Teleoptometry & Remote Care

How to Get Reimbursed for Teleoptometry Services: State-by-State Guide

Hitarth, B. Tech Computer Science & Engineering

• July 7, 2026 • 1 min read • 2 views

How to Get Reimbursed for Teleoptometry Services: State-by-State Guide

Teleoptometry reimbursement is one of the most rapidly evolving areas of eye care practice management. Since 2020, Congress, CMS, and state legislatures have passed a wave of telehealth-related legislation that expanded coverage, established parity requirements, and created new billing pathways for remote eye care services. In 2026, the reimbursement landscape is more favorable than it has ever been — but also more complex. This guide explains the key reimbursement rules, billing codes, and state-by-state considerations that every optometrist offering telehealth needs to understand.

Medicare Teleoptometry Coverage in 2026

Medicare coverage for telehealth services has been significantly expanded from pre-2020 rules. Key points for optometrists in 2026:

Medicare covers many eye care telehealth services delivered via two-way, real-time audio-video communication when the patient is at home or at an originating site (clinic, federally qualified health center, rural health clinic).
Store-and-forward (asynchronous) telehealth is covered by Medicare only in Alaska and Hawaii under current rules.
The patient must be an established Medicare patient for most telehealth services. New patient telehealth encounters have more restrictive rules.
Audio-only (telephone-only) telehealth coverage for Medicare was extended through the end of 2024 but requires Congressional action to continue in 2025-2026. Confirm current status with CMS before billing audio-only visits.
The place of service code for telehealth from a patient's home is POS 10 (telehealth, patient in home). Use POS 02 for telehealth when the patient is at a healthcare facility.

Commercial Insurance Telehealth Parity Laws

As of 2026, 46 states and the District of Columbia have enacted telehealth parity laws requiring commercial insurers to cover telehealth services at the same rate as in-person services. The four states without comprehensive parity laws (subject to legislative change) have varying partial coverage requirements. Parity means both coverage parity (the service must be covered if it is covered in person) and payment parity (it must be reimbursed at the same rate as an in-person visit).

However, parity laws do not mandate coverage of every telehealth modality. Most state parity laws apply to synchronous audio-video telehealth. Store-and-forward coverage under commercial insurance varies significantly by state and payer.

Billing Codes for Teleoptometry Services

Established Patient Telehealth Visits:

99212-99215 — E&M office visits (established patient) used for telehealth follow-up visits with appropriate GT or 95 modifier.
92012, 92014 — Eye exam codes for established patients are telehealth-eligible under most payer policies with appropriate modifier.

Modifiers for Telehealth Claims:

Modifier GT — Via interactive audio and video telecommunications systems (used for Medicare)
Modifier 95 — Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system (used for commercial insurance)
Modifier CR — Catastrophe/disaster-related (used during PHE waivers — confirm whether still applicable)

Remote Patient Monitoring:

99453 — Remote monitoring of physiologic parameters, initial setup and patient education
99454 — Device supply with daily recording(s) or programmed alert(s) transmission
These codes are relevant for glaucoma monitoring programs using home IOP devices

State-by-State Highlights for Optometrists

California: Strong parity law covering audio-video telehealth. Medi-Cal (California Medicaid) covers telehealth broadly including store-and-forward. Contact lens Rx via telehealth is generally not permitted for new patients.

Texas: Parity law in place. Texas Medicaid covers telehealth with standard modifiers. The Texas Optometry Act specifically addresses telehealth scope of practice — review the TOB guidance before launching a teleoptometry program.

Florida: Parity law in place. Medicaid covers telehealth. Strong adoption of teleoptometry for diabetic eye exam programs in FQHC settings.

New York: Comprehensive parity law. Commercial insurers must cover and reimburse telehealth at parity with in-person services. Strong Medicaid telehealth coverage.

Documentation Requirements for Teleoptometry Billing

Telehealth claims require the same clinical documentation as in-person visits — the modality of delivery does not reduce documentation requirements. Additionally, document: the technology platform used, that the patient provided verbal consent to the telehealth visit, the patient's physical location at the time of service, and that you verified the patient's identity. These four elements address the most common audit triggers for telehealth claims and should be a standard part of your telehealth encounter template.

Frequently Asked Questions

Yes. Optometry licensure is state-specific. To treat a patient via telehealth, you must generally be licensed in the state where the patient is physically located at the time of the visit — not where your practice is located. Seventeen states have enacted optometry telehealth interstate practice provisions or have joined the Optometry Interstate Compact (OIC) as of 2026, which simplifies multi-state telehealth practice. Verify the licensure requirements for every state where you plan to offer telehealth services.

Medicare requires that telehealth services be delivered via an interactive, real-time audio and video communication system. The platform must be HIPAA-compliant (with a signed BAA from the vendor). CMS maintains a list of acceptable telehealth technologies. Consumer platforms without a BAA — including standard FaceTime and Zoom without a healthcare plan — are not compliant for Medicare telehealth, though CMS issued enforcement discretion guidance during the COVID PHE that may have expired.

Facility fees for telehealth are a complex area. When you bill using POS 02 (telehealth, provider at a facility), some facility fee billing may apply. When using POS 10 (patient at home), facility fee billing is generally not applicable. Check with a healthcare billing attorney or your state optometry association for guidance specific to your practice setting.

Store-and-forward (asynchronous) teleoptometry involves capturing clinical images or data at one time and transmitting them for review by a clinician at a later time — without a live synchronous session. Common applications in optometry include diabetic retinal screening programs and anterior segment disease review. Medicare currently covers store-and-forward only in Alaska and Hawaii. Commercial payer coverage varies by state parity law and individual payer policy. Several state Medicaid programs (including California and Arizona) cover store-and-forward for defined services.