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Telehealth Services: What Medicare Covers

As a general rule, it’s always best to see your doctor in-office. However, if you live in a rural area or have certain health conditions, that may not be possible. Thankfully, Medicare covers some telehealth services in certain situations.

What are telehealth services?

Telehealth services (sometimes called telemedicine) are medical services provided by a doctor or qualified healthcare specialist using a two-way telecommunication system with real-time audio and video. This is used by a doctor or other healthcare professional who cannot be at your current location,

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How do you qualify?

A patient must meet specific requirements in order for Medicare to pay for these services.

You must meet five conditions in order for Medicare to cover telehealth services:

  1. The beneficiary is located in a qualifying rural area.
  2. The beneficiary is located in at one of eight qualifying originating sites (see below).
  3. The services are provided qualified distant site practitioners (see below).
  4. The beneficiary and practitioner communicate via an interactive audio and video telecommunication system that allows real-time communication between both parties.
  5. The service is on Medicare’s list of covered telehealth services.

You may receive telehealth services at one of the following eight qualifying originating sites:

  1. Offices of physicians or practitioners
  2. Hospitals
  3. Critical Assess Hospitals (CAHs)
  4. Rural health clinics
  5. Federally-qualified health centers
  6. Hospital-based or CAH-based renal dialysis centers (including satellites)
  7. Skilled nursing facilities
  8. Community mental health centers

The following healthcare professionals may administer telehealth services:

  • Physicians
  • Nurse practitioners (NP)
  • Physicians assistants (PA)
  • Midwives
  • Clinical nurse specialists (CNS)
  • Certified registered nurse anesthetists
  • Clinical psychologists (CP) and clinical social workers (CSW)
  • Registered dietitians or nutritional professionals

What does Medicare cover?

Part B covers all Medicare-approved telehealth services. Medicare will pay 80 percent of the cost of service, and you are responsible for the remaining 20 percent as well as the Part B deductible.

Additional amounts you may need to pay depend upon factors like:

  • Any secondary insurance you may have
  • How much your doctor charges for the services
  • Whether your doctor accepts Medicare assignment
  • The type of facility where you receive the treatment

To see if you qualify for these services, call Medicare at 1-800-MEDICARE (1-800-633-4227). 

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