Telehealth requirements change across programs, payers, locations, provider types, services, and dates of service. Build a verification checklist around the patient’s actual coverage and the rules in effect on the service date.
Questions for the workflow
- Is the service covered through the planned technology and communication method?
- Do patient and practitioner locations affect eligibility, licensure, or reporting?
- Are provider type, enrollment, consent, supervision, or documentation requirements satisfied?
- Which codes, modifiers, and place-of-service values apply for this payer and date?
- Does the plan require authorization, cost-sharing disclosure, or another notice?
- Can the record support the duration, modality, participants, and clinical work reported?
Keep dated evidence
Save or reference the payer source used for the decision, including its effective date. When guidance changes, document which version governed the encounter rather than silently replacing the older rule in your internal procedure.
Primary references: Use current guidance from Telehealth.HHS.gov, the CMS Medicare telehealth page, and the patient’s specific payer.
