Medicare Telehealth Services Now Included In Expanded Payment Protocol

Medicare Telehealth Services Now Included In Expanded Payment Protocol


The Centers for Medicare & Medicaid Services (CMS) has decided Medicare will expand its payment protocol for professional Medicare telehealth services provided to beneficiaries in all areas of the country, in all settings. “Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health” (CMS, 2020). Due to the current Public Health Emergency (PHE) declared for 2019 Novel Coronavirus (COVID-19), this expansion was considered a necessary step to assist in healthcare reimbursement and only designed to last as long as this emergency.

The White House task force, in coordination with CMS and the HHS Office of Inspector General (OIG), invoked the 1135 Waiver, which allows modifications to Medicare, Medicaid, and Children’s Health Insurance Program (CHIP), under section 1135 of the Social Security Act (CMS, 2020). The growth of telehealth use under the 1135 Waiver authority will now allow flexibility for Medicare to pay for office, hospital, and other visits that were previously prohibited.

Types of Medicare Telehealth Services

Preventative efforts to contain the community spread of the virus and limit the exposure to other patients and staff members will slow viral spread (CMS, 2020). Increasing the use of technology is being used as a measure of safety. One type of this service is a Telehealth Visit, where the provider uses “an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home” (CMS, 2020). Remote site practitioners “can include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutritional professionals” (CMS, 2020).

medicare telehealth servicesAnother remote service is “Virtual Check-In,” which is a brief communication technology-based service (CMS, 2020). This service is no longer limited to just rural areas but can still only be reported when the billing practice has an established relationship with the patient. Two HCPCS codes capture these services, either by telephone (G2012) or recorded video and/or images submitted by the patient (G2010).

E-Visits are the third type of telehealth service, which is non-face-to-face patient-initiated communications with their doctors by using online patient portals. As with “Virtual Check-In,” the patient must be established, and there are no restrictions for location. “The patient must generate the initial inquiry, and communications can occur over 7 days. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063,” divided by 5-10-minute, 11-20-minute, and 21- or more minute increments (CMS, 2020). These CPT codes may be billed by physicians and nurse practitioners, while non-physician healthcare professionals bill the HCPCS codes. These include physical/occupational therapists, speech pathologists, and clinical psychologists.

Stay tuned for our next article providing in-depth knowledge of the coding and billing guidelines for Medicare telehealth services. Review our previous articles on the CMS telemedicine updates in the times of COVID-19, which discuss coding in response to the 1135 waiver, virtual services and telemedicine providers, and the Medicare telemedicine reimbursement guidelines, on the YES Blog.

Patients must verbally consent to these services to receive the benefits of telemedicine. Although these services should be provided to existing patients, there will be no audits conducted during the PHE to determine if a patient is new or existing. Due to invocation of the 1135 waiver, Medicare will now allow payment on these expanded telehealth services. This also permits flexibility for healthcare providers to reduce or waive cost-sharing paid by federal healthcare programs.

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