Insurane Coverage & Reimbursement for Telemedicine
Telemedicine has emerged as a cost-effective alternative to the more traditional face-to-face way of providing medical care. In most countries, this is accepted practice. In countries with fee-for-service financial payments, it is important for procedures delivered via telemedicine to be billed or coded correctly so they can be paid for appropriately.
Current Telehealth Insurance Coverage
(as published by the American Telemedicine Association)
Medicaid: All states allow reimbursement for physician services that do not require direct interactions with a patient, such as for radiology or reading an EKG. Forty-five states have some Medicaid coverage for other remote video or store-and-forward services, usually for services in rural areas. The details of state Medicaid coverage vary widely and are seldom the same as in-person coverage for a specific service. The variations in telehealth Medicaid policies relate to service coverage, payment methodology, distance requirements, eligible patient populations and health care providers, authorized technologies, and patient consent.
Medicare: Many “telehealth” services, such as remote radiology, pathology and some cardiology, are covered simply as "physician services." For traditional fee-for-service beneficiaries living in rural areas, Medicare covers physician services using video conferencing. The ~14 million beneficiaries in Medicare Advantage (managed care) plans, have complete flexibility in using Telehealth, as long as their provider offers the service.
Private Insurance Coverage: Twenty states and the District of Columbia require that private insurers cover Telehealth the same as they cover in-person services. Many other insurers cover at least some Telehealth service, and many more have expressed interest in expanding their telehealth coverage.
Resources for Reimbursement Information:
- American Telemedicine Association’s State Telemedicine Policy Center
- ATA State Telemedicine Legislation Tracking Matrix
- ATA State Medicaid Best Practice: School-Based Telehealth (July 2013)
- NCSL State Coverage for Telehealth Services
- Medicare's Telemedicine/Telehealth Payment Policies (Dept. of Health & Human Services)
- Medicare's Reimbursement for Telemedicine Services (white paper by ATA)
- CTEC Telemedicine Reimbursement Handbook (2012 California Edition)
- FQCH Telemedicine Reimbursement Models
- AMD's Private Payer Reimbursement Information Directory
- USDA's Distance Learning and Telemedicine Loan and Grant Program (DLT)
AMD Telemedicine Blog