Billing & Reimbursement

Telehealth Coverage Policies

Different payers each have their own set of medical coverage policies. A medical coverage policy outlines what services, procedures, and technologies the insurer considers medically necessary and therefore eligible for reimbursement. Coverage policies are regularly updated to reflect new clinical evidence, regulatory changes, and evolving standards of care.

Medical coverage policies may not apply uniformly to all providers. Organizations that have direct contracts or negotiated agreements with the insurer could have different terms, such as expanded or restricted coverage, unique payment structures, or alternative authorization requirements. In these cases, the direct contract overrides the standard medical policy. Providers should always review their contract language and verify how coverage criteria apply within their specific agreement.

• Center for Connected Health Policy (CCHP) provides up-to-date info on Federal and State policies
• CMS List of Covered Medicare Telehealth Services
• BCBSSC’s Telemedicine and Telehealth Policies (CAM176 and CAM032 – accept Disclaimer and search for policy under ‘T’)
• UnitedHealthcare Telehealth/Virtual Health Policy (PDF)
• SC Department of Health and Human Services 2024-2025 Telehealth Proviso Report including details on telehealth flexibilities being made permanent
• SC Department of Health and Human Services (SC Medicaid) Physicians Services Provider Manual
• The Medical University of South Carolina maintains a “South Carolina Virtual Care Coverage” document which outlines telehealth-related CPT codes and their coverage status by each SC payer. Information in this document may frequently change and will be updated accordingly as payer policies adjust. South Carolina Virtual Care Coverage Document (updated as of January 7, 2026)

SCTA Payer Priorities and Scorecard

The SCTA Sustainability Workgroup has outlined some key telehealth coverage and reimbursement recommendations for payers to enhance sustainability of telehealth programs in SC:

• Expand provider types to include behavioral health, rehabilitative therapies (PT/OT/SLP), and audiology
• Cover and reimburse for asynchronous and non-face-to-face telehealth modalities including:
  • Remote Physiologic Monitoring and Remote Therapeutic Monitoring
  • Interprofessional Consultations (eConsult)
  • Store-and-Forward
  • Collaborative Care Behavioral Health Integration (CoCM)
  • Virtual Check-Ins and Audio-Only Telehealth
• Continue to allow FQHCs and RHCs serve as distant sites for telehealth

Download the Payer Scorecard (PDF) for more details.

Billing Education

Telehealth Billing Module

Overview: Stay up to date on the evolving landscape of telehealth reimbursement. Designed for healthcare professionals across South Carolina, this course covers federal, state, and private payer billing policies, including documentation requirements and key regulations under the SC Telehealth & Telemedicine Modernization Act.
Modality: Online Module
Length: 45 minutes
Developing Organization: SC AHEC
Credits Available: 0.75 CEUs
Access the module ➜