Billing for rural telehealth
Billing and reimbursement for rural and frontier telehealth services is, in many ways, no different than any other healthcare service. There are also some stark differences.
On this page:
Medicare and Medicaid billing reimbursement
The Centers for Medicare & Medicaid Services Office of Minority Health focuses on rural health services and providers. They also offer regional rural health coordinators that can assist with region-specific questions and concerns.
For more information on Medicare billing and coding, see the 2022 physician fee schedule.
Uninsured or underinsured patients
While the number of uninsured people in rural areas is falling, there are still more uninsured rural residents than urban residents.
Whether or not a patient can afford to pay for medical care, including appointments, prescriptions, or preventative care measures often depends on their eligibility for state and federal assistance programs.
Providers can help by offering free or low cost services, including:
- Free vaccination clinics
- Free or low cost annual wellness visits
- Free or low cost well child visits
- Insurance navigators or financial advisors to help patients apply for and maintain Medicaid or Medicare coverage
You could also look at offsetting the cost of uninsured or underinsured patients by looking for grants tailored specifically to rural health care providers and clinics.
Read more:
Center for Connected Health Policy
Medicare billing guidance
The COVID-19 public health emergency led the Center for Medicare and Medicaid Services (CMS) to expand its coverage for telehealth care. Many state Medicaid programs and private insurers are also covering telehealth appointments the same as an in-person appointment, with patients paying their typical co-pays.
Get more information on billing for direct-to-consumer telehealth.
Coding guidance is subject to change. Please refer to the complete list of telehealth services covered by Medicare during the COVID-19 public health emergency from the Centers for Medicare & Medicaid Services.
Maternal telehealth
| Category | Telehealth CPT codes and HCPCS codes |
|---|---|
| Evaluation and monitoring outpatient follow-up | 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 |
| Observation care discharge | 99217* |
| Initial observation care | 99218, 99219, and 99220 ** |
| Initial hospital care | 99221, 99222, and 99223 ** |
| Subsequent observational care | 99224, 99225, 99226 |
| Subsequent hospital care | 99231, 99232, 99233 |
| Telephone evaluation and monitoring service | 99441, 99442, 99443 |
| Diabetes management | G0108 |
| Medical nutrition therapy | 97802, 97803 |
Annual Wellness Visits
| Category | Telehealth CPT codes and HCPCS codes |
|---|---|
| Annual wellness visit | G0438, G0439 |
| Advanced planning | 99497, 99498 |
Chronic care telehealth
Audio-only or video telehealth
| Category | Telehealth CPT codes and HCPCS codes |
|---|---|
| Telephone evaluation and management service | 99441, 99442, 99443; G0438, G0439 |
| Screening, brief intervention, and referral to treatment | G0396, G0397 G0442, G0443, G0444, G0445, G0446, G0447 |
| Evaluation and monitoring outpatient follow-up | 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 |
| Observation care discharge | 99217 * |
| Initial observation care | 99218, 99219, 99220 ** |
| Subsequent observational care | 99224, 99225, 99226 |
| Opioid use disorder treatment | G2086, G2087, G2088 |
| Alcohol and substance abuse assessment | G0396, G0397 |
| Diabetes Care Management: Phone evaluation and management | 99441, 99442, 99443 |
| Diabetes self-management training | G0108, G0109 |
| Medical nutrition therapy | 97802, 97803, 97804, G0270 |
| Psychotherapy | 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838 |
| Renal Care: Phone evaluation and management | 99441, 99442, 99443 |
| Renal Care: Outpatient dialysis services | 90951, 90952, 90953, 90954, 90955, 90956, 90957 ,90958, 90959, 90960, 90961, 90962 |
| Renal Care: Hospital care services, with the limitation of 1 telehealth visit every 3 days | 99231, 99232, 99233 |
| Renal Care: Individual and group kidney disease education | G0420, G0421 |
| Renal Care: Transitional care management services | 99495, 99496 |
| Renal Care: Advance care planning | 99497, 99498 |
| Renal Care: Prolonged service | 99354, 99355, 99356, 99357 |
| Renal Care: Telehealth consultations, critical care | G0508, G0509 |
| Pulmonary Care: Phone evaluation and management | 99441, 99442, 99443 |
| Pulmonary Care: Rehabilitation | 94625, 94626, G0424 |
| Pulmonary Care: Transitional care management services | 99495, 99496 |
| Pulmonary Care: Advance care planning | 99497, 99498 |
| Pulmonary Care: Prolonged service | 99354, 99355, 99356, 99357 |
| Pulmonary Care: Ventilator management | 94002, 94003, 94004, 94005 |
| Pulmonary Care: Evaluate patient use of inhaler | 94664 |
| Cardiac Care: Phone evaluation and management | 99441, 99442, 99443 |
| Cardiac Care: Transitional care management services | 99495, 99496 |
| Cardiac Care: Advance care planning | 99497, 99498 |
| Cardiac Care: Prolonged service | 99354, 99355, 99356, 99357 |
| Cardiac Care: Cardiac rehab | 93797, 93798, G0422, G0423 |
| Cardiac Care: In-person ventricular assist device interrogation | 93750 |
| Stroke and Rehabilitation Care: Phone evaluation and management | 99441, 99442, 99443 |
| Physical Therapy Services | 97161, 97162, 97163, 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, 97761, G2061, G2062, G2063 |
| Occupation Therapy Services | 97165, 97166, 97167, 97168 |
| Speech Therapy | 92507, 92508, 92521, 92522, 92523, 92524, 92526 |
| Aphasia Assessment | 96105 |
| Cancer Care: Phone evaluation and management | 99441, 99442, 99443 |
| Cancer care: Radiation oncology treatment management | 77427 |
| Dementia Care: Phone evaluation and management | 99441, 99442, 99443, G0438, G0439 |
| Dementia Care: Cognitive assessment and care plan services | 99483 |
*Remains available until December 31, 2023
**Will expire at some point after the COVID-19 public health emergency is declared over