Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: March 05, 2012

Each request for adding a service to the list of Medicare telehealth services must address the items outlined below.

• Contact information of the requestor. Name, Title, Organization, Email, Phone, Co-signers should include the same. We encourage collaborative submissions.
• The HCPCS code(s) that describes the service(s) proposed for addition or deletion to the list of Medicare telehealth services. 
• A description of the type(s) of medical professional(s) providing the telehealth service at the distant site.
• A detailed discussion of the reasons the proposed service should be added to the definition of Medicare telehealth.
• An explanation as to why the requested service cannot be billed under the current scope of telehealth services, for example, the reason why the HCPCS codes currently on the list of Medicare telehealth services would not be appropriate for billing the service requested.
• Evidence that supports adding the service(s) to the list on either a permanent or provisional basis as explained in the section labeled “CMS Review Criteria.”

Requests are due to the CMS Telehealh Review Process mailbox no later than February 10, to be considered for the current cycle of annual notice and comment rulemaking.

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