Requests for adding services to the list of Medicare telehealth services are assigned by CMS to one of the following categories:

• Category #1: Services similar to office and other outpatient visits, consultation, and office psychiatry services.
  • Category 1 services are reviewed to ensure that the services proposed for addition to the list of Medicare telehealth services are similar to the services listed above. For example, in reviewing these requests for addition, we look for similarities between the proposed and existing telehealth services in terms of the roles of, and interactions among, the beneficiary, the physician (or other practitioner) at the distant site and, if necessary, the telepresenter. We also look for similarities in the telecommunications system used to deliver the proposed service, for example, the use of interactive audio and video equipment. If a proposed service meets the criteria set forth above, we would add it to the list of Medicare telehealth services.

• Category #2: Services that are not similar to an office or other outpatient visit, or office psychiatry services, for example, physical therapy services, endoscopy services, and distant monitoring of patients in intensive care units.
  • Our review of these requests includes an assessment of whether the use of a telecommunications system to deliver the service produces similar diagnostic findings or therapeutic interventions as compared with a face-to-face "hands on" delivery of the same service. In other words, the discrete outcome of the interaction between the clinician and patient facilitated by a telecommunications system should correlate well with the discrete outcome of the clinician-patient interaction when performed face to face. Requestors must submit evidence indicating that the use of a telecommunications system does not affect the diagnosis or treatment plan as compared to a face-to-face delivery of the service.
  • If the evidence shows that the proposed telehealth service is equivalent to the face to face delivery of the service, we would add it to the list of telehealth services. However, if we determine that the use of a telecommunications system changes the nature or outcome of the service, for example, the nature of clinical intervention, as compared with the face-to-face delivery of the service, we would view the request as a new service, rather than a different method of delivering an existing Medicare service.
  • Under Medicare, new services: (1) Must fall into a benefit category; (2) must be reasonable and necessary in accordance with section 1862(a)(1)(A) of the Act; and (3) must not be specifically excluded from coverage. As with any service, the requestor has the option of applying for a national coverage determination. Information on applying for a national coverage determination may be found on our website at http://www.cms.hhs.gov; then select "Coverage," under the topics heading, then "Process."

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