Billing for direct-to-consumer telehealth
If you decide to provide direct-to-consumer telehealth services and choose to accept health insurance, you will have to learn about rules and regulations for billing and reimbursement.
During the COVID-19 public health emergency, the federal government, state Medicaid programs, and private insurers have expanded coverage for telehealth. Most insurance companies cover some type of telehealth service, often including on-demand telemedicine. As a rule, you should verify each insurance policy and always ask patients to look into their coverage ahead of a virtual visit.
Medicare now covers telehealth, including virtual check-ins with a provider via phone or telehealth platform, and e-visits through an online patient portal — many of which are considered direct-to-consumer telehealth.
The Centers for Medicare & Medicaid maintains an up-to-date list of telehealth services. It is important to remember that some of these services are temporary additions in place during the COVID-19 public health emergency, and may change after the official emergency is lifted.
While each state is different, most have expanded coverage for telehealth due to COVID-19. Check your state’s current laws and reimbursement policies to see what is covered.
Many changes to COVID-19 reimbursement rules also cover on-demand telehealth. They include specific information related to virtual or audio-only visits. For tips on coding private insurance claims, see:
- Coding Scenarios during COVID-19 — from the American Academy of Family Physicians
Tip: For help setting up billing and reimbursement for a new service, contact the National Telehealth Policy Resource Center .