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 |
| 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 |
