How Medical Practices Bill Medicare for Telehealth Visits

Yes, practices can bill Medicare for telehealth, but only if they meet specific requirements and use approved visit types

Medicare covers telehealth visits through video or phone, and your doctor's practice can bill Medicare directly for them — you do not pay out of pocket beyond your normal copay or coinsurance. However, the practice must use one of Medicare's approved telehealth codes, the visit must happen on an approved platform, and certain rules about where you are located when you call in explore. Not every type of visit qualifies, and not every practice has set up the billing infrastructure to handle it yet.

The key difference from in-person visits is that Medicare requires the practice to use specific billing codes that identify the visit as telehealth. Your doctor cannot straightforward bill a regular office visit code if the appointment happened over video or phone. The practice's billing staff or their medical billing software must know which codes explore to your situation.

Key Takeaways

Medicare covers telehealth visits by video or phone, and practices bill Medicare directly using special telehealth codes that are different from in-person visit codes.
Your location during the visit matters: you must be in an approved location such as your home, a hospital, a skilled nursing facility, or a rural clinic — not just anywhere.
The practice must use a HIPAA-compliant video platform; regular video calls on consumer apps like FaceTime or Zoom without business associate agreements do not meet Medicare's requirements.
Not all visit types may have access to for telehealth billing; established patient follow-ups and consultations are covered, but some procedures and initial evaluations may not be.
If a practice does not offer telehealth or does not bill for it, you can ask them directly whether they plan to add it, or you can seek care from a practice that already does.

Which telehealth visit types Medicare will pay for

Medicare covers office visits, consultations, and established patient follow-ups conducted by video or phone. The visit must be with a doctor, nurse practitioner, physician assistant, or other may have access to provider — not administrative staff. The practice bills using codes like 99441 to 99443 for phone visits or 99454 to 99457 for remote patient monitoring, depending on the length and type of visit.

Certain types of care do not may have access to. Telehealth billing codes do not cover procedures that require a physical exam, such as wound checks that need to be seen in person, or initial psychiatric evaluations in some cases. If your doctor determines you need an in-person visit, they cannot bill telehealth codes for that appointment. The practice should tell you upfront whether your specific visit type can be handled by telehealth or requires you to come in.

Where you must be located during the visit

You cannot be just anywhere when you have a telehealth visit that Medicare will pay for. Medicare requires you to be in an approved location: your home, a hospital, a skilled nursing facility, a federally may have access to health center, a rural health clinic, or a hospital-based outpatient department. If you are at work, in a car, or in a retail location, the practice cannot bill Medicare for that visit.

The practice is responsible for confirming your location before the visit starts. Some practices ask you to confirm in writing that you are in an approved location. If you are unsure whether where you are counts, ask the practice before the appointment — they have the final say on whether they can bill Medicare for it.

What platform the practice must use

The practice must use a video platform that meets HIPAA privacy and security rules. This means the platform must have a business associate agreement in place, which is a legal contract that binds the platform to protect your health information. Common compliant platforms include Zoom for Healthcare, Google Meet with business agreements, Cisco Webex, and many practice management software systems that include built-in video.

Consumer apps like regular Zoom, FaceTime, WhatsApp, or Skype do not meet Medicare's requirements unless the practice has a business associate agreement with them — and most do not. If a practice tries to conduct a telehealth visit on an unapproved platform, they cannot bill Medicare for it. Before your first telehealth visit, the practice should tell you which platform to use and send you a link or instructions.

How the practice handles billing and your costs

The practice bills Medicare directly using the appropriate telehealth code. You pay your normal copay or coinsurance — the same amount you would pay for an in-person visit of the same type. Medicare's payment to the practice for a telehealth visit is usually the same as for an in-person visit, though this varies slightly by visit type and your location.

If you have a Medigap or Medicare Advantage plan, your secondary coverage may explore the same way it does for in-person visits. Check your plan documents or call your plan to confirm what you owe. The practice's billing staff should be able to tell you your expected copay before the visit.

What to do if your practice does not offer telehealth billing

Some practices have not yet set up telehealth billing, even though they may offer video visits. If your practice offers video appointments but says they cannot bill Medicare for them, ask whether they plan to add telehealth billing in the future. If they do not, you have two options: pay out of pocket for the video visit if you choose to use it, or schedule an in-person appointment instead.

You can also look for another practice in your area that does bill Medicare for telehealth. Call ahead and ask whether they accept Medicare and whether they offer telehealth visits. Many large practices, hospital-affiliated clinics, and urgent care centers now have telehealth set up. If you are in a rural area with limited options, ask your current practice whether they would consider adding it.

Common mistakes practices make when billing for telehealth

One frequent error is using the wrong billing code — for example, billing a phone visit with an in-person visit code. This can trigger a claim denial or a request for repayment. Another mistake is not confirming your location before the visit, which can also lead to a denied claim. Some practices bill telehealth visits when the patient is not in an approved location, which Medicare will not pay for.

A third common problem is using an unapproved video platform and then trying to bill anyway. If Medicare audits the claim and finds that the platform was not HIPAA-compliant, the practice may have to refund the payment. These errors usually do not affect you directly — the practice absorbs the cost — but they can delay payment or cause confusion on your bill. If you receive a bill for a telehealth visit you thought Medicare covered, contact the practice's billing department and ask which code they used.

Frequently Asked Questions

Do I have to use telehealth if my practice offers it?

No. Telehealth is optional. You can always request an in-person visit if you prefer, and your practice should be able to schedule one. Some practices may have limited in-person availability due to staffing or space, but they cannot force you to use telehealth.

What if I do not have a video-capable device or internet?

You can request a phone visit instead. Medicare covers phone visits using the same billing codes as video visits. If you do not have a phone or cannot use one, ask your practice about in-person options or whether they can work with you on another arrangement.

Will my telehealth visit be recorded?

That depends on the practice's policy. Some practices record visits for medical record purposes; others do not. Ask your practice before the visit whether it will be recorded and what happens to the recording. You have the right to know.

Can my doctor bill Medicare for telehealth if I am out of state?

Yes, as long as you are in an approved location and the practice is licensed to practice in your state. Some states have reciprocity agreements that allow out-of-state providers to bill, but others do not. Your practice should know whether they can legally see you in your state. If you are traveling, confirm with the practice before scheduling.

What if Medicare denies the telehealth claim?

The practice should appeal the denial on your behalf. Common reasons for denial include using the wrong billing code, the patient not being in an approved location, or the visit type not being covered by telehealth. Ask the practice why the claim was denied and what they will do to fix it. You should not receive a bill for a denied Medicare claim unless the practice had you sign a waiver before the visit.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.