Telehealth Reimbursement – UPDATE

Posted April 4, 2012 10:47 am by Adam Rule

Reimbursement is usually the first or second question that people ask us at LearnTelehealth.org.  I wish there were one place to go for resources on telehealth reimbursement but there’s not. Reimbursement varies from state-to-state and from payor-to-payor. There’s no federal requirement for private insurance to reimburse for telehealth yet. To that end, I give you this always-in-progress list:

UPDATE: If you live in Arkansas and are interested in telehealth reimbursement for mental health we have some links below:

Rehabilitative Services for Persons with Mental Illness (RSPMI) Arkansas Medicaid Information page – Contains up-to-date memorandums, provider manual, official notices, fee schedule and more.

Arkansas RSPMI Fee Schedule – List of CPT codes, modifiers, maximum allowable $ amount and more in this table.

Centers for Medicare and Medicaid Services (CMS) Telehealth Services Fact Sheet – A great resource explaining the basics of what’s covered, what qualifies as an Originating Site, who’s qualified to be a Distant Site Practitioner and the common CPT and HCPCS codes. Also contains contact information for regional Rural Health Coordinator offices.

CMS Manual on Claims Processing for Telehealth Services – Includes more technical language and current list of CPT and HCPCS codes.

American Telemedicine Association’s (ATA) Medicare Payment White Paper Summarizes the CMS reimbursement rules and claims submission process. Dated January 2012

ATA’s Private Payer Reimbursement Report for Telemedicine – Discusses and reports findings of a survey of private payer reimbursement.. Published in the Telemedicine and e-Health journal in 2007 (Vol. 13, No. 1).

Other ATA White Papers – Other White Papers from the ATA ranging from telehealth technology to home monitoring.

Center for Telehealth and e-Health Law (CTEL) articles about telehealth reimbursement – Three articles and information on telehealth reimbursement as it relates to legal issues.

ATA’s State Telemedicine Policy resource – A list of all 50 states in a wiki-style breakdown of telehealth policy.