Telehealth
Telehealth is the delivery of clinical services over telecommunications between a patient and a provider at different locations, billed under rules that vary by payer and by date.
Updated
Telehealth (or telemedicine) is the furnishing of healthcare services using real-time telecommunications — typically two-way audio and video — between a patient and a provider who are in different locations. It is a modality of delivering a service, not a separate service itself; the service furnished is reported with the same CPT/HCPCS code used for the in-person equivalent, accompanied by a place-of-service code or modifier that identifies it as telehealth.
Coverage and payment for telehealth vary by payer, by the service furnished, and by date. Medicare, Medicaid, and commercial plans each set their own conditions — eligible originating sites, eligible providers, audio-only rules, geographic limits — and several of those conditions have changed over time, so the rule that applied for one date of service may not apply for another.
In practice
Because telehealth billing depends on the payer's current rules, verifying coverage for the specific modality (video vs. audio-only), the originating site, and any required modifier is part of billing a telehealth encounter rather than a one-time setup. A service that is covered as telehealth for one payer may not be covered that way for another on the same date.
Commonly confused with
- Place of service: Telehealth is the modality; a place-of-service code reports the setting on the claim. A telehealth service carries a POS code that identifies it as telehealth, but the two are distinct concepts.