Telehealth Reimbursement & Private Payers

Private insurers are beginning to embrace the advantages of telemedicine. They have discovered the huge financial savings, improved patient outcomes, and exceptional convenience of telemedicine.

Here, we tell you what you need to know about private insurers and telemedicine reimbursement:

Parity Laws

The number of states with parity laws covering private insurers and reimbursement to telehealth services has grown to 32 plus Washington, D.C. These laws mean that private payers must cover services provided through telehealth to the same extent that they cover in-person services.

State Variations

There are significant variations across the states, however:

  • All parity laws cover live video telehealth.
  • Some 16 states have some sort of reimbursement for remote patient monitoring.
  • Not all require reimbursement at the same rate as in-person services. Colorado, Missouri, and Virginia require payment on the same basis as in-person services, which allows them to take into consideration the cost differences of telehealth versus in-person services.
  • There is full parity in 23 states and Washigton, D.C., meaning coverage and reimbursement for telemedicine services is comparable to those for in-person services.
  • Only Arizona restricts parity to geographic regions and specific services.
  • Only Michigan, Oregon, and Vermont approve reimbursement for telehealth that uses interactive, audio-visual systems.
  • Arkansas sets arbitrary restrictions on patient locations and provider types and mandates an in-person visit to establish a patient-provider relationship.
  • Only Nevada extends parity to workers’ compensation programs.

Private Payers & Telemedicine

The five major private commercial health insurers (Aetna, Cigna, Blue Cross Blue Shield, Humana, and United Healthcare) cover some form of telemedicine.

Policy Requirements

It is important to check with the specific provider to confirm what they mean by covering telemedicine. A patient with a premium policy may have coverage, for example, whereas cheaper policies may not reimburse for telehealth services.

Rates for Telemedicine Reimbursement

In general, private payers appear to reimburse for telemedicine at the same rate as they do for corresponding in-person services. State policy and your negotiated reimbursement rates with that payer will dictate the rate, however.

Billing Private Payers

There are no set guidelines for billing telemedicine. You will need to call the eligibility and benefits department of the commercial insurance provider in question. They will tell you the codes and documentation you’ll need for billing telemedicine.

That said, most providers will tell you to use the relevant CPT/HCPCS code along with the GT modifier.