Finally, the service itself must be listed among the eligible cpt/hcpcs codes CMS publishes each year as covered telehealth services. In CY 2016, there are approximately 37 covered services (with approximately 50 associated codes). Unless a service is listed among the approved service codes for telehealth services, Medicare will not cover the service if provided via telehealth.
The result of Medicare’s restrictive telehealth law has been narrow coverage and few claims submitted. For example, in CY 2015, Medicare paid a total of $17.6 million for telehealth service claims, compared to an overall $600 billion Medicare program budget. At the same time, patient demand for the convenience and access to care offered by telehealth services has created a willingness for patients (including Medicare beneficiaries) to self-pay out of pocket to enjoy the benefits of these new technologies.