Payment and Reimbursement

Parity laws & Billing updates

Lack of, or insufficient reimbursement for telehealth services is one of the most often quoted reasons for providers’ reluctance to engage in Telehealth services (Call, 2017). State parity laws, which enact the obligation for payers to equally reimburse both telehealth and in-person clinical encounters, have been critically important. The Centers for Medicaid and Medicare Services (CMS) have achieved significant progress in the arena of reimbursement. Recent policy changes include a Provider Fee Schedule that now allows payments for a number of new telehealth services, including prolonged preventative services, virtual check-ins and evaluations of photos and videos submitted by patients; billing issues have also been addressed with new CPT codes. Changes to the Medicare Advantage plans, for which coverage of telehealth services have long lagged behind, are also in the works.