Before COVID-19
Before Covid 19, Medicare would only pay for telemedicine offered in a HPSA (Health Professional Shortage Area), and the patient had to be in one of the following sites:
- Physicians or practitioner offices
- Hospitals
- Critical Access Hospitals (CAH)
- Rural Health Clinics
- Federally Qualified Health Centers
- Hospital-based or CAH-based Renal Dialysis Centers
- Skilled Nursing Facilities (SNF)
- Community Mental Health Centers (CMHC)
- Note: Independent Renal Dialysis Facilities are not eligible originating site
Telehealth
The Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their providers without having to travel to a healthcare facility. CMS defines telehealth as a two-way, real-time interactive communication between a patient and a physician or practitioner at a distant site through telecommunications equipment that includes, at a minimum, audio and visual equipment.
- Doctors and practitioners can use telehealth for the face-to-face encounter to qualify for Medicare home health care.
- Medicare can pay for office visits furnished via telehealth across the country and including in patient’s place of residence through 12/31/24.
- Telehealth can be provided to patients by Doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers. These services that can be furnished by telehealth are evaluation and management (E&M) visits, mental health counseling, and preventative health screenings. These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
- Since the PHE ended, after the patient meets the Part B deductible, a 20% copayment of the Medicare-approved amount for your doctor or other health care providers service will apply.
- Covered healthcare providers must comply with NIPAA rule when providing telehealth service since the end of the PHE.
| Codes and Reimbursement | |||||
|---|---|---|---|---|---|
| Service | Code | Description | Reimbursement | ||
| Telehealth visits – a visit with a provider that uses a telecommunications system | 9920-99215 | Office or other outpatient visits | These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits. | ||
| E Visits with established patients through an online patient portal (patient initiated) | 99421 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes | |||
| 99422 | Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes | ||||
| 99423 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes. | ||||
If you have any questions, comments, or concerns, please email Ask.LHC@lhcgroup.com.
