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MIR-2006-10AB, October 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Medicare Telehealth Services
Provider Types Affected
Method II Critical Access Hospitals (CAHs) who bill Medicare fiscal intermediaries (FIs) for telehealth services and telehealth originating sites that bill the Medicare FI
Provider Action Needed
CR5201, from which this article was taken, announces (effective January 1, 2007) a correction to the payment amount regarding telehealth services when the distant site practitioner is located in a critical access hospital (CAH) that has elected Method II and the physician or practitioner has reassigned his or her benefits to the CAH. In this situation, Medicare FIs will make payment for the telehealth service at 80 percent of the Medicare Physician Fee Schedule (MPFS) and not according to the optional payment method as discussed in the Medicare Claims Processing Manual, Chapter 4, Section 250.2. This chapter of the manual is available at http://www.cms.hhs.gov/Manuals/IOM/list.asp  on the CMS Web site. Chapter 12 of the same manual includes further telehealth information.
Also, in accordance with the Medicare telehealth originating site payment methodology, Medicare FIs will make payment to originating sites at the lesser of 80 percent of the actual charge or the originating site facility fee. The originating site facility fee was established by Section 1834(m) of the Social Security Act at $20 and is adjusted annually by the Medicare Economic Index.
Additional Information
You can find more information about billing telehealth services, including revised portions of Chapter 12 of the Medicare Claims Processing Manual, by going to CR5201, located at http://www.cms.hhs.gov/Transmittals/downloads/R1026CP.pdf  on the CMS Web site.
Additional telehealth instructions are available in Chapter 15, Section 270, of the Medicare Benefit Policy Manual at http://www.cms.hhs.gov/Manuals/IOM/list.asp on the CMS Web site.
If you have any questions, please contact your FI at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5201
Pub. 100-4, Transmittal# R1026CP, CR# 5201
Related CR Release Date: August 11, 2006
Effective Date: January 1, 2007
Implementation Date: January 2, 2007
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