Private Insurance Payments Similar for Telehealth, In-Person Claims

September 28, 2023 - Like in 2020, private insurer payments for telehealth claims were similar to in-person claims in 2021, with payments ranging from $43 to $299 for patient evaluation and management and mental health therapy services, according to a Peterson-KFF Health System Tracker assessment.

The Peterson Center on Healthcare and KFF partnered to create the Peterson-KFF Health System Tracker, which provides information on trends and challenges that impact the performance of the United States healthcare system. For the new assessment, researchers studied Health Care Cost Institute (HCCI) professional claims filed in the 2021 calendar year. They included data on people with employer-sponsored health insurance and physician claims paid as primary coverage.

In 2021, private insurers paid healthcare providers similarly for telehealth and in-person claims for evaluation and management services.

The report notes that evaluation and management claims are the most common for outpatient medical visits and cover the charge for a physician or other clinician to diagnose and treat a patient.

During the study period, about 11 percent of evaluation and management claims, including both physical and behavioral healthcare, were for services delivered via telehealth.

On average, private insurer payment for in-person service claims for evaluation and management of new patients ranged from $94 to $293, according to severity level, compared to $96 to $299 for telehealth service claims. For established patients, average payments ranged from $30 to $214 for in-person evaluation and management service claims and from $29 to $218 for telehealth claims.

In this assessment, about 18 percent of evaluation and management claims for established patients were for services provided via telehealth versus 8 percent of claims for new patients.

Similarly, average payments for mental health therapy claims were similar for in-person and telehealth services in 2021, when more than half of mental health therapy claims (54 percent) were for telehealth-delivered services.

On the lower end of the payment spectrum, the average private insurer payment for in-person group psychotherapy claims was $43 in 2021, compared with $45 for telehealth claims. On the other end of the spectrum, the average payment for psychiatric diagnostic evaluation with medical services was $196 for in-person claims and $195 for telehealth claims.

The assessment further shows that the average paid amount for telehealth claims was within plus or minus 10 percent of in-person claims for the vast majority of healthcare providers offering the same evaluation and management or mental health therapy service in person and through telehealth.  

These 2021 telehealth and in-person claims payment trends are similar to 2020, and if they continue, it may undercut the prediction that telehealth will reduce spending on common health services, according to the researchers.

"Telehealth use surged during the pandemic, but the future of telehealth will be shaped by its effect on total health spending, federal and state regulations relating to scope of practice and reimbursement, and payer coverage and reimbursement policies," they concluded.

Prior research has shown that state laws regulating payment parity for telehealth and in-person services can significantly boost telehealth use.

According to a study published in June, US states with telehealth payment parity laws had a 23 percent higher likelihood of telehealth use among residents compared to states that did not implement these laws. For the study, researchers examined data from 760,474 people who used either video or telephone to engage in telehealth. They gathered the data from the US Census Bureau's Household Pulse Survey.

Currently, 21 states have implemented payment parity laws, eight have payment parity policies in place with caveats, and 21 have no payment parity laws, according to Manatt Health.