by Wyn Staheli, Director of Research
April 13th, 2016
Telehealth has experienced significant growth over the last several years. Providers need to understand the important role it should play in their practice.
When it comes to defining telehealth, the the Center for Connected Health Policy (CCHP) has stated the following: "States alternate between using the term “telemedicine” or “telehealth”. In some states both terms are explicitly defined in law and/or policy and regulations. In some cases, “telehealth” is used to reflect a broader definition, while “telemedicine” is used mainly to define the delivery of medical services."
Medicare coverage of telehealth services is generally only limited to specific services provided within a Health Professional Shortage Area (HPSA) or another location not included in a Metropolitan Statistical Area (MSA). Currently, there is legislation being considered to expand coverage for chronic care management services regardless of location.
Modifiers: Medicare requires the use of modifiers GT or GQ when billing to indicate what type of telecommunication method was used to provide the covered service. Appending one of these modifiers, indicates that the service was provided in an eligible geographic area which includes rural health professional shortage areas (HPSA) and counties not classified as a metropolitan statistical area (MSA).
FEDERAL LEGISLATION: In July 2015, the Medicare Telehealth Parity Act of 2015 was introduced in Congress in an effort to both modernize the way Medicare pays for telehealth services and to expand coverage. This piece of legislation didn't go anywhere, but it seems that new bills continue to be introduced to try and move federal programs into the 21st century.
FOR MORE INFORMATION: Review the CMS Telehealth Services Fact Sheet for additional guidance and details on coverage.
According to a report by the Center for Connected Health Policy (CCHP) states have been making progress in trying to overcome barriers to the advancement of this technology. As of January 2016, 48 states and Washington DC’s Medicaid programs have some type of coverage for telehealth.
A CCHP 2016 report on the State Telehealth Laws and Reimbursement Policies says that "States continue to pursue their own unique set of telehealth policies as more and more legislation is introduced each year. Some states have incorporated policies into law, while others have addressed issues such as definition, reimbursement policies, licensure requirements, and other important issues in their Medicaid Program Guidelines."
As of January 2017, 36 (up from 29 in 2015) states have enacted telemedicine laws for private insurance. According to a 2015 report by the American Telemedicine Association, "Over the past four years the number of states with telemedicine parity laws – that require private insurers to cover telemedicine-provided services comparable to that of in-person – has doubled."
Keep in mind that even though parity laws require private sector insurance companies to provide coverage for telehealth services, exactly WHAT is covered varies by state AND by plan. Providers must verify coverage details with individual payers.