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Best practice guide

Telehealth for rural areas
For providers Best practice guides Telehealth for rural areas

Billing for rural telehealth

Billing and reimbursement for rural and frontier telehealth services is, in many ways, no different than any other healthcare service. There are also some stark differences.

Medicare and Medicaid billing reimbursement

The Centers for Medicare & Medicaid Services Office of Minority Health focuses on rural health services and providers. They also offer regional rural health coordinators that can assist with region-specific questions and concerns.

For more information on Medicare billing and coding for telehealth services, see the 2023 physician fee schedule. CMS also provides additional guidance on billing for services at rural health clinics as well as resources for rural health care.

Uninsured or underinsured patients

While the number of uninsured people in rural areas is falling, there are still more uninsured rural residents than urban residents.

Whether or not a patient can afford to pay for medical care, including appointments, prescriptions, or preventative care measures often depends on their eligibility for state and federal assistance programs.

Providers can help by offering free or low cost services, including:

  • Free vaccination clinics
  • Free or low cost annual wellness visits
  • Free or low cost well child visits
  • Insurance navigators or financial advisors to help patients apply for and maintain Medicaid or Medicare coverage

You could also look at offsetting the cost of uninsured or underinsured patients by looking for grants tailored specifically to rural health care providers and clinics.

Medicare billing guidance

The COVID-19 public health emergency led the Center for Medicare and Medicaid Services (CMS) to expand its coverage for telehealth care. Many state Medicaid programs and private insurers are also covering telehealth appointments the same as an in-person appointment, with patients paying their typical co-pays.

Get more information on billing for direct-to-consumer telehealth.

Coding guidance is subject to change. Please refer to the complete list of telehealth services covered by Medicare during the COVID-19 public health emergency from the Centers for Medicare & Medicaid Services.

Maternal telehealth

Billing codes
Category Telehealth CPT codes and HCPCS codes

Evaluation and monitoring outpatient follow-up

99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

Observation care discharge

99217*

Initial observation care

99218, 99219, and 99220 **

Initial hospital care

99221, 99222, and 99223 **

Subsequent observational care

99224, 99225, 99226

Subsequent hospital care

99231, 99232, 99233

Telephone evaluation and monitoring service

99441, 99442, 99443

Diabetes management

G0108

Medical nutrition therapy

97802, 97803

Annual Wellness Visits

Billing codes
Category Telehealth CPT codes and HCPCS codes

Annual wellness visit

G0438, G0439

Advanced planning

99497, 99498

Chronic care telehealth

Audio-only or video telehealth

Billing codes
Category Telehealth CPT codes and HCPCS codes

Telephone evaluation and management service

99441, 99442, 99443; G0438, G0439

Screening, brief intervention, and referral to treatment

G0396, G0397 G0442, G0443, G0444, G0445, G0446, G0447

Evaluation and monitoring outpatient follow-up

99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

Observation care discharge

99217 *

Initial observation care

99218, 99219, 99220 **

Subsequent observational care

99224, 99225, 99226

Opioid use disorder treatment

G2086, G2087, G2088

Alcohol and substance abuse assessment

G0396, G0397

Diabetes Care Management: Phone evaluation and management

99441, 99442, 99443

Diabetes self-management training

G0108, G0109

Medical nutrition therapy

97802, 97803, 97804, G0270

Psychotherapy

90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838

Renal Care: Phone evaluation and management

99441, 99442, 99443

Renal Care: Outpatient dialysis services

90951, 90952, 90953, 90954, 90955, 90956, 90957 ,90958, 90959, 90960, 90961, 90962

Renal Care: Hospital care services, with the limitation of 1 telehealth visit every 3 days

99231, 99232, 99233

Renal Care: Individual and group kidney disease education

G0420, G0421

Renal Care: Transitional care management services

99495, 99496

Renal Care: Advance care planning

99497, 99498

Renal Care: Prolonged service

99354, 99355, 99356, 99357

Renal Care: Telehealth consultations, critical care

G0508, G0509

Pulmonary Care: Phone evaluation and management

99441, 99442, 99443

Pulmonary Care: Rehabilitation

94625, 94626, G0424

Pulmonary Care: Transitional care management services

99495, 99496

Pulmonary Care: Advance care planning

99497, 99498

Pulmonary Care: Prolonged service

99354, 99355, 99356, 99357

Pulmonary Care: Ventilator management

94002, 94003, 94004, 94005

Pulmonary Care: Evaluate patient use of inhaler

94664

Cardiac Care: Phone evaluation and management

99441, 99442, 99443

Cardiac Care: Transitional care management services

99495, 99496

Cardiac Care: Advance care planning

99497, 99498

Cardiac Care: Prolonged service

99354, 99355, 99356, 99357

Cardiac Care: Cardiac rehab

93797, 93798, G0422, G0423

Cardiac Care: In-person ventricular assist device interrogation

93750

Stroke and Rehabilitation Care: Phone evaluation and management

99441, 99442, 99443

Physical Therapy Services

97161, 97162, 97163, 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97542, 97750, 97755, 97760, 97761, G2061, G2062, G2063

Occupation Therapy Services

97165, 97166, 97167, 97168

Speech Therapy

92507, 92508, 92521, 92522, 92523, 92524, 92526

Aphasia Assessment

96105

Cancer Care: Phone evaluation and management

99441, 99442, 99443

Cancer care: Radiation oncology treatment management

77427

Dementia Care: Phone evaluation and management

99441, 99442, 99443, G0438, G0439

Dementia Care: Cognitive assessment and care plan services

99483

*Remains available until December 31, 2023

**Will expire at some point after the COVID-19 public health emergency is declared over

Last updated: November 23, 2022

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