Jeffrey Wade
Telehealth services have become increasingly popular since the COVID-19 pandemic, with many people opting for virtual appointments with their doctors from the comfort of their homes. While telehealth services were expanded during the pandemic to reduce the risk of older adults being exposed to COVID-19 in doctors' waiting rooms, this expansion was set to expire on March 31, 2025. However, recent bills and resolutions have been introduced to extend this coverage, with bipartisan support for Medicare coverage of telehealth appointments. This article will provide a comprehensive guide on how to bill insurance for telehealth services, including information on finding telehealth providers that accept Medicaid and understanding insurance coverage for telehealth visits.
| Characteristics | Values |
|---|---|
| Finding a telehealth provider that accepts Medicaid | No longer a challenge |
| Telehealth services | Primary physician visits, mental health counselling, tele-vision services for the elderly and disabled, tele-nursing, telerehabilitation, home telemonitoring of chronic diseases such as diabetes or congestive heart failure, and telemedicine |
| Telemedicine apps | Free to download |
| Co-pays for telemedicine visits | Check with your insurance provider for exact details |
| Medicaid recipients | Eligible for the Lifeline and Affordable Connectivity Program (ACP) from the Federal Government |
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What You'll Learn
Telehealth insurance coverage
Each state's Medicaid plan is different, but most will not charge a co-pay for telemedicine visits. It is always worth checking with your insurance provider for exact details on how telehealth services are covered. For those not on Medicaid or outside your insurance network, you can still use one of the many Telemedicine apps to set up low-cost telehealth visits to receive care for non-emergency health issues. Most telehealth apps are free to download, and your provider can help set you up on the platform they prefer. These apps will link to your insurance and tend to have lower co-pays than in-person visits.
Medicare coverage for telehealth appointments has broad bipartisan support and has been extended several times through various spending bills. The latest extension was set to expire on March 31, 2025, but a new bill has been passed to extend coverage through the end of the fiscal year on September 30, 2025. This coverage has been a boon for those who have difficulty getting to a physician's office, including older adults in rural areas or with mobility issues, and caregivers strapped for time.
There have been several attempts to pass legislation to make telehealth coverage permanent, but these have not yet been successful. In March 2025, a bipartisan healthcare package that included telehealth extensions was objected to on the Senate floor. However, there is still broad support for continuing telehealth coverage, and it is likely that further attempts will be made to extend or make permanent the current coverage.
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Reimbursement
For those with Medicaid insurance, telemedicine can be a great way to receive affordable care. During the COVID pandemic, telehealth and telemedicine saw a significant increase in usage as people sought care from their homes. Telehealth services are an increasingly popular way to receive healthcare from the comfort of your own home.
If you are not on Medicaid or are seeking care from a provider outside of your insurance network, you can still use one of the many Telemedicine apps to set up low-cost telehealth visits to receive care for non-emergency health issues. Most telehealth apps are free to download, and your provider can help set you up on the platform they prefer. These apps will link to your insurance and tend to have lower co-pays than in-person visits.
While phone calls are available, more doctors require you to have a smartphone or tablet for the telehealth visit as they can better diagnose your health issue with a video call. As a Medicaid recipient, you are eligible for the Lifeline and Affordable Connectivity Program (ACP) from the Federal Government. Through these programs, you can eliminate your cell phone bill and have all the data you need for any telehealth medical care.
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Medicaid insurance providers
It is important to note that telehealth is considered a delivery method rather than a benefit type. This distinction gives states the discretion to determine whether to offer coverage for telehealth services and the flexibility to decide the specifics of such coverage. States can choose which types of telehealth are covered, the locations where coverage applies, and the types of practitioners or providers that may be reimbursed. However, states must ensure that all providers practice within the scope of their State Practice Act or other relevant state requirements.
In terms of reimbursement, states have the option to reimburse the physician or practitioner at the distant site and also cover a facility fee for the originating site. Additional costs, such as technical support, transmission charges, and equipment, can be included as add-on expenses. These supplementary costs can be incorporated into the fee-for-service rates or separately reimbursed by the state as administrative costs. If billed and reimbursed separately, these costs must be linked to a covered Medicaid service.
It is worth noting that some states have enacted legislation requiring providers using telehealth technology across state lines to hold a valid state license in the patient's state. Medicaid insurance providers should be aware of and comply with any such requirements or restrictions imposed by the state, as they are binding under current Medicaid rules.
Additionally, specific programs or sections within the Medicaid framework, such as the SUPPORT Act Section 1009, address services and treatments for substance use disorders delivered via telehealth, including in school-based health centers.
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Telehealth apps
When using a telehealth app, it is important to check with your insurance provider to understand the specifics of your coverage. Most telehealth apps are free to download, and your provider can recommend a preferred platform. These apps will often link to your insurance, offering lower co-pays than in-person visits, and sometimes eliminating co-pays altogether. For example, Medicaid members can take advantage of the Lifeline and Affordable Connectivity Program (ACP) from the Federal Government, which can help eliminate cell phone bills and provide the necessary data for virtual medical appointments.
The type of telehealth services covered by insurance can vary, but they often include primary physician visits, mental health counseling, tele-vision services for the elderly and disabled, tele-nursing, telerehabilitation, and home telemonitoring of chronic diseases. These services provide valuable support for individuals who may have difficulty visiting a doctor's office, such as those in rural areas or with mobility issues.
To bill insurance for telehealth services through an app, users should first confirm that their provider accepts their specific insurance plan. Each insurance company will have its own process for billing and reimbursement, so it is essential to follow the guidelines provided by the insurance carrier. This may involve submitting the necessary documentation, such as a detailed invoice or superbill, and any relevant diagnostic codes. By following the billing procedures outlined by the insurance company, users can ensure they receive the full benefits of their coverage for telehealth services.
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Phone or video calls
Billing insurance for telehealth services over phone or video calls can be done, but it is important to note that different states have different regulations and restrictions on telehealth reimbursement. It is also important to check with the insurance provider for exact details on how telehealth services are covered.
For those with Medicaid insurance, finding providers that accept this form of insurance is no longer a challenge, and most will not charge a co-pay for telemedicine visits. However, for those not on Medicaid or outside of their insurance network, there may be low-cost telehealth visits available to treat non-emergency health issues.
It is best practice to call the insurance payer and verify that the client is covered for telehealth services under their plan. Even if the client has telehealth benefits, it is recommended to document the reference number for the call in case the claim is later declined. It is also important to note that billing requirements may change, so it is good practice to call annually to verify if there have been any changes to their telehealth requirements.
There are three major types of payers: Medicare, Medicaid, and commercial payers. It is important to understand the specific policies of each payer and the types of telehealth they cover.
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Frequently asked questions
The Current Procedural Terminology (CPT) codes for telehealth services are 99202-99215 and 98000-98007. The Healthcare Common Procedure Coding System (HCPCS) code is 99441-99443.
Medicare policies for telehealth are subject to change. Telehealth services provided at an originating site (POS 02) are paid at the facility rate. Medicare does not require a modifier for audio-video telehealth services.
Private insurance companies have their own billing and reimbursement policies, which are subject to change. It is recommended that you check with the patient's insurance company for their most recent policies.
There are two telehealth-specific POS: POS 02 is used for services provided in a location other than the patient's home, and POS 10 is used for services provided to a patient located in their home.
