Telehealth Billing Overview

Telehealth Billing Overview

Telehealth (sometimes referred to as Telemedicine) is the use of telecommunications technology to provide healthcare services to persons who are at some distance from the Provider.

  • 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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Telehealth Billing




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