Can a Medical Practice Bill Medicare for Telehealth Services?

Medicare’s expansion of telehealth coverage has transformed how medical practices deliver care and generate revenue. However, billing Medicare for telehealth requires understanding specific eligibility criteria, approved platforms, and documentation standards. Practices that fail to comply with these requirements risk claim denials and potential telehealth fraud investigations.

What Types of Telehealth Services Does Medicare Cover?

Medicare Part B covers a broad range of telehealth services including evaluation and management (E/M) visits, behavioral health consultations, and specialist consultations. The coverage includes established patient office visits and expanded new patient telehealth services under current regulatory flexibilities. Practices should verify which specific services qualify under current Medicare guidelines, as coverage can vary by service type and policy updates.

What Are the Billing Codes and Reimbursement Rates?

Unlike some payers, Medicare reimburses telehealth visits at the same rate as in-person visits using the same CPT codes. The five levels of E/M coding (99202-99215 for office visits) apply to both modalities. Reimbursement amounts vary by geographic location due to Medicare’s geographic practice cost indices, making it essential for practices to understand their local payment rates.

What Are the Patient Eligibility Requirements?

Medicare requires that patients have a prior in-person visit or established relationship with the provider for most telehealth services. Geographic restrictions that previously limited telehealth to rural areas have been substantially relaxed, allowing patients to receive telehealth from home or most locations. This expansion has made telehealth accessible to more beneficiaries nationwide.

What Technology Platforms Must Practices Use?

Medicare requires that telehealth platforms meet HIPAA privacy and security requirements and support synchronous (real-time) video and audio communication. Consumer-grade platforms like Zoom or FaceTime do not meet Medicare requirements unless specifically configured for HIPAA compliance. Practices should use healthcare technology platforms specifically designed for medical practice, such as Teladoc, Amwell, or practice management system integrated solutions.

What Documentation Is Required for Billing?

Medicare requires that medical records document the telehealth service delivery method (video, telephone, or other modality) and confirm the visit met all requirements for that service type. Documentation must be identical in quality and detail to in-person visit notes. The provider must note that synchronous communication occurred and that the patient’s identity was verified. Poor documentation is a leading cause of claim denials and audit findings.

Common Billing Mistakes to Avoid

Practices frequently make mistakes by using consumer-grade platforms, billing for services outside Medicare’s covered list, or submitting claims without proper documentation of the telehealth modality. Other errors include failing to verify the patient is established with the provider or billing telephone-only visits when video was required. These mistakes result in claim denials and increased audit risk. Remote patient monitoring should not be billed as telehealth visits—they require separate codes and documentation.

Frequently Asked Questions

Does Medicare pay the same amount for telehealth as in-person visits?

This parity in reimbursement makes telehealth financially equivalent to in-person visits for practices, eliminating concerns about revenue reduction when offering remote care options.

Can practices bill Medicare for telephone-only visits?

Telephone-only visits are covered for established patients under certain conditions, but practices should prioritize video-based telehealth when possible to maximize covered service options and ensure compliance with evolving Medicare policies.

What should practices do to ensure Medicare telehealth billing compliance?

Compliance requires ongoing education, proper platform selection, and documentation discipline. Consulting HealthIT.gov resources and monitoring CMS updates helps practices stay current with telehealth regulations.