Top 10 Tips: Telemedicine and Medicare

Top 10 Tips: Telemedicine and Medicare

There are many areas surrounding telemedicine which can be tricky, as is revealed in discussions on the same over at, and one of these areas is issues around telemedicine and reimbursement. If you are looking for information on Medicare’s telemedicine reimbursement policy, then you are in the right place as this article, together with the brilliant folks over at, will look to highlight the top 10 tips on telemedicine and Medicare.

Of “Originating Sites” and “Distant Sites”

These are two terms that you must have seen somewhere when reading up on telemedicine and Medicare. An Originating Site, as covered over at, is the location of the Medicare beneficiary, or the patient, while, as per discussions on the same also over at, a Distant Site refers to the location of the eligible healthcare provider. These are two terms you have to be familiar with as far as telemedicine and Medicare is concerned.

Professionals eligible to provide telemedicine

Another important tip worth pointing out as far as telemedicine and Medicare goes is the fact that Medicare limits the type of healthcare professionals eligible to provide telemedicine services to Medicare patients, as per the gurus over at Providers who may legally provide telemedicine services to Medicare patients are physicians, nurse practitioners, nurse midwives, physician assistants, clinical nurse specialists, clinical psychologists, and social workers as well as registered dietitians and nutrition professionals as covered over at

Medicare coverage and the patient’s location

As is also revealed in discussions on the same over at, a patient’s location at the time of telemedicine service will also affect Medicare coverage. This means that there are certain conditions that the Originating Site has to meet to qualify for Medicare coverage. On the other hand, there are no restrictions as far as the Distant Site is concerned, with this being a tip that you should be aware of as far as telemedicine and Medicare goes.

What are these conditions as pertains to the Originating Site?

These conditions include the fact that the Originating Site has to be located within a Health Professional Shortage Area, HPSA. It should also be one of the following health facilities: hospitals, physicians or practitioner offices, rural health clinics, skilled nursing facilities, community mental health centers, critical access hospitals, hospital-based or critical access hospital-based renal dialysis centers or federally qualified health centers. As per discussions over at, your patient needs to be both at a facility that falls in any of these categories and located in a health professional shortage area for the telemedicine service to be covered under Medicare.

Facility fees

It is also important to note that Medicare reimburses for both the actual telemedicine services while also paying the Originating Site a facility fee for hosting the patient, as discussed over at This means that if you have a patient in your office and you host a telemedicine visit with a physician in another location, say a specialist, you could bill for the facility fee.

Medicare and videoconferencing

It is important to note that, as is revealed in discussions over at, Medicare restricts reimbursement based on the type of technology the physician uses to deliver care. When most people think of telemedicine, the first thing that comes to mind is a live video conferencing two-way interaction between a patient and provider. Here, except for a few pilot programs in Hawaii and Alaska, Medicare only reimburses for telemedicine services delivered over videoconferencing.

Medicare and store-and-forward as well as Mobile Health.

Store-and-forward, which is covered in great detail over at, is also restricted as far as Medicare coverage is concerned. An important tip to note as far as telemedicine and Medicare is concerned is the fact that, except for the Medicare CCM program, Medicare doesn’t reimburse for services delivered through store-and-forward like say through fax or email. Medicare also doesn’t reimburse for the use of mobile communication devices to deliver care to patients, which is yet another thing worth pointing out.

Medicare and remote patient monitoring

Another important tip worth considering is as pertains Medicare and remote patient monitoring, which is also covered in detail over at As it stands, Medicare doesn’t have any specific legislation as regards reimbursement for remote patient monitoring. However, this is likely to change in the future as this form of telemedicine delivery becomes more and more commonly used.

Billing for telemedicine under Medicare

When it comes to billing for telemedicine under Medicare, you have to be aware, as a practitioner, of the list of eligible procedures and their CPT/HCPCS codes, as you will need to use one of these codes when billing as is covered in detail over at the brilliant The use of these codes has to be accompanied by a “GT” modifier, which will help indicate that the procedure in question took place virtually.

Rates of reimbursement for telemedicine as far as Medicare is concerned

One question that most practitioners ask, as is revealed in discussions on the same over at, is if Medicare will reimburse them at the same rates as they would be for an in-person visit. The answer to this question is “Yes”, as the healthcare professional delivering the telemedicine service will be reimbursed at the current fee schedule rate.

The above tips cover some of the most important things you should know as far as telemedicine and Medicare is concerned, with more on this and other related topics to be found over at