Getting paid for telehealth services

May 28, 2019

Reimbursement varies between payers, so be sure and check with those in your area to ensure they reimburse for telehealth services prior to performing and billing.

Q: I have several colleagues who are getting paid for telehealth services. Is this something that is being reimbursed? If so, how do we bill?

A: Reimbursement varies between payers, so be sure and check with those in your area to ensure they reimburse for telehealth services prior to performing and billing.

There are several requirements that must be met in order to bill telehealth services.

Originating site

An originating site is the location of an eligible Medicare patient at the time the service furnished via a telecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:

  • a county outside of a Metropolitan Statistical Area (MSA) or

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

Authorized originating sites include physician practices, hospitals, rural health clinics.

Distant site practitioners

Another requirement for telehealth services is the type of practitioners at the distant site who can perform and be reimbursed for covered telehealth services, and those include: Physicians, nurse practitioners, physician assistants, and others.

Requirements for billing

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.

In order to indicate that services were performed as telehealth services at a distant site, you need to list Place of Service (POS) 02: Telehealth on the claim.  This is where the services are provided or received, through telehealth telecommunication technology.

Use the correct modifier

Simply using the appropriate CPT and POS codes sometimes is not enough. Since Medicare and payers are tracking the number of telehealth visits, they require these modifiers for specific situations:

  • A GT modifier is used for interactive audio and telecommunications system on institutional claims billed under CAH Method II only.

  • A GQ modifier is used for asynchronous telecommunication system visits (only for Federal telemedicine demonstration programs in Alaska or Hawaii).

Originating site payment

Originating sites are paid a facility fee for telehealth services, per HCPCS code Q3014. Bill for the originating site facility fee, which is separately billable, and append the GQ modifier.