What is Telehealth?

Telehealth visits are services provided via an interactive audio and video telecommunications system that allows for real-time communication between the provider and the beneficiary (except in AK and HI, where information can be transmitted and reviewed later and still be considered telehealth).

Telehealth visits differ from other remote options including: E-Visits and Virtual Check-Ins. For definitions of these services, see Medicare Telehealth and Remote Patient Monitoring Coding & Billing Guide.

Medicare Telehealth

Watch a video summary from CMS to learn more about Medicare telehealth services: who can provide services, what Medicare can pay for, what services a beneficiary can receive. Medicare permits billing for some telephonic, virtual, and eVisit services and has expanded virtual visits to include new patient visits (see Medicare Billing Codes, below). You may also be interested in our tip sheet on Telehealth Implementation and Workflow.

Who may render/ bill for Medicare telehealth?

• Physicians (MD, DO)
• Nurse practitioners (NP)
• Physician assistants (PA)
• Nurse-midwives (CNM)
• Clinical nurse specialists (CNS)
• Certified registered nurse anesthetists (CRNA)
• Registered dietitians or nutrition professional (RD, DSME)
• Clinical psychologists (CPs)*
• 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 be paid for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838. See the guide in “Billing Codes” below for more information.

Key Takeaways on Medicare Telehealth

• Patients should initiate service, but providers permitted to inform patients of options
• Providers may work cross-state lines regardless of licensure state
• Providers may work from home
• Services may be for all diagnoses; not just COVID-19
• OIG is allowing practices to reduce or waive fees (deductibles) or co-insurance
• E&M frequency limitations have been removed for telehealth
• Sequestration negative adjustments are suspended from May 1, 2020 to December 31, 2020

Medicare Billing Codes

• Complete code lists from CMS
• Medicare Telehealth and Remote Patient Monitoring Services – Coding & Guidelines

Documentation

Documentation for a telehealth service should include:

• consent to telehealth services placed in the medical record;
• orders, updates to the care plan, and charges;
• location of patient and clinician during the visit;
• wording to note technology used and limitations;
• wording about follow-up; and
• the names and roles of any other persons participating in the telehealth service.

Please be sure to check for updates to covered telehealth services, payment policies, and criteria, as these are expected to continue to change as services evolve.

Not billing Medicare?

Check out the current state laws and reimbursement policies for telehealth in your state.

Review the “Learn More About Telehealth” section, below, to review our additional resources on Telehealth (includes a Medicaid billing presentation).

Review payer policies including:

• Aetna Provider Resources
• Blue Cross Blue Shield Coronavirus Updates
• Cigna Coronavirus Resource Center
• Fallon Health Payment Policies
• Harvard Pilgrim Healthcare’s Interim Telemedicine/Telehealth Payment Policy (COVID – 19 Pandemic)
• Humana Patient Responsibility
• Molina Healthcare COVID-19
• MVP Hegalthcare Telemedicine Updates
• Tufts Telemedicine Services Professional Payment Policy
• UnitedHealthcare COVID-19 Resources and Billing Scenarios

Telemedicine Platform Overview

Below is a breakdown of several popular platforms and their lowest-cost (or free) features. Many platforms offer expanded options at higher subscription levels. All platforms provide some level of user training and support. Click on the platform name to visit their website and learn more.

Platform	Cost	Limits on Number and Length of Meetings	Screen Sharing	Key Features and Restrictions
Doximity	Free (only for use by U.S. medical students and clinically-practicing healthcare professionals)	Unlimited number Unlimited time	No	HIPPA compliant Text link option Secure fax No app install for patients
eCW Televisit	$2/visit, $100/user/mo cap until 6/30	Unlimited number Unlimited time	No	HIPPA compliant No app install for patients
Doxy.me	Free (upgrades: $35/mo Pro, $50/mo clinic)	Unlimited number Unlimited time	No (free) Yes (Pro)	HIPPA compliant Text link option No app install for patients
Zoom	Free (upgrades: $15/user.mo pro, $20/user/mo business)	Unlimited number Unlimited time 1:1, 40 min/call cap group	Yes	Private-facing App required
RingCentral	Free (upgrades: $15/user/mo essential, $20/user/mo advanced)	Unlimited audio 500min/mo video cap Unlimited min/call 1:1 40 min/call cap group	Yes	Private-facing No app install for patients
GoToMeeting	Free (upgrades: $14/user/mo pro, $16/user/mo business)	Unlimited number, 40 min/call cap	Yes	Private-facing App required
Skype	Free	Unlimited audio 100 hr/mo video cap 10 hr/day video cap 4 hr/call time limit	Yes	Private-facing App required
FaceTime	Free	Unlimited meetings Unlimited time	No	Private-facing Apple device and app required
Google Duo	Free	Unlimited meetings, 25 hr/call cap	No	Private-facing App required

Learn More about Telehealth

Joint our Project ECHO®: Expanded Telehealth Services for COVID-19 Series. We have had 4 sessions already and would like to extend the invite out to anyone else that may be interested. Please register for future sessions for all of the below-noted sessions:

• May 12^th Utilizing Telemedicine for Behavioral Health and Substance Use Disorder
• May 19^th Lessons Learned – highlights of previous sessions and guidance updates

Additionally, we would also like to provide you with the opportunity to watch and hopefully obtain pertinent information from the two sessions that have been already offered.

• April 14^th Expanded Medicare Telehealth Services for Covid-19 and Caring for Patients during COVID-19
  • Access the didactic slides
  • Access the recorded session
• April 21^st Medicaid Billing and Reimbursement During COVID-19
  • Access the didactic slides
  • Access the recorded session