- Coverage and payment for Medicare Telehealth includes consultation, office visits, individual psychotherapy, pharmacologic management, and other services delivered via an interactive audio and video telecommunications system.
- Providers are located at the Distant Site and beneficiaries are located at the Originating Site.
Distant Site vs. Originating Site
Distant Site: The location of the Physician or non-Physician Practitioner (NPP) at the time of service.
- The Physician or NPP provides the service using an interactive audio and video telecommunication system that permits real-time communication with the Beneficiary.
- The location must be on the Provider's Enrollment File.
- Example: If the Provider uses their home as an office location, Home must be listed on the Enrollment File.
- The Provider must be licensed and enrolled in the state in which the services are provided.
- Example: If the Beneficiary is in California but the Provider is in Florida, the Provider must be licensed and enrolled with Medicare Administrative Contactor (MAC) in Florida.
- A Distant Site Practitioner (subject to State Law) includes:
- Physician
- Nurse Practitioner (NP)
- Physician Assistant (PA)
- Certified Nurse-Midwife (CNM)
- Clinical Nurse Specialist (CNS)
- Certified Registered Nurse Anesthetist (CRNA)
- Clinical Psychologist (CP)
- Clinical Social Worker (CSW)
- Registered Dietitian or Nutrition Professional (MNT)
Originating Site: The location of the Beneficiary (Patient) at the time of service.
- Beneficiaries are eligible for Telehealth Services if they are treated at an Originating Site located in a Rural Health Professional Shortage Area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA).
- If the statutory requirements for the Originating Site are not met, the Claim for the Originating Site and Distant Site must be submitted with Modifier GY.
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