Telemedicine billing is a daunting task since the insurance policy guidelines and codes used may vary according to the payer.

1. How to Correctly Do
Medical Billing for
Telemedicine
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Telemedicine is an excellent alternative to traditional face-to-face way of providing
healthcare services with cost-effectiveness, increased patient satisfaction and
convenient high-quality care. Though it is an accepted practice, reimbursement
issues are still plaguing healthcare providers. They need to bill and code the
procedures delivered via telemedicine correctly to achieve appropriate payment.
However, not every payer provides coverage for telemedicine services and the
coverage policies differ from payer to payer. In order to make medical billing and
coding for telemedicine services effective, healthcare providers should pay close
attention to the following areas.
Verify for Telemedicine Coverage
Your entire effort will go in vain, if you submit your claims without knowing that your
patient’s insurance does not cover telemedicine services. The best way to avoid such
a situation is to call the payer and verify whether they cover for telemedicine before
the first telemedicine visit. Once the insurance company representative confirms that
telemedicine services are covered, you can proceed with the telemedicine visit. When
you call the payer, make sure that the representative’s answers are documented
correctly in the telemedicine insurance verification form. You can use this
document to fight against a denied claim later.
Understand Each Payer’s Coverage Policy
While verifying telemedicine coverage, you should not only confirm that the
insurance policy covers telemedicine services, but also understand the telemedicine
coverage policy specific to each payer. You can ask what type of healthcare services
delivered via telemedicine are covered, whether they specifically cover live video
telemedicine, what are the criteria to qualify for telemedicine coverage, and whether
there are any restrictions for the number of telemedicine visits in a year. The general
telemedicine coverage guidelines for major payers are as follows:

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 Medicare – When it comes to reimbursement, Medicare is complicated and
restrictive. It covers fewer than 20 sections of telehealth services. The patient
must meet the following criteria for Medicare reimbursement for telehealth
services.
 The patient must be seen at an authorized site such as skilled nursing
facilities, doctor offices, public hospitals and certain private hospitals
 The patient must be seen by an approved practitioner (nurse, doctor
with medical degree, clinical psychologist)
 The actual service must be included within the covered codes
Medicare provides reimbursement only if the services are conducted in a
facility located in a Health Professional Shortage Area (HPSA). This facility
cannot be included within a Metropolitan Statistical Area (MSA) as well.
 Medicaid – Medicaid approved providing reimbursement for telehealth
services in about 40 states. Even so, the actual reimbursement policy differs
in each state with some covering real-time visits while others cover off-site
services including telehome care. Certain remote monitoring services are also
covered. However, Medicaid reimbursements are more expansive than those
provided through Medicare.
 Private Payers – Private payer coverage leads to broader telehealth
coverage. However, the actual reimbursement policies vary according to the
payer. Many states have adopted telehealth parity statutes though. These
insist that payers provide reimbursement in the same manner they provide
coverage for in-person services.
Medical Coding
Most payers allow providers to bill for telemedicine using the appropriate evaluation
and management CPT code (99201 – 05, 99211-15) along with a GT modifier. (This

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modifier tells the corresponding payer that the healthcare service is delivered via
telemedicine). Medicare covers a very long list of CPT/HCPCS codes. Some of them
are given below.
 G0406: Follow-up inpatient consultation, limited, physicians typically spend
15 minutes communicating with the patient via telehealth
 G0407: Follow-up inpatient consultation, intermediate, physicians typically
spend 25 minutes communicating with the patient via telehealth
 G0408: Follow-up inpatient consultation, complex, physicians typically spend
35 minutes communicating with the patient via telehealth
 G0425: Telehealth consultation, emergency department or initial inpatient,
typically 30 minutes communicating with the patient via telehealth
 G0426: Telehealth consultation, emergency department or initial inpatient,
typically 50 minutes communicating with the patient via telehealth
 G0427: Telehealth consultation, emergency department or initial inpatient,
typically 70 minutes communicating with the patient via telehealth
 99201–99215: Office or other outpatient visits
 99231 – 99233: Subsequent hospital care services, with the limitation of 1
telehealth visit every 3 days
 99307 – 99310: Subsequent nursing facility care services, with the
limitation of 1 telehealth visit every 30 days
Certain private payers insist that you use the following telemedicine specific code.
 99444: Online medical evaluation - physician non-face-to-face E&M service
to patient/guardian or healthcare provider not originating from a related E&M
service provided within the previous 7 days
The codes used for reporting telehealth services may vary according to the payer
and the state.

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Facility Fees
If you are participating in a telemedicine program that bills through Medicare
(sometimes, Medicaid), then you should have a clear understanding about facility
fees. This is the amount paid to the local health facility that organized the
telemedicine visit for the patient. As per the existing Medicare telemedicine model, a
patient is required to come to an eligible originating site for the telemedicine visit
with a healthcare provider at another remote or distant site. It is possible for that
originating site to charge a facility fee to cover the costs of hosting the telemedicine
visit. However, the originating site has to meet the following conditions.
 The facility must be physician or practitioner offices, hospitals, critical access
hospitals (CAH), rural health clinics, federally qualified health centers,
hospital-based or CAH-based renal dialysis centers, skilled nursing facilities
(SNF) or community mental health centers (CMHC)
 The facility must be located within a Health Professional Shortage Area (HPSA)
You can bill HCPCS code Q314 to charge the facility fee. On the whole, it is quite
difficult to assign the most appropriate codes and bill the claims according to each
payer. It is a hectic job to call each payer and confirm the codes they accept and
assign them accordingly. For busy practices, it will prove beneficial to rely upon an
experienced medical billing company that provides medical billing and coding
solutions for telehealth services to avoid confusion and receive timely payments.