Telehealth Service Sites Expand

As of Jan. 1, 2009, eligible originating sites for payment of telehealth services will include hospital-based or critical access hospital-based renal dialysis facilities (including satellites), skilled nursing facilities and community mental health centers. This amendment to the Social Security Act is mandated by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008.

In addition to the three new sites, qualified originating sites are:

  • Physician’s or practitioner’s office
  • Hospital
  • Critical access hospital (CAH)
  • Rural health clinic
  • Federally qualified health center

Independent renal dialysis facilities are not eligible originating sites and do not qualify for payment of telehealth services.

An originating site is the location of an eligible Medicare beneficiary at the time the service is furnished via telecommunications.

The originating site facility fee is a separately billable Medicare Part B payment. Payment is not based on the Outpatient Prospective Payment System (OPPS). The update fee is included in the Medicare Physician Fee Schedule (MPFS) final rule.

When the originating site is a physician’s or practitioner’s office, the payment amount is the lesser of 80 percent of the actual charge or 80 percent of the originating facility fee, regardless of geographic location.

For more details, read CMS Transmittal 97, Change Request 6215, released Nov. 14.


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8 Responses to “Telehealth Service Sites Expand”

  1. Pat Boey says:

    For telehealth which cpt code do we use for physician/nurses professional fee?


  2. Cheryl Macias CPC says:

    Hello in answer to your question you are to use the Office CPT
    99212-99215 Hope this helps and the CPT codes are listed on CMS in the online manual.


    Cheryl Macias CPC

  3. LuRae says:

    Dont you have to add the “GT’ modifier on the code?

  4. lurae says:

    Do all carriers pay for this service?

  5. Sherry says:

    From my currrent research it is your regular consultation codes along with the the 99201-99215 codes, but with a GT modifier and in some cases the Q3014 that needs to be paired up with the location of 11. Also there is out of state codes that MAY be required as in T1014 and U1-UD… Still getting more information myself!! Good Luck!!

  6. Sherry says:

    Yes you do and it needs to match the pos of 11 and you may have to use code Q3014…As I responded to the first inquiry I am still doing the research, but plan on being done by the end of the day with it!

    Sherry CPC, CCS-P

  7. LaTrece says:

    What are the documentation requirements for billing an E/M for a telehealth service since the key components for a direct face-to-face probably would not be met?



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