CMS Increases List of Payable Medicare Telemedicine Services

CMS Increases List of Payable Medicare Telemedicine Services


Adapting to the influx of telemedicine 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 telehealth services, as well as guidelines on how to bill for telemedicine, which were outlined in our previous article.

Telehealth visits jumped 50% in March 2020, reveals Frost and Sullivan consultants (CNBC, 2020). According to The Medical Futurist, appointments on the telehealth provider app PlushCare have increased by 70% since the COVID-19 outbreak, and usage of Amwell’s telemedicine app in the United States has gone up 158% since January (2020). Forrester’s report “Predictions 2020: Healthcare” forecasts that COVID-19 cases will contribute 900 million virtual visits in 2020 (CNBC, 2020).

The following chart of telemedicine CPT codes 2020 are temporarily payable under the MPFS per CMS during the public health emergency for the COVID-19 pandemic [Updated July 2020].

“When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the PHE, bill with:Per Medicare, please keep the following in mind (CMS, 2020):

  • Place of Service (POS) equal to what it would have been had the service been furnished inperson
  • Modifier 95, indicating that the service rendered was actually performed via telehealth”

All eligible telehealth CPT 2020 codes per CMS can be found here. Please consult payers for individual payer guidelines regarding eligible CPT codes and modifier/POS requirements.

For continuous updates on how to code and bill telehealth services in relation to COVID-19, stay tuned to our YES Blog.

Vanessa Youmans

Vanessa Youmans, MA, CCS, CPC – Director OP/Profee Coding & Auditing

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