Table 5.

Comparison of CMS Telehealth Regulatory Requirements Before and After the COVID-19 Emergency Declaration¹⁷

Requirement	Before Declaration	After Declaration
HIPAA-compliant communication technology	Required	DHHS and OCR will exercise enforcement discretion regarding HIPAA violations made by providers during “good faith” attempts to provide patient care during the COVID-19 pandemic, when use of a non–HIPAA compliant IT platform is necessary.16
Eligible patients	Limited telehealth visits to patients whom the provider had seen within the previous 3 years	DHHS exercises enforcement discretion regarding an established relationship with a particular practitioner; DHHS will not conduct audits to ensure that such a prior relationship existed.20
Reimbursement rate parity with in-person visits	No	Yes
Originating site restrictions	Patients eligible if they lived in a rural location, were in a designated healthcare facility, and were not within a metropolitan region	Originating site restrictions waived
Interstate practice	Providers allowed to provide telemedicine services only for patients who were currently within a state or jurisdiction where the provider holds an active license	Waiver of interstate licensure restrictions allow states to determine qualifications for providers in other states to provide care for patients across state lines
Flexibility for reduction or waiver of co-insurance/deductible	No	Yes; DHHS allows flexibility for providers to reduce or waive co-insurance or deductibles for federal healthcare programs
POS code	02 (Telehealth)	CMS suggests a POS code of 11 during the COVID-19 public health emergency for telemedicine encounters to indicate that the patient would normally have been seen in the office; other payors may still prefer a POS code of 02 for telehealth services
Duration of regulations	Re-evaluated on yearly CMS final rule	Expires at the retirement of the public health emergency declaration

CMS = Centers for Medicare & Medicaid Services; DHHS = Department of Health and Human Services; OCR = Office of Civil Rights; POS = place of service