Because telehealth has become more common in the age of COVID-19, it’s critical to understand how telehealth reimbursement works and how to teach your care team to manage it.
Telehealth covers a broad spectrum of digital healthcare services. Both large healthcare systems and small independent practices are applying this solution when they use remote patient monitoring for diabetes or hypertension, when they offer mental health and addiction healthcare services like teletherapy, and when they provide virtual visits through real-time video conferencing (telemedicine) — a form of telehealth.
COVID-19’s impact on telehealth reimbursement
Now that the coronavirus pandemic has disrupted the industry with telehealth services, Congress is getting pressured to evolve telehealth reimbursement policies beyond today’s virtual care restrictions. Rural health has been grappling with vanishing hospitals and far-flung healthcare sites for a while now, but COVID-19 has cast these challenges into the spotlight and inspired both patients and providers to accelerate their acceptance of telehealth visits. Medicare and Medicaid are leading the way and expanding coverage as other payers gradually follow suit.
This embrace of remote video real-time care delivery has extended to clinics and healthcare systems altering (perhaps permanently) the way healthcare is delivered — as well as how telehealth reimbursement policy is written and enforced on the federal level.
Even providers who previously didn’t offer telehealth services are now rushing to implement some form of virtual care to meet patient standards. At the same time, they’re struggling to make up for revenue lost from other streams such as elective surgeries — which are being put on hold during the pandemic. Though this mode of care delivery has never had an equal footing with in-person visits, the new demand for improved telehealth reimbursement is spurring regulatory action across the country.
Types of telehealth services
As the COVID-19 public health emergency winds down, telehealth reimbursement continues to evolve. The federal government, state Medicare and Medicaid programs, as well as private insurance companies expanded coverage for these virtual health care services:
Today’s telehealth services help teams of all sizes and specialties deliver patient-centered care, which helps improve outcomes and drive patient satisfaction. Telehealth services are typically delivered via these three modalities:
Video conferencing enables virtual visits with a wide range of healthcare providers in nearly all specialties. This format allows patients to see and interact with their healthcare provider face-to-face — making them feel like they’re in the room together — and is the closest to a traditional doctor-patient office visit.
Real-time healthcare delivered in this form is especially beneficial for patients with debilitating chronic conditions — such as diabetes, heart disease, or cancer — who may not be able to visit health centers and clinics as frequently as necessary to be evaluated by their healthcare provider. It’s particularly convenient for mental health and addiction patients having a difficult time leaving the house. It’s also a critically important way for coronavirus patients to have regular, real-time check-ins with their healthcare providers.
Store-and-forward telehealth is a health information gathering tool. This telecommunications system collects demographic data, medical history, and lab results, then sends them to another healthcare organization for third-party evaluation. Also called asynchronous telehealth, this practice allows healthcare providers who offer wide-ranging healthcare services to collaborate on holistic virtual care plans for patients.
With all of a patient’s medical information in one place, healthcare providers have instant access to data that may have otherwise taken them months to discover through one-on-one consultations. This puts healthcare providers in the best possible position to deliver real-time exemplary medical care to their patients.
- Remote patient monitoring
Remote patient monitoring (RPM) utilizes wireless wearable technology devices to gather patients’ medical information so that their healthcare provider can monitor their health remotely in real time. RPM devices include blood pressure cuffs, digital scales, blood glucose monitors, and smartwatches, as well as smart shoes and socks.
Healthcare providers can use the medical information collected from these devices to track their patients’ health and intervene when necessary. With the support of health centers’ clinicians, patients can learn how to self-manage their condition with an RPM device, then discuss their collected data during telehealth visits to gain greater independence.
Virtual check-ins allow you to talk to your doctor, nurse practitioner, physician assistant, therapist, or other specialist using a device like your phone, integrated audio/video system, or captured video image without going to the doctor’s office.
Virtual check-ins can be used for real-time COVID-19 treatment from anywhere, including places of residence (like homes, nursing homes, and assisted-living facilities). According to Medicare.gov, medical insurance covers virtual care check-ins (or “brief communication technology-based services”) with healthcare providers. The patient is responsible for paying 20% of the Medicare-approved amount for telehealth services, and the Part B deductible applies.
Before you begin relying on virtual care, you should know these points:
- Medicare requires that patients discuss telehealth services with their providers before starting virtual visits.
- Patient-provider communication must not be related to an in-office visit within the past 7 days and must not lead to an office visit within the next 24 hours (or the soonest appointment available).
- Patients’ verbal consent for a virtual check-in must be documented in their medical record. Your care team needs to obtain a single consent for a year’s worth of these telehealth services per patient.
- Medicare also covers telehealth visits.
Always check the latest updates on Medicare and Medicaid services in your state, as they are revised often.
Another trend that has become more popular during the pandemic is telehealth delivery via e-visits — secure email dialogues. During e-visits, patients compose a free-form message and then send it to their clinician through a protected web site or patient portal. Providers then respond with medical advice, usually within a day or two. E-visits are ideal for distant-site rural health providers treating patients who live very far from clinics, care for children full time, or don’t want to spend time traveling to a traditional office for a diagnosis of minor symptoms.
Of the 20,000 participants of a study published by the JAMA Network, 62% used e-visits to order prescriptions. Although patient characteristics and symptoms varied significantly, these e-visits took 2 to 3 minutes of each provider’s time. No quality concerns were identified during random medical record reviews of follow-up visits. Seven days later, only 13.5% of the e-visits had an outpatient appointment follow-up booked.
E-visits offer quick, safe patient access to virtual health care for specific conditions without scheduling visits way in advance, securing transportation, or taking time off work. This study’s results suggest that a predominance of e-visits delivered virtual care successfully without follow-up visits.
Telehealth services save healthcare providers time as well, increasing their ROI. Virtual visits outside of office hours provide an additional revenue stream. Also, if office hours are booked but you can schedule virtual visits in the evening, patients can avoid a visit to the urgent care center or the emergency room while preserving continuity of care.
Providers who offer telehealth services say they are most effective for treating mild conditions in patients that are too busy or too far away to come to the office. Some of the conditions commonly treated during e-visits include urinary infections, cold and flu symptoms, sinus problems, coughs — and of course, COVID-19. For long-term virtual care, healthcare providers monitor patient progress with chronic conditions like diabetes, heart disease, and dementia.
Private insurance telehealth reimbursement
Most insurance providers cover at least some form of virtual care. Contact the insurance providers you accept to see if they cover reimbursement for any telehealth services.
There are additional code changes for COVID-19 reimbursement and related care that cover telehealth, digital virtual care, audio-only, and in-person visits. You should verify each payer’s policy and ask patients to verify their coverage ahead of appointments.
States that require private insurance telehealth reimbursement
American Telemed reports that the majority of states have adopted policies to enable their Medicaid program to provide the same coverage and payment policies for telehealth services and in-person services. Member organizations and policymakers are identifying and learning from the states that excel in telehealth policy as well as addressing the barriers and opportunities in states that have been slower to adopt telehealth reimbursement.
Currently, 36 states and D.C. have parity policies for private payer coverage. Just 21 states and D.C. have Medicaid coverage parity policies. So far, 40 states and D.C. have adopted policies or received awards that improved coverage and reimbursement of telehealth. Among the states that have not passed laws include New Mexico, South Carolina, West Virginia, Ohio and Michigan.
How to code telehealth reimbursement
The American Academy of Family Physicians (AAFP) continues to advocate for maximum payer flexibility for clinicians and will update this information for the duration of the public health emergency. The Academy recommends that clinicians verify each payer’s policy and ask patients to verify their coverage ahead of appointments.
The major payers — Aetna, Anthem, Cigna, Humana, UHC, as well as Medicare — use the same code for:
- In-person office visits
For COVID-19 care: CPT Codes: 99201-99205, 99211-99215
For non-COVID-19 care: CPT Codes: 99201-99205, 99211-99215
- Telehealth visits [audio-only or audio-video]
For COVID-19 care: CPT Codes: 99201-99205, 99211-99215
For non-COVID-19 care: CPT Codes: 99201-99205, 99211-99215
For COVID-19 and non-COVID-19 related care: CPT 99421-99423
- Virtual check-ins
For COVID-19 and non-COVID-19 related care: HCPCS codes G2012 and G2010
As you can see, there are no COVID-specific requirements for virtual check-ins or e-visits, which illustrates the fact that these services are becoming increasingly more common for many conditions. Most payers are waiving cost-sharing for e-visits and virtual check-ins. Make sure to inform your patients that you offer these services and work with them on a payment plan if needed.
Medicare and Medicaid telehealth reimbursement
Most state legislatures have expanded Medicaid telehealth coverage during the COVID-19 public health emergency to allow patients to use:
- Telehealth services via phone, video, or digital messaging
- Their homes as the originating telehealth site
- Telehealth reimbursement parity for telehealth services
If you want more information about your state’s billing and telehealth reimbursement policies, check the National Telehealth Policy Resource Center inventory of COVID-19-related state actions to find requirements during the emergency period, and in some cases, even after it ends.
Medicare telehealth reimbursement during COVID-19
The federal government has expanded Medicare telehealth reimbursement during the COVID-19 public health emergency by allowing:
- Freedom from geographic restrictions for patients or providers
- All eligible healthcare providers to bill Medicare for telehealth services, including federally qualified health centers (FQHCs) and rural health clinics (RHCs)
- Eligibility for this list of telehealth services from the Centers for Medicare & Medicaid Services
- Providers to reduce or waive patient cost-sharing (copayments and deductibles) for telehealth visits
- Providers to deliver services outside of the state where they are licensed — find the hotline for your area in this list of Medicare
- Administrative Contractors (MACs)
- The use of multiple modalities (video, chat, or telephone)
Medicare telehealth reimbursement codes
Medicare increased payments for certain evaluation and management services delivered via telephone visits and audio-only telehealth for the duration of the COVID-19 public health emergency:
- Telehealth CPT codes
- 99441 (5–10 minutes)
- 99442 (11–20 minutes)
- 99443 (20–30 minutes)
These telehealth reimbursements match similar in-person services which have increased from $14–$41 to about $60–$137. In addition, Medicare is waiving the audio-video requirement for many telehealth services during the pandemic, but is still establishing new post-pandemic billing guidelines and payment rates. Codes that have audio-only waivers during the public health emergency are noted in the list of telehealth services.
Telehealth reimbursement for the uninsured
The federal government is reimbursing health care providers for COVID-19 testing, treatment, and vaccine administration costs for uninsured individuals, including related services provided via virtual telehealth visits. The cost of the vaccine itself has already been covered. Reimbursements for any of these services, subject to funding availability, are generally paid at Medicare rates.
For more details on COVID-19 reimbursement and billing, see:
If you have questions about telehealth reimbursement for uninsured patients who need care related to COVID-19, call the HRSA COVID-19 Uninsured Program Provider Support Line at 866-569-3522.
Telehealth reimbursement for Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHCs)
During the COVID-19 public health emergency:
- FQHCs and RHCs can bill Medicare for telehealth services as distant site providers, at a reimbursement rate of $92.03, retroactive to January 27, 2020.
- Your patient’s home is an eligible originating site for telehealth care.
- Virtual care coverage now includes online digital evaluation and management — services which Medicare does not consider telehealth and reimburses at a different rate. See virtual communication billing codes for RHCs and FQHCs for more details.
Ready to embrace the healthcare of the future?
Telehealth reimbursement doesn’t need to be so complicated that it prevents you from delivering the care your patients need. To learn more about leveraging telehealth services in your health system or clinic, read our guide to telehealth.