14 min read
Medicare pays for store-and-forward telehealth in two states, and only through federal pilot programs there. A rash photo reviewed in Ohio brings in nothing under that pathway. The same work draws payment from 40 state Medicaid plans.
That gap has nothing to do with medicine. It comes down to which word applies.
State statutes, medical boards, and payers hang their rules on the split between telehealth and telemedicine.
Telemedicine covers remote clinical care: diagnosis, treatment, monitoring. Telehealth covers all of that plus provider training, staff meetings, patient portals, and public health work.
HRSA draws that line. CMS, the AMA, and AHRQ treat the two words as swappable. A payer policy may not match the definition you learned in training.
The consequences land in three places. Prescribing rules in many states call for live video before a first script. DEA flexibilities for controlled drugs run out December 31, 2026.
Billing splits across four delivery modes, each with its own code family and coverage rules. Licensing follows your patient's location during the visit, not your office address.
Texas, Michigan, and Georgia each draw the boundary somewhere different. Texas divides by who delivers care. Michigan folds telemedicine inside telehealth. Georgia sorts by how care reaches the patient.
Store-and-forward counts in Georgia, while audio-only sits in a narrow lane. Georgia's Medicaid policy also runs tighter than its own statute, and that mismatch catches practices that read only the law.
What follows covers the definitions, the four delivery modes, those three states, and the deadlines coming in the next two years.
Telemedicine is the narrow half of the telehealth vs telemedicine pairing. It covers clinical care delivered to a patient who isn't physically in your office. Video visits count. So does a phone call where a clinician reviews symptoms and adjusts a prescription, depending on what your state allows.
Purpose is what sets the boundary. If the encounter exists to diagnose a condition, start or change treatment, or track how a patient is doing, it sits inside telemedicine. A dermatologist reading a photo of a rash is practicing it. A nurse practitioner running a post-op follow-up over video is too.
The working answer to what is telemedicine fits in one question your front desk can ask: does this encounter change the patient's care plan? When the answer is yes, the licensing, prescribing, and documentation rules that apply in your exam room apply here as well.
Remote care is about a century older than the internet. On November 29, 1879, an anonymous writer in The Lancet described a midnight phone call from a worried mother. She thought her baby's cough was croup. The doctor had her hold the child up to the receiver, listened, and ruled croup out.
Nobody left the house that night. The call still ran the same steps a video visit runs today. A symptom gets reported, a clinician assesses it from a distance, and a decision follows.
Television carried the idea further. The Nebraska Psychiatric Institute in Omaha linked to Norfolk State Hospital in 1959, using two-way closed-circuit television across 112 miles. Psychiatrists ran group therapy and consultations over that link, and medical students trained on it.
Massachusetts General Hospital set up a similar link in 1968. It reached a health station at Logan Airport just 2.7 miles away, where heavy Boston traffic made the trip slow. Broadband and smartphones arrived much later and put that same setup within reach of a two-provider clinic.
Every telemedicine service ties back to one patient's health. If a task doesn't touch diagnosis, treatment, or monitoring, it falls outside telemedicine and lands elsewhere under telehealth.
Four functions cover most of what a practice delivers and bills as telemedicine.
| Function | What Happens | What It Looks Like |
|---|---|---|
| Virtual consultation | Real-time video or phone call with a physician, specialist, or nurse practitioner to discuss symptoms, review history, and reach a diagnosis | A parent reaches a pediatrician at 2 AM about a child's high fever |
| Remote diagnosis | Transmitted images or live video exams used to identify a condition | A dermatologist reviews high-resolution photos of a mole sent through a secure portal to screen for skin cancer |
| Treatment and prescribing | A treatment plan built from a virtual visit, with medications prescribed where the law allows | A psychiatrist runs a therapy session and manages medication for a patient with depression over live video |
| Follow-up care | Recovery checks after a procedure, or ongoing management of a chronic condition | A patient in a rural area sees a neurologist in a major city by video to manage Parkinson's disease |
Prescribing is where the rules turn local. Some states want live video before a first prescription, so a phone call won't clear the bar. Your state medical board sets that line, not the platform you use.
Telehealth is the wider of the two terms. Telemedicine sits inside it.
HRSA is the agency inside the Department of Health and Human Services that draws the line. Its definition of telehealth spans five areas:
Remote clinical care
Patient education
Staff education
Health administration
Public health
Only the first one treats a patient.
The short answer to what is telehealth: any use of technology that supports health care, clinical or not. Provider training counts. So do staff meetings held over video and continuing medical education.
One caveat matters for billing. CMS, the AMA, and AHRQ use telehealth and telemedicine as swappable words. A payer policy may not honor the split HRSA draws. Read the definition in the document in front of you.
The gap between telehealth and telemedicine shows up in five non-clinical areas. Four of them never generate a patient claim. One does, and that is where practices get tripped up.
A primary care doctor sits in on a live webinar run by a cardiologist. Heart failure protocols are the topic. No patient is involved, no chart gets opened, and no claim goes out.
Medical schools run virtual grand rounds the same way. A case gets presented from one campus, and clinicians anywhere can join the room.
State medical boards require CME hours before they renew a license. Accredited live webinars can carry the same credit as a course you would fly to. For a two-provider clinic, remote credit keeps the schedule open while a doctor earns hours.
A rural GP sends a patient's EKG and case files through a store-and-forward system. A cardiologist reads them and sends back a written opinion. Your patient never leaves town and never books a specialist visit.
This one carries a billing wrinkle worth knowing. CMS pays for six interprofessional consult codes, running from 99446 through 99452. Tight rules come with them:
Surgeons at two hospitals talking through a hard case over secure video sit in the same bucket. Their work is clinical thinking, and the patient is not in the room.
Budget and staffing meetings for a hospital system happen remotely. So do credentialing reviews, quality committee calls, and vendor demos. None of it reaches a patient, and all of it counts.
Multi-site groups lean on this hardest. A three-location practice can run one morning huddle over video instead of three separate ones. Billing staff can work a claims queue from home and stay in the same system as the front desk.
Technology overlaps with clinical telemedicine almost completely here. Same video tool, same secure messaging, same login. What changes is who joins the call and whether a chart is open.
Patients pull lab results, read up on their condition, and book the next visit from a phone app. Someone newly diagnosed with diabetes might work through an online module a nurse assigned. Nobody bills for any of it.
Portal traffic blurs the line when a message turns clinical. A patient asks whether to stop a medication, and a clinician answers. That exchange can qualify as an online digital evaluation and management service.
Health agencies track outbreaks, push out alerts, and run large vaccine drives. All of that runs on the same technology HRSA names in its definition of telehealth.
Practices feed the system whether or not they think about it. Immunization data flows to a state registry. Reportable conditions go to a health department. Surveillance data leaves the EHR on a schedule your vendor set up during implementation.
A health system can also pull remote monitoring data from thousands of patients. Each reading is telemedicine on its own. Rolled together into a population view, that same data becomes public health work with no single chart attached.
Seven differences separate the two terms once you get past the definitions. Keep this table handy for payer calls and policy reviews, where the wrong word costs you a claim.
| Distinction | Telemedicine | Telehealth |
|---|---|---|
| Scope | Remote diagnosis, treatment, and monitoring | Everything telemedicine covers, plus education, administration, and public health |
| Primary goal | Change one patient's health status | Support the wider health system and community health |
| Services | Virtual visits, e-prescribing, remote diagnosis | CME, provider consults, admin meetings, patient portals |
| Who uses it | Licensed clinical staff treating patients: doctors, NPs, PAs | Clinicians, administrators, educators, patients, public health officials |
| Core question | Can you treat this patient remotely? | Can technology improve this health-related process? |
| Real-world analogy | A cardiologist reads an EKG sent from a rural clinic | The setup around that read: the secure link, the training that certified the reader, the dashboard tracking turnaround |
| Regulatory focus | Patient-provider relationship, prescribing rules, standard of care | Data privacy under HIPAA, technology standards, reimbursement across a wider service set |
The Center for Connected Health Policy sorts telehealth into four delivery modes. CCHP is a nonprofit policy group run under the Public Health Institute. States lean on its work when they write their own rules.
Live video, store-and-forward, remote patient monitoring, and mobile health make up the four.
One wrinkle is worth flagging first. When CCHP tracks what state Medicaid plans pay for, audio-only takes the place of mobile health. Its Fall 2025 report counts 32 state plans that cover all four.
Some states also write words like live or interactive into the telehealth definition. That wording pushes store-and-forward and remote monitoring outside the term, and outside payment.
Live video means a real-time, two-way audio and video link between a patient and a provider. Most people picture this when they hear telemedicine. Urgent care visits, primary care check-ups, specialist consults, and talk therapy all run on it.
The comparison to FaceTime or Zoom needs a caveat. During the pandemic, OCR let providers use consumer apps with no signed business associate agreement. That grace period ended on August 9, 2023.
Standard consumer Zoom, Skype, and FaceTime no longer clear the bar. A vendor that will not sign a BAA leaves you exposed in an audit.
Live video also carries weight the other three modes do not. Many states require it to start the patient-provider relationship before a first script.
DEA rules now let a doctor prescribe Schedule II through V controlled drugs by video with no in-person exam first. That window shuts December 31, 2026, and permanent rules are due before then.
Store-and-forward collects clinical data and sends it on for review later. Nobody is on a call together.
Four steps, every time:
A primary care provider gets an expert read without the patient booking a second visit. Time zones stop mattering.
Payment is where store-and-forward gets thin. Medicare covers it only through federal pilot programs in Alaska and Hawaii, under 42 CFR 410.78.
Claims from those programs carry the GQ modifier. Everywhere else, Medicare pays nothing for a pure store-and-forward case.
State Medicaid is friendlier. 40 state Medicaid plans pay for store-and-forward, per CCHP's Fall 2025 report. Check yours before you build a workflow around it.
RPM sends health data from a patient's home to their care team. A connected blood pressure cuff, glucose meter, smart scale, or wearable sensor takes the reading and passes it along.
High blood pressure, diabetes, and heart failure are the common targets. Post-surgical patients get watched for early signs of trouble.
Billing runs on thresholds, not visits. CMS added two codes for 2026 that loosened the old rules.
| Code | Covers | Threshold |
|---|---|---|
| 99453 | Device setup and patient education | Once per episode of care |
| 99445 | Device supply and data transfer | 2 to 15 days in 30 |
| 99454 | Device supply and data transfer | 16 or more days in 30 |
| 99470 | Treatment management time | First 10 to 19 minutes a month |
| 99457 | Treatment management time | First 20 minutes a month |
| 99458 | Extra management time | Each added 20 minutes |
Two rules trip people up. 99445 and 99454 cannot both be billed in the same 30-day window. Neither can 99470 and 99457 share a month. Readings also have to transmit digitally, so a patient texting you a number does not count.
mHealth is care and health information delivered through a phone or tablet. Reminder texts, medication apps, diet and exercise trackers, patient portals, and health education all sit here.
mHealth reaches patients more often than the other three modes. It also rarely bills as a service of its own. When CCHP tracks what state Medicaid plans cover, audio-only takes mHealth's spot on the list.
Reminder texts carry a rule worth knowing. The FCC lets HIPAA-covered providers send treatment-related texts without prior express written consent. That exemption is narrow:
Add one marketing line to a reminder text and you fall outside it. TCPA damages start at $500 per message and reach $1,500 if a court finds the violation willful.
State law controls five things:
Which state applies depends on where your patient sits during the visit, not where you sit. Rules come from that state's medical board and Medicaid agency.
Three states show how far the definitions can drift apart.
| Texas | Michigan | Georgia | |
|---|---|---|---|
| Governing split | Two terms, divided by who delivers care | One term, with telemedicine nested inside | One term, with telemedicine sorted by delivery method |
| Telemedicine | Delivered by a Texas-licensed physician, or under that physician's delegation | Defined by cross-reference to MCL 500.3476 | A form of telehealth, including secure video and store-and-forward |
| Telehealth | Any other service by a Texas-licensed clinician in scope | Clinical care, education, public health, health administration | The broader term, covering non-clinical use |
| Watch for | Teledentistry is now its own category | Prescribing follows the prescriber's license | Statute and Medicaid policy don't match |
Texas splits the two terms by who gives the care.
A telemedicine medical service comes from a Texas-licensed doctor. It can also come from a clinician working under that doctor's delegation and supervision. A telehealth service is anything else, done by a Texas-licensed clinician within their own scope.
The chapter has grown since that split was written. Occupations Code Chapter 111 now reads Telemedicine, Teledentistry, and Telehealth. Teledentistry is carved out on its own.
Michigan runs everything through one word. MCL 333.16283 defines telehealth as tech used to support long-distance care, teaching, public health, or health admin.
Telemedicine survives inside that wording. The statute says telehealth may include telemedicine. It then points to the Insurance Code at MCL 500.3476 for what telemedicine means.
Prescribing follows the prescriber, not the label on the service. Under MCL 333.16285, a clinician doing telehealth may prescribe if they count as a prescriber and stay in scope. Michigan counts dentists, podiatrists, optometrists, PAs, and advanced practice nurses.
Georgia defines telemedicine as a form of telehealth. It then sorts the term by how care reaches the patient. The insurance code covers real-time two-way audio, visual, or other electronic contact. It names secure video and store-and-forward transfer as included methods.
Audio-only sits in a narrow lane. It counts only when video is unavailable, broadband is lacking, or video is impractical or unwise. The treating provider makes that call.
Georgia Medicaid runs tighter than the statute. Its guidance calls for two-way real-time gear. Phone calls and store-and-forward are not allowed for billable therapy work.
| Texas, Michigan, and Georgia are three rule sets out of more than fifty. Yours may draw the line somewhere none of these three would predict. We keep a state-by-state guide to telemedicine policies and regulations. Check your own before you build a workflow on a definition. |
Remote care stopped being an experiment. Four shifts are worth tracking, and each one already has a date on it.
AI reached the clinic through imaging. The FDA's list of authorized AI-enabled devices hit 1,524 through March 2026.
Radiology tools account for 1,164 of them, about 76% of everything on the list. GE HealthCare holds the most authorizations at 130, followed by Siemens at 95 and Philips at 58.
Growth is speeding up. The agency cleared 92 AI devices in the first quarter of 2026 alone, 28% more than the quarter before.
The evidence base has not kept pace. One review of 691 cleared devices found 1.6% cited randomized trial data. Under 1% reported actual patient outcomes. Another 5.8% were recalled, mostly for software defects.
Clearance also says nothing about payment. A cleared tool may still have no billing code attached to it. And as of March 2026, no authorized device runs on generative AI or a large language model.
CMS spent 2026 rebuilding the RPM code set around shorter episodes. Two codes joined the list on January 1.
99445 covers device supply when a patient sends 2 to 15 days of data in 30. It pays at the same rate as 99454, the 16-day code, at roughly $47 nationally. 99470 covers the first 10 to 19 minutes of management time each month, at roughly $26.
Both codes exist because the old floors locked practices out. A post-discharge patient monitored for nine days used to produce nothing billable. Neither did a month where a nurse spent 14 minutes on the chart.
Two constraints came with the flexibility. 99445 and 99454 cannot share a 30-day window, and 99470 and 99457 cannot share a month. Readings still have to transmit digitally, so a number a patient reads aloud over the phone does not count.
A single chronic patient now moves through several rule books in one month. An office visit, video check-ins, home readings, and a specialist curbside all sit under different codes and different consent rules.
| Leg of care | Code family | Consent rule |
|---|---|---|
| Video visit | Telehealth E/M | Informed consent, per state statute |
| Home readings | 99453, 99445, 99454, 99457, 99470, 99458 | Patient consent, digital transfer required |
| Specialist curbside | 99446 through 99452 | Documented patient consent before the consult |
| Reminder texts | Not billable | FCC treatment exemption, opt-out in every message |
Consent is where practices get caught. Each leg carries its own rule, and none of them inherit from the visit before it.
Texas now names teledentistry in its own statute, alongside telemedicine and telehealth. Chapter 111 covers three categories where it once covered two.
Medicare's therapy coverage has a harder edge. Congress extended telehealth for physical therapists, occupational therapists, speech-language pathologists, and audiologists through December 31, 2027.
The Consolidated Appropriations Act 2026 was signed on February 3. That was a two-year extension, not a permanent fix.
On January 1, 2028, those four groups lose the ability to bill Medicare for telehealth unless Congress acts again. Behavioral health sits on firmer ground, with the in-person requirement for home-based telehealth delayed until at least January 1, 2028.
The words telehealth and telemedicine matter because other people's rules attach to them. Your state board decides which one lets you prescribe. Your payer decides which one gets paid. HRSA's definition settles neither question.
So the setup matters more than the vocabulary. A practice running video visits, home readings, and reminder texts works under three rule sets at once. Each carries its own consent requirement and its own code family.
Curogram handles the communication layer under all of it. Our platform connects with the EHR systems practices already run, so a virtual visit does not mean typing the same thing twice.
Two-way SMS carries the parts patients touch: reminders, intake forms, and the link that starts a visit.
Based on our internal data, Curogram clients average a confirmation rate above 75%. Atlas Medical Center cut no-shows from 14.20% to 4.91% in three months. Across our client base, no-show rates run 53% below the industry average.
Waiting room tools mirror the check-in and checkout your front desk already does. The virtual side needs no separate process for staff to learn.
Recall messaging picks up patients who fall off the schedule. At one multi-location practice, 35% of patients who got an SMS recall booked within a month. Recalls alone brought back 1,240 patients.
Deadlines in this article are close. DEA prescribing flexibilities end December 31, 2026. Medicare therapy telehealth ends December 31, 2027. Whatever your state calls the service, your workflow has to hold when the rules move.
Schedule a demo with our team and see how Curogram fits the workflow you already run.
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