Page 21 Telehealth and Remote Patient Monitoring RPM for Long Termand Post Acute Care A Primer and Provider Selection Guide 2013

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6 PoTenTial lTPaC Provider related to the location or geographic areas. Prac-
business models titioners at the distant site who may furnish and
receive payment for covered telehealth services

6.1 Medicare Coverage (subject to state law, including inter-state licensure
laws) are: physicians; nurse practitioners (NP);
Under its fee-for-service model, Medicare pays a physician assistants (PA); nurse midwives; clinical
distant practitioner for a limited number of Part B nurse specialists (CNS); clinical psychologists (CP)
services that are furnished by a physician or practi- and clinical social workers (CSW) ; and registered
vi
tioner to an eligible beneficiary via a telecommuni- dietitians or nutrition professionals.
cations system. For eligible telehealth services, the
use of a telecommunications system substitutes for As a condition of payment, an interactive audio
an in-person encounter. An originating site is the and video telecommunications system that permits
location of an eligible Medicare beneficiary (pa- real-time communication between the physician or
tient) at the time the service being furnished via a practitioner at the distant site and the beneficiary,
telecommunications system occurs. Medicare ben- at the originating site, must be used. Asynchronous
eficiaries are eligible for telehealth services only if store-and-forward technology is permitted only in
they are presented from an originating site located federal telemedicine demonstration programs con-
42
in a rural Health Professional Shortage Area or in ducted in Alaska or Hawaii. For a list of Medicare
a county outside of a Metropolitan Statistical Area. telehealth services, please see the following fact
Entities that participate in a Federal telemedicine sheet: http://www.cms.gov/Outreach-and-Educa-
demonstration project approved by (or receiving tion/Medicare-Learning-Network-MLN/MLN-
funding from) the Secretary of the Department of Products/downloads/telehealthsrvcsfctsht.pdf.
Health and Human Services as of December 31, It is important to note that when telehealth is used
2000, qualify as originating sites regardless of geo- with patients in nursing homes, one of the eligible
graphic location. originating sites, the payment goes to the distant

The originating sites authorized by law are all medi- physician, clinician or practitioner.
cal facilities; these sites include: offices of physicians
or practitioners; hospitals; Critical Access Hospi- 6.1.1 Medicare Reimbursement of Home
tals (CAH); Rural Health Clinics (RHC); Federally Telehealth
Qualified Health Centers (FQHC); hospital-based Section 1895(e) of the Social Security Act43 states
or CAH-based Renal Dialysis Centers (including that telehealth services are outside the scope of the
satellites) ; skilled nursing facilities (SNF); and Medicare home health benefit and home health
v
Community Mental Health Centers (CMHC). The Prospective Payment System (PPS). This provision
patient’s home is not an eligible originating site.

Distant sites from which practitioners furnish vi CPs and CSWs cannot bill for psychiatric diagnostic interview
telehealth services are not subject to restrictions examinations with medical services or medical evaluation and management
services under Medicare. These practitioners may not bill or receive
payment for Current Procedural Terminology (CPT) codes 90792, 90833,
v Note: Independent Renal Dialysis Facilities are not eligible originating sites. 90836, and 90838.

LeadingAge Center for Aging Services Technologies (CAST)