title: Medicare Telehealth Services and Nephrology: Policies for Eligibility and Payment.
abstract: The criteria for Medicare payment of telehealth nephrology services, and all other Medicare telehealth services, are set forth in section 1834(m) of the Social Security Act. There are just over 80 professional physician or practitioner services that may be furnished via telehealth and paid under Medicare Part B, when an interactive audio and video telecommunication system that permits real-time communication between a beneficiary at the originating site and the physician or practitioner at the distant site substitutes for an in-person encounter. These services include 16 nephrology billing codes for furnishing ESRD services for monthly monitoring and assessment and two billing codes for chronic kidney disease education. In recent years, many mobile health devices and other web-based tools have been developed in support of monitoring, observation, and collaboration for people living with chronic disease. This article reviews the statutory and program guidance that governs Medicare telehealth services, defines payment policy terms (e.g., originating site and distant site), and explains payment policies when telehealth services are furnished.
authors.affiliation: Centers for Medicare and Medicaid Services, Center for Clinical Standards and Quality, Division of Value, Incentives and Quality Reporting, Baltimore, MD. Electronic address: stephanie.frilling@cms.hhs.gov.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Frilling
mesh_terms: D004608:Eligibility Determination; D006291:Health Policy; D006801:Humans; D006278:Medicare; D016345:Medicare Part B; D009398:Nephrology; D012051:Reimbursement Mechanisms; D017216:Telemedicine; D014481:United States
keywords: Eligible Medicare telehealth individual; Medicare telehealth; Medicare telehealth reimbursement; Telehealth distant site; Telehealth originating site