Telemedicine Reimbursement

Will I get reimbursed for telemedicine?

It depends. Telemedicine reimbursement is not definitive, it varies by location, services provided, and payers.

Does health insurance cover telemedicine?

Currently, there is no set standard for private health insurance providers regarding telemedicine. Some insurance companies recognize the value of telemedicine and pay for it, whereas others aren’t quite there yet. For insurance companies which lack telemedicine reimbursement policies, prior approval is often needing before telemedicine will be reimbursed.

Fortunately, some states have parity laws that require insurance companies to reimburse at the same rate as in-person care for services provided.

States with parity laws
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Georgia
  • Hawaii
  • Indiana
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nevada
  • New Hampshire
  • New Mexico
  • New York
  • Oklahoma
  • Oregon
  • Rhode Island
  • Tennessee
  • Texas
  • Vermont
  • Virginia
  • Washington
States without parity laws
  • Alabama
  • Florida
  • Idaho
  • Illinois*
  • Iowa*
  • Kansas
  • Massachusetts
  • Nebraska
  • New Jersey*
  • North Carolina*
  • North Dakota
  • Ohio*
  • Pennsylvania*
  • South Carolina
  • South Dakota
  • Utah
  • West Virginia
  • Wisconsin
  • Wyoming
  • *Proposed legislation to change law.

Go to the ATA website ATA website to learn more and get the latest updates.

Does medicare or medicaid cover telemedicine?

In general, Medicare Fee-For-Service Program will cover from originating sites to individuals who live in a rural geographical location, Health Professional Shortage Area (HPSA) or a county outside a metropolitan statistical area. If eligible, Medicare will reimburse for services that are “face-to-face” with the patient through telemedicine.

Telemedicine in Medicaid is covered in 48 states. Telemedicine services covered include: real-time communication, store-and-forward technology, remote patient monitoring, and a newly developing focus on mhealth (mobile health), for health education and other services. Medicare Payment Rules

In general, office and other outpatient services are covered under CPT codes 99201-99215 for Medicaid and Medicare.

In order for clinical services or an (encounter) to be covered by Medicare services need to be provided by one of the following health care professionals:

  • Physician
  • Nurse practitioner (NP)
  • Physician assistants (PA)
  • Nurse-midwives
  • Clinical nurse specialists (CNS)
  • Certified registered nurse anesthetists
  • Clinical psychologists
  • Clinical social workers
Can telemedicine be used with global reimbursements?

Yes! Global reimbursements are single payment to a healthcare provider to cover all services related to a condition or event, such as surgery or childbirth. With global reimbursement, the health care provider has the flexibility to decide how they deliver their services, allowing them to use telemedicine when appropriate. Therefore, telemedicine is a great way save the clinic money by reducing operating costs for delivering in-person medical services.

Patients can self-pay for telemedicine

With self-paying patients, they can pay for any service they want, even if delivered via telemedicine. Often patients are willing to pay out of pocket for the convenience of receiving care by telemedicine. Of note, Doxy.me Professional and Clinic accounts allow you to collect payments from patients during a telemedicine session.

Doxy.me provides free and low-cost telemedicine solutions, allowing you to reduce your overhead expenses. Start saving money and sign up for your free telemedicine account today!

Learn about Telemedicine