Billing and coding Medicare Fee-for-Service claims
Read the latest guidance on billing and coding Medicare Fee-for-Service (FFS) telehealth claims.
Telehealth codes covered by Medicare
Medicare added over one hundred CPT and HCPCS codes to the list of telehealth services.
Telephone visits and audio-only telehealth
Medicare is temporarily waiving the audio-video requirement for many telehealth services. Codes that have audio-only waivers are noted in the list of telehealth services.
Place of Service codes
When billing telehealth claims, it is important to understand the place of service (POS) codes as it affects reimbursement.
The POS code explains where the provider and patient are located during the telehealth encounter. There are currently two POS codes:
- POS 02: Telehealth provided other than in patient's home. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
- POS 10: Telehealth provided in patient's home. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.
Common telehealth billing mistakes
Avoiding mistakes in the reimbursement process can help implementing telehealth into your practice a smoother experience.
Incorrect billing codes
More than 100 telehealth services are covered under Medicare. However, some CPT and HCPCS codes are only covered temporarily.
Using the wrong code can delay your reimbursement. This can happen for a variety of reasons, such as a misunderstanding of what code applies to what service or input error.
Stay up to date on the latest Medicare billing codes for telehealth to keep your practice running smoothly.
Post-visit documentation must be as thorough as possible to ensure prompt reimbursement.
While there are many similarities between documenting in-person visits and telehealth visits, there are some key factors to keep in mind.
Make a note of whether the patient gave you verbal or written consent to conduct a virtual appointment.
Telephone codes are required for audio-only appointments, while office codes are for audio and video visits.
Time of visit
A common mistake made by health care providers is billing time a patient spent with clinical staff. Providers should only bill for the time that they spent with the patient.
Many states require telehealth services to be delivered in “real-time”, which means that store-and-forward activities are unlikely to be reimbursed. You can find information about store-and-forward rules in your state here .
Originating sites and distant sites
Learn about eligible sites as well as telehealth policies specific to Federally Qualified Health Centers and Rural Health Clinics.
More information about FFS billing
If you are looking for detailed guidance on what is covered and how to bill Medicare FFS claims, see:
- Billing for Telehealth Encounters: An Introductory Guide on Fee-for-Service (PDF) – from the National Policy Center - Center for Connected Health Policy