MACRA & Telehealth Reimbursement

MACRA is of potential interest to the telehealth community for several reasons. First, let us give you a little background. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is bipartisan legislation. It was signed into law on April 16, 2015 and is commonly called the Permanent Doc Fix. It is a United States statute that revises the Balanced Budget Act of 1997 to change the payment system for professionals who treat Medicare patients. 

In May 2018, the Center for Medicare and Medicaid Services Administration (CMS) released a brief but noteworthy document entitled, Summary of Policies in the Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, and CT Modifier Reduction List.


MACRA & Telehealth Reimbursement Facts

Given that Medicare is the “testing ground” for new healthcare policy in the United States, MACRA is not only of interest to Medicare providers, but also those who wish to glimpse the future of telehealth reimbursement trends in the U.S.  Among other key telehealth reimbursement facts outlined, the CMS report mentions:

  • 49 states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service (up one state – Rhode Island – since the fall 2017 report);
  • 15 states reimburse for asynchronous or store-and-forward services other than teleradiology (unchanged since fall 2017, though Georgia was added to the list and Hawaii was subtracted);
  • 9 states reimburse for live video, store-and-forward, and RPM;
  • 32 states provide a transmission and/or facility fee (unchanged since fall 2017);
  • 39 states or jurisdictions have guidelines in place for private payer reimbursement of telehealth (up two states – Iowa and Utah – from the fall 2017 report); and
  • 31 states have a consent requirement in either Medicaid policy, law or regulation, an increase of one state.

Keeping you informed of such news is our goal at TBHI. If you haven’t joined our FREE weekly newsletter summarizing this news, join here.

For more information about other telebehavioral health and telemental health reimbursement, see the Telebehavioral Health Institute’s “Maximizing Telehealth Reimbursement: New Billing, Coding & Credentialing Strategies for 2019.” This online professional training event addresses a number of successful strategies to get paid for telepractice today as well as the 2019 CPT codes. It comes with a handout and CME or CE hour, valid toward licensure renewal for most healthcare disciplines.


Recommended Reimbursement Articles

99091: New Telehealth CPT Code for Remote Patient Monitoring

Remote patient monitoring (RPM) is the term used to refer to a broad range of technologies that allow clients/patients to be monitored when in non-professional settings, such as their homes, at work, and even at play. While such systems have been at the periphery of telehealth for almost two decades, they now can be brought into the mainstream of telehealthcare by allowing a client or patient to monitor their own behavior (thoughts) or bodily processes (heart rate, temperature, etc.) continuously, that is, throughout the day.

CMS Congressional report

CMS Congressional Report: 85.4% of all Telehealth Users Had Mental Health Diagnosis

Professionals looking for current metrics related to opportunities in telemental health or telebehavioral health will find a treasure-trove in the recent Centers for Medicare and Medicaid (CMS) Congressional report. The November 15, 2018 CMS Congressional report is entitled, Information on Medicare Telehealth. It offers a wide number of recently compiled metrics, expressed concerns and overall telehealth opportunities about the overall industry serving Medicare recipients, and succinctly compiles a useful array of facts that can be of use to behavioral professionals and their organizations.

Medicare Next Generation ACO Model Telehealth Expansion Waiver

In the United States traditional fee-for-service system of Medicare, use of the telehealth benefit is limited to rural Health Professional Shortage Areas (HPSA). As of January 2018, this restriction has changed for more than 50 “Accountable Care Organizations” (ACOs). ACOs are groups of doctors, hospitals, and other health care providers who voluntarily form a group voluntarily to give coordinated care to Medicare recipients seeking healthcare.

Epstein Becker & Green 2018 Telehealth Report

Telehealth services became notably more popular amount clients/patients, practitioners, employers and legislators according to a 2018 telehealth report from law firm, Epstein Becker & Green. Their 3rd annual telebehavioral healthcare report focused on laws, regulations and policies. They also noted that adoption amongst insurance companies continues to lag.


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