits (that is, the AIR or FQHC PPS).

There must be an in-person mental health service furnished within 6 months prior to the furnishing of the telecommunications service and that in general, there must be an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders.  This applies only to patients receiving services at home.  If the patient and practitioner consider the risks and burdens of an in-person service and agree that, on balance, these outweigh the benefits, and the practitioner documents the basis for that decision in the patient’s medical record, then the in-person visit requirement is not applicable for that 12-month period.

In person requirement delayed under Medicare until on or after January 1, 2025.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215 & delay in implementation in HR 2617 (2022 Session).  (Accessed Feb. 2023).

RHCs and FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. You may use audio-only technology in situations when your patient can’t access or doesn’t consent to use audio-video technology. You can report and get paid in the same way as in-person visits.

Audio-video visits: Use modifier 95 (Synchronous Telemedicine Service Rendered via Real Time Interactive Audio and Video Telecommunications System).

Audio-only visits: Use new service-level modifier FQ.

SOURCE: Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health Centers, MLN Matters SE22001, (June 6, 2022), (Accessed Feb. 2023).

A mental health visit is a medically-necessary face-to-face encounter between an RHC or FQHC patient and an RHC or FQHC practitioner during which time one or more RHC or FQHC mental health services are rendered. Effective January 1, 2022, a mental health visit is a face-to-face encounter or an encounter furnished using interactive, real-time, audio and video telecommunications technology or audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

The CAA, 2023 extends the telehealth policies of the CAA, 2022 through December 31, 2024 if the PHE ends prior to that date. The in-person visit requirements for mental health telehealth services and mental health visits furnished by RHCs and FQHCs begin on January 1, 2025 if the PHE ends prior to that date. There must be an in-person mental health service furnished within 6 months prior to the furnishing of the mental health service furnished via telecommunications and that an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reasons for this decision in the patient’s medical record.

RHCs and FQHCs are instructed to append modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) in instances where the mental health visit was furnished using audio-video communication technology and to append modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System) in cases where the service was furnished using audio-only communication.

Mental health services that qualify as stand-alone billable visits in an FQHC are listed on the FQHC center website, http://www.cms.gov/Center/Provider-Type/FederallyQualified-Health-Centers-FQHC- Center.html. Services furnished must be within the practitioner’s state scope of practice.

Medicare-covered mental health services furnished incident to an RHC or FQHC visit are included in the payment for a medically necessary mental health visit when an RHC or FQHC practitioner furnishes a mental health visit. Group mental health services do not meet the criteria for a one-one-one, face-to-face encounter in an FQHC or RHC.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, Jan. 26, 2023, pg. 20 (Accessed Feb. 2023).

Communication Technology-Based Services (CTBS)

‘Brief communication technology-based service, e.g. virtual check-in’ allows for real-time audio-only telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Feb. 2023).

Interprofessional consultations are reimbursable by CMS as part of their CTBS services (CPT codes include 99451, 99452, 99446, 99447, 99448, and 99449). Cost sharing will apply. These interprofessional services may be billed only by practitioners that can bill Medicare independently for evaluation and management services.  Includes telephone and internet assessments.

SOURCE CY 2019 Final Physician Fee Schedule. CMS, p. 31-40 (Accessed Feb. 2023).

Online digital evaluation services (e-visit) are reimbursable for physicians and qualified non-physician health care professionals.  These are non-face-to-face codes that describe patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.

SOURCE: CY 2020 Final Physician Fee Schedule. CMS, p. 799 (Accessed Feb. 2023).

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes communication technology-based services (Includes the Brief Communication Technology-Based Service, Remote Evaluation of Pre-Recorded Patient Information) to an RHC or FQHC patient. RHCs and FQHCs receive payment for communication technology-based services or remote evaluation services when an RHC or FQHC practitioner provides at least 5 minutes of communications-based technology or remote evaluation services to a patient who has been seen in the RHC or FQHC within the previous year.

G0071 should be billed for both services.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, & Virtual Communication Services RHCs and FQHCs FAQs, December 2018, (Accessed Feb. 2023).

RHCs and FQHCs are not eligible for reimbursement of interprofessional consultation services, as only practitioners that can bill Medicare independently for evaluation and management services are eligible.

SOURCE CY 2019 Final Physician Fee Schedule. CMS, p. 31-40 (Accessed Feb. 2023).

Home Health Agencies

An individualized plan of care must be established and periodically reviewed by the certifying physician or allowed practitioner.  The plan of care must include all of the following: … Any provision of remote patient monitoring or other services furnished via telecommunications technology (as defined in § 409.46(e)) or audio-only technology. Such services must be tied to the patient-specific needs as identified in the comprehensive assessment, cannot substitute for a home visit ordered as part of the plan of care, and cannot be considered a home visit for the purposes of patient eligibility or payment.

Telecommunications technology, as indicated on the plan of care, can include: remote patient monitoring, defined as the collection of physiologic data (for example, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient or caregiver or both to the home health agency; teletypewriter (TTY); and 2-way audio-video telecommunications technology that allows for real-time interaction between the patient and clinician. The costs of any equipment, set-up, and service related to the technology are allowable only as administrative costs. Visits to a beneficiary’s home for the sole purpose of supplying, connecting, or training the patient on the technology, without the provision of a skilled service, are not separately billable.

SOURCE:  42 CFR Sec. 409.43 & 409.46 as updated by CMS Final Rule for CY 2021 Home Health Prospective Payment System (Accessed Feb. 2023).

Starting on or after January 1, 2023, they may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. CMS will require this information on HH claims starting on July 1, 2023. Home Health Agencies will submit the use of telecommunications technology on the HH claim using the following 3 G-codes:

• G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
• G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
• G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)

SOURCE: Telehealth Home Health Services: G-Codes, MLN Matters MM12805, (Effective Date: Jan. 1, 2023), (Accessed Feb. 2023).

No reference found for email and fax.

Last updated 02/26/2023

Live Video

POLICY

Medicare Part B pays for covered telehealth services included on the telehealth list when furnished by an interactive telecommunications system if certain conditions are met.

The Secretary shall pay for telehealth services that are furnished via a telecommunications system by a physician or a practitioner to an eligible telehealth individual notwithstanding that the individual physician or practitioner providing the telehealth service is not at the same location as the beneficiary.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Feb. 2023).

Permanent Policy – Requirements for mental health services furnished through telehealth

Payment may not be made under this paragraph for telehealth services furnished on or after the day that is the 152nd day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title) by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this subchapter (or would have been made under this subchapter if such individual were entitled to, or enrolled for, benefits under this subchapter at the time such item or service is furnished)—

• within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and
• during subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

These requirements do not apply to services:

• Under this paragraph (with respect to telehealth services furnished to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder); or
• under this subsection without application of this paragraph.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Feb. 2023).

Temporary Policy – Ends Dec. 31, 2024 – Delay of In-Person mental health requirement

In general. Payment may not be made under this paragraph for telehealth services furnished on or after January 1, 2025 (or, if later, the first day after the end of the emergency period described in 1395(g)(1)(B)) by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this title (or would have been made under this title if such individual were entitled to, or enrolled for, benefits under this title at the time such item or service is furnished)—

• Within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and
• During subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removed originating site geographic conditions and added an individual’s home as a permissible originating telehealth services substance use disorder or co-occurring mental health treatment site.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

In addition to the requirement for the in-person visit mentioned above in statute, CMS will also require there to be an in-person, non-telehealth service within 12 months of each mental health telehealth service.  However, if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record, the in-person visit requirement will not apply for that particular 12-month period.  CMS will allow a clinician’s colleague in the same subspecialty in the same group to furnish the in-person, non-telehealth service to the beneficiary if the original practitioner is unavailable.

See eligible providers section for additional information for federally qualified health centers (FQHCs) and rural health clinics (RHCs).

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 63, (Accessed Feb. 2023).

6-month initial in-person visit requirement will not apply if a beneficiary began receiving mental health telehealth services during the PHE or during the 151-day period after the end of the PHE, then they would not be required to have an in-person visit within 6 months; rather, they will be considered established and will instead be required to have at least one in-person visit every 12 months (so long as any such subsequent telehealth service is furnished by the same individual physician or practitioner (or a practitioner of the same sub-specialty in the same practice) to the same beneficiary). This means that these services would be subject to the requirement that an in-person visit is furnished within 12 months of each mental health telehealth service for those services that are subject to in-person visit requirements (unless an exception is documented by their treating practitioner). For discussion of additional requirements for these services, please see the discussion in the CY 2022 PFS final rule.

SOURCE: CY 2023 Physician Fee Schedule, CMS, p. 167, (Accessed Feb. 2023).

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ELIGIBLE SERVICES/SPECIALTIES

The term “telehealth service” means professional consultations, office visits, and office psychiatry services (identified as of July 1, 2000, by HCPCS codes 99241–99275, 99201–99215, 90804–90809, and 90862 (and as subsequently modified by the Secretary)), and any additional service specified by the Secretary.  The Secretary shall establish a process that provides, on an annual basis, for the addition or deletion of services (and HCPCS codes), as appropriate.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Feb. 2023).

Medicare Part B pays for covered telehealth services included on the telehealth list when furnished by an interactive telecommunications system if certain conditions are met, except that for the duration of the Public Health Emergency as defined in § 400.200 of this chapter, Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management and end stage renal disease related services included in the monthly capitation payment furnished by an interactive telecommunications system if certain conditions are met.

A clinical psychologist and a clinical social worker may bill and receive payment for individual psychotherapy via a telecommunications system, but may not seek payment for medical evaluation and management services.

The physician visits required under Sec. 483.40(c) [rehabilitative services such as physical therapy, speech-language pathology, occupational therapy, and rehabilitative services for mental disorders and intellectual disability] may not be furnished as telehealth services.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

A physician, NP, PA, or CNS must furnish at least one ESRD-related “hands on visit” (not telehealth) each month to examine the beneficiary’s vascular access site.

The subsequent nursing facility services frequency limitation provided via telehealth is now 14 days, not 30 days.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p. 4, June 2021, (Accessed Feb. 2023).

Changes to the list of Medicare telehealth services are made through the annual physician fee schedule rulemaking process. During the Public Health Emergency for the COVID-19 pandemic, as defined in § 400.200 of this chapter, we will use a sub-regulatory process to modify the services included on the Medicare telehealth list during the Public Health Emergency taking into consideration infection control, patient safety, and other public health concerns resulting from the emergency. A list of the services covered as telehealth services under this section is available on the CMS website.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth is available on the CMS website, including temporary codes during the public health emergency. Find the complete List of Telehealth Services by downloading the ZIP and opening the Excel or text files.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p. 5, June 2021 & CMS Telehealth List Year 2/13/2023.  (Accessed Feb. 2023).

Communication Technology-Based Services (CTBS)

CMS makes separate payment for brief communication technology-based services. This includes ‘brief communication technology-based service, e.g. virtual check-in’ by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion). The code (G2012) allows real-time audio-only telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission. The service is limited to established patients.

Interprofessional consultations are reimbursable by CMS as part of their CTBS services (CPT codes include 99451, 99452, 99446, 99447, 99448, and 99449). Cost sharing will apply. These interprofessional services may be billed only by practitioners that can bill Medicare independently for evaluation and management services.  Includes telephone and internet assessments.

CTBS services are not regarded by CMS as telehealth.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Feb. 2023).

Temporary Policy – Ends Dec. 31, 2024 – Hospice Services

During the emergency period described in section 1135(g)(1)(B) [42 USCS § 1320b-5(g)(1)(B)], and, in the case that such emergency period ends before December 31, 2024, during the period beginning on the first day after the end of such emergency period described in such section 1135(g)(1)(B) and ending on December 31, 2024, a hospice physician or nurse practitioner may conduct a face-to-face encounter required under this clause via telehealth, as determined appropriate by the Secretary.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

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ELIGIBLE PROVIDERS

Temporary Policy – Ends Dec. 31, 2024

Practitioner. The term “practitioner” has the meaning given that term in section 1842(b)(18)(C) [42 USCS § 1395u(b)(18)(C)] and, in the case that the emergency period described in section 1135(g)(1)(B) ends before December 31, 2024, for the period beginning on the first day after the end of such emergency period and ending on December 31, 2024, shall include a qualified occupational therapist (as such term is used in section 1861(g) [42 USCS § 1395x(g)]), a qualified physical therapist (as such term is used in section 1861(p) [42 USCS § 1395x(p)]), a qualified speech-language pathologist (as defined in section 1861(ll)(4)(A) [42 USCS § 1395x(ll)(4)(A)), and a qualified audiologist (as defined in section 1861(ll)(4)(B) [42 USCS § 1395x(ll)(4)(B)).

…

In the case that such emergency period ends before December 31, 2024, during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024—

• the Secretary shall pay for telehealth services that are furnished via a telecommunications system by a Federally qualified health center or a rural health clinic to an eligible telehealth individual enrolled under this part notwithstanding that the Federally qualified health center or rural clinic providing the telehealth service is not at the same location as the beneficiary;
• the amount of payment to a Federally qualified health center or rural health clinic that serves as a distant site for such a telehealth service shall be determined under subparagraph (B); and
• for purposes of this subsection—
  • the term “distant site” includes a Federally qualified health center or rural health clinic that furnishes a telehealth service to an eligible telehealth individual; and
  • the term “telehealth services” includes a rural health clinic service or Federally qualified health center service that is furnished using telehealth to the extent that payment codes corresponding to services identified by the Secretary under clause (i) or (ii) of paragraph (4)(F) are listed on the corresponding claim for such rural health clinic service or Federally qualified health center service.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Permanent Policy

The Secretary shall pay to a physician or practitioner located at a distant site that furnishes a telehealth service to an eligible telehealth individual an amount equal to the amount that such physician or practitioner would have been paid under this title had such service been furnished without the use of a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Feb. 2023).

The physician or practitioner at the distant site must be licensed to furnish the service under State law. The physician or practitioner at the distant site who is licensed under State law to furnish a covered telehealth service may bill, and receive payment for, the service when it is delivered via a telecommunications system.

The practitioner at the distant site is one of the following:

• A physician
• A nurse practitioner
• Physician Assistant
• A clinical nurse specialist
• A nurse-midwife
• A clinical psychologist
• A clinical social worker
• A registered dietitian or nutrition professional
• A certified registered nurse anesthetist

SOURCE: 42 CFR Sec. 410.78 & Medicare Learning Network Factsheet. Telehealth Services, p. 4, June 2021 (Accessed Feb. 2023).

A clinical psychologist and a clinical social worker may bill and receive payment for individual psychotherapy via a telecommunications system, but may not seek payment for medical evaluation and management services.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services. They cannot bill or get paid for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 4, June 2021 (Accessed Feb. 2023).

CMS allows Opioid Treatment Programs (OTPs) to use two-way interactive audio-video communication technology, as clinically appropriate, in furnishing substance use counseling and individual and group therapy services.  An intake add-on code by live video for the initiation of treatment with buprenorphine, when clinically appropriate and in compliance with other requirement was also added.

SOURCE:  CY 2020 Final Physician Fee Schedule. CMS, p. 249, & CY 2023 Final Physician Fee Schedule, CMS, p. 1055, (Accessed Feb. 2023).

Communication Technology-Based Services

Payment for communication technology-based and remote evaluation services. For communication technology-based and remote evaluation (including the virtual check-in) services furnished on or after January 1, 2019, payment to RHCs and FQHCs is at the rate set for each of the RHC and FQHC payment codes for communication technology-based and remote evaluation services.

SOURCE:  42 CFR 405.2464 (Accessed Feb. 2023).

RHCs and FQHCs are not eligible for reimbursement of interprofessional consultation services, as only practitioners that can bill Medicare independently for evaluation and management services are eligible.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Feb. 2023).

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes communication technology-based services (Includes the Brief Communication Technology-Based Service, Remote Evaluation of Pre-Recorded Patient Information) to an RHC or FQHC patient. RHCs and FQHCs receive payment for communication technology-based services or remote evaluation services when an RHC or FQHC practitioner provides at least 5 minutes of communications-based technology or remote evaluation services to a patient who has been seen in the RHC or FQHC within the previous year.

G0071 should be billed for both services.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, & Virtual Communication Services RHCs and FQHCs FAQs, December 2018, (Accessed Feb. 2023).

Mental Health for FQHCs and RHCs

Revised definition of a ‘mental health visit’ to include encounters furnished through interactive, real-time telecommunications technology, but only when furnishing services for purposes of diagnosis, evaluation or treatment of a mental health disorder.

FQHCs and RHCs will be able to furnish mental health visits to include visits furnished using interactive, real-time telecommunications technology and will RHCs and FQHCs can report and be paid for furnishing those visits in the same way they currently do when these services are furnished in-person.  RHCs and FQHCs will be paid for mental health visits furnished via telecommunications technology at the same rate they are paid for in-person mental health visits (that is, the AIR or FQHC PPS).

There must be an in-person mental health service furnished within 6 months prior to the furnishing of the telecommunications service and that in general, there must be an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders.  This applies only to patients receiving services at home.  If the patient and practitioner consider the risks and burdens of an in-person service and agree that, on balance, these outweigh the benefits, and the practitioner documents the basis for that decision in the patient’s medical record, then the in-person visit requirement is not applicable for that 12-month period.

In person requirement delayed under Medicare until on or after January 1, 2025.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215 & delay in implementation in HR 2617 (2022 Session).  (Accessed Feb. 2023).

RHCs and FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. You may use audio-only technology in situations when your patient can’t access or doesn’t consent to use audio-video technology. You can report and get paid in the same way as in-person visits.

These visits are different from telehealth services provided during the COVID-19 Public Health Emergency (PHE). Don’t bill HCPCS code G2025 for a mental health visit you provide via telecommunications.

These in-person visit requirements apply only to a patient getting mental health visits via telecommunications at home:

• There must be an in-person mental health visit 6 months before the telecommunications visit
• In general, there must be an in-person mental health visit at least every 12 months while the patient is getting services from you via telecommunications to diagnose, evaluate, or treat mental health disorders

NOTE: Section 304 of the Consolidated Appropriations Act (CAA), 2022, delayed the in-person visit requirements under Medicare for mental health visits that RHCs and FQHCs provide via telecommunications technology. For RHCs and FQHCs, in-person visits won’t be required until the 152nd day after the end of the COVID-19 PHE.

CMS will allow for limited exceptions to the requirement for an in-person visit every 12 months based on patient circumstances in which the risks and burdens of an in-person visit may outweigh the benefit. These include, but aren’t limited to, when:

• An in-person visit is likely to cause disruption in service delivery or has the potential to worsen the patient’s condition
• The patient getting services is in partial or full remission and only needs maintenance level care
• The clinician’s professional judgment says that the patient is clinically stable and that an in-person visit has the risk of worsening the patient’s condition, creating undue hardship on self or family
• The patient is at risk of withdrawing from care that’s been effective in managing the illness

With proper documentation, the in-person visit requirement isn’t applicable for that 12-month period. You must document the circumstance in the patient’s medical record.

SOURCE: Mental Health Visits via Telecommunications for Rural Health Clinics and Federally Qualified Health Centers, MLN Matters SE22001, (June 6, 2022), (Accessed Feb. 2023).

A mental health visit is a medically-necessary face-to-face encounter between an RHC or FQHC patient and an RHC or FQHC practitioner during which time one or more RHC or FQHC mental health services are rendered. Effective January 1, 2022, a mental health visit is a face-to-face encounter or an encounter furnished using interactive, real-time, audio and video telecommunications technology or audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology for the purposes of diagnosis, evaluation or treatment of a mental health disorder.

The CAA, 2023 extends the telehealth policies of the CAA, 2022 through December 31, 2024 if the PHE ends prior to that date. The in-person visit requirements for mental health telehealth services and mental health visits furnished by RHCs and FQHCs begin on January 1, 2025 if the PHE ends prior to that date. There must be an in-person mental health service furnished within 6 months prior to the furnishing of the mental health service furnished via telecommunications and that an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reasons for this decision in the patient’s medical record.

RHCs and FQHCs are instructed to append modifier 95 (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) in instances where the mental health visit was furnished using audio-video communication technology and to append modifier 93 (Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System) in cases where the service was furnished using audio-only communication.

Mental health services that qualify as stand-alone billable visits in an FQHC are listed on the FQHC center website, http://www.cms.gov/Center/Provider-Type/FederallyQualified-Health-Centers-FQHC- Center.html. Services furnished must be within the practitioner’s state scope of practice.

Medicare-covered mental health services furnished incident to an RHC or FQHC visit are included in the payment for a medically necessary mental health visit when an RHC or FQHC practitioner furnishes a mental health visit. Group mental health services do not meet the criteria for a one-one-one, face-to-face encounter in an FQHC or RHC.

SOURCE:  CMS, Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Medicare Benefit Policy Manual Chapter 13 Update, Jan. 26, 2023, pg. 20 (Accessed Feb. 2023).

Home Health (HH) Agencies

Starting on or after January 1, 2023, they may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. CMS will require this information on HH claims starting on July 1, 2023. Home Health Agencies will submit the use of telecommunications technology on the HH claim using the following 3 G-codes:

• G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
• G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
• G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)

SOURCE: Telehealth Home Health Services: G-Codes, MLN Matters MM12805, (Effective Date: Jan. 1, 2023), (Accessed Feb. 2023).

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ELIGIBLE SITES

Temporary Policy – Ends Dec. 31, 2024

Expanding access to telehealth services. In the case that the emergency period described in section 1135(g)(1)(B) ends before December 31, 2024, with respect to telehealth services identified in subparagraph (F)(i) as of the date of the enactment of this clause [enacted March 15, 2022] that are furnished during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024, the term “originating site” means any site in the United States at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system, including the home of an individual.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Permanent Policy

Eligible Sites:

• The office of a physician or practitioner.
• A critical access hospital
• A rural health clinic
• A Federally qualified health center
• A hospital
• A hospital-based or critical access hospital- based renal dialysis center (including satellites).
• A skilled nursing facility
• Rural emergency hospital
• A community mental health center
• A renal dialysis facility for purposes of individuals with end-stage renal disease getting home dialysis.
• The home of an individual, but only for purposes of individuals with end-stage renal disease getting home dialysis or telehealth services to treat substance use disorder or individuals with co-occurring mental health disorders, or mental health disorders under certain circumstances.
• Mobile Stroke Unit
• The home of a beneficiary for the purposes of diagnosis, evaluation, and/or treatment of a mental health disorder for services furnished on or after the first day after the end of the PHE as defined in our regulation at § 400.200 except as otherwise provided in this paragraph. Payment will not be made for a telehealth service furnished under this paragraph unless the following conditions are met:
  • The physician or practitioner has furnished an item or service in-person, without the use of telehealth, for which Medicare payment was made (or would have been made if the patient were entitled to, or enrolled for, Medicare benefits at the time the item or service is furnished) within 6 months prior to the initial telehealth service;
  • The physician or practitioner has furnished an item or service in-person, without the use of telehealth, at least once within 12 months of each subsequent telehealth service described in this paragraph, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens associated with an in-person service outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reason(s) for this decision in the patient’s medical record.
  • The requirements of paragraphs (b)(3)(xiv)(A) and (B) may be met by another physician or practitioner of the same specialty and subspecialty in the same group as the physician or practitioner who furnishes the telehealth service, if the physician or practitioner who furnishes the telehealth service described under this paragraph is not available.

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removed originating site geographic conditions and added an individual’s home as a permissible originating telehealth services substance use disorder or co-occurring mental health treatment site.

Medicare doesn’t apply originating site geographic conditions to hospital-based and CAH based renal dialysis centers, renal dialysis facilities, and patient homes when practitioners provide monthly ESRD-related medical evaluations in patient homes. Independent Renal Dialysis Facilities aren’t eligible originating sites.

The 2018 Bipartisan Budget Act removed originating site geographic conditions and added eligible originating sites to diagnose, evaluate, or treat acute stroke symptoms.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5 [some info excluded due to document being out of date]  & 42 CFR Sec. 410.78.  (Accessed Feb. 2023).

Requirements for mental health services furnished through telehealth

Payment may not be made under this paragraph for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this title:

• within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and
• during subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

These requirements do not apply to services:

• Under this paragraph (with respect to telehealth services furnished to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder); or
• under this subsection without application of this paragraph.

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removed originating site geographic conditions and added an individual’s home as a permissible originating telehealth services substance use disorder or co-occurring mental health treatment site.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) & Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

CMS has directed place of service (POS) code 02 to be used for telehealth provided in places other than the patient’s home.  POS code 10 should be used when telehealth is provided in the patient’s home.

SOURCE: Medicare Learning Network, MLN # MM12427, New/Modifications to the Place of Service POS Codes for Telehealth, Jan. 1, 2022 (implementation Apr. 4, 2022), (Accessed Feb. 2023).

In addition to the requirement for the in-person visit mentioned above in statute, CMS will also require there to be a an in-person, non-telehealth service within 12 months of each mental health telehealth service.  However, if the patient and practitioner agree that the benefits of an in-person, non-telehealth service within 12 months of the mental health telehealth service are outweighed by risks and burdens associated with an in-person service, and the basis for that decision is documented in the patient’s medical record, the in-person visit requirement will not apply for that particular 12-month period.  This applies only to patients receiving services at home.  CMS will allow a clinician’s colleague in the same subspecialty in the same group to furnish the in-person, non-telehealth service to the beneficiary if the original practitioner is unavailable.

The home (for purposes of mental health reimbursement), can include temporary lodging, such as hotels and homeless shelters.  CMS clarifies that for circumstances where the patient, for privacy or other personal reasons, chooses to travel a short distance from the exact home location during a telehealth services, the services is still considered to be furnished “in the home of an individual”.

In person requirement delayed under Medicare until on or after January 1, 2025.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 63 & 64, & delay in implementation in HR 2617 (2022 Session).  (Accessed Feb. 2023).

Treatment of stroke telehealth services

The originating site and geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke, as determined by the Secretary.

With respect to telehealth services for acute stroke, the term “originating site” shall include any or critical access hospital, any mobile stroke unit, or any other site determined appropriate by the Secretary, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Feb. 2023).

Providers qualify as originating sites, regardless of location, if they were participating in a Federal telemedicine demonstration project approved by (or getting funding from) the U.S. Department of Health & Human Services.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

Accountable Care Organizations (two-sided model tested or expanded under 1115A of the Social Security Act)

In the case of telehealth services for which payment would otherwise be made under this title furnished on or after January 1, 2020, the home of a beneficiary shall be treated as an originating site.  In the case of telehealth services where the home of a Medicare fee-for-service beneficiary is the originating site, the following shall apply:

• There shall be no facility fee paid to the originating site.
• No payment may be made for such services that are inappropriate to furnish in the home setting such as services that are typically furnished in inpatient settings such as a hospital.

SOURCE:  Social Security Act Sec. 1899 (Accessed Feb. 2023).

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GEOGRAPHIC LIMITS

Temporary Policy – Ends Dec. 31, 2024

Expanding access to telehealth services. In the case that the emergency period described in section 1135(g)(1)(B) ends before December 31, 2024, with respect to telehealth services identified in subparagraph (F)(i) as of the date of the enactment of this clause [enacted March 15, 2022] that are furnished during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024, the term “originating site” means any site in the United States at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system, including the home of an individual.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Permanent Policy

The term “originating site” means only those sites described below:

• In an area that is designated as a rural health professional shortage area under section 332(a)(1)(A) of the Public Health Service Act
• In a county that is not included in a Metropolitan Statistical Area; or
• From an entity that participates in a Federal telemedicine demonstration project that has been approved by (or receives funding from) the Secretary of Health and Human Services as of December 31, 2000.

The geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of the home dialysis monthly ESRD-related visit, at a hospital-based or critical access hospital-based renal dialysis center, a renal dialysis facility, or the home.

Additional exceptions exist for treatment of acute stroke, substance use disorder and mental health (see below).

The Health Resources and Services Administration (HRSA) decides HPSAs and the Census Bureau decides MSAs. Find potential Medicare telehealth originating site payment eligibility at HRSA’s Medicare Telehealth Payment Eligibility Analyzer.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) & Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021 (Accessed Feb. 2023).

Treatment of stroke telehealth services

The geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke, as determined by the Secretary.

With respect to telehealth services to treat acute stroke, the term “originating site” shall include any hospital or critical access hospital, any mobile stroke unit, or any other site determined appropriate by the Secretary, at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Feb. 2023).

Substance Use Disorder

The geographic requirements shall not apply with respect to telehealth services furnished on or after July 1, 2019, to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder, as determined by the Secretary, or, on or after the first day after the end of the emergency period described in section 1135(g)(1)(B), subject to subparagraph (B), to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder, as determined by the Secretary at any originating site except a renal dialysis facility.

Originating sites must be:

• Located in a health professional shortage area (as defined under section 332(a)(1)(A) of the Public Health Service Act that is either outside of a Metropolitan Statistical Area (MSA) as of December 31st of the preceding calendar year or within a rural census tract of an MSA as determined by the Office of Rural Health Policy of the Health Resources and Services Administration as of December 31st of the preceding calendar year, or
• Located in a county that is not included in a Metropolitan Statistical Area as defined in section 1886(d)(2)(D) of the Act as of December 31st of the preceding year, or
• An entity participating in a Federal telemedicine demonstration project that has been approved by, or receive funding from, the Secretary as of December 31, 2000, regardless of its geographic location.

The geographic requirements specified above do not apply to the following telehealth services:

• Home dialysis monthly ESRD-related clinical assessment services furnished on or after January 1, 2019, at a hospital-based or critical access hospital-based renal dialysis center, a renal dialysis facility, or the home; and
• Services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
• Services furnished on or after July 1, 2019 to an individual with a substance use disorder diagnosis, for purposes of treatment of a substance use disorder or a co-occurring mental health disorder.
• Services furnished on or after the first day after the end of the PHE as defined in our regulation at § 400.200 for the purposes of diagnosis, evaluation, and/or treatment of a mental health disorder. Payment will not be made for a telehealth service furnished under this paragraph unless the physician or practitioner has furnished an item or service in person, without the use of telehealth, for which Medicare payment was made (or would have been made if the patient were entitled to, or enrolled for, Medicare benefits at the time the item or service is furnished) within 6 months prior to the initial telehealth service and within 6 months of any subsequent telehealth service.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

Accountable Care Organizations (two-sided model tested or expanded under 1115A of the Social Security Act)

In the case of telehealth services for which payment would otherwise be made under this title furnished on or after January 1, 2020, the geographic limitation shall not apply with respect to any eligible originating site (including the home of a beneficiary) subject to State licensing requirements.

SOURCE:  Social Security Act Sec. 1899 (Accessed Feb. 2023).

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FACILITY/TRANSMISSION FEE

Eligible originating sites are eligible for a facility fee equal to:

• for the period beginning on October 1, 2001, and ending on December 31, 2001, and for 2002, $20; and
• for a subsequent year, the facility fee specified in subclause (I) or this subclause for the preceding year increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) for such subsequent year.

No facility fee shall be paid under this subparagraph to an originating site that is the home.

Treatment of Acute Stroke:  No facility fee shall be paid to an originating site with respect to a telehealth service if the originating site does not otherwise meet the requirements for an originating site, including geographic requirements.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Feb. 2023).

No facility fee for new sites. In the case that the emergency period described in section 1135(g)(1)(b) ends before December 31, 2024, with respect to telehealth services identified in paragraph (4)(F)(i) as of the date of the enactment of this clause [enacted March 15, 2022] that are furnished during the period beginning on the first day after the end of the emergency period and ending December 31, 2024 described in section 1135(g)(1)(B) [42 USCS § 1320b-5(g)(1)(B)], a facility fee shall only be paid under this subparagraph to an originating site that is described in paragraph (4)(C)(ii) (other than subclause (X) of such paragraph).

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC for the separately billable Part B originating site facility fee. The originating site facility fee does not count toward the number of services used to determine payment for partial hospitalization services when a CMHC serves as an originating site.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 5, June 2021, (Accessed Feb. 2023).

Last updated 02/26/2023

Miscellaneous

CMS issued a letter to clarify for states that Medicaid and CHIP coverage and payment of interprofessional consultation is permissible, even when the beneficiary is not present, as long as the consultation is for the direct benefit of the beneficiary.

SOURCE:  Centers for Medicare & Medicaid Services, Coverage and Payment of Interprofessional Consultation in Medicaid and the Children’s Health Insurance Program (CHIP), SHO #23-001, Jan. 5, 2023, (Accessed Feb. 2023).

The Secretary shall conduct a study using medical record review, as described in subparagraph (C), on program integrity related to telehealth services under part B of title XVIII of the Social Security Act.  See bill for details.

SOURCE: House Bill 2617, (2022 Session), (Accessed Feb. 2023).

Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate you furnished the billed service as a professional telehealth service from a distant site. As of January 1, 2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method II must submit institutional claims using the GT modifier.

Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay you the appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). If you are located in, and you reassigned your billing rights to, a CAH and elected the Optional Payment Method II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percent of the Medicare PFS facility amount for the distant site service.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 5, June 2021, (Accessed Feb. 2023).

In January 2023, the Centers for Medicare & Medicaid Services (CMS) implemented a telehealth indicator on Medicare Care Compare and in the Provider Data Catalog (PDC) to expand the information available to patients and caregivers when choosing doctors or clinicians (87 FR 70109 – 70111). In response to the ongoing COVID-19 public health emergency (PHE), CMS expanded Medicare payment for telemedicine services to improve patients’ access to care.

SOURCE: CMS, Telehealth Indicator on Medicare Care Compare – Doctors and Clinicians Public Reporting, Jan. 2023, (Accessed Feb. 2023).

Medicaid Requirements

Unless required by regulation or policy, states are not required to submit a (separate) SPA for coverage or reimbursement of Medicaid coverable services delivered though telehealth if they decide to reimburse for services delivered though telehealth in the same way/amount that they pay for face-to-face services.

States must submit a (separate) reimbursement (attachment 4.19B) SPA if they want to provide reimbursement for services or components of services delivered through telehealth differently than is currently being reimbursed for face-to-face services.

States may submit a coverage SPA to better describe the services they choose to cover through telehealth, such as which providers/practitioners are identified by the state to use telehealth to deliver services; where it is provided; how it is provided, etc. In this case, and in order to avoid unnecessary SPA submissions, it is recommended that a brief description of the framework of telehealth may be placed in an introductory section of the state plan, e.g., Section 3 – Services: General Provisions 3.1 Amount, Duration and Scope of Services, and then a reference made to coverage through telehealth in the applicable benefit sections of the state plan. For example, in the physician section it might say that dermatology services can be delivered via telehealth provided all state requirements related to telehealth as described in the state plan are otherwise met.

SOURCE: Medicaid.gov.  Telehealth (Accessed Feb. 2023).

CMS will add a telehealth indicator to the Physician Compare Finder found on the Medicare website as is applicable and technically feasible.

SOURCE: CY 2023 Physician Fee Schedule, CMS, p. 2088, (Accessed Feb. 2023).

Last updated 02/26/2023

Out of State Providers

Doctors of Medicine and Osteopathy – The requirement that a doctor of medicine be legally authorized to practice medicine and surgery by the State in which he/she performs his/her services means a physician is licensed to practice medicine and surgery. (Similar regulations exist for other types of practitioners, see manual).

SOURCE:  Medicare General Information, Eligibility and Entitlement, Chapter 5 – Definitions, Updated 11/2/2018, Sec. 70, p. 31-32.  (Accessed Feb. 2023).

Items and services furnished outside the United States are excluded from coverage (with exceptions for beneficiaries traveling in Canada and emergency situations).

…

Payment may not be made for a medical service (or a portion of it) that was subcontracted to another provider or supplier located outside the United States. For example, if a radiologist who practices in India analyzes imaging tests that were performed on a beneficiary in the United States, Medicare would not pay the radiologist or the U.S. facility that performed the imaging test for any of the services that were performed by the radiologist in India.

SOURCE:  Medicare Benefit Policy Manual, Chapter 16 – General Exclusions from Coverage, Revised 11/6/14, Sec. 60, p. 24.  (Accessed Feb. 2023).

Last updated 02/26/2023

Overview

CMS reimburses for live video under certain circumstances and for specific services when the patient is in a rural area and at a specified originating site with a few exceptions.  Mental health is the biggest exception (and also includes an allowance for audio-only service delivery).  However, there are requirements for in-person visits at regular increments.  See below for further details.

CMS also pay for traditional services delivered via store-and-forward in Alaska and Hawaii telehealth demonstration pilots.  Additionally, they define communication technology-based services separately and provide reimbursement for those services when delivered via live video, asynchronously as well as remote physiologic monitoring depending on the applicable code’s description. However, as communication technology-based services are not considered “telehealth” by CMS, they are not under the same statutory restrictions telehealth-delivered services face.  More details are provided below.

* Requirements around patient location, eligible providers, and in-person visit requirements is currently waived or implementation delayed until January 1, 2025 due to passage of HR 2617.

Last updated 02/26/2023

Remote Patient Monitoring

POLICY

Although not considered to fall under the definition of telehealth, in 2018 CMS began making separate payment for the collection and interpretation of physiologic data.  In 2019, they expanded their reimbursement to three remote physiologic monitoring codes, and an add-on code was added in 2020.  Currently eligible codes include 99091, 99453, 99454, 99457, 99458.  Each code has its own requirements in the code description.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 123-125 & CY 2020 Final Physician Fee Schedule, CMS, p. 429, (Accessed Feb. 2023).

Remote therapeutic monitoring codes are similar to remote physiologic monitoring codes, however the primary billers are meant to be psychiatrists, nurse practitioners, and physical therapists, and allows non-physiological data to be collected.  Codes include 98975, 98976, 98977, 98980, and 98981.  Each code has its own requirements in the code description.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215, (Accessed Feb. 2023).

Note that chronic care management, principle care management, and transitional care management may also have remote monitoring applications.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 126-128; CY 2020 Final Physician Fee Schedule. CMS, p. 390-421 & Medicare Learning Network Booklet, Chronic Care Management Services, September 2022 (Accessed Feb. 2023). 

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CONDITIONS

Note that specific condition requirements apply for chronic care management, principle care management, and transitional care management which may also have remote monitoring applications.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 123-125; CY 2020 Final Physician Fee Schedule, CMS, p. 429 & Medicare Learning Network Booklet, Chronic Care Management Services, September 2022, (Accessed Feb. 2023).

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PROVIDER LIMITATIONS

For remote physiologic monitoring, we note that the term, ‘‘other qualified healthcare professionals,’’ used in the code descriptor is defined by CPT, and that definition can be found in the CPT Codebook.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 123-125, (Accessed Feb. 2023).

CMS has designated RPM codes 99457 and 99458 as defined in Sec. 410.26(b)(5).  See below for referenced definition:

In general, services and supplies must be furnished under the direct supervision of the physician (or other practitioner). Designated care management services can be furnished under general supervision of the physician (or other practitioner) when these services or supplies are provided incident to the services of a physician (or other practitioner). The physician (or other practitioner) supervising the auxiliary personnel need not be the same physician (or other practitioner) who is treating the patient more broadly. However, only the supervising physician (or other practitioner) may bill Medicare for incident to services.

SOURCE: CY 2020 Final Physician Fee Schedule. CMS, p. 431 & 42 CFR 410.26, (Accessed Feb. 2023).

FQHCs/RHCs

Beginning CY 2022, RHCs and FQHCs can bill CCM and TCM services for the same patient during the same time period

SOURCE:  Medicare Learning Network Booklet, Chronic Care Management Services, September 2022 , p. 9 (Accessed Feb. 2023).

Services such as RPM are not separately billable because they are already included in the RHC AIR or FQHC PPS payment.

SOURCE: CY 2020 Final Physician Fee Schedule. CMS, p. 432, (Accessed Feb. 2023).

Home Health Agencies

An individualized plan of care must be established and periodically reviewed by the certifying physician or allowed practitioner.  The plan of care must include all of the following: … Any provision of remote patient monitoring or other services furnished via telecommunications technology (as defined in § 409.46(e)) or audio-only technology. Such services must be tied to the patient-specific needs as identified in the comprehensive assessment, cannot substitute for a home visit ordered as part of the plan of care, and cannot be considered a home visit for the purposes of patient eligibility or payment.

Telecommunications technology, as indicated on the plan of care, can include: remote patient monitoring, defined as the collection of physiologic data (for example, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient or caregiver or both to the home health agency; teletypewriter (TTY); and 2-way audio-video telecommunications technology that allows for real-time interaction between the patient and clinician. The costs of any equipment, set-up, and service related to the technology are allowable only as administrative costs. Visits to a beneficiary’s home for the sole purpose of supplying, connecting, or training the patient on the technology, without the provision of a skilled service, are not separately billable.

SOURCE:  42 CFR Sec. 409.43 & 409.46 as updated by CMS Final Rule for CY 2021 Home Health Prospective Payment System (Accessed Feb. 2023).

Starting on or after January 1, 2023, they may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. CMS will require this information on HH claims starting on July 1, 2023. Home Health Agencies will submit the use of telecommunications technology on the HH claim using the following 3 G-codes:

• G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
• G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
• G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)

SOURCE: Telehealth Home Health Services: G-Codes, MLN Matters MM12805, (Effective Date: Jan. 1, 2023), (Accessed Feb. 2023).

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OTHER RESTRICTIONS

No reference found.

Last updated 02/26/2023

Store and Forward

POLICY

Store and Forward For Telehealth Demonstration Projects in Alaska and Hawaii Only:

Asynchronous store-and-forward technologies means the transmission of a patient’s medical information from an originating site to the physician or practitioner at the distant site. The physician or practitioner at the distant site can review the medical case without the patient being present. An asynchronous telecommunications system in single media format does not include telephone calls, images transmitted via facsimile machines and text messages without visualization of the patient (electronic mail). Photographs visualized by a telecommunications system must be specific to the patient’s medical condition and adequate for furnishing or confirming a diagnosis and or treatment plan. Dermatological photographs, for example, a photograph of a skin lesion, may be considered to meet the requirement of a single media format under this provision.

For Federal telemedicine demonstration programs conducted in Alaska or Hawaii only, Medicare payment is permitted for telehealth when asynchronous store and forward technologies, in single or multimedia formats, are used as a substitute for an interactive telecommunications system.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

In the case of any Federal telemedicine demonstration program conducted in Alaska or Hawaii, the term “telecommunications system” includes store-and-forward technologies that provide for the asynchronous transmission of health care information in single or multimedia formats.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Feb. 2023).

You must use an interactive audio and video telecommunications system that permits real-time communication between you at the distant site, and the beneficiary at the originating site.  Transmitting medical information to a physician or practitioner who reviews it later is permitted only in Alaska or Hawaii Federal telemedicine demonstration programs.

If you performed telehealth services “through an asynchronous telecommunications system”, add the telehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99201 GQ). You are certifying the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5, June 2021, (Accessed Feb. 2023).

Temporary Policy – Ends Dec. 31, 2024

Practitioner. The term “practitioner” has the meaning given that term in section 1842(b)(18)(C) [42 USCS § 1395u(b)(18)(C)] and, in the case that the emergency period described in section 1135(g)(1)(B) ends before December 31, 2024, for the period beginning on the first day after the end of such emergency period and ending on December 31, 2024, shall include a qualified occupational therapist (as such term is used in section 1861(g) [42 USCS § 1395x(g)]), a qualified physical therapist (as such term is used in section 1861(p) [42 USCS § 1395x(p)]), a qualified speech-language pathologist (as defined in section 1861(ll)(4)(A) [42 USCS § 1395x(ll)(4)(A)), and a qualified audiologist (as defined in section 1861(ll)(4)(B) [42 USCS § 1395x(ll)(4)(B)).

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Home Health (HH) Agencies

Starting on or after January 1, 2023, they may voluntarily report the use of telecommunications technology in providing HH services on HH payment claims. CMS will require this information on HH claims starting on July 1, 2023. Home Health Agencies will submit the use of telecommunications technology on the HH claim using the following 3 G-codes:

• G0320: Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system
• G0321: Home health services furnished using synchronous telemedicine rendered via telephone or other real-time interactive audio-only telecommunications system
• G0322: The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (for example, remote patient monitoring)

SOURCE: Telehealth Home Health Services: G-Codes, MLN Matters MM12805, (Effective Date: Jan. 1, 2023), (Accessed Feb. 2023).

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ELIGIBLE SERVICES/SPECIALTIES

Store and Forward For Telehealth Demonstration Projects in Alaska and Hawaii Only:

The term “telehealth service” means professional consultations, office visits, and office psychiatry services (identified as of July 1, 2000, by HCPCS codes 99241–99275, 99201–99215, 90804–90809, and 90862 (and as subsequently modified by the Secretary)), and any additional service specified by the Secretary.  The Secretary shall establish a process that provides, on an annual basis, for the addition or deletion of services (and HCPCS codes), as appropriate.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Feb. 2023).

Medicare Part B pays for covered telehealth services included on the telehealth list when furnished by an interactive telecommunications system if certain conditions are met, except that for the duration of the Public Health Emergency as defined in § 400.200 of this chapter, Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management and end stage renal disease related services included in the monthly capitation payment furnished by an interactive telecommunications system if certain conditions are met.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

Changes to the list of Medicare telehealth services are made through the annual physician fee schedule rulemaking process. During the Public Health Emergency for the COVID-19 pandemic, as defined in § 400.200 of this chapter, we will use a sub-regulatory process to modify the services included on the Medicare telehealth list during the Public Health Emergency taking into consideration infection control, patient safety, and other public health concerns resulting from the emergency. A list of the services covered as telehealth services under this section is available on the CMS website.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth is available on the CMS website, including temporary codes during the public health emergency. Find the complete List of Telehealth Services by downloading the ZIP and opening the Excel or text files.

SOURCE:  Medicare Learning Network Factsheet. Telehealth Services, p. 5, June 2021 & CMS Telehealth List Year 2023.  (Accessed Feb. 2023).

The Secretary shall pay to a physician or practitioner located at a distant site that furnishes a telehealth service to an eligible telehealth individual an amount equal to the amount that such physician or practitioner would have been paid under this title had such service been furnished without the use of a telecommunications system.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m).  (Accessed Feb. 2023).

The physician or practitioner at the distant site must be licensed to furnish the service under State law. The physician or practitioner at the distant site who is licensed under State law to furnish a covered telehealth service may bill, and receive payment for, the service when it is delivered via a telecommunications system.

The practitioner at the distant site is one of the following:

• A physician
• A physician
• A nurse practitioner
• A clinical nurse specialist
• A nurse-midwife
• A clinical psychologist
• A clinical social worker
• A registered dietitian or nutrition professional
• A certified registered nurse anesthetist

SOURCE: 42 CFR Sec. 410.78 & Medicare Learning Network Factsheet. Telehealth Services, p. 4, June 2021 (Accessed Feb. 2023).

Eligible Sites:

• The office of a physician or practitioner.
• A critical access hospital
• A rural health clinic
• A Federally qualified health center
• A hospital
• A hospital-based or critical access hospital- based renal dialysis center (including satellites).
• A skilled nursing facility
• Rural emergency hospital
• A community mental health center
•  A renal dialysis facility for purposes of individuals with end-stage renal disease getting home dialysis.
• The home of an individual, but only for purposes of individuals with end-stage renal disease getting home dialysis or telehealth services to treat substance use disorder or individuals with co-occurring mental health disorders, or mental health disorders under certain circumstances.
• Mobile Stroke Unit
• The home of a beneficiary for the purposes of diagnosis, evaluation, and/or treatment of a mental health disorder for services furnished on or after the first day after the end of the PHE as defined in our regulation at § 400.200 except as otherwise provided in this paragraph. Payment will not be made for a telehealth service furnished under this paragraph unless the following conditions are met:
  • The physician or practitioner has furnished an item or service in-person, without the use of telehealth, for which Medicare payment was made (or would have been made if the patient were entitled to, or enrolled for, Medicare benefits at the time the item or service is furnished) within 6 months prior to the initial telehealth service;
  • The physician or practitioner has furnished an item or service in-person, without the use of telehealth, at least once within 12 months of each subsequent telehealth service described in this paragraph, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens associated with an in-person service outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reason(s) for this decision in the patient’s medical record.
  • The requirements of paragraphs (b)(3)(xiv)(A) and (B) may be met by another physician or practitioner of the same specialty and subspecialty in the same group as the physician or practitioner who furnishes the telehealth service, if the physician or practitioner who furnishes the telehealth service described under this paragraph is not available.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m) & Medicare Learning Network Factsheet. Telehealth Services, p. 4 & 5 [some info excluded due to document being out of date]  & 42 CFR Sec. 410.78.  (Accessed Feb. 2023).

Temporary Policy – Ends Dec. 31, 2024 – Delay of In-Person mental health requirement

In general. Payment may not be made under this paragraph for telehealth services furnished on or after January 1, 2025 (or, if later, the first day after the end of the emergency period described in 1395(g)(1)(B)) by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this title (or would have been made under this title if such individual were entitled to, or enrolled for, benefits under this title at the time such item or service is furnished)—

• Within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and
• During subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Providers qualify as originating sites, regardless of location, if they were participating in a Federal telemedicine demonstration project approved by (or getting funding from) the U.S. Department of Health & Human Services.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

Communication Technology-Based Services (CTBS)

CMS makes separate payment for remote evaluation of recorded video and/or images submitted by the patient. The code, G2010 describes remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.

HCPCS code G2010 may be billed only for established patients. The follow-up with the patient could take place via phone call, audio/video communication, secure text messaging, email, or patient portal communication.

SOURCE CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Feb. 2023).

Online digital evaluation services (e-visit) are reimbursable for physicians and qualified non-physician health care professionals.  These are non-face-to-face codes that describe patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.

SOURCE CY 2020 Final Physician Fee Schedule. CMS, p. 799, (Accessed Feb. 2023).

Interprofessional consultations are reimbursable by CMS as part of their CTBS services (CPT codes include 99451, 99452, 99446, 99447, 99448, and 99449). Cost sharing will apply. These interprofessional services may be billed only by practitioners that can bill Medicare independently for evaluation and management services.  Includes telephone and internet assessments.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Feb. 2023).

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes communication technology-based services (Includes the Brief Communication Technology-Based Service, Remote Evaluation of Pre-Recorded Patient Information) to an RHC or FQHC patient. RHCs and FQHCs receive payment for communication technology-based services or remote evaluation services when an RHC or FQHC practitioner provides at least 5 minutes of communications-based technology or remote evaluation services to a patient who has been seen in the RHC or FQHC within the previous year.

G0071 should be billed for both services.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, & Virtual Communication Services RHCs and FQHCs FAQs, December 2018, (Accessed Feb. 2023).

RHCs and FQHCs are not eligible for reimbursement of interprofessional consultation services, as only practitioners that can bill Medicare independently for evaluation and management services are eligible.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40, (Accessed Feb. 2023).

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GEOGRAPHIC LIMITS

Store and Forward For Telehealth Demonstration Projects in Alaska and Hawaii Only:

For asynchronous store and forward telecommunications technologies, the only originating sites are Federal telemedicine demonstration programs conducted in Alaska or Hawaii.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

Temporary Policy – Ends Dec. 31, 2024

Expanding access to telehealth services. In the case that the emergency period described in section 1135(g)(1)(B) ends before December 31, 2024, with respect to telehealth services identified in subparagraph (F)(i) as of the date of the enactment of this clause [enacted March 15, 2022] that are furnished during the period beginning on the first day after the end of such emergency period and ending on December 31, 2024, the term “originating site” means any site in the United States at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system, including the home of an individual.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Permanent Policy

The term “originating site” means only those sites described below:

• In an area that is designated as a rural health professional shortage area under section 332(a)(1)(A) of the Public Health Service Act
• In a county that is not included in a Metropolitan Statistical Area; or
• From an entity that participates in a Federal telemedicine demonstration project that has been approved by (or receives funding from) the Secretary of Health and Human Services as of December 31, 2000.

The geographic requirements shall not apply with respect to telehealth services furnished on or after January 1, 2019, for purposes of the home dialysis monthly ESRD-related visit, at a hospital-based or critical access hospital-based renal dialysis center, a renal dialysis facility, or the home.

Additional exceptions exist for treatment of acute stroke and substance use disorder (see below).

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Feb. 2023).

An originating site is the location where a Medicare patient gets physician or practitioner medical services through a telecommunications system. The patient must go to the originating site for the services located in either:

• County outside a Metropolitan Statistical Area (MSA)
• Rural Health Professional Shortage Area (HPSA) in a rural census tract

The Health Resources and Services Administration (HRSA) decides HPSAs and the Census Bureau decides MSAs. Find potential Medicare telehealth originating site payment eligibility at HRSA’s Medicare Telehealth Payment Eligibility Analyzer.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

Substance Use Disorder

The geographic requirements shall not apply with respect to telehealth services furnished on or after July 1, 2019, to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder, as determined by the Secretary, or, on or after the first day after the end of the emergency period described in section 1135(g)(1)(B), subject to subparagraph (B), to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder, as determined by the Secretary at any originating site except a renal dialysis facility.

Requirements for mental health services furnished through telehealth

Payment may not be made under this paragraph for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this title:

• within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and
• during subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

These requirements do not apply to services:

• Under this paragraph (with respect to telehealth services furnished to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder); or
• Under this subsection without application of this paragraph.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Feb. 2023).

Originating sites must be:

• Located in a health professional shortage area (as defined under section 332(a)(1)(A) of the Public Health Service Act that is either outside of a Metropolitan Statistical Area (MSA) as of December 31st of the preceding calendar year or within a rural census tract of an MSA as determined by the Office of Rural Health Policy of the Health Resources and Services Administration as of December 31st of the preceding calendar year, or
• Located in a county that is not included in a Metropolitan Statistical Area as defined in section 1886(d)(2)(D) of the Act as of December 31st of the preceding year, or
• An entity participating in a Federal telemedicine demonstration project that has been approved by, or receive funding from, the Secretary as of December 31, 2000, regardless of its geographic location.

The geographic requirements specified above do not apply to the following telehealth services:

• Home dialysis monthly ESRD-related clinical assessment services furnished on or after January 1, 2019, at a hospital-based or critical access hospital-based renal dialysis center, a renal dialysis facility, or the home; and
• Services furnished on or after January 1, 2019, for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
• Services furnished on or after July 1, 2019 to an individual with a substance use disorder diagnosis, for purposes of treatment of a substance use disorder or a co-occurring mental health disorder.
• Services furnished on or after the first day after the end of the PHE as defined in our regulation at § 400.200 for the purposes of diagnosis, evaluation, and/or treatment of a mental health disorder. Payment will not be made for a telehealth service furnished under this paragraph unless the physician or practitioner has furnished an item or service in person, without the use of telehealth, for which Medicare payment was made (or would have been made if the patient were entitled to, or enrolled for, Medicare benefits at the time the item or service is furnished) within 6 months prior to the initial telehealth service and within 6 months of any subsequent telehealth service.

SOURCE: 42 CFR Sec. 410.78 (Accessed Feb. 2023).

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removed originating site geographic conditions and added an individual’s home as a permissible originating telehealth services substance use disorder or co-occurring mental health treatment site.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 3, June 2021, (Accessed Feb. 2023).

Requirements for mental health services furnished through telehealth

Payment may not be made under this paragraph for telehealth services furnished on or after the day that is the 152nd day after the end of the emergency period described in section 1320b–5(g)(1)(B) of this title) by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in person, without the use of telehealth, for which payment is made under this subchapter (or would have been made under this subchapter if such individual were entitled to, or enrolled for, benefits under this subchapter at the time such item or service is furnished)—

• within the 6-month period prior to the first time such physician or practitioner furnishes such a telehealth service to the eligible telehealth individual; and
• during subsequent periods in which such physician or practitioner furnishes such telehealth services to the eligible telehealth individual, at such times as the Secretary determines appropriate.

These requirements do not apply to services:

• Under this paragraph (with respect to telehealth services furnished to an eligible telehealth individual with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder); or
• under this subsection without application of this paragraph.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Feb. 2023).

Communication Technology-Based Services (CTBS)

Geographic limits do not apply to Communication Technology-Based Services.

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TRANSMISSION FEE

Store and Forward For Telehealth Demonstration Projects in Alaska and Hawaii Only:

Eligible originating sites are eligible for a facility fee equal to:

• for the period beginning on October 1, 2001, and ending on December 31, 2001, and for 2002, $20; and
• for a subsequent year, the facility fee specified in subclause (I) or this subclause for the preceding year increased by the percentage increase in the MEI (as defined in section 1842(i)(3)) for such subsequent year.

No facility fee shall be paid under this subparagraph to an originating site that is the home.

Treatment of Acute Stroke:  No facility fee shall be paid to an originating site with respect to a telehealth service if the originating site does not otherwise meet the requirements for an originating site, including geographic requirements.

SOURCE:  Social Security Act, Sec. 1834(m) (US Code Title 42, Sec. 1395m).  (Accessed Feb. 2023).

HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC for the separately billable Part B originating site facility fee. The originating site facility fee does not count toward the number of services used to determine payment for partial hospitalization services when a CMHC serves as an originating site.

SOURCE: Medicare Learning Network Factsheet. Telehealth Services, p. 5, June 2021, (Accessed Feb. 2023).

No facility fee for new sites. In the case that the emergency period described in section 1135(g)(1)(b) ends before December 31, 2024, with respect to telehealth services identified in paragraph (4)(F)(i) as of the date of the enactment of this clause [enacted March 15, 2022] that are furnished during the period beginning on the first day after the end of the emergency period and ending December 31, 2024 described in section 1135(g)(1)(B) [42 USCS § 1320b-5(g)(1)(B)], a facility fee shall only be paid under this subparagraph to an originating site that is described in paragraph (4)(C)(ii) (other than subclause (X) of such paragraph).

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m) as amended by HR 2617 (2022 Session).  (Accessed Feb. 2023).

Communication Technology-Based Services (CTBS)

No originating site or transmission fee for Communication Technology-Based Services.