The fact sheet provides information about originating sites; distant site practitioners; telehealth services; and billing and payment for professional services furnished via telehealth and the originating site facility fee.
Here is some important background information on telehealth services.
Telehealth Services Overview
Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter.
An originating site is the location of an eligible Medicare beneficiary at the time the service furnished via a telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:
- A rural health professional shortage area (HPSA) located either outside of a metropolitan statistical area (MSA) or in a rural census tract; or
- A county outside of a MSA.
Originating sites authorized by law are:
- offices of physicians or practitioners;
- critical access hospitals (CAH);
- rural health clinics;
- federally qualified health centers;
- hospital-based or CAH-based renal dialysis centers (including satellites);
- skilled nursing facilities; and
- community mental health centers (CMHCs).
Practitioners at the distant site who may furnish and receive payment for covered telehealth services (subject to state law) are:
- nurse practitioners (NPs);
- physician assistants (PAs);
- clinical nurse specialists (CNSs);
- certified registered nurse anesthetists;
- registered dietitians or nutrition professionals; and clinical psychologists (CPs) and clinical social workers (CSWs). Note: CPs and CSWs cannot bill for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services under Medicare. These practitioners may not bill or receive payment for CPT codes 90792, 90833, 90836, and 90838.
As a condition of payment, physicians or practitioners at the distant site must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the beneficiary at the originating site.
If your organization requires assistance with billing for telehealth services, contact medical billing company PGM Billing. PGM is a leading integrated physician billing, practice management and electronic medical record service that provides highly efficient medical claims processing that helps healthcare providers improve their collections and cash flow, while gaining valuable insight into their organization’s performance.