Medicare telehealth is remote care typically using audio and video technology, and in some cases audio only. Telehealth policy has a history of complexity and nuance that has changed rapidly since the beginning of the COVID-19 Public Health Emergency (PHE).
With the COVID-19 PHE the Federal Government loosened Medicare telehealth restrictions to better accommodate patients. The PHE ended on May 11, 2023, but Congress has since expired, extended or made permanent various telehealth policies through various Acts. The KFF article, “What to Know About Medicare Coverage of Telehealth” listed in Table 1 includes a timeline of major Medicare telehealth coverage expansions.
Claim coverage and billing requirements have also changed in step with policy change. Table 1 below contains a list of selected telehealth resources intended to help researchers interested in using Medicare FFS claims data to research telehealth.
Table 1. Selected Telehealth Resources
| Category | Brief Description | Web Address |
|---|---|---|
| Hubs | Dept. of Health and Human Services Telehealth Hub | https://telehealth.hhs.gov/ |
| Center for Connected Health Policy (CCHP) | https://www.cchpca.org/ | |
| Summary Datasets | Medicare Telehealth Trends Dataset (includes methodology) | https://data.cms.gov/summary-statistics-on-use-and-payments/medicare-service-type-reports/medicare-telehealth-trends |
| Articles | Kaiser Family Foundation's, "What to Know About Medicare Coverage of Telehealth" | https://www.kff.org/medicare/what-to-know-about-medicare-coverage-of-telehealth/ |
| Medicare Coverage | Medicare Plan Coverage - Telehealth | https://www.medicare.gov/coverage/telehealth |
| Medicare Plan Coverage - Virtual Check-Ins | https://www.medicare.gov/coverage/virtual-check-ins | |
| Medicare Plan Coverage - E-Visits | https://www.medicare.gov/coverage/e-visits | |
| Medicare Claims Billing | CMS.gov - List of HCPCS codes payable under Medicare's telehealth policy | https://www.cms.gov/medicare/coverage/telehealth/list-services (Previous versions of the list may be retrieved from the CMS Web Archive) |
| CMS.gov - Medicare Claims Processing Manual Chapter 12 - Physicians/Nonphysician Practitioners (search on "telehealth") | https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912 | |
| HHS Telehealth Hub - "Billing for telehealth" | https://telehealth.hhs.gov/providers/billing-and-reimbursement | |
| Medicare Learning Network (MLN) | https://www.cms.gov/training-education/medicare-learning-networkr-mln/resources-training%20 (search for "Telehealth) | |
| CCHP - "Medicare Billing for Telehealth Encounters- An Introductory Guide for Fee-For-Service" (Sep 2024) | https://www.cchpca.org/2024/09/2024BillingGuide4FINAL.pdf | |
| CCHP - "Billing for Telehealth Encounters- An Introductory Guide for Fee-For-Service" (Mar 2022) | https://www.cchpca.org/2022/03/2022BillingGuidefinal.pdf | |
| CMS.gov - "Remote Patient Monitoring: Use & Bill Correctly" | https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/fast-facts/remote-patient-monitoring-use-bill-correctly | |
| Policy (Recent and Historical) | Center for Connected Health Policy (CCHP) | https://www.cchpca.org/ |
| CMS.gov - "Coronavirus waivers & flexibilities" | https://www.cms.gov/coronavirus-waivers | |
| CMS.gov - "Useful Links- Discussion of Telehealth Policies in Previous Rulemaking" | https://www.cms.gov/medicare/coverage/telehealth/useful-links | |
| MLN Matters - "Medicare Fee-for-Service Response to the Public Health Emergency on COVID-19" (May 2023) | https://www.cms.gov/files/document/se20011.pdf | |
| CMS.gov - "COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers" (updated May 2021) | https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf | |
| CMS.gov - "Medicare Telemedicine Health Care Provider Fact Sheet" (Mar 2020) | https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet |
Table 1 caption: Selected resources for Medicare telehealth claims research.
Conclusion
Although the list of resources in Table 1 is intended to help researchers build understanding of Medicare telehealth, it is not an exhaustive list. Researchers must find the information they need to accurately capture telehealth-based services in Medicare claims data for their particular study.