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.

Learn More

Telehealth Billing




    • Related Articles

    • Telehealth Billing

      Telehealth for Medicare For Medicare telehealth charges, use the POS code for an in-person visit. For instance, you would use an 11 for what would have been an office visit. Medicare requires Modifier 95 in order for the provider to be reimbursed at ...

    • Statements/Invoices Overview

      Statements/Invoices Overview Statement and Invoice Profiles must be set up before Statements can be sent. Statements and Invoices must be set up separately. Both require Proofs to be approved. Statement Profiles Setup Setup for Invoice Billing System ...

    • Worklists Overview

      A User can only see the Worklists if Permissions have been granted in User Maintenance. Organize your Workflow with Worklists Use Worklists to organize work by assigning Tasks with due dates and follow-up dates. Administrators control the information ...

    • Reports Criteria Overview

      Most Reports default to the Post Date which is controlled by the date used in the Reference Batch. My Reports Panel: The Reports that the User has run are shown in this Panel. You can choose to see Unread reports only. Report History: This is the ...

    • Pay To/Billing Locations

      Internal Only: Update a Practice Address Set up Pay To/Billing Locations This is your Physical Address and Remit Address. Set up your Physical Address as your Billing Location where services are rendered. This is the physical address that the Payer ...