US · guidance
CMS Pub. 100-04, ch. 12, § 190.3.5
Payment for Subsequent Hospital Care Services and
Subsequent Nursing Facility Care Services as Telehealth Services
(Rev. 10716; Issued: 04-06-21; Effective: 01-01-21; Implementation: 07-06-21)
Subsequent hospital care services are limited to one telehealth visit every 3 days. The
frequency limit of the benefit is not intended to apply to consulting physicians or
practitioners, who should continue to report initial or follow-up inpatient telehealth
consultations using the applicable HCPCS G-codes.
Similarly, subsequent nursing facility care services are limited to one telehealth visit
every 30 days. Beginning with dates of service on and after January 1, 2021, the limit for
nursing facility care services is one telehealth visit every 14 days. Furthermore,
subsequent nursing facility care services reported for a Federally-mandated periodic visit
under 42 CFR 483.40(c) may not be furnished through telehealth. The frequency limit of
the benefit is not intended to apply to consulting physicians or practitioners, who should
continue to report initial or follow-up inpatient telehealth consultations using the
applicable HCPCS G-codes.
Inpatient telehealth consultations are furnished to beneficiaries in hospitals or skilled
nursing facilities via telehealth at the request of the physician of record, the attending
physician, or another appropriate source. The physician or practitioner who furnishes the
initial inpatient consultation via telehealth cannot be the physician or practitioner of
record or the attending physician or practitioner, and the initial inpatient telehealth
consultation would be distinct from the care provided by the physician or practitioner of
record or the attending physician or practitioner. Counseling and coordination of care
with other providers or agencies is included as well, consistent with the nature of the
problem(s) and the patient’s needs. Initial and follow-up inpatient telehealth
consultations are subject to the criteria for inpatient telehealth consultation services, as
described in section 190.3 of this chapter.
History
(Rev. 10716; Issued: 04-06-21; Effective: 01-01-21; Implementation: 07-06-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
5cbe0384c0f989ad5b92d54d78d18764483fd5b7696b8df7aac33c43c9e3e06a
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