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Medicare coverage for telehealth has expanded but still has limits
By Jayme Matchinski on April 15, 2019 at 12:15 PM

Image of a cellphone showing an app for calling a doctor, with the words "Health Care Today Series: The Telehealth Landscape"The expansion of telehealth is changing the landscape of health care. This is the second in a four-part series exploring what providers should know about this growing area.

Before 2015, Medicare did not pay separately for telehealth, and telehealth and telemedicine services were bundled into “evaluation and management” codes. However, in 2015, the Center for Medicare & Medicaid Services (CMS) added further telehealth coverage. CMS has added seven telehealth billing codes, including codes for psychotherapy, prolonged office visits and annual wellness visits conducted electronically. CMS also began paying for remote patient monitoring for chronic conditions.

CMS has reimbursed providers for remote patient face-to-face services via live video conferencing requirements when the eligible beneficiary in the originating site is located outside of a Metropolitan Statistical Area (MSA) for eligible medical services, and the telehealth is provided by eligible providers (physicians, nurse practitioners, and/or physician assistants) and by an eligible facility. If these requirements are met, the practitioner delivering services will be reimbursed for medical services in the same amount as the current fee schedule and nonmetro facility eligible for facility fee. However, Medicare reimbursement for telehealth continues to be available only at clinical sites in rural areas. CMS restricts telehealth services to beneficiaries that live in counties outside of a MSA and within a health professional shortage area (HPSA) as designated by the federal government.

Medicare does not cover home health services that are provided via telehealth. Medicare reimbursement is not permitted for any covered home health services paid under the home health prospective payment system. In addition, Medicare does not reimburse for remote non-face-to-face services, as such services are not considered to be telehealth by CMS and are covered as on-site services. An example of remote non-face-to-face services is an interpretation of an electrocardiogram that has been transmitted via telephone.   

Included in the bipartisan budget deal signed by the president to end the government shutdown, Congress passed a short-term funding package on Feb. 8, 2019, that included two years of funding for several health care programs. FAST (Furthering Access to Stroke Telemedicine) Act was included in this budget deal. FAST expands telemedicine for stroke by requiring Medicare to reimburse for telestroke services regardless of where a patient receives treatment.

Next in our telehealth series: Medicaid Coverage for Telehealth. Read the previous installment here.

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