Article

MLN Booklet

TELEHEALTH SERVICES

ICN MLN901705 March 2020

Target Audience: Medicare Fee-For-Service Providers

The Hyperlink Table, at the end of this document, provides the complete URL for each hyperlink.

TABLE OF CONTENTS

Originating Sites………………………………………………………………………………………………………………….. 3

Distant Site Practitioners……………………………………………………………………………………………………… 4

Telehealth Services……………………………………………………………………………………………………………… 4

Telehealth Services Billing and Payment………………………………………………………………………………. 7

Telehealth Originating Sites Billing and Payment………………………………………………………………….. 8

Resources…………………………………………………………………………………………………………………………… 8

Helpful Websites………………………………………………………………………………………………………………….. 9

Regional Office Rural Health Coordinators…………………………………………………………………………… 9

CPT codes, descriptions and other data only are copyright 2018 American Medical Association. All Rights Reserved.

Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association. Applicable FARS/

HHSAR Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related

components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA

does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data

contained or not contained herein.

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Telehealth Services MLN Booklet

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CMS Alert!

Medicare Beneficiaries Expanded Telehealth Benefits During COVID-19 Outbreak

Under the Coronavirus Preparedness and Response Supplemental Appropriations Act

and Section 1135 waiver authority, the Centers for Medicare & Medicaid Services (CMS)

broadened access to Medicare telehealth services, so beneficiaries can get a wider range of

services from their doctors and other clinicians without traveling to a health care facility. On

March 6, 2020, Medicare began temporarily paying clinicians to furnish beneficiary telehealth

services residing across the entire country.

Before this announcement, Medicare could only pay clinicians for telehealth services, such

as routine visits in certain circumstances. For example, the beneficiary getting the services

must live in a rural area and travel to a local medical facility to get telehealth services from

a doctor in a remote location. In addition, the beneficiary generally could not get telehealth

services in their home.

Under this Section 1135 waiver expansion, a range of providers, such as doctors, nurse

practitioners, clinical psychologists, and licensed clinical social workers, can offer a

specific set of telehealth services. The specific set of services beneficiaries can get include

evaluation and management visits (common office visits), mental health counseling, and

preventive health screenings. Beneficiaries can get telehealth services in any health care

facility including a physician’s office, hospital, nursing home or rural health clinic, as well

as from their homes. This change broadens telehealth flexibility without regard to the

beneficiary’s diagnosis, because at this critical point it is important to ensure beneficiaries

follow CDC guidance including practicing social distancing to reduce the risk of COVID-19

transmission. This change will help prevent vulnerable beneficiaries from unnecessarily

entering a health care facility when clinicians can meet their needs remotely.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/factsheets/

medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/

files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

Telehealth Services MLN Booklet

Learn about these Medicare telehealth services topics:

●● Originating sites

●● Distant site practitioners

●● Telehealth services

●● Telehealth services billing and payment

●● Telehealth originating sites billing and payment

●● Resources

●● Helpful websites and Regional Office Rural Health Coordinators

Medicare pays for specific (Part B) physician or practitioner services furnished through a

telecommunications system. Telehealth services substitute for an in-person encounter.

ORIGINATING SITES

An originating site is the location where a Medicare beneficiary gets physician or practitioner medical

services through a telecommunications system. The beneficiary must go to the originating site for the

services located in either:

●● A county outside a Metropolitan Statistical Area (MSA)

●● A rural Health Professional Shortage Area (HPSA) in a rural census tract

The Health Resources and Services Administration (HRSA) decides HPSAs, and the Census Bureau

decides MSAs. To see a potential Medicare telehealth originating site’s payment eligibility, go to

HRSA’s Medicare Telehealth Payment Eligibility Analyzer.

Providers qualify as originating sites, regardless of location, if they were participating in a Federal

telemedicine demonstration project approved by (or getting funding from) the U.S. Department of

Health & Human Services as of December 31, 2000.

Beginning July 1, 2019, the

Substance Use-Disorder Prevention

that Promotes Opioid Recovery and

Treatment (SUPPORT) for Patients

and Communities Act removes

the originating site geographic

conditions and adds an individual’s

home as a permissible originating

telehealth services site for treatment

of a substance use disorder or a

co-occurring mental health disorder.

Each December 31 of the prior calendar year (CY),

an originating site’s geographic eligibility is based on

the area’s status. This eligibility continues for a full CY.

Authorized originating sites include:

●● Physician and practitioner offices

●● Hospitals

●● Critical Access Hospitals (CAHs)

●● Rural Health Clinics

●● Federally Qualified Health Centers

●● Hospital-based or CAH-based Renal Dialysis

Centers (including satellites)

●● Skilled Nursing Facilities (SNFs)

●● Community Mental Health Centers (CMHCs)

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Telehealth Services MLN Booklet

●● Renal Dialysis Facilities

●● Homes of beneficiaries with End-Stage Renal Disease

(ESRD) getting home dialysis

●● Mobile Stroke Units

Note: Medicare does not apply originating site geographic

conditions to hospital-based and CAH-based

renal dialysis centers, renal dialysis facilities, and

beneficiary homes when practitioners furnish monthly

home dialysis ESRD-related medical evaluations.

Independent Renal Dialysis Facilities are not eligible

originating sites.

Beginning January 1, 2019, the

Bipartisan Budget Act of 2018

removed the originating site

geographic conditions and added

eligible originating sites to diagnose,

evaluate, or treat symptoms of an

acute stroke. Go to MLN Matters®

article, New Modifier for Expanding

the Use of Telehealth for Individuals

with Stroke to learn how to use the

new modifier for billing.

DISTANT SITE PRACTITIONERS

Distant site practitioners who can furnish and get payment for covered telehealth services (subject to

State law) are:

●● Physicians

●● Nurse practitioners (NPs)

●● Physician assistants (PAs)

●● Nurse-midwives

●● Clinical nurse specialists (CNSs)

●● Certified registered nurse anesthetists

●● Clinical psychologists (CPs) and clinical social workers (CSWs)

o CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with

medical services or medical evaluation and management services. They cannot bill or get paid

for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.

●● Registered dietitians or nutrition professional

TELEHEALTH SERVICES

You must use an interactive audio and video telecommunications system that permits real-time

communication between you at the distant site, and the beneficiary at the originating site.

Transmitting medical information to a physician or practitioner who reviews it later is permitted only in

Alaska or Hawaii Federal telemedicine demonstration programs.

CPT only copyright 2018 American Medical Association. All rights reserved.

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Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services

Service HCPCS/CPT Code

Telehealth consultations, emergency department or initial inpatient G0425–G0427

Follow-up inpatient telehealth consultations furnished to

beneficiaries in hospitals or SNFs

G0406–G0408

Office or other outpatient visits 99201–99215

Subsequent hospital care services, with the limitation of 1 telehealth

visit every 3 days

99231–99233

Subsequent nursing facility care services, with the limitation of

1 telehealth visit every 30 days

99307–99310

Individual and group kidney disease education services G0420–G0421

Individual and group diabetes self-management training services,

with a minimum of 1 hour of in-person instruction furnished in the

initial year training period to ensure effective injection training

G0108–G0109

Individual and group health and behavior assessment

and intervention

96150–96154

Individual psychotherapy 90832–90838

Telehealth Pharmacologic Management G0459

Psychiatric diagnostic interview examination 90791–90792

End-Stage Renal Disease (ESRD)-related services included in the

monthly capitation payment

90951, 90952, 90954, 90955,

90957, 90958, 90960, 90961

End-Stage Renal Disease (ESRD)-related services for home dialysis

per full month, for patients younger than 2 years of age to include

monitoring for the adequacy of nutrition, assessment of growth and

development, and counseling of parents

90963

End-Stage Renal Disease (ESRD)-related services for home

dialysis per full month, for patients 2–11 years of age to include

monitoring for the adequacy of nutrition, assessment of growth

and development, and counseling of parents

90964

End-Stage Renal Disease (ESRD)-related services for home

dialysis per full month, for patients 12–19 years of age to include

monitoring for the adequacy of nutrition, assessment of growth

and development, and counseling of parents

90965

End-Stage Renal Disease (ESRD)-related services for home dialysis

per full month, for patients 20 years of age and older

90966

End-Stage Renal Disease (ESRD)-related services for dialysis

less than a full month of service, per day; for patients younger than

2 years of age

90967

End-Stage Renal Disease (ESRD)-related services for dialysis less

than a full month of service, per day; for patients 2–11 years of age

90968

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 5 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services (cont.)

Service HCPCS/CPT Code

End-Stage Renal Disease (ESRD)-related services for dialysis less

than a full month of service, per day; for patients 12–19 years of age

90969

End-Stage Renal Disease (ESRD)-related services for dialysis less than

a full month of service, per day; for patients 20 years of age and older

90970

Individual and group medical nutrition therapy G0270, 97802–97804

Neurobehavioral status examination 96116

Smoking cessation services G0436, G0437, 99406, 99407

Alcohol and/or substance (other than tobacco) abuse structured

assessment and intervention services

G0396, G0397

Annual alcohol misuse screening, 15 minutes G0442

Brief face-to-face behavioral counseling for alcohol misuse,

15 minutes

G0443

Annual depression screening, 15 minutes G0444

High-intensity behavioral counseling to prevent sexually transmitted

infection; face-to-face, individual, includes: education, skills training

and guidance on how to change sexual behavior; performed

semi-annually, 30 minutes

G0445

Annual, face-to-face intensive behavioral therapy for cardiovascular

disease, individual, 15 minutes

G0446

Face-to-face behavioral counseling for obesity, 15 minutes G0447

Transitional care management services with moderate medical

decision complexity (face-to-face visit within 14 days of discharge)

99495

Transitional care management services with high medical decision

complexity (face-to-face visit within 7 days of discharge)

99496

Advance Care Planning, 30 minutes 99497

Advance Care Planning, additional 30 minutes 99498

Psychoanalysis 90845

Family psychotherapy (without the patient present) 90846

Family psychotherapy (conjoint psychotherapy) (with patient present) 90847

Prolonged service in the office or other outpatient setting requiring

direct patient contact beyond the usual service; first hour

99354

Prolonged service in the office or other outpatient setting requiring direct

patient contact beyond the usual service; each additional 30 minutes

99355

Prolonged service in the inpatient or observation setting requiring

unit/floor time beyond the usual service; first hour (list separately in

addition to code for inpatient evaluation and management service)

99356

CPT only copyright 2018 American Medical Association. All rights reserved.

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Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services (cont.)

Service HCPCS/CPT Code

Prolonged service in the inpatient or observation setting requiring

unit/floor time beyond the usual service; each additional 30 minutes

(list separately in addition to code for prolonged service)

99357

Annual Wellness Visit, includes a personalized prevention plan of

service (PPPS) first visit

G0438

Annual Wellness Visit, includes a personalized prevention plan of

service (PPPS) subsequent visit

G0439

Telehealth Consultation, Critical Care, initial, physicians typically

spend 60 minutes communicating with the patient and providers

via telehealth

G0508

Telehealth Consultation, Critical Care, subsequent, physicians

typically spend 50 minutes communicating with the patient and

providers via telehealth

G0509

Counseling visit to discuss need for lung cancer screening using

low dose CT scan (LDCT) (service is for eligibility determination

and shared decision making

G0296

Interactive Complexity Psychiatry Services and Procedures 90785

Health Risk Assessment 96160, 96161

Comprehensive assessment of and care planning for patients

requiring chronic care management

G0506

Psychotherapy for crisis 90839, 90840

Prolonged preventive services G0513, G0514

A physician, NP, PA, or CNS must furnish at least one ESRD-related “hands on visit” (not telehealth)

each month to examine the beneficiary’s vascular access site.

TELEHEALTH SERVICES BILLING AND PAYMENT

Submit professional telehealth service claims using the appropriate CPT or HCPCS code.

If you performed telehealth services “through an asynchronous telecommunications system”, add the

telehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99201 GQ).

You are certifying the asynchronous medical file was collected and transmitted to you at the distant

site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate you

furnished the billed service as a professional telehealth service from a distant site. As of January 1,

2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method II

must submit institutional claims using the GT modifier.

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 7 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay you the

appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). If you are

located in, and you reassigned your billing rights to, a CAH and elected the Optional Payment Method

II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percent of the

Medicare PFS facility amount for the distant site service.

TELEHEALTH ORIGINATING SITES BILLING AND PAYMENT

HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC for

the separately billable Part B originating site facility fee.

Note: The originating site facility fee does not count toward the number of services used to determine

payment for partial hospitalization services when a CMHC serves as an originating site.

RESOURCES

Telehealth Services Resources

For More Information About… Resource

Telehealth Services CMS.gov/Medicare/Medicare-General-Information/Telehealth/

Telehealth-Codes.html

CMS.gov/Medicare/Medicare-General-Information/Telehealth

CMS.gov/Regulations-and-Guidance/Guidance/Manuals/

Downloads/clm104c12.pdf

Physician Bonuses CMS.gov/Medicare/Medicare-Fee-for-Service-Payment/

HPSAPSAPhysicianBonuses

CMS.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNProducts/MLN-Publications-Items/

CMS1246598.html

Hyperlink Table

Embedded Hyperlink Complete URL

Health Professional Shortage Area https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/HPSAPSAPhysicianBonuses

Medicare Telehealth Payment

Eligibility Analyzer

New Modifier for Expanding the

Use of Telehealth for Individuals

with Stroke

Learning-Network-MLN/MLNMattersArticles/Downloads/

MM10883.pdf

Substance Use-Disorder Prevention

that Promotes Opioid Recovery and

Treatment (SUPPORT) for Patients

and Communities Act

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Telehealth Services MLN Booklet

HELPFUL WEBSITES

American Hospital Association Rural

Health Care

Critical Access Hospitals Center

Critical-Access-Hospitals-Center.html

Disproportionate Share Hospitals

Service-Payment/AcuteInpatientPPS/dsh.html

Federally Qualified Health Centers Center

Federally-Qualified-Health-Centers-FQHCCenter.

html

Health Resources and

Services Administration

Hospital Center

Hospital-Center.html

Medicare Learning Network®

National Association of Community

Health Centers

National Association of Rural Health Clinics

National Rural Health Association

Rural Health Clinics Center

Health-Clinics-Center.html

Rural Health Information Hub

Swing Bed Providers

Service-Payment/SNFPPS/SwingBed.html

Telehealth

General-Information/Telehealth

Telehealth Resource Centers

U.S. Census Bureau

REGIONAL OFFICE RURAL HEALTH COORDINATORS

To find contact information for CMS Regional Office Rural Health Coordinators who provide technical,

policy, and operational assistance on rural health issues, refer to CMS.gov/Outreach-and-Education/

Outreach/OpenDoorForums/Downloads/CMSRuralHealthCoordinators.pdf.

Medicare Learning Network® Product Disclaimer

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S.

Department of Health & Human Services (HHS).

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