Telehealth Services
Table of Contents
General Information
Medicare pays for a limited number of Part B services furnished by a physician or practitioner to a Medicare beneficiary via a telecommunications system. The use of a telecommunications system substitutes for an in-person encounter.
Before the COVID-19 PHE, Medicare patients were required to receive telehealth at an originating site located in a certain geographic location. As a result of changes instituted for the PHE, CMS will continue to allow through 12/31/2024, all patients to get telehealth in those same locations as well as their residence. They don’t need to be at an originating site, and there aren’t any geographic restrictions. After 12/31/2024, there may be originating site requirements and geographic location restrictions for non-behavioral/mental telehealth. For behavioral or mental telehealth, all patients can continue to receive telehealth in an originating site or their residence, with no originating site requirements or geographic location restrictions.
Originating Site
An originating site is the location where a patient is located and receives physician or practitioner medical services via telehealth.
Distant Site
A “distant site” is the location where a physician or practitioner provides the service to the patient via telehealth.
List of Covered Medicare Telehealth Services
Billing
Facility Fee for Originating Site
The originating site facility fee is a separately billable Part B payment. The payment amount to the originating site is the lesser of 80 percent of the actual charge or 80 percent of the originating site facility fee. The beneficiary is responsible for any unmet deductible amount and Medicare coinsurance. The contractor pays the facility fee outside of other payment methodologies. The originating site facility fee payment methodology for each type of facility can be found by referencing the Centers for Medicare & Medicaid Service (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 190, “Medicare Payment for Telehealth Services.”
Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014. When billing for the originating site, the POS is 11 and the location address is where the beneficiary was located. If the patient is presenting from their home, then Q3014 cannot be billed to Medicare.
Payment for Professional Fee
Claims for telehealth services are submitted to the contractors that process claims for the performing physician/practitioner’s service area. Physicians/practitioners submit the appropriate HCPCS procedure code for covered professional telehealth services with POS code 02 (Telehealth location other than home), or POS code 10 (Telehealth, home).
Place of Service Codes
For 2023, continue billing telehealth claims with the POS indicator you would bill for an in-person visit. You must use Modifier 95 to identify them as telehealth through 12/31/2023.
After 12/31/2023, use POS 02 to indicate you provided the billed service as a professional telehealth service when the originating site is other than the patient’s home. Use POS 10 for telehealth services when the patient is in their home.
| Place of Service | Provider Location (Distant Site) (Includes Physicians, NPPs and PT/OT/SLPs) | Patient Location (Originating Site) | Modifier 95 | Q3014- Originating Site Fee |
|---|---|---|---|---|
| 02 | An office different from the office or facility where the patient is located or the providers home | Office or Facility | No | Yes, at patient location |
| 10 | Office/Provider’s home | Patient’s home or current residence | No | No |
| 19, 21, 22, 23 | Hospital location | Patient’s home or current residence | Yes, add modifier 95 to denote telehealth - will pay at MPFS nonfacility rate | No |
Related Content
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 190
- CMS Telehealth web page ‒ Process for additions/deletions for telehealth services
- MLN Fact Sheet® Telehealth Services
Reviewed 11/21/2024