Federal

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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FEDERAL RESOURCES

  1. Medicare Program: Medicare
  2. Administrator: Centers for Medicare and Medicaid Services (CMS)

MEDICARE REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes*
  • Audio Only: Yes*

PRIVATE PAYER LAW

  • Law Exists: No
  • Payment Parity: No

FQHCs

  • Originating sites explicitly allowed for Live Video:  Yes
  • Distant sites explicitly allowed for Live Video:  No
  • Store and forward explicitly reimbursed:  No
  • Audio-only explicitly reimbursed:  Yes
  • Allowed to collect PPS rate for telehealth:  No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: N/A
  • Consent Requirements: No
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 12/04/2022

Audio-Only Delivery

CMS: COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

STATUS: Active, Expires at end of PHE. Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: New and Expanded Flexibilities for RHCs and FQHCs during the COVID-19 PHE

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Hospice: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.

CMS: Interim Final Rule on COVID-19 PHE (additional allowances)

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Interim Final Rule on COVID-19 PHE (original rule)

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: COVID-19 Frequently Asked Questions

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

Last updated 12/04/2022

Cross-State Licensing

Health and Human Services: 10th Declaration under the PREP Act: Cross State Licensing for delivering medical countermeasures

STATUS: Active, Expires at end of PHE

Last updated 12/04/2022

Easing Prescribing Requirements

CMS: COVID-19 Frequently Asked Questions

STATUS: Active, Expires at end of PHE

Drug Enforcement Agency:  Questions and Answers for Telemedicine

STATUS: Active, Expires at end of PHE

Drug Enforcement Agency:  Buprenorphine and Telephone

STATUS: Active, Expires at end of PHE

Last updated 12/04/2022

Miscellaneous

CMS: Medicare Shared Savings Program: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE

Federal Office of Civil Rights: FAQs on Telehealth and HIPAA during COVID-19

STATUS: Active, Expires at end of PHE

Federal Office of Civil Rights: Notification of Enforcement Discretion for Telehealth Remote Communication during COVID

STATUS: Active, Expires at end of PHE

Federal Office of Civil Rights:  Guidance on How HIPAA Rules Permit Covered Health Care Providers and Health Plans to Use Remote Communication Technologies for Audio-Only Telehealth

STATUS: Permanent

Federal Communications Commission: COVID-19 Telehealth Program

STATUS: Active

Federal Communications Commission: Emergency Broadband Benefit Program

STATUS: Active

Occupational Safety and Health Administration (OSHA): Occupational Exposure to COVID-19; Emergency Temporary Standard

STATUS: Active

HR 1319: American Rescue Plan Act of 2021

STATUS: Enacted

Last updated 12/04/2022

Originating Site

CMS: COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Interim Final Rule on COVID-19 PHE (additional allowances)

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Interim Final Rule on COVID-19 PHE (original rule)

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: New and Expanded Flexibilities for RHCs and FQHCs during the COVID-19 PHE

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Hospitals and CAHs (including Swing Beds, DPUs), ASCs and CMHCs: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: COVID-19 Frequently Asked Questions

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: FAQs for Hospitals and Critical Access Hospitals regarding EMTALA

STATUS: Active

HR 6074: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020

STATUS: Enacted

HR 748: CARES Act

STATUS: Enacted

HR 133: Consolidated Appropriations Act, 2021

STATUS: Enacted

Last updated 12/04/2022

Private Practice

No reference found.

Last updated 09/01/2022

Provider Type

CMS: COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: New and Expanded Flexibilities for RHCs and FQHCs during the COVID-19 PHE

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Interim Final Rule on COVID-19 PHE (additional allowances)

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Interim Final Rule on COVID-19 PHE (original rule)

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: COVID-19 Frequently Asked Questions

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: FAQs for Hospitals and Critical Access Hospitals regarding EMTALA

STATUS: Active

HR 6074: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020

STATUS: Enacted

HR 748: CARES Act

STATUS: Enacted

Last updated 12/04/2022

Service Expansion

CMS: COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Interim Final Rule on COVID-19 PHE (additional allowances)

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: New and Expanded Flexibilities for RHCs and FQHCs during the COVID-19 PHE

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Interim Final Rule on COVID-19 PHE (original rule)

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: COVID-19 Frequently Asked Questions

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.  Some telehealth flexibilities extended 151 after end of PHE by HR 2471.

CMS: Home Health Agencies: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.

CMS: Hospice: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.

CMS: Inpatient Rehabilitation Facilities: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.

CMS: End Stage Renal Disease (ESRD) Facilities: CMS Flexibilities to Fight COVID-19

STATUS: Active, Expires at end of PHE.

CMS: Interim Final Rule on COVID-19 – MIPS Update

STATUS: Active, Expires at end of PHE

CMS: FAQs for Hospitals and Critical Access Hospitals regarding EMTALA

STATUS: Active

HR 6074: Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020

STATUS: Enacted

HR 748: CARES Act

STATUS: Enacted

HR 133: Consolidated Appropriations Act, 2021

STATUS: Enacted

Last updated 12/04/2022

Definition

Medicare Advantage (MA)

The term “additional telehealth benefits” means services—

  • For which benefits are available under part B, including services for which payment is not made under section 1834(m) due to the conditions for payment under such section; and
  • That are identified for such year as clinically appropriate to furnish using electronic information and telecommunications technology when a physician or practitioner providing the service is not at the same location as the plan enrollee.

The term “additional telehealth benefits” does not include capital and infrastructure costs and investments relating to such benefits.

SOURCE:  Social Security Act, Sec. 1852 (Accessed Dec. 2022).

Additional telehealth benefits means services:

  • For which benefits are available under Medicare Part B but which are not payable under section 1834(m) of the Act; and
  • That have been identified by the MA plan for the applicable year as clinically appropriate to furnish through electronic exchange when the physician or practitioner providing the service is not in the same location as the enrollee.

Electronic exchange means electronic information and telecommunications technology.

SOURCE:  42 CFR Sec. 422.135 (Accessed Dec. 2022).

Last updated 12/04/2022

Parity

SERVICE PARITY

There is service parity for Medicare Advantage with what is covered through telehealth by Medicare Part B, however there is not service parity with all covered services generally.

Subject to the conditions and limitations set forth in this subpart, an MA organization offering an MA plan must provide enrollees in that plan with coverage of the basic benefits (except that additional telehealth benefits may be, but are not required to be, offered by the MA plan) and, to the extent applicable, supplemental benefits by furnishing the benefits directly or through arrangements, or by paying for the benefits.

Basic benefits are all items and services (other than hospice care or coverage for organ acquisitions for kidney transplants) for which benefits are available under parts A and B of Medicare, including additional telehealth benefits.

SOURCE:  42 CFR Sec. 422.100 (Dec. 2022).


PAYMENT PARITY

MA plans offering additional telehealth benefits may maintain different cost sharing for the specified Part B service(s) furnished through an in-person visit and the specified Part B service(s) furnished through electronic exchange.

SOURCE:  42 CFR § 422.254 (Accessed Dec. 2022).

Last updated 12/04/2022

Requirements

Medicare Advantage (MA)

For plan year 2020 and subsequent plan years, an MA plan may provide additional telehealth benefits to enrolled individuals.

The Secretary shall specify requirements for the provision or furnishing of additional telehealth benefits, including with respect to the following:

  • Physician or practitioner qualifications (other than licensure) and other requirements such as specific training.
  • Factors necessary for the coordination of such benefits with other items and services including those furnished in-person.
  • Such other areas as determined by the Secretary.

If an MA plan provides a service as an additional telehealth benefit –

  • the MA plan shall also provide access to such benefit through an in-person visit (and not only as an additional telehealth benefit); and
  • an individual enrollee shall have discretion as to whether to receive such service through the in-person visit or as an additional telehealth benefit.

If a plan provides additional telehealth benefits, such additional telehealth benefits shall be treated as if they were benefits under the original Medicare fee-for-service program option.

SOURCE:  Social Security Act, Sec. 1852 (Accessed Dec. 2022).

An MA plan may treat additional telehealth benefits as basic benefits covered under the original Medicare fee-for-service program provided that the requirements of this section are met. If the MA plan fails to comply with the requirements of this section, then the MA plan may not treat the benefits provided through electronic exchange as additional telehealth benefits, but may treat them as supplemental benefits, subject to CMS approval.

An MA plan furnishing additional telehealth benefits must:

  • Furnish in-person access to the specified Part B service(s) at the election of the enrollee.
  • Advise each enrollee that the enrollee may receive the specified Part B service(s) through an in-person visit or through electronic exchange.
  • Comply with the provider selection and credentialing requirements provided in § 422.204, and, when providing additional telehealth benefits, ensure through its contract with the provider that the provider meet and comply with applicable State licensing requirements and other applicable laws for the State in which the enrollee is located and receiving the service.
  • Make information about coverage of additional telehealth benefits available to CMS upon request. Information may include, but is not limited to, statistics on use or cost, manner(s) or method of electronic exchange, evaluations of effectiveness, and demonstration of compliance with the requirements of this section.

An MA plan furnishing additional telehealth benefits may only do so using contracted providers. Coverage of benefits furnished by a non-contracted provider through electronic exchange may only be covered as a supplemental benefit.

MA plans offering additional telehealth benefits must exclude any capital and infrastructure costs and investments directly incurred or paid by the MA plan relating to such benefits from their bid submission for the unadjusted MA statutory non-drug monthly bid amount.

SOURCE:  42 CFR § 422.135 (Accessed Dec. 2022).

Last updated 12/05/2022

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 Dec. 2022).

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 Dec. 2022).

For purposes of Medicaid, telemedicine 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 electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

SOURCE: Medicaid.gov.  Telemedicine (Accessed Dec. 2022).

 

Last updated 12/05/2022

Email, Phone & Fax

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 the 152nd day after the PHE for COVID-19.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215 & delay in implementation in CY 2023 Physician Fee Schedule, CMS p. 958, (Accessed Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 2019, (Accessed Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

No reference found for email and fax.

Last updated 12/05/2022

Live Video

POLICY

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 Dec. 2022).

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.

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).


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 Dec. 2022).

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.

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

Some codes expire at end of public health emergency (PHE) plus 151 days.  Category 3 codes available through Dec. 31, 2023 and Category 1 and 2 codes are permanent.

SOURCE: CY 2023 Physician Fee Schedule, CMS, p. 156-159 & Centers for Medicare and Medicaid Services. List of Telehealth Services (Accessed Dec. 2022).

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 Dec. 2022).


ELIGIBLE PROVIDERS

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 the 152nd day after the PHE for COVID-19.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 214-215 & delay in implementation in CY 2023 Physician Fee Schedule, CMS p. 958, (Accessed Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).


ELIGIBLE SITES

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 the 152nd day after the PHE for COVID-19.

SOURCE: CY 2022 Physician Fee Schedule, CMS, p. 63 & 64, & delay in implementation in CY 2023 Physician Fee Schedule, CMS p. 958, (Accessed Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).


GEOGRAPHIC LIMITS

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).


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 Dec. 2022).

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 Dec. 2022).

Last updated 12/05/2022

Miscellaneous

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 Dec. 2022).

Medicaid Requirements

Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy and quality of care. States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology.

States are not required to submit a (separate) SPA for coverage or reimbursement of telemedicine services, if they decide to reimburse for telemedicine services the same way/amount that they pay for face-to-face services/visits/consultations.

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

States may submit a coverage SPA to better describe the telemedicine services they choose to cover, such as which providers/practitioners are; 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 telemedicine be placed in an introductory section of the State Plan and then a reference made to telemedicine coverage 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 telemedicine provided all state requirements related to telemedicine as described in the state plan are otherwise met.

SOURCE: Medicaid.gov.  Telemedicine (Accessed Dec. 2022).

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 Dec. 2022).

Last updated 12/05/2022

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 Dec. 2022).

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 Dec. 2022).

Last updated 12/05/2022

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.

Last updated 09/01/2022

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 Sept. 2022).

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 Sept. 2022).

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, March 2022 (Accessed Sept. 2022). 


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, July 2019, (Accessed Sept. 2022).


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 Sept. 2022).

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 Sept. 2022).

FQHCs/RHCs

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 Sept. 2022).

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 Sept. 2022).


OTHER RESTRICTIONS

No reference found.

Last updated 12/05/2022

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).


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 Dec. 2022).

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 Sept. 2022).

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 Dec. 2022).

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 Dec. 2022).

Some codes expire at end of public health emergency (PHE) plus 151 days.  Category 3 codes available through Dec. 31, 2023 and Category 1 and 2 codes are permanent.

SOURCE: CY 2023 Physician Fee Schedule, CMS, p. 156-159 & Centers for Medicare and Medicaid Services. List of Telehealth Services (Accessed Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 2019, (Accessed Dec. 2022).

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 Dec. 2022).


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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

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 Dec. 2022).

Communication Technology-Based Services (CTBS)

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


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 Dec. 2022).

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 Dec. 2022).

Communication Technology-Based Services (CTBS)

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

Last updated 12/04/2022

Cross State Licensing

Veterans Benefits

Notwithstanding any provision of law regarding the licensure of health care professionals, a covered health care professional may practice the health care profession of the health care professional at any location in any State, regardless of where the covered health care professional or the patient is located, if the covered health care professional is using telemedicine to provide treatment to an individual.

For purposes of this section, a covered health care professional is any health care professional who—

  • is an employee of the Department;
  • is authorized by the Secretary to provide health care under this chapter;
  • is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the Department; and
    • has an active, current, full, and unrestricted license, registration, or certification in a State to practice the health care profession of the health care professional; or
    • with respect to a health care profession listed under section 7402(b) of this title, has the qualifications for such profession as set forth by the Secretary.

The provisions of this section shall supersede any provisions of the law of any State to the extent that such provision of State law are inconsistent with this section.

No State shall deny or revoke the license, registration, or certification of a covered health care professional who otherwise meets the qualifications of the State for holding the license, registration, or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection (a).

SOURCE:  38 USCS Sec. 1730C, (Accessed Dec. 2022).

Last updated 12/04/2022

Definitions

Controlled Substances Act

The term “practice of telemedicine” means, for purposes of this title, the practice of medicine in accordance with applicable Federal and State laws by a practitioner (other than a pharmacist) who is at a location remote from the patient and is communicating with the patient, or health care professional who is treating the patient, using a telecommunications system referred to in section 1834(m) of the Social Security Act, which practice—

  • is being conducted—
    • while the patient is being treated by, and physically located in, a hospital or clinic registered under section 303(f); and
    • by a practitioner—
      • acting in the usual course of professional practice;
      • acting in accordance with applicable State law; and
      • registered under section 303(f) in the State in which the patient is located, unless the practitioner—
        • is exempted from such registration in all States under section 302(d); or
        • is—
          • an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract; and
          • registered under section 303(f) in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f)
  • is being conducted while the patient is being treated by, and in the physical presence of, a practitioner—
    • acting in the usual course of professional practice;
    • acting in accordance with applicable State law; and
    • registered under section 303(f) in the State in which the patient is located, unless the practitioner—
      • is exempted from such registration in all States under section 302(d); or
      • is—
        • an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract; and
        • registered under section 303(f) in any State or is using the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f);
  • is being conducted by a practitioner—
    • who is an employee or contractor of the Indian Health Service, or is working for an Indian tribe or tribal organization under its contract or compact with the Indian Health Service under the Indian Self-Determination and Education Assistance Act;
    • acting within the scope of the employment, contract, or compact described in clause (i); and
    • who is designated as an Internet Eligible Controlled Substances Provider by the Secretary under section 311(g)(2).
      • is being conducted during a public health emergency declared by the Secretary under section 319 of the Public Health Service Act; and
      • involves patients located in such areas, and such controlled substances, as the Secretary, with the concurrence of the Attorney General, designates, provided that such designation shall not be subject to the procedures prescribed by subchapter II of chapter 5 of title 5, United States Code;
  • is being conducted by a practitioner who has obtained from the Attorney General a special registration under section 311(h);
  • is being conducted –
    • in a medical emergency situation—
      • that prevents the patient from being in the physical presence of a practitioner registered under section 303(f) who is an employee or contractor of the Veterans Health Administration acting in the usual course of business and employment and within the scope of the official duties or contract of that employee or contractor;
      • that prevents the patient from being physically present at a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f);
      • during which the primary care practitioner of the patient or a practitioner otherwise practicing telemedicine within the meaning of this paragraph is unable to provide care or consultation; and
      • that requires immediate intervention by a health care practitioner using controlled substances to prevent what the practitioner reasonably believes in good faith will be imminent and serious clinical consequences, such as further injury or death; and
  • by a practitioner that—
    • is an employee or contractor of the Veterans Health Administration acting within the scope of that employment or contract;
    • is registered under section 303(f) in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f); and
    • issues a controlled substance prescription in this emergency context that is limited to a maximum of a 5-day supply which may not be extended or refilled; or
  • is being conducted under any other circumstances that the Attorney General and the Secretary have jointly, by regulation, determined to be consistent with effective controls against diversion and otherwise consistent with the public health and safety.

SOURCE:  21 USCS Sec. 802, (Accessed Dec. 2022).

Last updated 12/04/2022

Licensure Compacts

No reference found.

Last updated 12/04/2022

Miscellaneous

No reference found.

Last updated 12/05/2022

Online Prescribing

Controlled Substance Act

No controlled substance that is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act may be delivered, distributed, or dispensed by means of the Internet without a valid prescription … Nothing in this subsection shall apply to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the ‘practice of telemedicine’ [see definition in section above].

SOURCE:  21 USCS Sec. 829, (Accessed Dec. 2022).

Note that the practice of telemedicine is allowed to be used in prescribing controlled substances during a public health emergency declared by the Secretary under section 319 of the Public Health Service Act; and when the patients involved are located in such areas, and such controlled substances, as the Secretary, with the concurrence of the Attorney General, designates.

See Definitions section for all telemedicine exceptions.

SOURCE:  21 USCS Sec. 802, (Accessed Dec. 2022).

The Attorney General may issue to a practitioner a special registration to engage in the practice of telemedicine for purposes of section 102(54)(E) if the practitioner, upon application for such special registration—

  • demonstrates a legitimate need for the special registration; and
  • is registered under section 303(f) in the State in which the patient will be located when receiving the telemedicine treatment, unless the practitioner—
  • is exempted from such registration in all States under section 302(d); or
  • is an employee or contractor of the Department of Veterans Affairs who is acting in the scope of such employment or contract and is registered under section 303(f) in any State or is utilizing the registration of a hospital or clinic operated by the Department of Veterans Affairs registered under section 303(f).

Regulations. Not later than 1 year after the date of enactment of the SUPPORT for Patients and Communities Act, in consultation with the Secretary, the Attorney General shall promulgate final regulations specifying—

  • the limited circumstances in which a special registration under this subsection may be issued; and
  • the procedure for obtaining a special registration under this subsection.

SOURCE:  21 USCS Sec. 831, (Accessed Dec. 2022).

Last updated 12/04/2022

Professional Board Standards

No reference found.

Last updated 12/05/2022

Definition of a Visit

For FQHCs, a visit is either of the following:

Face-to-face encounter (or, for mental health disorders only, an encounter that meets the requirements under paragraph (b)(3) of this section) between an RHC patient and one of the following:

  • Physician assistant.
  • Nurse practitioner.
  • Certified nurse midwife.
  • Visiting registered professional or licensed practical nurse.
  • Clinical psychologist.
  • Clinical social worker.
  • Qualified transitional care management service.

A face-to-face encounter between a patient and either of the following:

  • A qualified provider of medical nutrition therapy services as defined in part 410, subpart G, of this chapter.
  • A qualified provider of outpatient diabetes self-management training services as defined in part 410, subpart H, of this chapter.

A medical visit is a face-to-face encounter between a RHC or FQHC patient and one of the following:

  • Physician assistant.
  • Nurse practitioner.
  • Certified nurse midwife.
  • Visiting registered professional or licensed practical nurse.

A medical visit for a FQHC patient may be either of the following:

  • Medical nutrition therapy visit.
  • Diabetes outpatient self-management training visit.

Visit – Mental health. 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, including an in-person mental health service furnished within 6 months prior to the furnishing of the telecommunications service 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, between an RHC or FQHC patient and one of the following:

  • Clinical psychologist.
  • Clinical social worker.
  • Other RHC or FQHC practitioner, in accordance with paragraph (b)(1) of this section, for mental health services.

SOURCE:  Code of Federal Regulation Title 42, Sec. 405.2463, (Accessed Dec. 2022).

FQHC visits must:

  • Be medically necessary
  • Be face-to-face medical or mental health visits or qualified preventive health visits between the patient and an FQHC practitioner (physician, NP, PA, CNM, CP, or CSW), and the practitioner provides one or more qualified FQHC services
  • In certain limited situations, include a registered nurse (RN) or a licensed practical nurse (LPN) homebound patient visit
  • Meet certain conditions when a qualified practitioner offers outpatient DSMT or MNT services and the FQHC meets the requirements to provide these services

SOURCE: CMS MLN Booklet, Federally Qualified Health Center, Oct. 2022, pg. 6 (Accessed Dec. 2022).

Last updated 12/05/2022

Eligible Distant Site

FQHCs are not listed as an eligible distant site provider that can deliver services via telehealth.  However, FQHCs can provide telecommunications for mental health visits using audio-video technology and audio-only technology. See MLN Guidance for requirements.

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

FQHCs provide: …

  • Virtual communication services like communication-based technology and remote evaluation services.
  • Mental health services using telecommunications (starting January 1, 2022).

We pay for virtual communication services when an FQHC practitioner meets certain requirements, including:

  • Practitioner provides at least 5 minutes of billable FQHC virtual communications, either through communication-based technology or remote evaluation services
  • Patient had at least 1 face-to-face billable visit within previous year
  • Virtual visit isn’t related to services provided within last 7 days
  • Virtual visit doesn’t lead to in-person FQHC service within the next 24 hours or at next appointment

When the virtual communication HCPCS code G0071 is on an FQHC claim alone or with other payable services, we require FQHCs to submit HCPCS code G2012 (communication technology based services) or HCPCS code G2010 (remote evaluation services).

When an FQHC practitioner provides virtual communication services, they don’t need to meet face-to-face, so the coinsurance doesn’t apply.

SOURCE: CMS MLN Booklet, Federally Qualified Health Center, October 2022 (Accessed Dec. 2022).

See: Federal Medicare Live Video Distant Site

Last updated 12/05/2022

Eligible Originating Sites

FQHCs are listed as an eligible originating site.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m). (Accessed Dec. 2022).

See: Federal Medicare Live Video Eligible Sites

Last updated 12/05/2022

Facility Fee

FQHCs are listed as an originating site eligible for a facility fee.

SOURCE:  Social Security Act, Sec. 1834(m) (Title 42, Sec. 1395m). (Accessed Dec. 2022).

See: Federal Medicare Live Video Facility/Transmission Fee

Last updated 12/05/2022

Home Eligible

FQHC services are covered when provided in outpatient settings only, including a patient’s place of residence, which may be a skilled nursing facility or a nursing facility, other institution used as a patient’s home, or are hospice attending physician services furnished during a hospice election.

FQHC services are not covered in a hospital, as defined in section 1861(e)(1) of the Act.

SOURCE: Code of Federal Regulation, Title 42, Sec. 405.2446, (Accessed Dec. 2022).

FQHC visits may take place:

  • In the FQHC
  • At the patient’s home, including an assisted living facility
  • In a Medicare-covered Part A skilled nursing facility (SNF)
  • At the scene of an accident
  • A hospice facility (when an FQHC physician, NP, or PA who’s employed or working under contract for an FQHC but isn’t employed by a hospice program provides them)

FQHC visits can’t take place at:

  • An inpatient or outpatient hospital department, including a critical access hospital (CAH)
  • A facility with specific requirements excluding FQHC visits

SOURCE: CMS MLN Booklet, Federally Qualified Health Center, Oct. 2022 (Accessed Dec. 2022).

Visiting nurse services is covered under the following circumstances:

  • The RHC or FQHC is located in an area in which the Secretary has determined that there is a shortage of home health agencies.
  • The services are rendered to a homebound individual.
  • The services are furnished by a registered professional nurse or licensed practical nurse that is employed by, or receives compensation for the services from the RHC or FQHC.
  • The services are furnished under a written plan of treatment. See regulation for more details.

SOURCE: Code of Federal Regulation, Title 42, Sec. 405.2416, (Accessed Dec. 2022).

Last updated 12/05/2022

Modalities Allowed

Live Video

FQHCs are not listed as an eligible distant site provider that can deliver services via telehealth.  However, permanent Medicare policy allow FQHCs to provide mental health visits using audio-video technology and audio-only technology.

These visits are different from telehealth services provided during the COVID-19 Public Health Emergency (PHE).

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 Dec. 2022).

Medicare pays FQHCs for virtual communication services when an FQHC practitioner meets certain requirements, including:

  • Practitioner provides at least 5 minutes of billable FQHC virtual communications, either through communication-based technology or remote evaluation services
  • Patient had at least 1 face-to-face billable visit within previous year
  • Virtual visit isn’t related to services provided within last 7 days
  • Virtual visit doesn’t lead to in-person FQHC service within the next 24 hours or at next appointment

When the virtual communication HCPCS code G0071 is on an FQHC claim alone or with other payable services, we require FQHCs to submit HCPCS code G2012 (communication technology-based services) or HCPCS code G2010 (remote evaluation services).  When an FQHC practitioner provides virtual communication services, they don’t need to meet face-to-face, so the coinsurance doesn’t apply.

SOURCE: CMS MLN Booklet, Federally Qualified Health Center, Oct. 2022, pg. 11 (Accessed Dec. 2022).

See: Federal Medicare Live Video


Store and Forward

FQHCs can get reimbursement for the virtual communication service G2010 which includes remote asynchronous evaluation.

SOURCE: CMS MLN Booklet, Federally Qualified Health Center, Oct. 2022, pg. 11 (Accessed Dec. 2021).

See: Federal Medicare Store-and-forward


Remote Patient Monitoring

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 Dec. 2022).

FQHCs can also be reimbursed for chronic care management, which can include elements of RPM.

SOURCE:  Centers for Medicare and Medicaid Services, Care Management in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), Frequently Asked Questions, Dec. 2019, (Accessed Dec. 2022).

See: Federal Medicare Remote Patient Monitoring


Audio-Only

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

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 Dec. 2022).


Virtual Communications

Medicare waives the RHC and FQHC face-to-face requirements when an RHC or FQHC furnishes communication technology-based services (may include audio-only/telephone) 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.

SOURCE:  Medicare Learning Network Matters Factsheet, MM10843, Aug. 10, 2018, & Virtual Communication Services RHCs and FQHCs FAQs, December 2018, (Accessed Dec. 2022).

See: Federal Medicare Email, Phone & Fax

Last updated 12/05/2022

Patient-Provider Relationship

No reference found.

Last updated 12/05/2022

PPS Rate

Mental Health Visits via Telecommunications

FQHCs and RHCs will be able to furnish mental health visits to include visits furnished using interactive, real-time telecommunications technology. 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).

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

FQHCs bill G0470 (or other appropriate FQHC specific mental health visit payment code) with Modifiers 95 (audio-video) or FQ (audio-only).

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

Virtual Communication Services: 

Medicare requires FQHCs submit HCPCS code G2012 (communication technology-based services), and HCPCS code G2010 (remote evaluation services) virtual communication services claims, when the virtual communication HCPCS code, G0071, is on an FQHC claim alone or with other payable services.

SOURCE: CMS MLN Booklet, Federally Qualified Health Center, Oct. 2022, pg. 11 (Accessed Dec. 2022).

Last updated 12/05/2022

Same Day Encounters

For RHCs and FQHCs that are authorized to bill under the reasonable cost system, encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit, except when the patient –

  • Suffers an illness or injury subsequent to the first visit that requires additional diagnosis or treatment on the same day;
  • Has a medical visit and a mental health visit on the same day; or
  • Has an initial preventive physical exam visit and a separate medical or mental health visit on the same day.

SOURCE:  Code of Federal Regulation Title 42, Sec. 405.2463, (Accessed Dec. 2022).