CurrentimperialinsurancecompanyofutahPolicy N/A

Long‑Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

Customize your policy alerts

Sign up for all imperialinsurancecompanyofutah policy alerts

Know when imperialinsurancecompanyofutah releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

A toolkit providing guidance and curated resources for implementing telehealth and telemedicine in nursing homes during the COVID-19 public health emergency, intended for providers and nursing home staff.

Policy Summary

Payerimperialinsurancecompanyofutah

PolicyLong‑Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 6, 2020

Next Review DateN/A

Key ActionMedicare will pay for professional services furnished via telehealth in all areas and settings during the COVID-19 public health emergency; nursing home staff must facilitate the telemedicine session by managing onsite technology.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Mar 6, 2020date telehealth flexibilities effective

1135 waiver includedwaiver resources

Multiple provider typesdistant-site practitioners

OCR enforcement discretionprivacy/HIPAA guidance

Telehealth Coverage & Implementation Criteria

Telehealth coverage and implementation criteria for nursing homes during COVID-19

Covered when ALL of the following are met:

ALL of the following

ALL of the following
- For duration of the COVID-19 Public Health Emergency starting March 6, 2020
ALL of the following
- Medicare will pay for professional services furnished to beneficiaries in all areas of the country and in all settings, including in beneficiaries' homes and in healthcare facilities
ALL of the following
- The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient (examples include commonly used services like FaceTime and Skype)
ALL of the following
- Distant-site practitioners who may furnish and be paid for covered telehealth services (subject to state law): physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals
ALL of the following
- A staff member must facilitate the telemedicine session onsite at the nursing home by managing technology to connect the patient and clinician
ALL of the following
- During the COVID-19 nationwide public health emergency, HHS OCR will exercise enforcement discretion and waive penalties for HIPAA violations for providers serving patients in good faith through everyday communications technologies

ALL of the following

HHS will not audit to require a prior established patient relationship for claims submitted during the public health emergency

ALL of the following

Payment and allowable practitioners are subject to applicable state law regarding practitioner scope of practice

Telehealth and Virtual Service Codes

Common telehealth and virtual service codesmixedCovered

99201-99215	Office or other outpatient visits (telehealth)
G0425-G0427	Telehealth consultations, emergency department or initial inpatient
G0406-G0408	Follow-up inpatient telehealth consultations for hospitals or SNFs
G2012	Virtual check-in HCPCS
G2010	Remote evaluation HCPCS
99421-99423	E-visits (online digital evaluation and management)
G2061-G2063	Telephone E/M codes (HCPCS)

Established relationship audit relief

Audit relief for established patient relationshipHHS will not audit to confirm a prior established patient relationship for claims submitted during the COVID-19 public health emergency.

Applicable periodDuring the COVID-19 nationwide public health emergency (claims submitted during the PHE).

ScopeApplies to telehealth services where an established relationship would otherwise be required under 1135 waiver provisions.

Medicare Payment & Practitioner Eligibility

Billing Rule

Medicare payment and eligible distant‑site practitioners

Medicare will make payment for professional services furnished to beneficiaries in all areas of the country and in all settings for the duration of the COVID-19 Public Health Emergency; distant-site practitioners eligible to furnish and receive payment for covered telehealth services include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals (subject to state law).

Payments apply for services furnished in any healthcare facility and in the beneficiary's home.
Use of telehealth is subject to state law regarding practitioner scope of practice.

Key Terms

Telehealth / Telemedicine definitions and related guidance

Telehealth/Telemedicine (definition)Exchange of medical information between sites via electronic communication to improve a patient's health, including Medicare telehealth visits, virtual check-ins, and e-visits.

Medicare telehealth visit (definition)A visit with a provider that uses telecommunication systems (interactive audio-video) between a provider and a patient.

Examples of virtual servicesMedicare telehealth visits, virtual check-ins, and e-visits as summarized by CMS guidance.

Use of common communication appsOCR will exercise enforcement discretion and waive penalties for HIPAA violations when providers serve patients in good faith using everyday technologies (e.g., FaceTime, Skype) during the COVID-19 PHE.

Medicare telehealth visit

Medicare telehealth visitA visit with a provider that uses telecommunication systems between a provider and a patient (interactive audio-video).

Associated codes (examples listed elsewhere in toolkit)Common telehealth service codes include office/outpatient visit CPTs and HCPCS codes referenced in the toolkit (see coding section).

Patient relationship guidanceTelehealth visits may be furnished for new or established patients; HHS will not audit prior relationship during the PHE where an established relationship would otherwise be required.

Policy Summary

Payerimperialinsurancecompanyofutah

PolicyLong‑Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMar 6, 2020

Next Review DateN/A

SourceLink

On This Page

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

Long‑Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

Customize your policy alerts

Sign up for all imperialinsurancecompanyofutah policy alerts

Know when imperialinsurancecompanyofutah releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Telehealth Coverage & Implementation Criteria

Telehealth coverage and implementation criteria for nursing homes during COVID-19

Covered when ALL of the following are met:

ALL of the following

ALL of the following
- For duration of the COVID-19 Public Health Emergency starting March 6, 2020
ALL of the following
- Medicare will pay for professional services furnished to beneficiaries in all areas of the country and in all settings, including in beneficiaries' homes and in healthcare facilities
ALL of the following
- The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient (examples include commonly used services like FaceTime and Skype)
ALL of the following
- Distant-site practitioners who may furnish and be paid for covered telehealth services (subject to state law): physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals
ALL of the following
- A staff member must facilitate the telemedicine session onsite at the nursing home by managing technology to connect the patient and clinician
ALL of the following
- During the COVID-19 nationwide public health emergency, HHS OCR will exercise enforcement discretion and waive penalties for HIPAA violations for providers serving patients in good faith through everyday communications technologies

ALL of the following

HHS will not audit to require a prior established patient relationship for claims submitted during the public health emergency

ALL of the following

Payment and allowable practitioners are subject to applicable state law regarding practitioner scope of practice

Telehealth and Virtual Service Codes

Common telehealth and virtual service codesmixedCovered

99201-99215	Office or other outpatient visits (telehealth)
G0425-G0427	Telehealth consultations, emergency department or initial inpatient
G0406-G0408	Follow-up inpatient telehealth consultations for hospitals or SNFs
G2012	Virtual check-in HCPCS
G2010	Remote evaluation HCPCS
99421-99423	E-visits (online digital evaluation and management)
G2061-G2063	Telephone E/M codes (HCPCS)

Established relationship audit relief

Audit relief for established patient relationshipHHS will not audit to confirm a prior established patient relationship for claims submitted during the COVID-19 public health emergency.

Applicable periodDuring the COVID-19 nationwide public health emergency (claims submitted during the PHE).

ScopeApplies to telehealth services where an established relationship would otherwise be required under 1135 waiver provisions.

Medicare Payment & Practitioner Eligibility

Billing Rule

Medicare payment and eligible distant‑site practitioners

Payments apply for services furnished in any healthcare facility and in the beneficiary's home.
Use of telehealth is subject to state law regarding practitioner scope of practice.

Key Terms

Telehealth / Telemedicine definitions and related guidance

Medicare telehealth visit (definition)A visit with a provider that uses telecommunication systems (interactive audio-video) between a provider and a patient.

Examples of virtual servicesMedicare telehealth visits, virtual check-ins, and e-visits as summarized by CMS guidance.

Medicare telehealth visit

Medicare telehealth visitA visit with a provider that uses telecommunication systems between a provider and a patient (interactive audio-video).

Associated codes (examples listed elsewhere in toolkit)Common telehealth service codes include office/outpatient visit CPTs and HCPCS codes referenced in the toolkit (see coding section).