Medicare and Medicaid telehealth coverage
During the Public Health Emergency (PHE), certain Medicare telehealth payment requirements have been waived to allow beneficiaries in all areas of the country to receive telehealth services, including at their home. This waiver allows full reimbursement for audio only and video services. During the PHE, penalties will be waived for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, and telephones with audio and video capabilities. The telehealth waiver is effective until the PHE ends as declared by the Secretary of HHS. This is irrespective of individual state PHE declarations.
Payment for Medicare telehealth services is the same as if the services were furnished in person. For Medicare telehealth services, the claim should reflect the designated Place of Service (POS) code02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.
The Virginia Department of Medical Assistance Services (DMAS), Virginia’s state Medicaid agency, expanded telehealth coverage and flexibility in the delivery of care through telehealth. Medicaid covered services delivered through telehealth are reimbursed as long as the provider assures the same rights to confidentiality as is given in face-to -face care and the provider obtains informed consent from the patient to provide care via telehealth. DMAS waived the existing requirement that telehealth services must be done in real-time via a platform with audio and visual connections, thus allowing audio only care or care provided via the telephone. DMAS also waived the requirement that staff must be with the patient at the originating site and also allowed the patient and provider to be at home when care is delivered. Until further notice, Medicaid is not requiring the provider to bill using telehealth Codes only but is allowing the use of CPT or HCPCS codes when billing, which allows for same reimbursement as in person. Finally, DMAS is allowing the delivery of behavioral health services via telehealth including service needs assessments and addiction, recovery and treatment services for opioid use disorders and outpatient psychiatric services.
Virginia state law requires telehealth visits to be reimbursed the same as in-office visits by commercial insurers. During the public health emergency, telehealth visits for Medicare and Medicaid patients also are being reimbursed at the same rate as in-person visits.
