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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

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.

Medicaid

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.

Private insurance

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

Have a question?

Contact the staff at the regional telehealth resource center   that’s closest to you for help with your telehealth program.