What Coverage is Included in Medicare Telehealth Appointments?

What Coverage is Included in Medicare Telehealth Appointments?

The Covid-19 pandemic has led to a number of changes in how we access medical care, including the rise of telehealth. This service allows patients to consult their doctors from home via telecommunication services. Understanding how Medicare telehealth works and what it covers can help Medicare beneficiaries navigate this emerging medical service and receive the care they need.

What Is Telehealth?

Telehealth, which is also sometimes referred to as telemedicine, is medical service offered online with real-time, two-way communication between you and your doctor. This kind of service not only allows patients and doctors to reduce their exposure to Covid-19 and other communicable diseases, but it also minimizes the need to take time off work or find childcare during doctor visits. It can also provide increased access to specialists.

While some medical issues require in-person consultations, there are a number of care options that can be handled via telehealth, including:

  • Lab results
  • Therapy or counseling
  • Prescription management
  • Skin conditions
  • Recurring conditions (such as migraines)
  • Urgent care issues
  • Follow-ups for surgical or other procedures

Does Medicare Cover Telehealth?

Prior to the Covid-19 pandemic, Medicare only covered telehealth consultations for beneficiaries living in rural areas. Medicare paid for these rural beneficiaries to use telehealth because they did not always have access to local doctors to handle their medical needs.

When Covid-19 was declared a public health emergency in early March 2020, coverage of telehealth services expanded for traditional Medicare by Congress and the Centers for Medicare & Medicaid Services. Medicare telehealth options are currently set to revert back to the pre-pandemic rules after Dec. 31, 2023, unless CMS decides to make the coverage of telehealth for all geographic areas permanent.

What Services Can You Receive With Medicare Telehealth?

There are several telehealth services that all Medicare beneficiaries can access, regardless of geographic location, even prior to the pandemic-related changes. These Medicare telehealth services include:

  • Visits for monthly end-stage renal disease
  • Acute stroke diagnosis, evaluation or treatment
  • Treatment for substance abuse occurring alongside mental health issues

Prior to March 2020, beneficiaries who did not live in a rural health care area could not access any telemedicine services other than those three options.

However, the expansion of Medicare telehealth means that the following services are now also covered by the program, whether you live in a rural area or not:

  • Services at renal dialysis facilities and at home (meaning you could get a telehealth consult from a specialist while visiting your dialysis facility, as well as receiving a consultation at home)
  • Some emergency department visits
  • Some physical and occupational therapy visits
  • Some services offered via audio-only devices

What are Virtual Check-Ins and E-Visits?

It's also important to note that Medicare does not consider virtual check-ins and e-visits to be true telehealth, and it covers both of these types of remote medical services as part of Medicare Part B, no matter your location.

Virtual check-ins must meet several conditions:

  1. You must speak with your doctor or practitioner to start your virtual check-in. This means you cannot have a check-in if you only speak to a receptionist or other staff.
  2. The check-in must not be about a recent medical visit (within the past week) or lead to an in-person visit within the next 24 hours or the soonest available appointment.
  3. You must give verbal consent to the doctor for the virtual check-in, which must be noted in your file.

If you meet these conditions, this communication with your doctor is considered a virtual check-in and will be covered by Medicare.

E-visits are consultations with your doctor or health care provider via an online patient portal. E-visits with several types of health care providers are covered by Medicare including:

  • Doctors

  • Nurse practitioners

  • Physician assistants

  • Occupational therapists

  • Physical therapists

  • Speech language pathologists

  • Clinical social workers and clinical psychologists (in specific circumstances)

Staying Healthy with Medicare Telehealth

While house calls may be a thing of the past, new technology has made it possible for us to stay home while still seeing our doctors. Whether you are trying to limit your exposure to Covid-19, are too ill to get yourself to the doctor or simply need regular check-ins that don't take too much time from your day, Medicare telehealth can help keep you healthy while staying home.

Emily Guy Birken AuthorThumbnail

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