The Medicare and Medicaid programs each take a different approach to reimbursing telehealth services. This article provides an overview and links to resources to help navigate the intricacies and differences in reimbursement for Medicare and Medicaid telehealth services.
Medicare Telehealth Coverage
In an effort to ensure equitable access to healthcare regardless of geographical constraints, the Centers for Medicare & Medicaid Services cover many telehealth services for reimbursement. Patients with an established relationship with their physicians can participate in telehealth sessions. Below is an overview of Medicare’s telehealth services, including synchronous consultations, virtual check-ins, and e-visits.
Medicare Telehealth Services: involve synchronous telecommunications for consultations typically conducted in medical settings. Patients need a prior relationship with the physician for reimbursement. They can now participate from home, receiving equal coverage as in-person visits.
Virtual Check-Ins: allow established beneficiaries brief communication with their physicians via various telecommunications methods, aiming to reduce unnecessary trips to the doctor’s office and minimize COVID-19 risks. They’re billed using HCPCS codes G2012 for synchronous and G2010 for asynchronous communications.
E-Visits: entail non-face-to-face patient-initiated virtual communications, often through a patient portal, including evaluation and management visits. Billing codes such as HCPCS codes G2012 and G2010 facilitate reimbursement, streamlining access to essential healthcare services.
Medicaid & Telehealth
Medicaid offers reimbursement for live video services delivered via telehealth. This service is available in all fifty states and Washington DC under Medicaid fee-for-service. However, it’s important to note that to qualify for reimbursement, the services must meet federal requirements. The specifics of what and how they are reimbursed can vary significantly. Common restrictions include limitations on specialty types, service codes, and provider types, as well as requirements for patient location at specific originating sites.
Medicaid & Remote Patient Monitoring
Presently, 37 state Medicaid programs offer reimbursement for remote patient monitoring. However, Medicaid remote patient monitoring coverage and requirements vary significantly by state. Several of the state Medicaid programs that offer RPM reimbursement have restrictions such as which conditions qualify for monitoring and limiting reimbursement to only home health agencies, as well as criteria for remote monitoring devices that can be used for data collection.
Medicaid & Remote Therapeutic Monitoring
Medicaid does not cover remote therapeutic monitoring. However, Medicare covers both RPM and RTM, reimbursing providers for device supply, setup, time spent analyzing patient data, and interaction with patients to adjust treatment. The devices must collect data for at least 16 out of 30 days, and there are additional requirements must be met.
Medicaid & Telehealth Resources
The Center for Connected Health Policy (CCHP) is the primary resource to visit to understand state Medicaid reimbursement regulations for telehealth and remote patient monitoring. CCHP tracks and compiles research and reports on telehealth-related laws and regulations for all 50 states, including the District of Columbia, Puerto Rico, the Virgin Islands, and the federal level through its policy finder tool.
The free Policy Finder tool offers a database to search each state’s regulations and policies surrounding telehealth and remote patient monitoring.
Understanding Medicare and Medicaid Telehealth
By harnessing these resources and comprehending the intricacies of Medicare and Medicaid telehealth coverage, stakeholders can optimize healthcare delivery and ensure equitable access to essential services across diverse populations.
