Comparison Table Medicare and Kentucky Telehealth

Posted January 16, 2020

Comparison Table Medicare and Kentucky Telehealth

Comparison Medicare Kentucky Telehealth
Parity Yes – covers and reimburses based on the Medicare Physician  Fee Schedule Database (MPFSDB) Yes – covers and reimburses medical services to the same extent medical services are covered face-to-face when medically necessary and furnished by licensed healthcare providers and performed within their scope of practice

Medicaid Fee Schedule

Coverage Limited – although not every face-face service is covered many are

Expanded – Medicare now covers certain non-face-face services such as G2086 through G2088 that describe new bundled services for treatment of opioid disorders that include individual therapy and group counseling

Yes – coverage includes commercial plans and Medicaid

Any medically necessary face-to-face services provided by licensed healthcare providers within their scope of practice

Access to care No – services are limited to an originating site within a Health Professional Shortage Area (HPSA) or outside a Metropolitan Statistical Area (MSA) with one exception

The SUPPORT Act statutorily removed the geographic limitations for telehealth services furnished to individuals diagnosed with a substance use disorder (SUD) for the purposed of treating SUD or a co-occurring mental health disorder (see above)

Yes – allows patients to live anywhere and receive medically necessary treatment via telehealth by a healthcare provider licensed in KY
Expanded Technology Platform  No – For Medicare payment to occur, interactive audio and video telecommunications must be used, permitting real-time communication between the distant site physician or practitioner and the Medicare beneficiary Yes – communication technology platform is not limited as long as it meets all HIPAA standards
Store and Forward No – Medicare does not allow the use of asynchronous “store and forward” technology except in delivering these services when the originating site is a Federal telemedicine demonstration program in Alaska or Hawaii Yes – allows asynchronous (store and forward) for most specialties
Administrative Burden Yes – does not require prior authorization Yes – does not require prior authorization, medical review, or administrative clearance for telehealth that would not be required if the service were provided in person
Billing and Coding

Instructions

Yes – POS 02 is used to identify telehealth services

Yes – Medicare provides a limited 2020 list of covered HCPCS and CPT codes.

Yes – POS 02 is used to identify telehealth services

Yes –any covered face-to-face CPT or HCPCS that is medically necessary, performed by healthcare providers licensed in Kentucky and the service is within the healthcare providers scope of practice may be performed via telehealth