Payment for Telehealth Care

Payment and coverage for telehealth medical services are foundational to telehealth care expansion and adoption. Health care providers face a patchwork of State laws and private and public insurance policies based on various eligibility rules (eg, patient, location of services, type of services, provider and others). Pediatricians in the medical home face even more obstructive payment policies for telehealth visits with their own patients. To understand the complex telehealth payment environment two resources are helpful.

The American Telemedicine Association's "State Telemedicine Gaps Analysis Coverage and Reimbursement (May 2015) captures the complex policy landscape of 50 states with 50 different telemedicine insurance coverage and payment requirements. These findings are presented in an easy to understand format. It compares and grades telehealth coverage and payment standards for every state in the US.

The Center for Connected Health Policy's report on"State Telehealth Laws and Reimbursment Policies" is another excellent resource. While this guide focuses primarily on Medicaid fee-for-service policies, information on managed care is noted in the report if it was available. It aims to analyze and summarize the most recent policy language in each state as of July 2015. Click here for a copy of the report.

CPT Coding for Telehealth Care

Stay connected to the latest information on payment for telehealth care by joining the Section on Telehealth Care. (View SOTC Membership).


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