Telemedicine Reimbursement

Telemedicine can mean a variety of things, but most simply, telemedicine is any medical attention given through electronic communication. Since telemedicine can mean so many things, and is relatively new, insurance companies and state policies vary when it comes to telemedicine reimbursement. We do our best give you an overview below. 

Current telehealth insurance coverage can be split into 3 main categories:

Medicaid, Medicare, and Private Insurance

Private Insurance. Private insurance parity laws require telehealth services to be covered the same as in-person services. 31 states and the District of Columbia have telemedicine parity laws. Many insurers cover some sort of telehealth services and many more are interested in expanding their telehealth coverage.

Medicaid. All 50 states have some type of coverage for telemedicine. 11 states cover all telehealth services as if they were in-person. The rest have various limitations such as patient location, service coverage, authorized technologies, patient and provider populations, and patient consent.

Medicare covers many telehealth services already under “physician services,” such as pathology, radiology, and some cardiology. For fee-for-service beneficiaries in rural areas, Medicare covers video conferencing when using physician services. Medicare Advantage covers all telehealth as long as providers offer those services.

Medicare reimburses for telemedicine, but only for certain types of healthcare providers. Included are: Physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified nurse anesthetists, clinical psychologists, clinical social workers, and registered dietitians or nutrition professionals.

Medicare also limits the type of approved originating site (where the patient is located) for reimbursement. To qualify as an eligible originating site, the location has to meet two conditions:

  • It has to be located in a Health Professional Shortage Area (HPSA) or a county outside of a Metropolitan Statistical Area (MSA).
  • It has to be one of the following types of healthcare facilities:
    • Physician or practitioner office

    • Hospital

    • Critical Access Hospitals (CAH)

    • RuralHealth Clinics

    • Federally Qualified Health Centers

    • Hospital-based or CAH-based Renal Dialysis Centers (including satellites)

    • Skilled Nursing Facilities (SNF)

    • Community Mental Health Centers (CMHC)

There is a new rule (11/16/15) that removes this originating site restriction for joint replacement beneficiaries. 

There is also a new rule that provides some coverage for home monitoring under the new chronic care management CPT code 99490.

We know navigating the world of telemedicine reimbursement can be daunting, so we've done our best to create an overview of each state's policies. Click on your State or Region below to learn more. 

Northeast    SOUTH ATLANTIC    MOUNTAIN WEST   SOUTH CENTRAL    North Central: East    North Central: West    Pacific 

For more information on reimbursement, please visit the American Telemedicine Association State Policy Resource Center and the Center for Connected Health Policy.