CMS released the Medicare telemedicine coding and reimbursement guidelines for healthcare providers to use during the COVID-19 pandemic (CMS, 2020). According to the CMS Medicare Telemedicine Health Care Provider Fact Sheet, reimbursement for these visits are considered the same as in-person visits and are paid at the same rate (CMS, 2020). The U.S. Department of Health & Human Services Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs (CMS, 2020).
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There are 3 main types of virtual health services physicians and other professionals can provide to Medicare beneficiaries: Medicare Telehealth Visits, Virtual Check-Ins, and E-Visits (CMS, 2020). Providers such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. See more on coding for telemedicine in response to the 1135 Waiver Authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, in our previous article here.
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COVID-19, or “Coronavirus Disease 2019,” is an infectious respiratory disease caused by the newly discovered Coronavirus, SARS-CoV-2, that ranges from mild to no symptoms, to severe symptoms and death (CDC, 2020). As of April 30, there are 3,222,107 confirmed COVID-19 cases worldwide, with 228,757 deaths and 992,592 recoveries (Johns Hopkins Coronavirus Resource Center, 2020). Coronaviruses consist of a large family of viruses that commonly occur in humans and different species of animals, such as bats, cattle, cats, and more (CDC, 2020). Animal coronaviruses may infect and spread among humans in rare occurrences, such as the outbreak of SARS-CoV-2 in Wuhan, Hubei Province, China (CDC, 2020).
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Due to the stay-at-home orders put in effect by state governors and the highly contagious COVID-19 virus, CMS has expanded coverage for its Medicare recipients through the use of telemedicine (CMS, 2020). According to CMS, “The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus” (2020).
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Adapting to the influx of telehealth services in response to the COVID-19 outbreak, CMS has adjusted the “List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth” in order to provide as much support and care as possible (2020). In addition, CMS issued updated criteria for risk adjustment of Medicare telemedicine services, as well as guidelines on how to bill for telemedicine,
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