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), CMS considered this expansion a necessary step to assist in healthcare reimbursement. The agency designed this policy to only 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. This allows modifications to Medicare, Medicaid, and Children’s Health Insurance Program (CHIP); the task force is doing this 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. This means Medicare can pay for office, hospital, and other visits that they previously prohibited.

Changes to 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). Public health authorities are increasing the use of technology as a measure of safety.

Types of Telehealth Visits

One type of this service is a Telehealth Visit. This is 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 services

Another remote service is “Virtual Check-In,” which is a brief communication technology-based service (CMS, 2020). CMS is no longer limiting the service to just rural areas. However, providers can still only report it 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. These are 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.” CMS divided these services by 5-10-minute, 11-20-minute, and 21- or more minute increments (CMS, 2020). Physicians and nurse practitioners may bill these CPT codes, while non-physician healthcare professionals bill the HCPCS codes. These include physical/occupational therapists, speech pathologists, and clinical psychologists.

Additional Information

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. These articles 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. These services should be provided to existing patients. However, Medicare will not be conducting audits 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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