Characterizing Telehealth Utilization from Administrative Claims in the US Using a Standardized Definition


Avula R1, Grabner M2, Eshete B3, Stanek E4, Willey V2
1HealthCore, Inc., Celina, TX, USA, 2HealthCore, Inc., Wilmington, DE, USA, 3HealthCore, Inc., Philadelphia, PA, USA, 4Anthem, Inc., Indianapolis, IN, USA

OBJECTIVES: In response to the disruption of in-person healthcare visits during the Covid-19 pandemic in the US, public and private payers expanded their coverage and reimbursement for telehealth (TH) services starting March 2020. To account for this new driver of healthcare resource utilization, we created a standardized definition of TH utilization from administrative claims to improve research quality. We used this definition to investigate trends in TH utilization in a large US commercially insured/Medicare Advantage/Supplement population.

METHODS: Administrative claims from 1/1/2006 to 8/31/2021 from the HealthCore Integrated Research Database® were used to identify TH claims. We defined TH based on outpatient claims containing at least one of the following TH designations (not mutually exclusive): place of service codes, CPT codes, CPT modifiers, and certain Tax IDs from known telehealth providers. Coding patterns and TH utilization over time were evaluated. All analyses were descriptive.

RESULTS: Over the 15-year period, 57% of TH claims occurred in 2020 and an additional 39% in 2021 (through August). In 2019/2020/2021, the share of outpatient claims designated as TH was 0.1%/4.8%/4.4%. Utilization was slightly higher among commercially-insured compared to Medicare Advantage/Supplement patients (5.0% vs. 3.9% in 2020). Most TH use was identified via CPT modifier codes (80%), followed by place of service codes (53%). Evaluation & management visits and specialist physician services each accounted for approximately 45% of all TH claims. Approximately 8% of TH claims were for audio-only visits based on submitted codes.

CONCLUSIONS: We created a standardized algorithm to identify TH using claims data. Consistent with prior reports, TH utilization increased substantially following onset of the Covid-19 pandemic in conjunction with increased coverage and reimbursement for the service. Incorporation of TH utilization via this algorithm is an essential tool for all health economic and outcomes research studies evaluating time periods from 2020 and beyond.

Conference/Value in Health Info

2022-05, ISPOR 2022, Washington, DC, USA

Value in Health, Volume 25, Issue 6, S1 (June 2022)




Real World Data & Information Systems, Study Approaches

Topic Subcategory

Data Protection, Integrity, & Quality Assurance, Reproducibility & Replicability


No Additional Disease & Conditions/Specialized Treatment Areas

Your browser is out-of-date

ISPOR recommends that you update your browser for more security, speed and the best experience on Update my browser now