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Telemedicine reimbursement
Written by Patricia King, JD   

Currently, Medicare pays for telemedicine only in limited areas:  the originating site must be located in a rural health professional shortage area, or in a county that is not included in a Metropolitan Statistical Area (Ref. 1).

In these areas, Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management, end stage renal disease related services included in the monthly capitation payment (except for one visit per month to examine the access site), individual medical nutrition therapy, and neurobehavioral status exams (Ref. 2).

In these areas, Medicare Part B pays for office and other outpatient visits, professional consultation, psychiatric diagnostic interview examination, individual psychotherapy, pharmacologic management, end stage renal disease related services included in the monthly capitation payment (except for one visit per month to examine the access site), individual medical nutrition therapy, and neurobehavioral status exams (Ref. 2).

To qualify, the physician/practitioner at the distant site must be licensed to furnish the service under state law and must be a physician, physician assistant, nurse practitioner, clinical nurse specialist, nurse midwife, clinical psychologist, clinical social worker, or registered dietitian or nutrition professional.  The originating site must be a physician/practitioner office, a critical access hospital, a rural health clinic (RHC), a federally qualified health center (FQHC), or a hospital.  In addition to the general payment rules, Medicare also sponsors a demonstration projects in telemedicine for diabetes education.

The Medicaid rules allow states to choose to cover telemedicine, and many states have taken advantage of this.  Illinois, for example, recently broadened coverage of telehealth services to cover services rendered not only by hospitals, but also by physicians, advanced practice nurses, podiatrists, FQHCs, RHCs and Encounter Rate Clinics, and also to cover telepsychiatry (Ref. 3).

The Medicaid rules allow states to choose to cover telemedicine, and many states have taken advantage of this.  Illinois, for example, recently broadened coverage of telehealth services to cover services rendered not only by hospitals, but also by physicians, advanced practice nurses, podiatrists, FQHCs, RHCs and Encounter Rate Clinics, and also to cover telepsychiatry (Ref. 3).

Some private payors cover telemedicine services, and twelve states require insurance companies to cover telemedicine (Ref. 4).

References

Ref. 1 42 C.F.R. § 410.78(b)(4).

Ref. 2 42 C.F.R. § 410.78(b).

Ref. 3 Illinois Department of Healthcare and Family Services, Informational Notice, Expansion of Telehealth Services, Jan. 12, 2010.

Ref. 4 The states are California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon, Texas and Virginia.  The American Telemedicine Association issued a news release concerning additional of coverage by Virginia, at http://media.americantelemed.org/press/ATA_PR_VirginiaLegislaturePassesBill_3.3.2010.pdf.

About the Author

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Patricia King is a health care attorney in Illinois, and principal of the web-based business Digital Age Healthcare LLC (http://www.digitalagemd.com/). 

 
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