Medicare Telehealth Payment Eligibility Analyzer
Check if an address is eligible for Medicare telehealth originating site payment.
Please provide a street address, city, and state or a street address and ZIP Code.
Authorized originating sites* which meet the following criteria shall be designated as eligible for Medicare telehealth payment:
- Analysis indicates that the address does not fall in a metropolitan statistical area OR
- If address falls in a metropolitan statistical area, then the address must be in a rural area and be in a Primary Care or Mental Health geographic Health Professional Shortage Area (HPSA).
Beginning January 1, 2019, the Bipartisan Budget Act of 2018 removed the originating site geographic conditions and added eligible originating sites to diagnose, evaluate, or treat symptoms of an acute stroke. Go to MLN Matters® article, New Modifier for Expanding the Use of Telehealth for Individuals with Stroke to learn how to use the new modifier for billing.
Beginning July 1, 2019, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removes the originating site geographic conditions and adds an individual’s home as a permissible originating telehealth services site for treatment of a substance use disorder or a co-occurring mental health disorder.
Medicare does not apply originating site geographic conditions to hospital-based and CAH-based renal dialysis centers, renal dialysis facilities, and beneficiary homes when practitioners furnish monthly home dialysis ESRD-related medical evaluations. Independent Renal Dialysis Facilities are not eligible originating sites.
*Authorized originating sites include:
- Offices of a Physician or Practitioner
- Critical Access Hospitals
- Community Mental Health Centers
- Skilled Nursing Facilities
- Rural Health Clinics
- Federally Qualified Health Centers
- Hospital-Based or Critical Access Hospital (CAH)-Based Renal Dialysis Centers (including satellites)
- Renal Dialysis Facilities
- Homes of beneficiaries with End-Stage Renal Disease (ESRD) getting home dialysis
- Mobile Stroke Units
All data on eligibility for Medicare telehealth payments is updated once each year. The results of the analyzer are consistent across the entire calendar year and will be updated on January 1 of the following year. The Medicare Learning Network has a fact sheet on Medicare telehealth services targeted towards Medicare fee-for-service providers.
For questions or clarification on geographic eligibility for Medicare telehealth payments, contact Steven Hirsch at the Federal Office of Rural Health Policy, 301-443-7322.
For more detailed information on Medicare telehealth payments, contact your local Telehealth Resource Center (TRC).