Medicare Telemedicine Billing
Under the Coronavirus Preparedness and Response Supplemental Appropriations Act and Section 1135 waiver authority, the Centers for Medicare & Medicaid Services (CMS) broadened access to Medicare telemedicine billing, so beneficiaries can get a wider range of services from their doctors and other clinicians without traveling to a health care facility. On March 6, 2020, Medicare began temporarily paying clinicians to furnish beneficiary telemedicine services residing across the entire country.
Under this Section 1135 waiver expansion, a range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, can offer a specific set of telemedicine services. The specific set of services beneficiaries can get include evaluation and management visits (common office visits), mental health counseling, and preventive health screenings. Beneficiaries can get telemedicine services in any health care facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.
An originating site is the location where a Medicare beneficiary gets physician or practitioner medical services through a telecommunications system. The beneficiary must go to the originating site for the services located in either:
- A county outside a Metropolitan Statistical Area (MSA)
- A rural Health Professional Shortage Area (HPSA) in a rural census tract
Authorized originating sites include:
- Physician and practitioner offices
- Critical Access Hospitals (CAHs)
- Rural Health Clinics
- Federally Qualified Health Centers
- Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
- Skilled Nursing Facilities (SNFs)
- Community Mental Health Centers (CMHCs)
- Renal Dialysis Facilities
- Homes of beneficiaries with End-Stage Renal Disease (ESRD) getting home dialysis
- Mobile Stroke Units
The Health Resources and Services Administration (HRSA) decides HPSAs, and the Census Bureau decides MSAs. To see a potential Medicare telemedicine originating site’s payment eligibility, go to HRSA’s Medicare Telehealth Payment Eligibility Analyzer. Each December 31 of the prior calendar year (CY), an originating site’s geographic eligibility is based on the area’s status. This eligibility continues for a full CY.
Distant Site Practitioners
Distant site practitioners who can furnish and get payment for covered telemedicine services (subject to State law) are:
- Nurse practitioners (NPs)
- Physician assistants (PAs)
- Clinical nurse specialists (CNSs)
- Certified registered nurse anesthetists
- Registered dietitians or nutrition professional
- Clinical psychologists (CPs) and clinical social workers (CSWs)
- 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.
Under the 1135 waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and included in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telemedicine/telehealth to their patients. Refer the following blog for the complete list of Telemedicine CPT Codes for Telemedicine Billing.
CPT © Copyright 2021 American Medical Association
Not sure about which Telemedicine CPT Codes to use? Insurance companies and Medicare are updating and changing Telemedicine CPT Codes almost daily. The best way to ensure you can bill and get paid for telemedicine is to call and verify coverage with the patient’s insurance before their first telemedicine visit. Stay connected for more articles on telehealth billing services. For any enquires on telemedicine billing for telehealth/telemedicine services, feel free to call E2E Medical Billing Services at 888-552-1290 or write to us at [email protected]