“Telehealth” is now more commonly used as it describes the wide range of diagnosis and management, education, and other related fields of health care. These include, but are not at all limited to:

• Dentistry
• Counseling
• Physical and occupational therapy
• Home health
• Chronic disease monitoring and management
• Disaster management
• Consumer and professional education

The most common kind of telehealth service is delivered through LIVE video. Live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology (compliant conferencing and video services).  This type of service is also referred to as “real-time” and may serve as a substitute for an in-person encounter when it is not available.  Live video can be used for both consultative and diagnostic and treatment services.

Reimbursement For Telehealth Services

Medicare and Medicaid covers certain services, like office visits and consultations, that are provided using an interactive 2-way telecommunications system (with real-time audio and video). This needs to be provided by a doctor or certain other health care provider who isn’t at your location.

There are some restrictions so it is good to look up the regulations and laws for your own state or contact your insurance provider.

There are the following possible reimbursements:

Reimbursement for Live Video

Live video is almost always included in the definition of telemedicine and telehealth and the most common form of telehealth.  Although live video is covered under the Medicaid program in many states, there are often restrictions on the type of provider, facility, service and geographic location.  It is important to reference your state’s laws, regulations and provider manual to view these.

Reimbursement for Remote Patient Monitoring

Remote Patient Monitoring is another area of telehealth that is less commonly reimbursed because it often does not occur in real time (although there are exceptions, as in tele-stroke).  A common requirement to be reimbursed for remote patient monitoring is for it to be conducted by a certified home health agency, although other requirements and restrictions often also apply, such as condition restrictions.

Reimbursement for Email/Phone/Fax

Email, phone and fax are often explicitly excluded from the definitions of telemedicine and telehealth and therefore are usually not eligible for reimbursement from state Medicaid programs.

Location of service provided

Just like Medicare, some state Medicaid programs limit the geographic location of the patient to rural areas or require a certain amount of distance between the originating and distant site.  Another form of location restriction is limiting reimbursement to a specified list of eligible originating site facilities.

For more information about what is covered by State click HERE.